This Week's News 27-31 July 2009

6

Rudd: Reform won't come cheap
ABC News, Australia

28/07/2009

Prime Minister Kevin Rudd has warned taxpayers that major reform of the country's health system will not come cheaply.
Mr Rudd and Health Minister Nicola Roxon begun six months of consultations on the recommendations put forward by the Health and Hospital Reform Commission at Sydney's Royal North Shore Hospital today.
The commission has estimated that the cost of its reforms could be as high as $5.7 billion a year, excluding funds for a new public dental system which it has estimated would need about $3.6 billion a year.
Speaking on Channel 9 this morning, Mr Rudd said the Government was considering how the reforms would be funded.
"I'm just being very blunt with people, if we want to improve and reform the system it won't come inexpensively," he said.
Mr Rudd did not elaborate on whether taxes could rise to fund the reforms.
"We're going to test all this with the Treasury which is why during the next six months, before we put a final proposal to the state and territory governments, we'll have all of these things rounded off," he said.
The Government has been criticised for putting off any decisions for six months, but yesterday Mr Rudd said he wanted to consider what action to take in conjunction with the Henry review of taxation, which will also be released late this year.
Earlier Ms Roxon reinforced the message that health reform will cost money, but said that did not mean that higher taxes were inevitable.
"I'm not saying that, but I'm saying we have to have a debate about what healthcare costs," she said.
"And that includes the public being involved in those discussions; the contributions they already make, can they be replaced and better targeted - that's really what the Denticare proposal is.
"I think that people are ready for a proper discussion about their expectations of the health system and what it might cost."
Ms Roxon says extra funding is already going to some areas identified by the commission, such as preventative care and changes to the health workforce.
"We got the commission's early advice when we were negotiating the healthcare agreement that was concluded in November last year," she said.
"So the big down payments in starting to introduce activity-based funding, prevention care, dealing with new arrangements in the workforce [have been rolled out]."
Ms Roxon has defended the Government's timetable to act on the commission's report, saying the Government is using the six-month consultation period to get the changes right.
"We're determined if we're going to go down the path of some very major changes, that we road test them, that we have the public on board," she said.
She says a referendum on a Commonwealth takeover of hospitals is still on the agenda for next year's federal election if the state's and territories do not agree with the Government's response to the report.

7

Big care centres to replace surgeries
Sydney Morning Herald

28/07/2009

Julie Robotham
LARGE health centres that offer treatment from multiple health disciplines could take the place of traditional GP surgeries, under a proposal the reform commission says would make the primary care sector more efficient and responsive to the needs of people with long-term illnesses.
The so-called comprehensive primary health care centres would offer the patients the option of signing up with a single such practice – rather than the current system supported by Medicare of consulting any GP.
The centres – whose establishment could be funded through one-off grants – would provide ‘‘a ‘one-stop shop’ approach so that patients can get access to an expanded range of services (for example, pathology, imaging, community nursing, allied health), with better coordinated referrals and networks of services’’.
Australia had begun to fall down an OECD league table of best-performing countries in primary care, the commission noted – a sign that ‘‘we have failed to improve on an already good system’’.
Forty per cent of all GPs worked in practices of four or fewer doctors, the report noted, and greater efficiencies might be possible through larger centres. But Sharyn Wilkins, an Engadine GP and chairman of the Sutherland Division of General Practice, said such a move could reduce access to health care, because people would haveto travel greater distances to centralised practices.
The current system – in which GPs could refer patients to any allied health professional, rather than to one individual within their own practice – allowed access to a greater variety of sub-specialists, Dr Wilkins said.
Physiotherapists, for example, might be specialists in sports, rehabilitation or hand treatment.
‘‘People are going to be limited in those choices,’’ Dr Wilkins said, and the plan did nothing to ease workforce shortages in areas where GP practices were already at capacity and unable to take on new patients.

8

Nepean nurses fear chop for 155
Sydney Morning Herald

26/07/2009

Kate Benson
NURSES at one of Sydney's busiest hospitals fear losing their jobs after being told more than 150 positions would be axed, while health workers in the state's north have been offered redundancy deals for the third time in six months, in a bid to clear debt of more than $130 million.
Nurses at Nepean Hospital were told 12 days ago that 155 positions would be lost, despite assurances that front-line staff would not be targeted.
"The nurses here are beside themselves. There is no fat on the bone," NSW Nurses Association branch secretary Peter Mason said yesterday.
"They are outraged and angered that management has refused to tell us where and when this will happen. I can't see where we could lose anyone without services being affected."
NSW Nurses Association general secretary Brett Holmes said it was not time to "get panicky" until it was clear which services would be affected. "But we have told them in no uncertain terms that if they don't consult with us there will be a war," Mr Holmes said.
In May, support staff at Nepean expressed no confidence in the area chief executive, Steven Boyages, over unfilled vacancies and management structures within the beleaguered Sydney West Area Health Service. They will stop work for two hours on Tuesday to protest at the privatisation of food services and a lack of staff.
On Friday, it was revealed that the North Coast Area Health Service was running more than $130 million in the red on last year's budget, including $19 million over budget at Lismore Hospital, $16 million at Coffs Harbour and more than $13 million at Port Macquarie.
All staff were sent emails asking them to consider taking redundancy to cut costs, but a statement by the area health service indicated the offers were aimed at administrative, corporate, support and management positions.

9

Medicare system failing indigenous
The Australian

27/07/2009

Siobhain Ryan
MEDICARE is failing indigenous Australians, funding just 500 follow-up consultations with doctors and 300 with allied health workers for Aboriginal people last financial year in the wake of nationwide health checks.
New figures from the payment agency show only minimal take-up of Medicare rebates targeted at indigenous people, despite the Rudd government's pledge to tackle the appalling state of Aboriginal health head-on.
In 2008-09, less than $8million out of a total Medicare budget of $14.3billion went towards rebates specifically for indigenous people, who have shorter life spans and almost three times the infant mortality rate of other Australians. Almost all the money spent went towards about 37,000 indigenous health checks and very little on follow-up of the problems found.
In a year when taxpayers funded 294 million Medicare services, just 556 were for indigenous people who went to see a doctor after their health check; 295 consultations with an Aboriginal health worker or other allied health worker were subsidised.
Sophie Couzos, public health medical officer with the National Aboriginal Community Controlled Health Organisation, said she was not surprised by the lack of Medicare spending on indigenous people.
Mainstream general practice was still to come to grips with the health checks, and "the follow-up stuff is even worse", she said.
Dr Couzos said Aboriginal health workers outside the Northern Territory had far less access to Medicare rebates to treat indigenous patients than those up north, and the criteria for governing payment were so inflexible it distorted the practice and priorities of Aboriginal health services.
"We're trying to force a fee-for-service model on when it's not fitting," she said.
Aboriginal and Torres Strait Islander people can make use of the mainstream Medicare system as well as targeted rebates for indigenous people.
But the Aboriginal health sector has argued for years that indigenous people miss out on their fair share of universal Medicare or Pharmaceutical Benefits Scheme funding, partly because of the lack of doctors in remote areas. It has lobbied instead to receive the equivalent per-capita amount in extra funding to expand services available through community controlled health centres.
Dr Couzos said the poor and vulnerable in indigenous communities often could not afford the out-of-pocket costs charged by mainstream GPs and allied health workers through the Medicare system.
Transport to and from doctors surgeries was also a problem, she said.

10

Health workers rally on job cuts
Northern Star, Australia

27/07/2009

Peter Weekes
HEALTH workers at Lismore Base Hospital will hold a stop-work meeting and rally today at 2pm in protest against the proposed job cuts to the sector.
The action is part of a state-wide campaign organised by the Health Services Union which fears many of its members' jobs will be outsourced as the NSW Health Department attempts to slash its spending by $200 million, including $30 million from the North Coast.
Health Services Union North Coast lead organiser Bob Hull said if the union's fears are realised 'several thousand' people would loss their jobs across the State.
“It will also have a severe and detrimental effect on the quality of the health system and patient care,” he said.
North Coast Area Health chief executive, Chris Crawford, who was unavailable for comment yesterday, has previously confirmed that about 400 nursing and health sector jobs would be cut to meet the department's target to reduce expenditure.
He has repeatedly stressed that no front-line positions would be affected.
Mr Hull said his union's primary concern at the moment was the proposed closure of the Goonellabah store and axing of its 15 jobs.
The store supplies medical equipment to hospitals between the Tweed and Coffs Harbour.
“They are talking about sourcing supplies from Newcastle,” Mr Hull said.
“That will have a detrimental effect.
“It will leave the North Coast unable to respond to emergencies and natural disasters.
“At the moment if Lismore runs out of supplies the store is only a couple of minutes up the road.
“If the Goonellabah store is closed, supplies will be eight hours away.”
The union's assistant secretary, Peter Mylan, said there was “no justification” for contracting out health services jobs.
“What needs to be recognised is that all workers in public health contribute to the good running of the system,” he said.
“All workers are front- line and any distinction drawn between front-line and backroom is artificial at best and dangerous at worst.”

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North America

1

Durbin proposes means to ease nationwide nursing shortage
Marion Daily Republican

24/07/2009

Washington - Sen. Dick Durbin (D-Ill.) proposed legislation Thursday to create incentives for healthcare workers to become nurses and for current nurses to become nurse faculty.
The Nurse Training and Retention Act addresses the United States' nursing shortage, which is expected to exceed one million by 2020.
"Everyone depends on nurses for quality patient care, yet the healthcare system in America lacks an adequate supply of nurses and the problem is getting worse," Durbin said. "Today's legislation proposes a new, innovative program that builds on our existing healthcare workforce — an important, but currently untapped resource."
The shortage in Illinois could top 21,000, Durbin said. According to information from the senator, 2,523 qualified nursing students were turned away due to lack of faculty and resources.
Durbin's legislation proposes a new grant through the Department of Labor to train healthcare workers to earn a nursing certificate or degree and assist current nurses in obtaining specialty training or advanced degrees to serve as educators.

2

Downturn masks shortage
The Tennessean

22/07/2009

By Peter I. Buerhaus
In 2015, 36 percent of the nation's registered nurses will be between ages 50 and 64. As large number of these RNs retire from their positions in hospitals, home-care agencies, nursing homes, doctor's offices, schools, public health agencies, birth centers, prisons, the military, and outpatient and community clinics, there is a very good chance that their jobs will not be filled by new nurses.
The reason: The nursing work force, which currently numbers 2.5 million, is not restocking its supply of RNs. This poses a big problem for society as, over the next decade, an estimated 78 million baby boomers will reach retirement age, and many will need three to four times the amount of health-care services as when they were younger.

As a result, the demand for RNs will accelerate, but the supply of RNs will be growing at an inadequate rate. The resulting shortage, currently estimated to range between a few hundred thousand to as many as 1 million RNs by 2020, would render a devastating impact on the health-care system.

People will experience long waits and delays to receive care; the quality and safety of care could fall apart in the absence of sufficiently staffed facilities; and the costs of health care will rise as care is produced less efficiently and wages are bid up sharply to attract RNs.

Work force is aging

This outcome is crystal-clear, given what we know. The vision of the nursing work force becomes murky, however, once we focus on what is occurring in today's environment. The recession is wringing out the nursing work force like water from a sponge — squeezing out available RNs who might have been retired or had cut back their hours — inducing them to work. In 2007 and 2008, RN employment in hospitals increased by nearly 250,000. More than half of this employment increase came from RNs over age 50, and another 50,000 RNs left their jobs in non-hospital settings to work in higher-paying hospitals that also offer better benefits, including health insurance. Consequently, many hospitals report that the nursing shortage that started back in 1998 is fading. Some hospitals are even turning away new nursing graduates.

While this may be good news, at least for hospitals, those contemplating a career in nursing may be led to believe that the profession is no longer a good choice. Such an outcome would be troublesome and shortsighted. Once the current recession eases, many RNs could leave their current positions to return to retirement or to their former non-hospital jobs, reigniting a shortage.

Meanwhile, many more RNs will have reached retirement age, setting in motion the long-term shortage noted above. Thus, it is important that policymakers avoid getting distracted by the current reaction to the recession and focus on preventing the fallout in the latter half of the next decade.

Now is the time to be producing more RNs, even though the current labor market is sending the opposite signal.

Peter I. Buerhaus, Ph.D, RN, FAAN, is the Valere Potter distinguished professor of nursing and and director of the Center for Interdisciplinary Health Workforce Studies at the Institute for Health and Public Health at Vanderbilt University Medical Center.

3

$1.1 Million Contract Awarded to Get Dislocated Workers into the Health Care Industry
PRLog.org, TX

23/07/2009

PRLog (Press Release) – Jul 23, 2009 – The Workforce Connection Board of Directors awarded a $1.1 million contract to a coalition of local organizations to create the first partnership of its kind in Nevada geared toward rapidly moving dislocated workers toward employment in health care careers.
Workforce Connection, formerly known as the Southern Nevada Workforce Investment Board, awarded the contract to Area Health Education Center of Southern Nevada (AHEC) in partnership with the College of Southern Nevada (CSN) and the Southern Nevada Medical Industry Coalition (SNMIC). The grant will fund a workforce development program focused on providing Southern Nevadans with education, training and employment in the health care industry.
“CSN is very excited about the potential of this partnership to assist workers in gaining entry level skills,” said CSN Interim Dean of the School of Health Sciences, Dr. Patricia Castro. “The skills and experience that these workers gain can eventually be applied to other health care programs, providing opportunities for professional growth in their chosen discipline.”
The Southern Nevada Healthcare Industry Education Training and Employment Project, also known as Health Careers Project, will serve the unemployed, underemployed, recipients of public assistance, low-income individuals, seniors, veterans, and/or the disabled.
CSN will provide assessment on potential participants recruited by AHEC to determine preparedness for one of four CSN health care programs: unit health coordinator, nursing assistant, phlebotomist, and basic emergency medical technician. Qualified participants will be enrolled into one of the CSN short-term programs where they will gain internship experience at a local healthcare facility with the potential of future employment.
“This collaboration offers great opportunity to prospective students who qualify for this program to come to CSN and receive a quality education, which can then prepare them for entry level employment in health care,” said CSN Interim Associate Vice President of Academic Affairs, Dr. Hyla Winters. “The School of Health Sciences is the premier provider of a workforce to health care in Southern Nevada and this collaboration will assist successful participants with the opportunity to begin working and return to CSN for advancement on a career pathway.”
AHEC will provide programmatic and fiscal management, case management, and job development services for the project, and will partner with the SNMIC to conduct outreach and marketing for the project.
“Nevada is facing crisis proportion problems as a result of the economic downturn and higher than national average unemployment rates. In addition, Nevada has historically faced a health professions workforce shortage. AHEC of Southern Nevada in collaboration with CSN, SNMIC and Workforce Connection, is taking the lead in creating unique and innovative approaches to link these programs and help unemployed residents gain a meaningful career with job security,” said Rose Yuhos, president of the national AHEC organization and executive director of AHEC of Southern Nevada. “Working together as a coalition, all four of our organizations can do much more than we could separately.”
About AHEC of Southern Nevada

Since 1989, Area Health Education Center (AHEC) of Southern Nevada has served the four southernmost counties of the state as a 501 (c) (3) non-profit organization that provides health education, training, professional continuing education, outreach, and academic enrichment services based on need. As part of the national Area Health Education Center System of 220 centers across the country and with affiliations through schools of medicine, nursing and allied health sciences, AHEC of Southern Nevada has taken a leadership role in planning for, and addressing, many of Nevada’s critical health education, health workforce, and health-related issues by mobilizing and engaging a wide range of community organizations and academic institutions in partnerships, collaboration and cooperation.

About CSN

Founded in 1971 and educating thousands of students a semester, the College of Southern Nevada (www.csn.edu) is the state’s largest and most ethnically diverse higher education institution. CSN has three main campuses in Henderson, North Las Vegas and Las Vegas and additional sites and centers located in urban and rural Southern Nevada. The College offers more than 200 degree and certificate options in more than 130 areas of study, including 25 degree and certificate programs available entirely online. Students create flexible, personalized schedules including day, evening and weekend classes taught on three main campuses and multiple locations throughout Southern Nevada. CSN -- Your future starts here.

# # #

K.C. Brekken; Communications Manager; College of Southern Nevada

Phone: [phone]; Fax: [phone]

[e-mail]

4

Contextual influences on health worker motivation in district hospitals in Kenya
7^th Space Interactive Web, NY

23/07/2009

Organizational factors are considered to be an important influence on health workers'uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels.
We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals.
Methods: Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med.
2002, 54: 1255-66) model of motivational influences was used to frame the study.. Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals.
Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses.
Results: Study settings are likely to have important influences on worker motivation.
Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers'expectations in terms of promotions, performance appraisal processes, and good communication.
Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards.
Conclusions: Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change.
Author: Patrick MbindyoDuane BlaauwLucy GilsonMike English

Credits/Source: Implementation Science 2009, 4:43

5

Stimulus will provide $220 million for health care training
Kansas City Star

21/07/2009

By JOHN MILBURN

The Associated Press

TOPEKA | U.S. Labor Secretary Hilda Solis said Tuesday that $220 million in federal stimulus funds will be disbursed to programs across the country to train workers in health care and other high-growth industries.
Tuesday was the first day that training programs could begin applying for the money through the Labor Department. Solis unveiled the plan during a tour of the Shawnee County Community Health Care Clinic in Topeka and the University of Kansas Medical Center in Kansas City, Kan., saying health care services would be one of the fastest-growing career fields over the next decade as the population ages.
“We know there’s a shortage,” Solis said after touring the clinic.
She devoted much of her remarks to health care and President Barack Obama’s desire to push a health care reform bill through Congress this summer. She said such training grants were part of the equation, helping to provide an adequate work force to meet demands in rural states and areas seeing high unemployment.
Solis said $25 million of the funds would be reserved for training in communities hurt by the recent restructuring of the auto industry.
The stimulus money will go to public entities and private nonprofit groups that train workers in health information technology, nursing, long-term care and allied health careers.
Solis said she didn’t know how many potential jobs could be created from the grants. But she said she hoped they would encourage private donors and foundations to match the dollars.
“This is a first down payment,” she said.
The Shawnee County health center in Topeka, which would be eligible for the aid, is home to the public clinic and county health department. It has a staff of 179 and treated nearly 7,000 clients in 2008, including many without health insurance.
The Labor Department will begin taking applications for the stimulus funds Tuesday.
Solis said reviews of applications would begin within two months and grants would be awarded by year’s end. She said applications that build on existing collaborations, such as programs through community colleges or technical schools, would be looked upon favorably.
The program targets people like Clayton Bledsoe, 40, a former quarry worker who began nursing training in 2006 when the economy began to sour. Solis pointed to Bledsoe, who took courses through Neosho County Community College in eastern Kansas and eventually earned his registered nursing degree, as an example of the type of retrained workers the program hopes to create.
Bledsoe works with geriatric patients at Anderson County Hospital in Garnett, about 50 miles south of Topeka.
He wanted to enter a field where “I wouldn’t have to worry about looking to find a job again,” Bledsoe said.
During her visit to the Kansas City medical center, Solis met with medical students who said they intended to return to their rural hometowns to practice after graduation. She also viewed a telemedicine demonstration, in which doctors in Kansas City used Web cameras to interact with and diagnose patients in remote areas of the state.
Solis said she hopes the grants boost such programs, as rural areas are especially hard-hit by a shortage of health care workers.