NSW Community Health Review

 
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Q2 - Are hospital demand management services best managed by Community Health services such as home based post acute care or CAPAC services or by hospitals?

  1. Incorporating CH within the hospital system has given the hospital a cost benefit. There has been little benefit, if any to CH services and a loss of CH profile in the local community which it serves. One of the issues for CH is the lack of a medico who leads the organisation (May the Goddess forgive me for saying such a thing) CH has never been competitive within the health system because it has lacked a medical leader and research base. CH has not been funded to research the programs/services it delivers. CH, an initiative of the Whitlam government, was funded to provide an enormous range of services in the local community without consideration of the needs that existed or changed within that community. There will always be 'ragging' of CH whilstever the 'Doctors' are not in charge. The struggle for CH to 'perform' will never succeed because the medico's are not in charge of it. CH was set us as a social health care model. This model was always unacceptable to the medico's and to the local GP's who historically were very resistant to CH in it's early days. The survival of CH to date, despite it's many area reviews, has largely been based on the hospital's inability to manage clients in the community for their ongoing care. Wouldn't you think that a two tier system such as hospital and community would work? Not likely it seems.
  2. CH provides a readily available and accessible service which anyone can access without a GP referral. The politics of CH has always been left of centre. What I mean by this comment is that the philosophy of CH and it's broadly based service delivery model was always unacceptable to medico's and especially local GP's. Competing for the health dollar has never been the forte of CH however the strength of CH is in it's ability to meet the needs of the local community in both treatment for ongoing care for a wide variety of co-morbidities as well as it's effective liaison with NGO's, local councils act to work co-operatively to ensure preventative and educative needs of the local community are met. Indeed, health recognises the value of partners to deliver and improve services to local communities acknowledging that health and the delivery of health services is everyone's business.
  3. The struggle for CH and the service it provides will continue whilever the AMA has such a strong hold on the politics of health delivery. e.g. While nurses see people in many capacities they are unable to refer patients to an outpatient clinic. The public health system says one has to have a GP referral to claim a Medicare rebate. I believe this is unacceptable.
  4. Hospital outreach programs such as PACS are medico driven and funded because they had the research background and capability. Setting up flying squads for each medical/surgical speciality has proved to be less that cost effective.
  5. The future for CH across the state will vary from area to area. CH services are noted for their responsiveness to the local community despite the decline in funding and support and an altered focus based on the hospital need to 'manage beds'. Future centres may well be based on a satellite system with state of the art communication and information systems available to staff. CH is part of the political system and is in a position to compete for the health dollar given the current leadership within the area. Give CH $$ to pick up post acute care and CAPAC as Ch are not only well placed to deliver such services but also have the expertise to manage. When the health system is under pressure there are tough questions to be asked both within the system and politically. I would look for balance in best buys. Acute care services are a black hole and it's almost as though we now have people standing by the hole throwing in the dollars. Start filling in the hole with good health promotion and health maintenance programs (state health promotion)!!!!!! Chronic care can be managed in the community and health promotion and health maintenance programs funded appropriately. There is an old saying 'you can't do it alone'. Collaboration is the way of the future.
  6. Depends on the health service requirements and demands for that particular area
  7. Smaller hospitals have no capacity to discharge plan and patient needs are best serviced in their community - not in acute care settings
  8. I have no doubt they need to be managed by Community Health, but with strong links to the hospital setting. The skills and knowledge of the Community health sector when dealing with people in their homes needs to be acknowledged. At the same time whoever is managing these services needs to be closely linked to the acute setting - the acute setting needs to have the confidence that the right care will be delivered. I can't emphasise enough that the skills Community health staff have in providing care to people in the community is vastly different to hospital staff and this needs to be acknowledged. I don't believe that a post acute service is simply a "hospital in the home". Someone's home is not a hospital. Community Health services have extensive skills and experience in caring for people in their home and in their community, as long as there is a strong link with the acute setting, these types of services are best managed by the Community health sector.
  9. When community health services are managed by hospitals the focus is on throughput.
  10. Hospitals can only deal with the bodies being pulled out of the end of the river. They don't have the philosophical capacity to even consider who might be throwing the people in further up stream
  11. While Community Health services are picking up some of this service delivery at present, there needs to be equivalent enhancement resources to reflect equity between hospital and community health funding for this work.
  12. The management of hospital demand management services would be best managed by Community Health services to ensure that funding for theses services is focused appropriately and quarantined to ensure that these services are delivered proactively in the community.
  13. It has to be a combination with both sides familiar and sensitive to the needs and resources of each. When only either /or is involved it allows one side to point the finger at the other and no accountability results.
  14. in partnership with acute service providers
  15. Would like to see more research about this issue
  16. I believe hospitals with links to Community Health for support such as social work and psychology, otherwise drags community Health in to acute care model.
  17. Hospitals have a long history of 'mining' community health for acute care resources, to the detriment of Primary Health Care. Let them have it, run it and leave us alone to do what we do best.
  18. It is safer due to the identified risks of hospitals to keep as many people out of them as possible.
  19. Resourcing is the issue for CH staff to be able to provide responsive and timely services which support hospital avoidance. This also needs to be balanced to enable CH staff to actively work with individuals on opportunistic health promoting activities.
  20. More resources should be put into community based expertise with in-reaching capacity if required (for example C&CC Nurse specialists, more CNC positions to support frontline CH nurses).
  21. But needs to be resources

  22. Community health is about prevention, education, treatment where people live. and in partnership with other services. It is not just hospital services in the community.

  23. however, must be resourced properly to enable this, it cannot happen within existing resources of CH services

  24. surely data collected on existing models would give best indicators on the most cost efficient and effective model. maybe a combination of both.