12 July 2012

On the Liberals, walk-in centres, and excrement flung with gay abandon

| johnboy
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Normally we try to shield you dear readers from the poo-flinging of our political class and focus on things that have concrete meaning.

But the wierd permutations of this story are worth having a look at.

It started out with the Liberals’ Jeremy Hanson drawing a long bow to take advise offered to the Chief Minister and turn it into a claim of misleading the public on election promises.

Information obtained by the Canberra Liberals shows Katy Gallagher’s one and only election commitment to build another walk in centre flies in the face of Health Directorate advice that the centres would make Emergency Department performance worse. ACT Shadow Health Minister Jeremy Hanson said today a Freedom of Information request shows the Health Directorate warned that walk in centres would increase pressure on the already stretched Emergency Department.

The issue here is that the Walk-In centre brings punters to the hospital precinct at which point professional opinion realises they should really be in the emergency department. This is not good for ED statistics, but overall is probably good for health outcomes, which is rather the point of the whole sodding exercise.

The Canberra Times took this and proclaimed “Liberals would ‘probably’ scrap walk-in clinic if elected”.

When you have to put your probably in air quotes we’re a long way from a decision.

This then became a confirmed decision in the hand of Labor hacks (handsome, witty hacks no doubt):

https://twitter.com/VictorViolante/status/223258797819428865

Watching this informational train wreck unfold I went back to the Liberals to ask them what their actual policy was.

Of course I got a non answer:

The walk in centre at Canberra Hospital hasn’t achieved what Katy Gallagher said it would, which is reducing pressure on the emergency department. Jeremy agrees with Katy Gallagher that it shouldn’t be at the Hospital. Our health policy will be released well before the election. It will be evidence-based, and unlike Katy Gallagher, we’ll be truthful about its benefits.

The monkeys at the zoo really would be better behaved and possibly more enlightening.

UPDATE 12/07/12 15:46: Victor has been in touch to point out his tweet was based on Radio 2CC’s reporting.

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Jethro said :

johnboy said :

If you’re talking about the commonwealth funding arrangements they’re a desperate effort to stop the state level thieves defunding their hospitals entirely.

It’s an ACT responsibility, commonwealth money is not a right.

States/territories cannot fund healthcare on their own. Every state/territory’s healthcare department would collapse without Commonwleath funding.

Any sort of healthcare system that relies on creating incentives through the removal of funding is a bit dodgy in my books.

It would be interesting to see the statistics re commonwealth funding pre and post creation of ACT govt and then comparing that to what the other states and territories received for the same period.That way we’d have a much clearer picture as to whether we’ve been given a fair slice of the pie over time.Naturally this in no way excuses poor budgetary decisions and stuff ups made during this period.

johnboy said :

Or provide more resources to the ED if that’s where the people needing medical attention are turning up.

Radical concept I know.

Whooahh.. Settle down there son, let’s not get carried away here.

Or, as someone said recently “don’t contaminate the issue with some common sense”

johnboy said :

If you’re talking about the commonwealth funding arrangements they’re a desperate effort to stop the state level thieves defunding their hospitals entirely.

It’s an ACT responsibility, commonwealth money is not a right.

States/territories cannot fund healthcare on their own. Every state/territory’s healthcare department would collapse without Commonwleath funding.

Any sort of healthcare system that relies on creating incentives through the removal of funding is a bit dodgy in my books.

The walk-in centre does not reduce the number of ED presentations.

Logical speculation suggests that locating two large walk-in centres in Tuggeranong and Belconnen respectively will place them in closer proximity to the population likely to need/want to use them. It is further speculated that siting the walk-in clinics away from the hospital campus might reduce the number of people who follow the “WIC can’t do what I need, therefore I will walk 50 metres to the ED” pathway instead of the “WIC can’t do what I need, therefore I will arrange a GP appointment” option.

We don’t know if putting WIC’s away from the hospital will reduce ED presentations because we haven’t tried it yet. We do know that the WIC at the hospital does _not_ reduce ED presentations.

ED overcrowding and very long waiting times are also not due to the number of walk-in patients with minor or “GP” problems, but rather are caused primarily by access block; a backlog of patients occupying ED beds who should be somewhere else in the hospital. There seems to be a general lack of understanding on this point, especially on the part of our politicians.

Irrespective of their effect on ED presentations, WIC’s are obviously a good thing for the health of the community, providing timely access to health professionals who can either sort out your problem or, at the very least, provide informed, professional triage and disposition advice on where you should go and who you need to see to get things sorted. Whilst not doing much to relieve the stress on ED, I suspect they likely do much to alleviate pressure for scarce GP appointments.

I have a few mates that work in the Canberra Hospital ED, the problem is they say that people show up at the walk in clinic to have things done like getiing stiches removed. The nurses on duty arent allowed to remove the stitches so they are sent to ED. obviously this is not an emergancy and if the walk in clinic did not exist people would book in at thier GP to get stitches removed. There seems to be a long list of things that Nurses are unable to do, most likley due to insurance issues and protocale rather than skill base.

It seems to me that this can be easily fixed, just change the rules a little to allow nurses to cover a few more treatments, then clearly advertise what you can have done at a walkin clinic and what you need to see you GP for.

johnboy said :

Or provide more resources to the ED if that’s where the people needing medical attention are turning up.

Radical concept I know.

I believe the solution to EDs that can’t cope with the influx of patients is to strip funding from them as an incentive to do better.

If you’re talking about the commonwealth funding arrangements they’re a desperate effort to stop the state level thieves defunding their hospitals entirely.

It’s an ACT responsibility, commonwealth money is not a right.

chewy14 said :

We should put a walk in centre in the middle of Namadgi National Park.

I’m sure this will improve their statistics immensely

who cares about statistics ….. someone will alter them anyways

On the subject of “medical certificates”, and an employers opinion on what counts and what doesn’t – I find it an interesting historical process which is kind of at odds with modern concepts of privacy.

Eg, if I am forced to take a day off because my [[embarrassing (possibly itchy) illness]] flairs up, and go and see a specialist who works at a clinic with a name very specific to my illness – should I then present a medical certificate under that letterhead to my boss?

Frankly, I can’t see what the problem.

Surely they just need to readjust the figures.

After all, it’s apparently an accepted method of dealing with things in the ACT these days.

As i’ve said before, the sad thing is that even when ‘adjusted’ the ED wait times were still the (or one of the) worst in the country. I shudder to think what the real figures will be when they are released (I assume they haven’t been yet, but i’m pretty clueless on htese things!).

The walk-in centre’s brilliant. I’ve used it a few times for minor problems when I haven’t been able to get into a doc. The nurses are extremely competent and there was no sense of a rush to get out, as there is (understandably) with a doc.

There should definitely be more of them.

Elizabethany8:31 am 13 Jul 12

Some workplaces will accept the sick certificates they provide, but it is up to the individual workplace whether they do or not. I have to say tat between my local GP and the Clinic, the nurses were much more thorough and gave me advice on how to deal with my cold, where the GP is obviously rushed for time, so only checked the basics. I still prefer the GP because I can book, so don’t have to be out when sick for hours at a time, but I go to the clinic if I can’t get a booking.

Not sure what Hanson is on about.

Firstly, I though the plan was for two walk in centres no where near the hospital, originally to replace the pathfinder one at the hospital but later at least one in addition to it.

Second, didn’t they announce not long ago some decent stats on the number of people diverted from the ED, even if there were a few referrals from the clinic to the ED.

And third, who on earth relies on reporting from 2CC?

With only nurses staffing the walk-in centre you’re better off either treating your cuts and abrasions at home or seeing a doctor if it’s more serious.

The nurses at the centre don’t prescribe medicines and they are not much use for anything other than advice. It’s a lovely centre that needs a few doctors added to make it useful. If they had free doctors there you would definitely see less non-emergency cases presenting at the hospital emergency department. Better still if they had community health centres with bulk-billing doctors you’d have less people turning up at emergency departments for free treatment.

As it is, Woden Hospital emergency is unable to handle more than a few serious cases at a time and struggles to clear patients for many hours – a recent stay for about 18 hours for my seriously ill elderly mother proves they are struggling. And she was lucky as she has serious heart problems and actually got into the emergency ward as opposed to the many lying on beds and sitting on chairs in the corridors within the department. Some with broken arms/legs, and many elderly.

The emergency department is however a much better place to be than in one of the wards at that hospital as the nursing and medical care within the rest of the hospital is inconsistent and disorganised. You do not want to be a patient there if you are not capable of checking your own medications or do not have family making sure you are getting the right medicines at the right times. For example, if I hadn’t been there last night a nurse would have given mum an extra dose of insulin due to a charting mix up which could have ended in tragedy.

I-filed said :

I’d love an explanation as to why the walk-in centre won’t give a medical certificate. GP cartel being kowtowed to perhaps?

From their web site: http://health.act.gov.au/walk-in-centre/what-we-do/

The Walk-in Centre can provide

* Fast, free access to health care
* Treatment of cuts, sprains and abrasions
* Advice and treatment for common illnesses
* A sick certificate
* Information about other health care services available to you in the ACT

I’d love an explanation as to why the walk-in centre won’t give a medical certificate. GP cartel being kowtowed to perhaps?

I think I am missing something here but is there any particular reason why it should be on the hospital grounds? I don’t see how it matters either way.

The Capucins at the zoo are pretty well behaved. No feces throwing that I’ve witnessed yet, and I have spent many an hour at the zoo.

The Macaques in Launceston are another story. I have never seen animals fornicate like those ones do. Apparently they all have herpes.

Elizabethany4:46 pm 12 Jul 12

I would love a walk in centre at belconnen, but agree that it shouldn’t be on the hospital grounds. It is hard enough getting parking at the hospital without adding another drawcard. If people need to go to hospital (as opposed to just seeing a Doctor), there is a system already in place that will pick you up and take you there as fast as possible.

The walk in centre is the most convenient and best thing ever. They should open more of them… it’s really annoying that they care more about a few numbers on a piece of paper than actually helping the community.

Can’t they do something to get more funding for the ED in the first place? You know, make everything better.

We should put a walk in centre in the middle of Namadgi National Park.

I’m sure this will improve their statistics immensely

CrocodileGandhi said :

Shouldn’t be at the hospital? Of course! We should put it in such a place that if someone who went there genuinely did need emergency care, it would be a laborious excercise to get them that treatment. Having it next to ED where it may be of use was clearly a dick move on the part of the Government. Congratulations Mr Hanson for proving that all politicians with your last name are complete idiots.

“Jeremy agrees with Katy Gallagher that it shouldn’t be at the Hospital”.

Apparently the CM feels the same way as Mr Hanson.

CrocodileGandhi3:49 pm 12 Jul 12

Shouldn’t be at the hospital? Of course! We should put it in such a place that if someone who went there genuinely did need emergency care, it would be a laborious excercise to get them that treatment. Having it next to ED where it may be of use was clearly a dick move on the part of the Government. Congratulations Mr Hanson for proving that all politicians with your last name are complete idiots.

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