NSW Community Health Review

 
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Q8-Are there any other comments that you would like to make

  1. More resources need to be allocated to manage chronic diseases. As a diabetes service that is attached to a tertiary hospital resources are hard to increase. The focus these days in bed numbers and how quickly we can get people out of hospital. The services that keep people out of a acute services do not have resources increased as we do not create a bed block. More money needs to be spent preventing diabetes and help the management. Such as affordable and accessible exercise programs. The focus is on the acute problem. Availability of psychological support for patients
  2. As a Child and Family Health Nurse for many years, I see this Health service as the 'backbone' of the nation. If more funds , more staff, more education & increased availability of services was poured into Child & Family Health we would not have half the health problems in our society that we have now.
  3. Health outcomes (both physical, mental and financially) would be enhanced by this service.
  4. All kinds of health issues that require intervention by all kinds of medical staff would be reduced with increased health education by staff and implementation by the parents if introduced at an early age'
  5. therefore reducing health costs at all levels.
  6. Where is Men’s health ?
  7. More funding is required to assist parent to become better parents.
  8. There is no qualification or training required for parenting, and there should be.
  9. Needs to be a state-wide revisit at the true level of funding and FTEs in each AHS in conjunction with population and community needs, and the impact that the reduction to budgets and FTEs is having and will have in the future due to these reductions. Community Health still viewed as the 'poor relation' in the Health Service rather than an integral part or partner with the inpatient setting. Too often Community is viewed as an area/place to reduce budget to prop up or assist in the shortfall of the inpatient setting.
  10. Community Health has been talked about for years and years as the way of the future for health care, but appears nothing is happening to make this a reality. The acute setting is still the focus of our health service. So much more could be done in the community if a coordinated plan was developed to make it happen. I understand it is a huge undertaking, but the evidence seems to suggest that it is the way of the future. The focus of our health service is on cost savings - cut cars, cut staff, put that position on hold, and don’t replace that position. How can we be expected to make any real changes if the only direction we are given is to make cuts, not given support/resources/direction to do things differently and more efficiently. I am sure thing are happening, but why is this not communicated or seen by staff who trying to make a difference on the ground. Looking forward to seeing what will come of all this.
  11. With the amalgamation of SESIAHS the concept of community health has been effectively erased. Community Health services are now "streamed" into what looks like a mix of concepts around disease and treatment groupings eg Aged & Chronic Care, Cardiology, Cancer, Child & Family etc which are all separately managed from each other, there is no coordination across streams. This leaves some community health centres in the position of having staff reporting to 11 stream managers sitting in hospitals based on what job they do i.e. CH nurses report to Aged Care, Child & Family report to Child & Family stream etc. The focus for "community health" now is around picking up the pieces from clients being discharged from hospital or being at the hospitals beck and call. Because the hospitals now control CH, the hospital management thinks that health promotion and prevention is redirecting someone from an Emergency department bed to somewhere in the community, where true prevention is ensuring people don't end up in emergency in the first place such as encouraging people to eat fruit not MacDonald’s! The current ideas being put forward such as moving towards the GPs controlling community health is also not ideal as the GPs will still focus on treatment and not prevention as treatment attracts more money. A more suitable model for CH is one where it is managed like the ambulance service or regional boards like in Victoria.
  12. needs one State model that sits in Clin Ops at the same level as hospitals.
  13. I do hope the term 'health prevention' actually means illness prevention.
  14. Each of the above groups could justifiable benefit from increased investment. however, wherever the funding is aimed it should be targeted at a real and substantial need, be outcome focussed and provided for a time frame sufficient to demonstrate real change. Real change will only come about by working with the community so a community development approach must underpin whatever approach is chosen. I believe this is sadly lacking now in community health services
  15. NSW Health needs to ensure that violence services have equitable specialist staff training positions across the state and clinical supervision of staff. For example some area health services have a dedicated child protection trainer/trainers and others have no dedicated positions. This area health service (NCAHS) does not have an Area Sexual Assault Coordination position which is extremely important to improving the forensic services that do/do not occur and for leadership of things like the NSW Interagency Plan to Tackle Aboriginal Child Sexual Assault. We need more Aboriginal dedicated workers in PANOC and Sexual Assault services - particularly in high population areas such as Kempsey.
  16. Where's men's health as an entity? I do not like the term 'health prevention' it is a term that needs removal from the health lexicon
  17. The profile and significance of Community Health generally has declined over the years. The services provided by Community Health do not seem to be valued by the broader Health Service. Community Health budget seems to shrink each year and the bulk of funding appears to go to Hospital Services.
  18. I found this a pointless survey and hence did not finish it
  19. A lot of emphasis about beds and not enough resources into community care which would prevent the need for so many beds
  20. Community Health funding has declined so much that services provided are minimal and often not effective due to high waiting lists and no specialties provided. Need to provide more funding for clinical services in community health to reduce problems which will lead to hospital admissions. Need to focus on children and families in terms of treatment but also on prevention and promotion.
  21. speech pathology services in the community require a significant enhancement in staffing to provide services that are efficient & effective to children 0-16 years. This will allow waiting times to be reduced which gives equity of access to all clients regardless of where they live within NSW and is independent of their socioeconomic status.
  22. User Pays aspects of care have to be considered in this hopelessly underfunded system
  23. I think that to provide the clinical service to clients, meet the expectation for health promotion and community development and health prevention an increasing in staff needs to occur. The increase needs to be in the clinicians not the administrators, there needs to be recognition that the service provided is valued and valuable, the need to fight with inpatient/acute care services for funding needs to be ceased. CH needs to be well funded not an after thought that gets the crumbs.
  24. A separate Government department for Community Health Programs - continued lack of support for CH programs - budget blowouts occurring in the acute sector and CH seems to be regarded as equally responsible.
  25. These questions reflect the trend to turn community health into a secondary and tertiary referral service in an illness based model, rather than a genuine primary care service that improves people’s health before they are even identifiable as sick. As originally conceived and (probably, I know it's hard to prove) to have the greatest impact on overall burden of disease, community health needs to respond holistically to health related problems which have not necessarily become diagnosable, categorised requests for units of service delivery. In other words quantitative management of illness based 'units of care' occurs at the expense of initiatives to create qualitative improvements in health.
  26. It is only through proper resource allocation to the community health environments that the HEALTH of individuals will actually improve.
  27. I find the expression "Health Prevention" a misnomer...
  28. Spend less on top-heavy management hierarchies and put the money into workers and adequate resources. Put dollars into prevention and early intervention to reduce costs of treating entrenched problems.
  29. Palliative care specific to neonates/ children more readily available in the community, staffed by professionals experienced in this group
  30. The above questions seem silly. Why wouldn't there need to be more money spent on the above, when Community Health has such a low share of the health budget?
  31. Inject more money into the system. Regular maintenance replace old small buildings which are past renovating with purpose built facilities-Clinic room (pap smears)bed has to double up for counselling, staff constantly changing rooms due to lack of rooms, no continuity most staff in our centre change rooms at least twice a week making access to their files awkward when they are in another room. Some have had to counsel on veranda or coffee shop to lack of facilities. Streamline procedures. For each specific area e.g. Admin. get the Admin. staff (different Levels) from various areas together for a think tank and find out what is the best practice, simplify the way processes are done etc the benefits of making time avail for Admin. to attend will be worth it with the savings in streamlining procedures.
  32. We should be developing relationships with youth via established groups like CHAIN and council initiatives.
  33. We should find a way to provide universal home visits to high risk groups for Child & family health, who currently are not seen because of OH&S issues
  34. Concerned re management structures - Currently under a Hospital management structure that looks upon Community Health as an excellent opportunity to cost save. Also concerned re management going with The Divisions or GPs, or with GPs. Its is acknowledged that GPs need to be closely aligned to Community health - and there are plenty of good reason why this would be so valuable. However, fears of it going to GPs solely to manage in one form or another would eventually see the erosion of Community Primary Health into a private concern driven by the click clack of the median rebate card machine!
  35. i believe that community health is more than hospital services in the community. Community health is about health and social education, prevention and treatment, easily accessable, non stigmatised services with the community. I feel that there is a trend in health management to ignore community health centres in favour of hospital funding.I believe management is more concerned with not spending money than implementing best practice health services.
  36. There should be more preventative services for child abuse as well as greater enhancement to current PANOC services
  37. CHC is the right avenue for friendly, approachable and holistic care.

  38. I think that it is very important to ensure consistency accross the Area Health Services. My understanding is that this was one of the aims of the amalgamation process. I would like to see consistency in areas such as: clinical processes, information systems & HR matters.

  39. CHC's are geographically accessible and with the exception of Newcastle Community health centre approachable (NCHC).  NCHC is the antithesis of Community health care - a largely inaccessible building for those with poor mobility (huge building with long walks), 19 services housed in one building with no-one interested in clients other than those that belong to their service, incompatible client groups housed together (methodone program with frail aged), a building that looks and tries to operate like a hospital, 10 examination rooms and 7 interview rooms available to staff when the majority of staff require interview rooms (few examinations happen at NCHC - so 10 rooms is excessive).  it is a mess for staff and clients and hopefully will not be replicated elsewhere

  40. We have more and more tied specific funding and absolutely no money going into baseline general services. The Central Coast has NO generalist counsellors, so if your problem doesn't fit a disease/age specific team there is no counselling available. This is outrageous, but the AHS exec made this decision without any consultation. Our Child and Family Health team has had no increase in funding for the past 15 years and yet more specific services have significantly increased referrals to the team. Younger adult disabled clients have no service at all!

  41. Community Health funding is the only way health can contribute to the reduction of capital intensive /end of life tertiary service demand.  this is essential to balance the world health budget.Other avenues depend on inter departmental policy.

  42. Children, young people and adults with physical disability e.g. Spina Bifida and Cerebral Palsy are totally neglected by NSW Health funded community health centres as they are too time consuming, ongoing and not acute problems.

  43. the need to establish good programs and continue not  cease after 3 years just when  program has started to make changes.Increase in the communication  between policy makers and  staff at ground level for a better understanding of the introduction of some prpograms

  44. With the state governemtn emphasis on keeping poeple out of hospitals & A&E departments, and providing more care in the community, therre needs to be more resources put towards it in CH, the extra load so generated cannot just be picked up within existing CH resources. And all plans and rhetoric at state, national & international levels talk about health promotion and illness prevention, but it has to be resourced properly  to achieve results. Note previous comment re gender analyis and gender considerations having to be a factor in all planning and policies and research.

  45. This review is an opportunity to address young people's health and improve services levels and equity between area health services.

  46. Mental health affects 1 in 4 people, it presents an enormous health burdon with very little of the health budget.

  47. It is hard to answer more less or same as our services are in such a state of uncertainty that it is hard to know more or less that what?