Welcome to my blog.
As Mercy Health's Group Chief Executive Officer, I'd like to share my thoughts on some of the key public health, aged and home care issues facing Australia today.
I look forward to your insights, views and feedback.
Stephen Cornelissen, Adjunct Professor
Group Chief Executive Officer
In mid-October, an independent review panel released Targeting zero: a review of hospital safety and quality assurance in Victoria, a detailed report into the Department of Health and Human Services' governance of quality and safety in Victorian hospitals.
The picture it paints is sobering. While focused predominately on system leadership issues, it also outlines a vision for engagement of clinical experts and patients in making our hospital system safer and more effective.
Mercy Health welcomes the review and applauds the Victorian Government's commitment to acting on all of its recommendations. All those involved are to be commended for the review panel's exhaustive research and analysis, which have shone much-needed light on our state's healthcare strengths and weaknesses.
While in no way diminishing the devastation those weaknesses have caused, nor the need for change, it is the strengths I want to emphasise here. As the government's response notes, "[The report also] highlights cases of excellence and success that have not been shared across the health system, as a missed opportunity to strengthen statewide systems and better protect patients."
Organisations such as ours, while needing to continually improve, have long integrated clinical and consumer voices into the fabric of our quality, safety and governance systems. We recognise multiple checks and balances, performed by people from across the spectrum of delivering and receiving our care, are crucial to ensuring that care is consistently safe and effective. Our quality framework is robust and continually evolving to keep pace with, and where possible lead, better practice (note I am not referring to best practice: better is more descriptive of the need to continue to strive to be, and do, better).
A brief scan of our 2015/16 Report of Operations, released last week for all Mercy Health staff to view, highlights our many stunning achievements over the past year. We are meeting the performance standards set by the Victorian Government, but welcome additional measures that more effectively measure the quality and safety of the healthcare system. If our system was fundamentally broken, these outcomes would be quite different. However, we must each make a commitment to not only look for opportunities for improvement, but be willing to lead and champion them.
I know I share with all Victorians the fervent wish that this review had not been necessary; that our system was perfect and no family had endured loss and anguish in what should have been the safest of places. As Dr Duckett said so movingly, "When my daughter was born, I cried with joy. I cannot imagine what it is like to have your child die." What we must do to honour those families is maintain an unwavering commitment to learn, improve and evolve by sharing our strengths with our partners in care.
We have heard much in the media recently about "the right to die."
The recent report from the Inquiry into end-of-life choices identifies 49 recommendations to improve patient choice and support. Mercy Health is fully supportive of 48 of these, which, if implemented, will result in better access to appropriate palliative care when and where it is needed. The recommendations also outline the improvement of advance care planning, through which people can have a much greater say in their death and can be confident their wishes will be heard and honoured.
However, I fear the 49th recommendation has the potential to monopolise the debate around how we can better support people in their end-of-life care. The recommendation is 'That the Victorian Government introduce a legal framework providing for assisted dying, by enacting legislation based on the assisted dying framework outlined in [the] Report'.
At the recent CHA conference, I had the great honour of listening to one of the most thoughtful and influential women in the world, Sr Carol Keehan DC. In her address she noted the work Catholic health services in Australia have undertaken in advocating for and providing palliative care to those in need.
She outlined why it is critical for Catholic ministries to continue to ensure patients, families and communities have access to and understand palliative care. She also spoke of the "stories of great suffering, indignities, and compromised autonomy which have led to millions... to put more faith in assisted suicide than they put in entrusting themselves to our care when they are dying.
"Think about how sad this is. But can we say state-of-the-art palliative care is available in each of our facilities? Can we say no patient or family need fear being subjected to excessive treatment, restraints, not be kept clean, their wishes not respected, not suffering intense pain and not being supported in their dying process?"
Sr Carol is right in noting it is sad when fear drives public health policy. We in Australia have a long way to go in implementing the 48 recommendations to reassure people that in our health services, they will always die serenely, peacefully and with appropriate human dignity.
It seems to me that irrespective of one's belief system, the debate on assisted dying is not one we as a country are ready to have. Until we have addressed the issue of access to improved palliative care with consistent and effective processes to ensure all people have a say in their death, we are at risk of making decisions out of ignorance of what could be, and fear of what might be.
Australia thrives on a culture of helping and being there for others. Catholic healthcare is built on the mission of providing compassionate care to those in most need. It is important we unite to ensure improvements in care for the dying, their families and their loved ones are made so that, at the very least, we can offer all people the comfort of a dignified death.
This is the time of year in which organisations reflect on the highs and lows of the past 12 months. For Mercy Health, that landscape represents much more than financial health: it is a map of how we have responded to community need that seems to change and grow at a faster pace each year.
We have ended the financial year on a reasonably positive note in both respects. While our financial performance fell short of expectations, our healthy balance sheet is a record of the hard work and resourcefulness of our staff. It is not always easy to maintain an excellent standard of care under increasing cost and funding pressures, but our access and performance results show we continue to achieve that aim.
We have taken strides forward in improving quality of life for aged care residents through our evolving model of care; our home and community care clients through participation in the NDIS rollout; and our health services' patients through innovative maternity support for Karen women, expanded dialysis services, and many other important initiatives.
Our achievements and vision for the next chapters in our care have been showcased recently in a booklet celebrating the 'Year of Mercy' which will be hand delivered to the Vatican next month. The booklet details key developments including our aged care expansion, embracing the household living model; our robust research culture; the expansion of Werribee Mercy Hospital's critical care and inpatient mental health services; and our memorandum of understanding with Apunipima Cape York Health Council, an Aboriginal Community Controlled Health Organisation with whom we will collaborate on educational and professional development opportunities.
A version of the booklet will also be distributed to the communities of the Institute of Sisters of Mercy of Australia and Papua New Guinea as well as the Catholic Dioceses we work within throughout Australia.
The booklet also restates our commitment to carrying forward Catherine McAuley's vision to meet contemporary needs with compassion and pragmatism. The founding Sisters were often forced to much out of little; this year has proved that the same dedication and resilience shine in those who carry the Mercy mission today.
The theme of 'strength in unity' has been much discussed both locally and globally over the past few weeks.
The federal election outcome, highlighting a growing divide in community values, is likely to result in a government significantly hamstrung by its reliance on divergent minority interests — some of them extreme. Of significant concern is the major parties' positions on aged care and public health, which if passed through a new parliament, could place those in greatest need at further risk of poverty, poor health and social isolation.
Neither party has committed to protecting access to complex care for aged care residents; this is unlikely to change given there is no incentive from within to change course. Older people who previously would have benefited from multidisciplinary care will miss out.
The future of free public healthcare is also far from clear, with doubt cast on the Coalition's plans for Medicare. The opportunity arose in this election campaign for unequivocal reassurance from the Prime Minister about the security of Medicare funding. His position on protections for the broader Medicare system remains unclear. What is clear is that any impediment to equal access to the best care available for all members of our community would hit those most vulnerable hard.
While the current political climate can mean progress on issues is halted, it can also provide opportunities to sway them in the community's favour. This week I will be writing to House of Representatives crossbench members, and to the new Turnbull ministers when known, requesting meetings to restate the importance of these issues. Australians need to stand together to ensure that all voices are heard at a state and federal level: a clear demonstration of being 'stronger together'.
This concept of 'stronger together' has been a focal point of the Remain campaign during the Brexit referendum. Its outcome has revealed a catastrophic social division within the United Kingdom between the values of collaboration, reciprocity and openness, and those of autonomy and individualism at all costs. The scare tactics used on immigration and border control, echoing those heard here during our election, resonated with too many Britons.
Their world view stands in stark relief against the Remain campaign's call to keep drawing on the political and economic strengths of the European Union. Brexit can be read as a cautionary tale about the politics of division and exclusion, from which Australia would do well to learn. Our historical identity as a nation should not overshadow our responsibility to act justly by including all people: a particularly salient message during last week's NAIDOC celebrations. In the current national and global landscape, commitment to inclusion and equity has never been more important.
Both the Government and Labor have been at pains during this election campaign to demonstrate they will protect Medicare because the public will not tolerate cuts to free public health.
But both sides have now agreed that a $1.2 billion cut to health services for people living in aged care is somehow acceptable.
I have been on the record saying that over-claiming should be dealt with when it occurs, but cuts to the Complex Health Care domain of the Aged Care Funding Instrument are unjust.
Firstly, they put pressure on aged care providers to find further savings. Two thirds of us are community-based organisations and the sector has already had to adjust and restructure to maintain the viability of aged care services in response to the previous round of federal and sector reforms.
Secondly, there is a risk that some providers might respond by limiting health care to residents in their homes. If this is unconscionable in the general community, then why would it be acceptable in aged care? It is a dilution of the very principle of Medicare which all sides of politics are so desperate to defend.
Of course, aged care residents who have private health insurance might still be able to afford to pay for health services, but for those who are not privately insured, they would be relegated to a second tier of healthcare – creating 'haves' and 'have-nots' for anything but the basics.
This is no longer just an argument about the true cost of aged care. Politicians need to admit that there will be a human cost for not providing care. These costs in aged care undermine the very principles of Medicare that they so vigorously defend.
In any election year, it is the people who have the least in life that stand to win, or lose, the most. Even minor reductions in funding for programs and services can hit the vulnerable hard.
As leader of a mission-based care provider, my role naturally encompasses advocacy. With the release of the 2016/17 Federal Budget and an upcoming election in July, it is critical that we each review our responses to key issues which will help define how we care into the future.
Across Australia, those living in residential aged care settings are likely to be significantly affected by planned funding cuts. Budget measures included changes to the current Aged Care Funding Instrument (ACFI), which enables residents with complex care needs to access pain management and other strategies that help them enjoy the best possible quality of life. The Government estimates this measure will save $1.2 billion over the next four years.
Clearly, this cut may hurt some of the most vulnerable in our community: the frail elderly. While I agree that costs cannot continue to grow at their current rate, better choices can be made and options exist to reduce, rather than remove, funding for services that improve residents' lives. For example, adjustments to means testing could achieve savings without compromising care, as could stronger disincentives for operators who exploit funding opportunities. This significant reduction in funds to the frail elderly is even harder to understand given the decision to reduce taxes for small and medium businesses, costing $5.3 billion in revenue over the same period.
To date, no political party has satisfactorily highlighted improving care outcomes for our ageing population as a major issue going into this election. The Age Well campaign is a national initiative by a coalition of 48 care providers to place aged care firmly on the political agenda. I support this campaign, ensuring the voices of those in need are heard and responded to by those we elect to lead our country.
When we step into polling booths on 2 July, we need to keep those voices in mind. Every Australian can play a part in shaping our shared health future. Most Australians believe healthcare should be central in setting priorities for government. Most will one day need support from aged care services, whether in homes or in the community. Each vote is an opportunity to advocate for the most vulnerable in our society.
Among the many emotions a person should experience when dying are moments of peace, reflection and acceptance. These are the gifts palliative care can give, by easing physical, emotional and spiritual pain throughout the journey to a dignified death.
National Palliative Care Week (22-28 May) offers each of us time to reflect on the long-running debate around dying with dignity, on serving those facing the end of their lives, and on the support of those who love them.
It is critical we place the sanctity of each person's life at the centre of our care, from their earliest moments until their last. In doing so we are able to support the quality, as well as duration, of life. Good palliative care, including advance care planning, can empower both patients and loved ones. It aims not to prolong life in the face of suffering, but to make each moment that remains as peaceful and meaningful as possible.
Palliative care workers are highly skilled and support communities in many settings. Yet for every person who receives palliative care, many more will need it in the future.
With an ageing population and a third of Australians reported to have at least one chronic condition, access to palliative care has never been more important. At this very moment palliative care faces a critical point where in parts of this country, demand is outstripping funding and/or service availability. As a society, we have a duty to ensure that health funding choices do not result in indignity. Early and easy access can help ensure the process of dying is rich with meaning and respect for the patient and those who love them.
As part of its leadership in this crucial issue, Mercy Health in conjunction with the Mercy Care Centre Community Advisory Group is hosting the Dying with Dignity and Choice forum in Young, New South Wales, on 27 May. This event will highlight the importance of quality healthcare for people with a terminal illness and offer a safe space for families to start discussing death. It also speaks to the organisation's founding belief: that every moment of every life is precious.
Our people work in some of the most challenging of environments, supporting our community through life and death issues on a daily basis. Ensuring staff and the community we serve feel safe, valued and heard is crucial to their health and to that of our organisation. Safety and mutual support are emphasised at every level of Mercy Health, from frontline care to our Boardroom.
This is why Mercy Health welcomes the renewed focus across the healthcare system on bullying and harassment in the workplace. The Victorian Government recently released its own strategy and while I do not want to debate its specifics, its intent and principles are relevant to everyone working in our sector.
At Mercy Health we are committed to effective risk management. We encourage transparency and open communication when concerns arise on either side of the care relationship, recognising that the welfare of our community, our people and our organisation are inextricable from each other.
We have long had a clear strategy for managing safety and culture in our workplaces, including programs to discourage and respond to bullying and other anti-social behaviour. They include reporting and complaints processes that offer a direct line to the most senior levels of the organisation. Anyone who uses or works within our services can formally register their concerns with confidence and they will be taken seriously at the highest levels.
These processes are reinforced by regular staff satisfaction surveys and programs to help teams identify positive solutions to workplace conflict. Within our ever-expanding and increasingly diverse workforce, these measures are fundamental to maintaining a safe, harmonious and respectful workplace.
They are also intrinsic to providing the best care to our equally diverse and evolving community. Our risk management strategy aims to manage risks as broadly and comprehensively as possible, from both a community welfare and organisational point of view. Ensuring staff and community feel confident to have input, especially in times of change and including voicing concerns, is intrinsic to its success.
I warmly encourage you to contribute to the transparency and collaborative spirit that inform our culture and our care. Our organisation today is the latest iteration of the first Sisters of Mercy's own equitable, mutually supportive community, and I am proud that we continue to model our values and behaviours on their example.
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