B.3 Scrutiny

Introduction/overview

ACT Health responds to requests from ACT Legislative Assembly Committees, including reports automatically referred from the ACT Auditor-General’s Office as required to assist with and ensure proper examination of matters.

ACT Health also responds to complaints that are referred from the ACT Ombudsman Office. In 2015–16, ACT Health received one complaint referred from the ACT Ombudsman.

Some matters that are referred to the ACT Ombudsman regarding ACT Health are not within the jurisdiction of the ACT Ombudsman and are referred to the Health Services Commissioner in the Human Rights Commission or referred back to ACT Health.

Annual and Financial Reports 2013–14

Annual and Financial Reports 2013–14
Report Entity Standing Committee on Health, Ageing, Community and Social Services
Report Number 5
Link to report http://www.parliament.act.gov.au/in-committees/standing_committees/Health,-Ageing,-Community-and-Social-Services/annual-and-financial-reports-2013-2014/reports?inquiry=649333
Report Title Annual and Financial Reports 2013-14
Government Response Title Standing Committee on Health, Ageing, Community and Social Services: Report No 5 Report on Annual and Financial reports 2013-14 – Government Response.
Date Tabled 4 August 2015
Recommendation Number and Summary of recommendation

Recommendation 10

The Committee recommends that the ACT Government consider annual benchmarking for emergency department timeliness against peer group hospitals to provide a better indication of how the ACT is performing compared to similar hospitals.

Recommendation 12

The Committee recommends that ACT Government consider establishing targets to measure how effectively diversion to other health care and human services management programs is working to reduce frequent re-presentations at emergency departments.

Recommendation 13

The Committee recommends that ACT Government look to revise its information systems promptly in order to facilitate the recording and reporting of timeliness measures for non-elective surgery.

Recommendation 14

The Committee recommends that the ACT Government undertake additional efforts to ensure that hospital staff comply with hand washing guidelines.

Action

Recommendation 10 – Agreed

ACT Health will endeavour to incorporate national peer group hospital results into our annual report for benchmarking purposes.

Currently, ACT Health does not have access to national datasets for the purpose of generating our own national comparative figures. As such, ACT relies on data that is made available to jurisdictions via national publications.

ACT Health currently sources national peer group results and individual hospitals performance results from federal bodies such as the Australian Institute of Health & Welfare (AIHW) and the National Hospital Performance Authority (NHPA) annual hospital publications retrospectivity.

As these national publications can often take some time before they are made available to jurisdictions, ACT Health cannot guarantee that the inclusion of the most recent national data into our annual report.

Nevertheless, ACT Health will incorporate historic publicised national results into our annual report as per data availability.

Recommendation 12 – Agreed in Principle

ACT Health is working with the ACT Capital Health Network (PHN) (formally ACT Medicare Local) to develop initiatives which are aimed at reducing pressure on Emergency Departments by providing better community based options. This initiative will initially focus on those with chronic conditions and those who present regularly at ED’s. Further extension will be determined following an evaluation of the work with the ACT PHN.

Recommendation 13 – Agreed

This recommendation is currently a high priority for ACT Health. ACT Health currently working on ways to improve the capturing and reporting of non elective surgery information to provide greater transparency in of this area.

Recommendation 14 – Agreed

ACT Health strives to achieve continuous improvements in all areas including compliance with hand hygiene requirements.

Since 2010 the Hand Hygiene Program at Canberra Hospital and Health Services (CHHS) has been coordinated via the Infection Prevention and Control Unit (IPCU) at Canberra Hospital, and has involved a multi-factorial approach to hand hygiene compliance ranging through education, audit and feedback, promotional activities, equipment and supplies, and focused area or unit specific intervention, with specific examples listed below. During this time the Hand Hygiene program has not only expanded significantly across the health service, but has also resulted in a steady increase in hand hygiene compliance (see graph), although further improvement is required, especially among Medical Practitioners.

Action

Following each audit period the IPCU analyses the results according to the ward area, moment of hand hygiene and type of healthcare worker, to determine the areas to target with specific interventions prior to the next audit cycle. Whilst the IPCU has been essential in coordinating the program, the importance of individual ward areas and healthcare worker groups in leading and driving the program at a local level needs to be recognised.

Hand hygiene compliance

Program

  • CHHS run the hand hygiene program as per the ‘5 moments’ set out by Hand Hygiene Australia in conjunction with the Commission on Safety and Quality.
  • The program now takes in 21 wards/units across the service, leaving only three areas which will be on the program by the third and final round of 2015.
  • All staff undertake essential infection prevention and control training and to date for 2015 2500 staff have been trained in the ‘5 moments of Hand Hygiene’ and infection control practices. This number includes doctors, nurses and allied health.
  • Round 1 of 2015 involved 18 units with a total of 6091 moments collected, with an overall rate of 78.7 per cent being achieved.
  • IPCU run auditor training monthly successful completion of which requires passing an exam to ensure the data collected is valid and accurate.
  • Each ward/unit collects their own moments and this has been an effective way to collect the data as it ensures staff own the information within their unit. They also see and handle problems or issues and address them as they arise, which is a more effective way to learn.
  • In addition to the national hand hygiene program, ACT Health run an auditing process of which the hand hygiene snapshot is a part. The snapshot reflects the national program and allows auditing to take place in the community and the outpatient setting.
  • Alcohol hand rub is readily available across ACT Health to make it easy to perform hand hygiene. It is available at the entry to wards, point of use within wards and in all outpatient settings.

Interventions include:

  • International Hand Hygiene Day (children from Woden Valley Childcare Centre helped to raise awareness); International infection control day in October (wear pink t-shirts and encourage wards to hold hand hygiene awareness days, e.g. 10A and women's and children often hold pink days); Infection control, ‘Bug Busters’ and hand hygiene newsletters are circulated every month; IPCU nurses provide on-the-spot positive and constructive feedback to staff from all disciplines.
  • Feedback from each audit period is provided to those wards/units that have been part of the Hand Hygiene program, including compliance rates and graphs to display.
  • Education and promotion is provided to wards/units that don’t meet the national benchmark during an audit period.
  • The Infection Control have fun days to promote hand hygiene and good infection control practices, e.g. an annual ‘Bake off’ with the theme of ‘My Hospital Rules’.
  • ‘No touch’ hand hygiene stations are situated in all foyers and entry points across the ACT Health.
  • A DVD has been developed and is on a replay loop in the foyer (this DVD was based on Chesterfield Hospital in the UK).
  • Skin assessment service is provided by infection control to ensure staff who develop skin irritations are reviewed.
Status Complete

 

ACT Auditor-General’s Office Performance Audit Report — Report No 8 of 2013 — Management of funding for community services
Reporting Entity ACT Auditor-General’s Office
Report Number 8
Report Title ACT Auditor-General’s Office Performance Audit Report - Report No 8 of 2013 - Management of funding for community services
Link to report http://www.audit.act.gov.au/auditreports/reports2013/Report_08-2013_-_Management_of_Funding_for_Community_Services.pdf
Government Response/Submission Title Government Response - Review of Auditor-General’s Report No 8 of 2013: Management of Funding for Community Services.
Date Tabled 6 August 2015
Recommendation Number and Summary of Recommendation

Recommendation 3

The Health Directorate should include in its grant procedures a requirements to undertake a risk assessment of grant recipients and reflect the level of risk in payment instalments arrangements.

Recommendation 6

The Health Directorate should enhance its service delivery and design for its Mental Health services through formalising its consideration of service design.

Recommendation 7

Service Funding Agreements should be amended to include a standard reporting template which, among other things, specified the relationship between key performance indicators, outputs and outcomes.

Action

Recommendation 3 - Agreed

There are a range of risk management processes already in place within the ACT Health Promotion Grants Program (ACTHPGP). These processes sit at various stages of the grants management cycle, and include initial eligibility checking of grant applicant organisations against a range of measures (including performance against previous ACT Government grants if relevant); confirmation of insurance; and registration of the organisation. Financial audits are also requested and reviewed.

In addition, the ACTHPGP will implement a formal risk assessment process, via a risk assessment matrix, and risk will be assessed against the volume of funding being applied for.

A review of the ACTHPGP in 2013 has resulted in a preference for larger value longer term grants, compared to the average value of grants previously awarded. As a result of this, payment instalment arrangements will be included in the new Deeds of Grant, administered from March 2014, commensurate with the scale of funding being awarded. The level of risk will be reflected in payment instalments and the deed of grant. Where appropriate performance benchmarks will be set and these will need to be demonstratively met before instalment payments are made.

Recommendation 6 – Agree in principle

Health Directorate is facilitating development of the Government’s Mental Health and Well being Framework 2015-25, which will inform the Mental Health Services Plan 2015-20. This will provide better alignment between planning and implementation including the objectives of mental health service funding agreements.

Recommendation 7 - Agreed

The Health Directorate will incorporate the results of current national health reforms in its agreement with the community sector. Health Directorate is cognisant of the national work underway to develop standard approach to performance indicators, measures, and data sets in relation to mental health. The ACT Health Mental Health Policy Unit will work with the ACT Mental Health Community Coalition to develop standard reporting templates for similar services

Status Complete

 

Inquiry into the Appropriation Bill 2015–16 and Appropriation (Office of the Legislative Assembly) Bill 2015–16
Reporting Entity Select Committee on Estimates 2015-16
Report Number 1
Report Title Inquiry into the Appropriation Bill 2015-16 and Appropriation (Office of the Legislative Assembly) Bill 2015-16
Link to report http://www.parliament.act.gov.au/__data/assets/pdf_file/0003/756309/Estimates-2015-Vol-1-report.pdf
Government Response Title The Government Response to the Report of the Select Committee on Estimates 2015-16 on the Inquiry into the Appropriation Bill 2015-16 and Appropriation (Office of the Legislative Assembly) Bill 2015-16
Date Tabled 11 August 2015
Recommendation Number and Summary of Recommendation

Recommendation 103

The Committee recommends that the ACT Government consider provide the results of the independent review of medical training culture at the Canberra Hospital to the Legislative Assembly within three months of receipt.

Recommendation 104

The Committee recommends that the ACT Government continue to work with all First Ministers and the Commonwealth Government to ensure sustainable health funding for State and Territory governments so they can continue to deliver high quality health services to the community.

Recommendation 105

The Committee recommends that the ACT Government collect data on why non-elective surgeries get cancelled and report back to the Legislative Assembly on how it will address the issues driving cancellations.

Recommendation 106

The Committee recommends that the ACT Government detail to the Legislative Assembly the proposed timetable and funding for the design and construction of the proposed new building 2/3, known as the ‘Tower Block’.

Recommendation 107

The Committee recommends that the ACT Government detail to the Legislative Assembly the expenditure of $40 million previously allocated for the proposed new building 2/3 at Canberra Hospital, known as the ‘Tower Block’.

Recommendation 108

The Committee recommends that the Health Directorate produce and use a standard table of definitions of ‘bed’ including definitions of acute, subacute, non-acute, and overnight and day beds, in-patient and out-patient beds, bed spaces and traditional and non-traditional beds.

Recommendation 109

The Committee recommends the ACT Government consider an improved way of communicating how health services and health outcomes are delivered to the community.

Recommendation 110

The Committee recommends that the ACT Government provide clear definitions for counting staff numbers including head count, fulltime employees, fulltime employees (ACT funded) and fulltime employees (externally funded) and fulltime employees (all funding sources), full time equivalents and agreed abbreviations.

Recommendation 111

The Committee recommends that the ACT Government provide a breakdown of Full Time Equivalents in its annual reports indicating the number of positions externally funded and the number funded by the ACT Government.

Recommendation 112

The Committee recommends that any decision-making by the ACT Government around community access to health services be undertaken with proper community consultation.

Recommendation 113

The Committee recommends that the ACT Government conduct a review into the number of patients admitted to the Adult Mental Health Unit with predominantly drug-related issues rather than mental health issues and that a plan be formulated for managing drug addicted/affected patients.

Recommendation 114

The Committee recommends that a whole-of-government inquiry be carried out, and the findings presented to the Legislative Assembly by March 2016, on the inpatient and outpatient services, support programs and care models for adolescents facing mental health issues.

Recommendation 115

The Committee recommends that the ACT Government table a copy of the framework for the Adult Mental Health Unit by the last sitting day in 2015.

Recommendation 116

The Committee recommends the ACT Government should consider addressing the social determinants of obesity through a whole-of-government approach, in conjunction with the obesity clinic.

Recommendation 117

The Committee recommends that the ACT Government investigate additional ways to ensure that breast screen services reach women at a level equivalent to at least that of other Australian states.

Recommendation 118

The Committee recommends the ACT Government explore opportunities to create a more child and family friendly space at Clare Holland House when they care for paediatric patients. This could include consideration of:

different needs of preschool, primary and secondary aged children;

providing specialist paediatric staff, either temporarily or permanently, when treating paediatric patients and their families; and

providing age appropriate temporary or permanent physical spaces for paediatric patients and their families.

Recommendation 119

The Committee recommends that the ACT Government consider determining the cost of alcohol-related injuries and diseases on the ACT community with regard to:

financial cost;

staff time; and

facilitation,

and report to the Legislative Assembly by the last sitting day in 2015.

Recommendation 120

The Committee recommends that the ACT Government consider determining the cost of tobacco-related injuries and diseases on the ACT community with regard to:

financial cost;

staff time; and

facilitation,

and report to the Legislative Assembly by the last sitting day in 2015.

Action

Recommendation 103 – Noted

On 17 June 2015, Mr Simon Corbell MLA, Minister for Health, announced an independent review into the training culture for doctors in specialist training programs at Canberra Hospital.

The Review of The Clinical Training Culture at Canberra Hospital is being undertaken by an independent consultancy firm, KPMG. That work is now well advanced.

The Minister has indicated that the report will be made available publicly subject to Government consideration.

Recommendation 104 – Agreed

The Government is actively engaged with other jurisdictions and the Commonwealth with the objective of addressing the Health funding cuts announced in the Commonwealth’s 2014-15 Budget.

Recommendation 105 – Agreed

The ACT Government is reviewing its data collection processes and electronic capabilities on the recording of non-elective surgery postponements.

A response that detailed how the ACT Government is addressing issues driving cancellations was provided to the Legislative Assembly through Question Taken on Notice No. 75.

Recommendation 106 – Noted

A business case for the Building 2/3 redevelopment will be considered in future budgets.

Recommendation 107 – Agreed

ACT Health informed the Select Committee on Estimates 2015-16 that the Capital Works Project referred to in Recommendation 107 was formally ceased in the 2013-14 Budget and replaced by a new Capital Works Project in the 2013-14 Budget titled “Clinical Services and Inpatient Unit Design and Infrastructure Expansion” ($40.8 million).

Recommendation 108 – Not Agreed

ACT Health does not report beds by care types, rather whether they are considered to be an overnight or same day bed. ACT Health currently has a total of 1,068 available beds in our public hospitals. Of these, 901 are considered to be overnight with the remaining 167 considered as same day beds. The beds available in our public hospitals treat a variety of differing care types and acuity levels. Whether the patients in our inpatient wards are acute or sub-acute is based on demand.

Recommendation 109 – Noted

Recommendation 110 – Agreed in principle

The only term used in relation to staffing in the Budget papers is “Full-Time Equivalents” and this is defined in the on-line Readers Guide to the 2015-16 Budget (see page 43)

Other definitions and abbreviations are also contained in the Glossary which is at Attachment B to the Readers Guide.

Recommendation 111 – Noted

Consideration will be given to providing this breakdown in the next Annual Report Directions.

Recommendation 112 - Noted

ACT Health already consults widely with the community and key stakeholders around community access to health services and will continue to do so.

Recommendation 113 – Not Agreed

ACT Health has clear admission criteria for the assessment and treatment of people with mental health issues or drug related issues. The decision to admit is made by a consultant doctor.

The Adult Mental Health Unit (AMHU) was commissioned in April 2012 to provide specialised mental health assessment, treatment and care for voluntary and involuntary people presenting with an acute mental illness that cannot be managed effectively in a less restrictive environment.

If people are assessed in the Emergency Department as having an acute mental illness, they are admitted into AMHU under the care of a treating Psychiatrist. If people are assessed as having drug related issues, they are medically stabilized and either admitted into the Withdrawal Unit under the care of an Addictions Physician or discharged home with referrals for community based Alcohol and Drug related care. If people are assessed as having both a mental illness and an addiction that requires inpatient care, they are admitted to the area that specialises in the patient’s predominant presenting issues.

Recommendation 114 – Not Agreed

The responsibility for responding to adolescents facing mental health issues is divided between the ACT and Commonwealth Governments. An estimated 25 per cent of young people will experience mental health problems in a given year, of these young people approximately 85 per cent will experience mild to moderate mental health problems and 15 per cent will experience severe mental illnesses. The Commonwealth Government has responsibility for primary mental health interventions for adolescents experiencing mild to moderate mental health problems; and the ACT Government, through ACT Health has responsibility for providing specialist mental health services for adolescents experiencing severe mental illnesses.

ACT Health engages with Commonwealth funded mental health programs and services which are the primary contact for the majority of adolescents experiencing mental health problems. This engagement includes liaison with GPs, direct engagement with the Capital Health Network (reconstituted ACT Medicare Local) and headspace ACT.

ACT Health has already undertaken considerable work reviewing the models of care for public child, adolescent and youth mental health services, and is currently undertaking the work regarding models of care for community adult mental health. The reviews are informing the ACT Health purchase of adolescent and youth mental health services from the community sector.

In addition, ACT Health has reviewed mental health inpatient services for adolescents while undertaking planning for the health infrastructure projects at Canberra Hospital.

Recommendation 115 – Agreed in principle

The Framework is in the process of being developed, and will include consultation with carer and consumer peak bodies. It is envisaged that the Framework will be completed in late 2015. Consideration will be given to tabling the Framework once it is finalised.

Recommendation 116 – Noted

The Government is already addressing the social determinants of obesity prevention and health promotion through the whole of government Healthy Weight Initiative across a range of focus areas.

The obesity clinic is a one-to-one clinical intervention for people with morbid obesity and does not focus on population level obesity prevention or promotional activities related to healthy weight.

Recommendation 117 – Agreed

In the Australian Monitoring Report 2012-2013 (due for release in September 2015), the ‘age-standardised’ participation rate of 54.2 per cent for the ACT is above the national average of 53.7 per cent.

Recommendation 118 – Agreed

This recommendation will be further explored in discussions between Calvary and ACT Health.

Clare Holland House has one respite care bed that is utilised as required for the provision of specialist paediatric palliative care.

If a paediatric patient is admitted to Clare Holland House, the ACT Paediatric Palliative Care Network (comprising Canberra Hospital Paediatric Unit, Bear Cottage, Prince of Wales and Westmead Hospitals) provides particular education and training in relation to patient-specific paediatric issues and this is organised prior to or during the admission. Clare Holland House conducts several paediatric specific in-service training sessions each year to educate staff of what may be expected when caring for a child.

For paediatric patients, families, parents and carers are encouraged to make the room as homely as they wish. There is a covered children’s playground and a range of toys, music, DVDs and electronic games that can be lent to children.

Recommendation 119 – Not agreed

Collins & Lapsley (2008) estimated that the economic costs [for Australia] associated with licit and illicit drug use in 2004-05 amounted to $56.1 billion, comprising $31.5 billion due to tobacco and $15.3 billion to alcohol. Determining the ACT specific costs would require the commissioning of special studies and this is not feasible within the required timeframe and available resources.

Recommendation 120 – Not agreed

Collins & Lapsley (2008) estimated that the economic costs [for Australia] associated with licit and illicit drug use in 2004-05 amounted to $56.1 billion, comprising $31.5 billion due to tobacco and $15.3 billion to alcohol. Determining the ACT specific costs would require the commissioning of special studies and this is not feasible within the required timeframe and available resources.

Status Complete

 

Auditor-General’s Report — Gastroenterology and Hepatology Unit, Canberra Hospital
Reporting Entity ACT Auditor-General’s Office
Report Number 4
Report Title Auditor–General’s Report - Gastroenterology and Hepatology Unit, Canberra Hospital
Link to report http://www.parliament.act.gov.au/__data/assets/pdf_file/0008/603773/Report-No-4-of-2014-Gastroenterology-and-Hepatology-Unit,-Canberra-Hospital.pdf
Government Response/Submission Title Auditor–General’s Report No 4 of 2014- Gastroenterology and Hepatology Unit, Canberra Hospital – Government Response
Date Tabled 13 August 2015
Recommendation Number and Summary of recommendation

Recommendation 1 (Chapter 3)

The Health Directorate should improve the governance of the GEHU by:

  • the three month outpatient administration structure pilot (commenced 17 March 2014) being evaluated to inform how best to provide medical transcription and outpatient referral processing and scheduling of services;
  • recording actions items and outcomes for the Division of Medicine Executive Meeting and the meetings between Executive and the GEHU. These should record decisions and actions agreed; be tabled and approved at subsequent meetings; and evidenced as such. Key messages from these meetings should be routinely communicated to staff and management;
  • The GEHU developing and implementing a business or action plan that prioritises strategies in the Directorate and Divisional strategic plans. The GEHU business or action plan should include key performance indicators (refer to recommendation 3d) and be regularly reviewed, at least annually, and finding from this reported to the Division of Medicine Executive Meeting.
  • The GEHU documenting its risks as part The GEHU developing, monitoring and reporting on key performance indicators (including setting targets) that cover all of its activities:
    • endoscopy (already the subject of a key performance indicator and target);
    • care for inpatients with gastroenterological diseases;
    • medical services;
    • clinics for outpatients with viral hepatitis, liver disease inflammatory bowel disease, gastrointestinal cancer and other complex gastrointestinal disorders; and
    • clinics for participants in the National Bowel Cancer Screening Program
  • The GEHU documenting its risks as part of its Business Plan, and reporting (at least annually) on any risk issues to the Division of Medicine Executive Meeting
Recommendation Number and Summary of recommendation

Recommendation 2 (Chapter 4)

  • The Health Directorate should develop and implement an action plan to reduce and stabilise the GEHU outpatient waiting list and guide GEHU in providing the best possible patient care. This plan should include actions to:
  • Define targets (including specific ones for categories and the number of clients triaged per full time staff specialist) and adopt guidelines for GEHU triaging.
  • Increase the use of electronic referrals to the GEHU by GPs.
  • Require that all GEHU health professionals report incidents where patient care has the potential to be compromised because of an incident, and do this using Riskman.
  • Investigate options to improve clinic organisation to be able to respond to varying patient demand.
  • Specify initial appointments per clinic and the type of patients seen in each clinic (general or sub-specialty) to provide clear direction on the work they are expected to complete in a four week clinic cycle.
  • Develop a process to guide clinic appointments being organised according to the urgency of a patient’s symptoms (their triage category) and not according to referral type (named or generic/NTANS; or general gastroenterology or sub-specialty).
  • Electronically perform referring, triaging and scheduling and if this is not possible, having as many steps in the process as possible performed electronically.
  • Incorporate information on probable waiting times and alternative treatment options in letters provided to all registered GEHU patients by GEHU administration.
  • Assess the merits and limitation of introducing ‘open’ endoscopy referrals in the GEHU.
  • Develop and implement criteria that must be met before GEHU outpatients schedule an appointment.
  • Affirm and/or expand the role of GPs (e.g. shared care) in supporting patients attending GEHU outpatients.
  • Use Riskman data and reports to address areas of concerns identified thorough incident reporting.
  • Collect analyse and report on GEHU data in order to strategically manage GEHU resources and demand for GEHU services.
Action

Recommendation 1 (Chapter 3)

a) Agreed
  • A revised reporting structure for administrative staff has been implemented in the GEHU. All administration staff have been combined under one management model to provide overall leadership and management of all GEHU referrals. Senior medical specialists are leading this work with significant progress towards triaging and booking patients. This has resulted in:
    • standardisation of core procedures
    • accurate and consistent reporting processes
    • creation of professional structure
    • maximisation of clinician time spent of clinical functions
    • standardised role descriptions for administrative staff have been developed
b) Agreed-in-Part
  • A detailed Action Statement, rather than Minutes of the meeting, is utilised.
  • The Action Statement records meeting attendees, the action, information about discussions relating to the action, the outcome/decision and the progress of each item. The Unit Director then facilitates communication of the actions to the staff of the GEHU.
  • The Division of Medicine Executive, GEHU Unit Director and Business Support Officer have arranged ongoing fortnightly meetings which commenced in July 2014.
c) Agreed
  • The Division of Medicine has a Business Plan that encompasses all clinical areas within the Division, including the GEHU. This Business Plan has been completed.
  • The GEHU has a specific Scorecard that is reported on monthly in the Scorecard meetings with Canberra Hospital Executive. The reporting includes KPIs for the GEHU and the results of each month as well as information regarding variances from the target.
d) Agreed
  • The GEHU reports on KPIs on a monthly basis is the divisional scorecard meetings. KPIs report on referral management, endoscopy waiting lists, GEHU procedures and occasions of service.
e) Agreed
  • GEHU risks are documented in the Divisional Business Plan as well as the Divisional Risk Register. The Business Plan reflects risks and their operation management strategies. This is undertaken in collaboration with Unit staff as appropriate.
  • Risks are reported on in the divisional Quality and Safety meeting which meets monthly and the Tier 1 Canberra Hospital and Health Services Quality and Safety Meeting which meets quarterly.
  • When incidents are reported through the IT system Riskman, a copy is sent to the relevant executive member (unit director/DON/ADON etc) who reviews each risk and actions taken.
Action

Recommendation 2 (Chapter 4)

a) Agreed
  • Targets have been developed in order to increase access to GEHU services and minimise waiting time. The Unit is progressing this and has met with all the Staff Specialists to increase new patients and increase patients seen across all services.
  • Targets have been agreed via Performance Plans between the Division of Medicine Executive Clinicians to increase the number of clinics and decrease the number patients awaiting appointment.
b) Agreed

All GEHU consultants are triaging electronically via the Clinical Portal.

c) Agree

All clinicians of the GEHU are aware that they must report all incidents in the Riskman system.

d) Agreed
  • The Executive Director of Medicine and Clinical Director of Medicine have met with the doctors of the GEHU and have finalised clinic allocations which allows for increased clinic time for some doctors and incorporates an increased emphasis on seeing of new referrals for each clinic, allowing for more patients to be seen overall.
  • A locum staff specialist has been recruited to add additional endoscopy clinics in June and July 2015.
e) Agreed

Through meetings with the Division of Medicine Executive and GEHU clinicians, agreements have been put in place for each clinician’s clinic, including the number of patients (initials and follow ups) to be seen in each clinic.

f) Agreed

Service Leads have been appointed to manage outpatient referrals for the GEHU. This work has ensured that referrals are distributed equitably to all clinicians of the unit and the number of GEHU patients with referrals awaiting clinical triage continues to decrease.

g) Agreed

Changes have been introduced to improve processes for acceptance and registration of referrals. A focus on increasing Gastroenterology Consultants utilisation of IT systems to triage has been undertaken in an effort to streamline referral processing.

h) Agreed

A Service Innovation and Redesign Framework project has been undertaken to manage the demand and flow of patients within GEHU who require outpatient clinic visits and procedures. This project aims to improve flow, create efficiencies and to improve utilisation of available resources.

i) Agreed

The assessment has been completed.

j) Agreed
  • This has been completed and the work is led by the Unit’s Service Leads. Service Leads have been appointed to manage outpatient referrals for the GEHU. This work has ensured that referrals are distributed equitably to all clinicians of the unit and the number of GEHU patients with referrals awaiting clinical triage continues to decrease.
  • Work around Health Pathways in collaboration with ACT Medicare Local will assist in defining the patient journey and the role of GPs and the tertiary Gastroenterology service at Canberra. HealthPathways, including a Gastroenterology pathway, has been active as of April 2015. The pathway triggers for specialist referral which are GEHU promulgated. The HealthPathways system is also used in the tertiary care setting by the GEHU when discharging patients to their primary care provider/GP.
k) Agreed
  • Work around Health Pathways in collaboration with ACT Medicare Local has assisted in defining the patient journey and the role of GPs and the tertiary Gastroenterology service at Canberra Hospital. The gastroenterology pathways provide evidence based guidelines to manage patients within primary care.
  • Liver Services are provided in the form of outreach at the AMC in collaboration with Justice Health.
  • Outreach services are also being explored for the ATSI patients at Winnunga Nimmitjara to increase access and compliance with management of liver treatment for ATSI patients.
l) Agreed

All clinicians of the GEHU are aware that they must report all incidents in the Riskman system.

m) Agreed

Data specific to the GEHU is now reported on a monthly basis at Divisional meetings which allows the service transparent visibility of demand and enables improved resource management.

Status Complete

 

Auditor-General’s Report — Integrity of data in Health Directorate
Reporting Entity ACT Auditor-General’s Office
Report Number 5
Report Title Auditor – General’s Report - Integrity of data in Health Directorate
Link to report http://www.audit.act.gov.au/auditreports/reports2015/Report%20No%205%20of%202015%20Integrity%20of%20Data%20in%20the%20Health%20Directorate.pdf
Government Response/Submission Title Government Response to the Auditor – General’s Report No 5 of 2015 - Integrity of data in Health Directorate
Date Tabled 17 September 2015
Recommendation Number and Summary of recommendation

Recommendation 1

As ACT Health implements its Information Management Strategy 2015-16, change management initiatives should include:

  • Training staff to ensure they have an adequate understanding of the strategy and specifically data integrity activities; and
  • Documenting and allocating responsibility for data integrity activities for the key systems including ACTPAS, EDIS and the data warehouse.

Recommendation 2

Outcome measures for data quality, including metrics, should be developed and incorporated into the Information Management Strategy. These should be monitored to ensure the adequacy of data integrity, particularly related to ABF data.

Recommendation 3

ACT Health’s Information Management Strategy should clearly articulate the following:

  • Key data risks associated with ABF-related data and submissions to national bodies;
  • Frequency, scope of control assessments and other assurance activities that will be undertaken to provide assurance in relation to ABF data integrity

The ABF data integrity risks and control assessments will need to be updated from year to year as national submission requirements change.

Recommendation 4

HIGH PRIORITY RECOMMENDATION

ACT Health should develop an emergency department data dictionary to standardise the definition of ABF related data and define ABF-related data mapping from EDIS in both hospitals to the data warehouse.

Recommendation 5

Calvary Public hospital should align its EDIS record close period (currently 7 days) with that of Canberra Hospital (Currently 2 days).

ACT Health should undertake a monthly assessment to monitor changes to patient records after the close period.

Recommendation 6

Canberra Hospital should finalise its draft EDIS training documents and implement a mandatory requirement to staff to complete EDIS training before receiving access to the system.

Recommendation Number and Summary of recommendation

Recommendation 7

HIGH PRIORITY RECOMMENDATION

Both Canberra and Calvary should establish useable audit logs for EDIS to allow monitoring activities after the close-off period. The audit logs should be reviewed regularly with results presented to the accountable hospital executives and to the Health Directorate.

Recommendation 8

HIGH PRIORITY RECOMMENDATION

ACT Health should finalise and implement the Non-admitted Patient Activity Data Standards.

Recommendation 9

HIGH PRIORITY RECOMMENDATION

ACT Health should develop and implement overarching policies and procedures related to data validation processes and activities. These should provide a consistent framework that is flexible and adaptable when needed to reflect local processes and organisational structure.

Recommendation 10

ACT Health should review the capability of its data warehouse and develop robust processes to track validation activities performed by the hospitals. It should also define and promulgate business rules required in correcting ABF-related data to ensure consistency across hospitals.

Recommendation 11

HIGH PRORITY RECOMMENDATION

ACT Health should develop KPIs for the validation of data that can be supported by information from the data warehouse.

Recommendation 12

HIGH PRIORITY RECOMMENDATION

ACT Health should finalise its business rules for data validation and incorporate these in its data warehouse, then re-commence the distribution of validation reports for the Non-admitted Patient areas at Canberra Hospital and Calvary Public Hospital and for the Calvary Public Hospital Emergency Department.

Recommendation 13

HIGH PRIORITY RECOMMENDATION

ACT Health should perform an analytical review to quality assure the six-monthly data submission before it is sent to IHPA.

Recommendation 15

HIGH PRIORITY RECOMMENDATION

  • ACT Health should undertake further investigation into the inconsistencies and anomalies identified by the data analytics, taking a risk-based approach to the investigation and focusing on the areas that have the potential to materially affect ABF data and funding.
  • As a priority, ACT Health should review the mapping of processes to extract data from emergency department systems to the data warehouse.
Recommendation Number and Summary of recommendation

Recommendation 16

  • Canberra Hospital and Calvary Public Hospital should review patient records on a random and weekly basis with a focus on the fields that are included in ABF reporting
  • Both hospitals should conduct refresher training on the use of the “type of visit” field

Recommendation 17

HIGH PRIORITY RECOMMENDATION

  • ACT Health should investigate the root causes of errors in non-admitted data, including errors in Indigenous status, postcode and funding sources and develop and implement policies and procedures for improvement.
  • ACT Health should implement a single patient administration system and standardise data management policies and procedures across all public outpatient clinics.

Recommendation 18

Canberra and Calvary Hospitals should improve their clinical coding with the following process changes:

  • Where coding is completed before the availability of the discharge summary, the record should be flagged to facilitate subsequent identification of potentially incorrectly coded episodes.
  • Where discharge summaries conflict with information in the record, a query should be forwarded to the treating clinician for clarification. These queries should be followed up and documented for future reference.
Action

Recommendation 1 – Agreed

The ACT Health Information Management Integrity Strategy will be disseminated more widely across ACT Health to ensure that all staff are aware of its content and the relationship between staff actions and data integrity.

ACT Health has finalised its data custodian guidelines which document and allocate responsibilities for data integrity activities for key systems in ACT Health.

Recommendation 2 – Agreed

The Data Credentialing Framework, which is referred to in the Information Management Strategy, includes the development of key performance measures for data quality and data quality assurance processes.

These measures will provide quality assessments of all major ACT data sets, including data submitted for ABF purposes.

Recommendation 3 – Agreed

ACT Health will amend its Information Management Strategy to ensure that key data risks and control assessments for ABF data is implicit within the Document. At present, the Strategy provides details about data quality control processes. However, additional specific references will be made in relation to ABF data validation and quality assurance processes.

Actions

Recommendation 4 – Agreed

ACT Health notes the separate use at each ACT public hospital of codes relating to the type of ED presentation. This matter, while important to address, has a very limited financial impact.

Notwithstanding this, standardised approaches to recording this information have been implemented, and ACT Health is developing the necessary data dictionary for the system.

Recommendation 5 – Agreed

ACT Health has implemented a range of activities to improve data integrity within the emergency department system. These include:

  • Removal of generic log-ons on all but one machine due to operational requirements
  • Swipe care access to machines
  • Adding the mandatory requirement for people to provide reasons for any change to records
  • Automated assigning of names to any changes
  • Automated checking of emergency department data to determine if inappropriate patterns are occurring

ACT Health will increase this activity to include more robust audit process now that these other activities are in place and working (see Recommendation 7).

Recommendation 6 – Agreed

Training documents have been finalised and an on-line training package has been completed.

Recommendation 7 – Agree in principle

As is noted in the report the EDIS audit logging functions can have a significant impact on system performance. Initial work has been completed to provide additional audits of activity within the emergency department as well as the initiatives already in place that minimise access to the system and minimise the possibility of inappropriate changes being made without a clear audit path.

While audit logging is desirable, this level of data quality assurance must be balanced against the need to provide a responsive service to emergency patients. Relevant areas of ACT Health will work with the Director of Information Integrity to develop a sustainable method of managing this risk.

Recommendation 8 – Agreed

ACT Health has commenced implementing the non-admitted standards. As noted in the report, data standards for Non-admitted data are less mature than in other domains of health activity and relevant areas of ACT Health will continue to develop and implement the standards as requirements change over time.

Recommendation 9 – Agreed

ACT Health established a new Data Credentialing Framework in 2014 which includes greater access to data validation processes and improved data validation and quality assurance systems. The main issues within the framework have been addressed and the programme of work will continue as the capability of ACT Health’s reporting infrastructure expands.

Action

Recommendation 10 – Agreed

As noted above in Recommendation 9, ACT Health is developing systems to better communicate data validation processes, as well as establishing formal and informal forums to discuss data quality matters. This process will improve data quality and provide the basis for changes to source systems to reduce the possibility of further data errors.

Recommendation 11 – Agreed

The establishment of KPIs and reports is incorporated within the Data Credentialing Framework.

This framework also includes an escalation process to ensure that data issues are addressed as required.

Recommendation 12 – Agreed

New validations for Non-admitted care have been developed based on the Non-admitted Patient Data Standards.

In addition, ACT Health has implemented processes that provides for improved communication of data quality issues with business areas across the organisation. Validations for Calvary Hospital emergency department activity have recommenced following completion of the work required by Calvary to enable this to occur.

Recommendation 13 – Agreed

ACT Health has implemented further validations and analysis on submissions to relevant national bodies, particularly with regard to the final data transform process flagged in the report.

Recommendation 15 – Agreed

ACT Health agrees that improved data analytics will provide for increased data quality over time. ACT Health has directed efforts to focus on the areas with the highest material impact (admitted services) and work is underway to maximise data quality in non-admitted services through the development of more robust standards and validation techniques.

ACT Health is also investigating the apparent anomalies with ED data, noting that the impact of them would not be material in a funding sense.

Recommendation 16 – Agreed

The report noted that coding errors were within nationally and internationally accepted standards. A number of systems are in place to identify issues and follow-up on discharge summaries. ACT Health and Calvary will review these with the view to introduce enhanced approaches that further minimise errors. In addition, ACT Health will undertake external coding audits as a further means of demonstrating compliance with relevant standards.

Action

Recommendation 17 – Agree in principle

ACT Health has already established new processes to focus on and improve data quality within non-admitted services. Some errors identified in the report have already been addressed and data re-submitted to IHPA. The new Advancing Data group (within non-admitted services) and the work to finalise the non-admitted data standards will provide a firm basis for improved data quality in this area. On top of this, new formal and informal forums will also be established to provide information to those responsible for entering data into systems related to non-admitted care.

ACT Health will need to undertake a review of the impact and capacity of establishing a single system for non-admitted services.

Recommendation 18 – Agree in principle

ACT Health will investigate the feasibility of implementing an automatic validation to detect the small number of overlapping episodes.

Status Complete

 

Inquiry into the Exposure Draft of the Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014 and related discussion paper
Reporting Entity Standing Committee on Health, Ageing, Community and Social Services
Report Number 6
Report Title Inquiry into the Exposure Draft of the Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014 and related discussion paper
Link to report http://www.parliament.act.gov.au/in-committees/standing_committees/Health,-Ageing,-Community-and-Social-Services/inquiry-into-exposure-draft-of-the-drugs-of-dependence-cannabis-use-for-medical-purposes-amendment-bill-2014-and-related-discussion-paper/report?inquiry=624651
Government Response/Submission Title Government Response to the Standing Committee on Health, Ageing, Community and Social Services Inquiry into the Exposure Draft of the Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014 and related discussion paper.
Date Tabled 19 November 2015
Recommendation Number and Summary of recommendation

Recommendation 1

The Committee recommends that the ACT Government write to the Commonwealth Minister for Health requesting the Commonwealth Government:

  • consider including Sativex and Marinol on the PBS to improve affordability;
  • consider providing easily accessible guidance material to medical practitioners on:
    • how to go about prescribing approved pharmaceutical cannabis products off-label;
    • the requirements of the Special Access Scheme and associated importation requirements;
  • simplify off-label prescribing and Special Access Schemes so that the processes can be navigated by medical practitioners with ease and are not excessively protracted; and
  • consider expanding access to approved pharmaceutical cannabis products for additional indications.

Recommendation 2

To facilitate the research and development of medicinal cannabis and cannabinoid preparations, the Committee recommends that the ACT Government write to the Commonwealth Minister for Health requesting the Commonwealth Government investigate amending the Poisons Standard by:

  • amending Schedule 9 to facilitate medical or scientific research; and
  • moving other non-psychoactive, non-addictive cannabinoids into a lesser schedule as has been done for cannabidiol.

Recommendation 3

The Committee recommends that the ACT Government work together with other State, Territory and Commonwealth governments to conduct further clinical trials of pharmaceutical products and crude cannabis.

Recommendation 4

The Committee recommends that the ACT Government work together with other State, Territory and Commonwealth governments to help facilitate ACT patient access to upcoming interstate trials.

Recommendation 5

The Committee recommends that the ACT Legislative Assembly reject the proposed Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014.

Recommendation Number and Summary of recommendation

Recommendation 6

The Committee supports a national approach to medicinal cannabis and encourages the ACT Government to continue to work with the Commonwealth, States and Territory on a national medicinal cannabis scheme.

Recommendation 7

The Committee recommends that if the ACT acts independently of the Commonwealth or other State and Territory jurisdictions on a medicinal cannabis scheme it needs to address the regulatory concerns raised in this report.

Action

Recommendation 1 – Agree in principle

  • consider including Sativex and Marinol on the PBS to improve affordability;
    • The ACT Government will write to the Commonwealth Minister for Health to request that consideration be given for Sativex to be included on the Pharmaceutical Benefits Scheme (PBS). Marinol is not currently listed on the Australian Register of Therapeutic Goods and will need to be registered prior to any application regarding potential listing on the PBS being pursued. Application to allow the sale of Marinol while unregistered in Australia can be made through the Special Access Scheme (SAS). However, the ACT notes that the decision to supply pharmaceuticals in Australia is a commercial decision that rests with the product sponsor.
    • It should also be noted that issues around the legal storage and distribution of Sativex will need to be addressed if it is to be remarketed in Australia, as it requires refrigeration.
  • consider providing easily accessible guidance material to medical practitioners on:
    • how to go about prescribing approved pharmaceutical cannabis products off-label;
    • Not agreed
    • There are no regulatory barriers to medical practitioners prescribing registered products for off-label use. However, a prescription itself does not guarantee that the sponsor will make the product available for the off-label purpose requested by a medical practitioner.
    • Further, the ACT Government considers that off-label prescribing of approved pharmaceutical products is common practice and well understood by medical practitioners
    • the requirements of the Special Access Scheme and associated importation requirements;
    • Agreed
    • The ACT Government will write to the Commonwealth Minister for Health suggesting that guidance materials be developed in relation to the Special Access Scheme and associated importation requirements.
  • simplify off-label prescribing and Special Access Schemes so that the processes can be navigated by medical practitioners with ease and are not excessively protracted;
    • Agreed
    • The ACT Government notes that there are multiple steps involved in accessing the Special Access Scheme. However, these steps are considered necessary to ensure the TGA can meet its obligations of responsibility in maintaining a balance between ensuring individuals gain timely access to important new therapeutic developments and maintaining broader community interest that therapeutic products available in Australia are evaluated for quality, safety and efficacy.
Action

There may, however, be some scope to streamline these processes. The ACT Government will write to the Commonwealth Minister for Health requesting that opportunities to simplify and streamline processes related to the Special Access Scheme be explored.

  • consider expanding access to approved pharmaceutical cannabis products for additional indications.
    • Agreed
    • The ACT Government supports a timely, proactive response from the Commonwealth when new research supports the medicinal use of cannabis in the treatment of additional conditions. For this to occur, the product sponsor must agree to expand the indications for use – a commercial decision. The ACT Government will write to the Commonwealth Minister for Health requesting that the TGA work with relevant sponsors to explore the potential for indications to be expanded.
    • However, it should be noted that medical practitioners already have the ability to prescribe pharmaceutical cannabis products (through the Special Access Scheme) for any indication they consider appropriate. It is noted that in such cases, the prescriber bears the responsibility for prescribing an unapproved product (as outlined in the Committee’s Report) which could be one of the reasons medical practitioners are reluctant to prescribe products for off-label use.

Recommendation 2

  • amending Schedule 9 to facilitate medical or scientific research
    • Not agreed
    • The ACT Government does not consider that this is necessary as there are already mechanisms under Commonwealth, ACT and other jurisdictions’ medicines and poisons legislation to enable medical or scientific research (including clinical trials) with Schedule 9 substances.
  • moving other non-psychoactive, non-addictive cannabinoids into a lesser schedule as has been done for cannabidiol
    • Agreed
    • The ACT Minister for Health will write to the Commonwealth Minister for Health seeking consideration of the rescheduling of other non-psychoactive, non-addictive cannabinoids into a lesser schedule (as has been done for cannabidiol) where there is appropriate profiling and research.
    • It should be noted that this would be dependent on industry or another party submitting a rescheduling application to the TGA (as occurred in late 2014 when the Victorian and Western Australian Departments of Health made an application to the Commonwealth to have cannabidiol classified as a Schedule 4 substance, which is the least restrictive schedule for prescription medicines). After public consultation, the decision was made to classify cannabidiol as a Schedule 4 substance from 1 June 2015.
    • An alternative is for the Commonwealth to prepare its own internal rescheduling submission. There is minimal precedent for this, however, it has been done on occasions (e.g. rescheduling of sodium oxybate).
Action

Recommendation 3 - Agree in principle

The ACT Government will continue to work with the Commonwealth, States and Territory governments on a national medicinal cannabis scheme, noting that is has already given its support to the trials recently announced by the NSW Government.

The actual conduct of clinical trials depends on a number of factors including the funding, methodology (including population size) and availability of product.

The ACT Government will continue to facilitate awareness of the process required to conduct clinical trials within the ACT.

Recommendation 4 - Agreed

The ACT Government will continue to work with the Commonwealth, State and Territory governments to help facilitate ACT patient access to upcoming interstate trials, where appropriate. The ACT Government has been actively engaged with the process of developing the framework for the recently announced NSW trials.

It should be recognised that many of those patients potentially eligible for upcoming trials in NSW may already be accessing treatment within the NSW medical system, for example, children with complex seizure disorders.

Recommendation 5 - Agreed

The ACT Government supports the compassionate intent behind the Draft Bill. However, the practical implementation of the scheme proposed in the Draft Bill would be extremely challenging.

The ACT Government reiterates its support for a national approach and the supply of a regulated, quality-controlled product.

Recommendation 6 - Noted

The ACT Government strongly supports the development of a nationally consistent regulatory framework.

The ACT Government will continue to work with the Commonwealth, State and Territory governments on a national medicinal cannabis scheme, noting the recent support given at a national level to the Regulator of Medicinal Cannabis Bill 2014 (the National Bill).The National Bill proposes the establishment of a national Office of Medicinal Cannabis.

Recommendation 7 - Noted

The ACT Government agrees that there are regulatory concerns as well as other issues to address in relation to the Draft Bill. These have been outlined previously in the ACT Government’s submission to the Standing Committee.

The ACT Government is supportive of the compassionate intent of the Draft Bill and notes that there is scope for further investigation of appropriate means for making medicinal cannabis available in the ACT. It acknowledges recent developments in cannabis policy nationally. The ACT Government prefers a national approach in which standardized medicinal cannabis products are available.

Action

On 17 October 2015 the Commonwealth Government announced that it would seek parliamentary approval to amend the Narcotics Drugs Act 1967 to allow the controlled cultivation of cannabis for medicinal and scientific purposes in Australia. The Commonwealth expects that material grown under its licensing scheme would be available in 2017 at the earliest.

Commonwealth legislation would facilitate cannabis being grown to manufacture medicinal or research products, and may lead to commercial growers becoming established in Australia. It will be designed to allow ‘farm to pharmacy’ control of the cannabis crop to be compliant with Australia’s obligations under the Single Convention on Narcotic Drugs 1961.

The licensing of a commercial supply of cannabis, either in the ACT or another state, could facilitate the provision of standardized medicinal products in the ACT. Commonwealth legislation would not alter the legal status of non-licensed medicinal cannabis products.

The Government of Victoria has, on 6 October 2015, announced its intention to license the cultivation of cannabis for distribution under the authority of a medical practitioner. The exact form of this scheme will not be known until legislation is introduced into the Victorian parliament, and it will take some time for a production and regulatory process to become established. The licensing of a cannabis crop in Victoria will require Commonwealth agreement.

The ACT Government is supportive of the use of medicinal cannabis in a clinical trial setting. Palliative care is a potential area of interest in which clinical trials could be performed in the ACT. However, clinical trials are subject to ethical approval processes, require the engagement of clinicians wishing to conduct them, and have a prescribed duration. The ACT Government cannot dictate these methodological requirements.

The ACT Government is supportive of further investigation of the feasibility of a Terminal Illness Cannabis Scheme (TIC scheme) similar to that which operates in NSW. There are several regulatory models under which such a scheme could operate, including administrative and legislative options for providing legal relief to people possessing cannabis for the management of a terminal illness. A TIC scheme could operate in parallel with the existing Simple Cannabis Offence Notification (SCON) scheme in the ACT.

There are options for capacity building which could assist people accessing medicinal cannabis products. Education of medical professionals as to the appropriate indications and methods of using cannabis is currently lacking and could be formally supported by the tertiary education sector. Laboratory testing of cannabis products would provide information about the medical suitability of strains currently being accessed for medicinal use and could be technically achieved with appropriate laboratory resourcing.

The ACT Government is committed to ensuring that any medicinal cannabis scheme introduced addresses the regulatory concerns outlined in the Standing Committee’s Report.

Status Complete

 

Review of the Auditor-General’s Report No. 4 of 2014: Gastroenterology and Hepatology Unit, Canberra Hospital
Reporting Entity Standing Committee on Public Accounts
Report Number 19
Report Title Review of the Auditor-General’s Report No. 4 of 2014: Gastroenterology and Hepatology Unit, Canberra Hospital
Link to report http://www.parliament.act.gov.au/__data/assets/pdf_file/0006/871917/8th-PAC-27-AG1-2016.pdf
Government Response Title Government Response to Public Accounts Committee Report No 19: Review of Auditor-General’s Report No 4 of 2014: Gastroenterology and Hepatology Unit, Canberra Hospital.
Date Tabled 10 March 2016
Recommendation Number and Summary of Recommendation

Recommendation 1

The Committee recommends that the Government provide an update to the Legislative Assembly on the progress of implementing the Auditor-General’s recommendations of Report No. 4 of 2014: Gastroenterology and Hepatology Unit, Canberra Hospital by the last sitting day in March 2016.

Action

Recommendation 1 - Agreed

The Government tabled its response to PAC Report No. 19 on 10 March 2016. The update on implementation of the Auditor-General’s recommendations, as per recommendation 1, and tabled by the responsible Minister on 10 March 2016, is attached.

Status Complete

 

Annual and Financial Reports 2014–15
Reporting Entity Standing Committee on Health, Ageing, Community and Social Services
Report Number 7
Report Title Annual and Financial Reports 2014-15
Link to report http://www.parliament.act.gov.au/__data/assets/pdf_file/0019/830053/8th-HACS-07-AR14-15.pdf
Government Response/Submission Title The Government Response is not due as at 30 June 2016
Date Tabled 10 March 2016
Recommendation Number and Summary of Recommendation

Recommendation 12

The Committee recommends that ACT Health investigate any negative effects upon graduate nurses from the current 12 month contract employment arrangements

Recommendation 13

The Committee recommends that ACT Health survey staff attitudes to diversity and Aboriginal and Torres Strait Islander people through its three-yearly survey and report its findings in the ACT Health Annual Report

Recommendation 14

The Committee recommends that ACT Health explore the reasons behind low completion rates for traineeships and for other Aboriginal and Torres Strait Islander programs.

Recommendation 15

The Committee recommends ACT Health require ACT Health Promotion Grant applicants to list on their applications any other grants applied for.

Action Not applicable
Status In progress

 

Auditor-General’s Report No. 1 of 2016: Calvary Public Hospital Financial and Performance Reporting and Management
Reporting Entity ACT Auditor-General’s Office
Report Number 1
Report Title Auditor-General’s Report No. 1 of 2016: Calvary Public Hospital Financial and Performance Reporting and Management
Link to report http://www.audit.act.gov.au/auditreports/reports2016/Report%20No.%201%20of%202016%20Calvary%20Public%20Hospital%20Financial%20and%20Performance%20Reporting%20and%20Management.pdf
Government Response/Submission Title The Government Response is not due as at 30 June 2016
Date Tabled 3 May 2016
Recommendation Number and Summary of Recommendation

Recommendation 1

The ACT Government should examine: a) the fundamental issue of whether or not the Calvary Network Agreement is the most appropriate mechanism for delivering Public Hospital services; and b) whether the Public Hospital staff employed by Calvary Health Care ACT Ltd should be engaged under the terms and conditions of the Public Sector Management Act 1994 and associated enterprise agreements.

Recommendation 2

The ACT Health Directorate and the Little Company of Mary Health Care Ltd should review, negotiate and amend the Calvary Network Agreement to address weaknesses identified in this audit report.

Recommendation 3

The ACT Health Directorate should document its consideration and management of risks associated with the purchase of public hospital services from Calvary Health Care ACT Ltd, including conducting a risk assessment and documenting the management of identified risks.

Recommendation 4

Calvary Health Care ACT Ltd should seek written confirmation from the ACT Health Directorate that the reporting of the external audit of 2014‐2015 Calvary Public Hospital’s financial reports is adequate for the purposes of clause 14.1 (a) of the Calvary Network Agreement, which requires the provision of externally audited annual reports for the public hospital to the ACT Government.

Recommendation 5

The ACT Health Directorate, in consultation with the Little Company of Mary Health Care Ltd and Calvary Health Care ACT Ltd, should commit to a timeframe for the finalisation and implementation of the successor to the interim funding model for Calvary Public Hospital services.

 

Recommendation 6

The Little Company of Mary Health Care Ltd and Calvary Health Care ACT Ltd should undertake investigations of inappropriate workplace behaviours by its Public Hospital staff in accordance with the Public Sector Management Act 1994 and any related regulations and relevant enterprise agreements.

Recommendation 7

Calvary Health Care ACT Ltd should include the following in its reporting to the ACT Health Directorate in relation the Calvary Network Agreement: a) reconciliation of year to date revenue to the actual funding paid year to date, including explanations for reconciling items; and b) information on the basis of how revenue items have been recognised, to ensure only approved funded items have been included in the revenue reported.

Recommendation 8

The Little Company of Mary Health Care Ltd and Calvary Health Care ACT Ltd should continue to review, amend and promulgate employee behaviour and conduct documents, including policies relating to employees’ conduct and ‘whistleblowing’, so that Calvary Health Care ACT Ltd public hospital staff are provided with information on: a) their duties and obligations under the Public Sector Management Act 1994, including their obligation to report any corrupt or fraudulent conduct or any possible maladministration to an appropriate authority; and b) options, including the making of a public interest disclosure under the Public Interest Disclosure Act 2012, for the reporting of any corrupt or fraudulent conduct or any possible maladministration to appropriate ACT public sector authorities, such as the ACT Health Directorate, the Commissioner for Public Administration or the ACT Auditor‐General.

Action Not applicable
Status In progress

 

Inquiry into Youth Suicide and Self Harm in the ACT
Reporting Entity Standing Committee on Health, Ageing, Community and Social Services
Report Number 8
Report Title Inquiry into Youth Suicide and Self Harm in the ACT
Link to report http://www.parliament.act.gov.au/__data/assets/pdf_file/0004/871915/8th-HACS-08-Inquiry-Into-Youth-Suicide-And-Self-Harm.pdf
Government Response/Submission Title The Government Response is not due as at 30 June 2016
Date Tabled 9 June 2016
Recommendation Number and Summary of Recommendation

Recommendation 1

The Committee recommends that the ACT Government update the Legislative Assembly on both the development of the national database, and progress made in relation to improving the collection of ACT data, particularly in relation to receiving consistent data from community based organisations.

Recommendation 2

The Committee recommends that the ACT Government update this Committee in relation to Australian Government funding negotiations in relation to mental health funding, including the Capital Health Network.

Recommendation 3

The Committee recommends that the ACT Legislative Assembly consider re-examining this matter when funding and research outcomes are made public in order to determine the most appropriate way to further develop early intervention measures, education approaches and access to service for suicide prevention activities in the ACT.

Action Not applicable
Status In progress

 

Review of the Auditor-General’s Report No. 1 of 2016: Calvary public hospital financial and performance reporting and management
Reporting Entity Standing Committee on Public Accounts
Report Number 27
Report Title Review of the Auditor-General’s Report No. 1 of 2016: Calvary public hospital financial and performance reporting and management
Link to report http://www.parliament.act.gov.au/__data/assets/pdf_file/0006/871917/8th-PAC-27-AG1-2016.pdf
Government Response/Submission Title The Government Response is not due as at 30 June 2016
Date Tabled 9 June 2016
Recommendation Number and Summary of Recommendation

Recommendation 1

The Committee recommends that the ACT Government take appropriate steps to ensure that its response to Auditor-General’s Report No. 1 of 2016: Calvary Public Hospital Financial and Performance Reporting, is tabled by the end of the first sitting week in August 2016.

Recommendation 2

The Committee recommends that the ACT Government report to the ACT Legislative Assembly by the last sitting day in August 2017, on the progress of its implementation of the recommendations made in Auditor-General’s Report No. 1 of 2016: Calvary Public Hospital Financial and Performance Reporting, that have been accepted either in-whole or in-part. This should include: (i) a summary of action to date, either completed or in progress (including milestones completed); and (ii) the proposed action (including timetable), for implementing recommendations (or parts thereof), where action has not yet commenced.

Recommendation 3

The Committee recommends that the ACT Government take appropriate steps to improve its contract management capability of all government contracts it enters into on behalf of the Territory. This should include: (i) clear allocation of contract management roles within acquiring entities; and (ii) adequately resourcing, relative to the size of each contract, the respective contract management functions within each acquiring entity to effectively manage the contract(s).

Recommendation 4

The Committee recommends that the ACT Government take appropriate steps to ensure that all contract acquiring entities within ACT Government monitor contractor performance in accordance with contract provisions, and where applicable, take appropriate steps to act on contractor underperformance.

Recommendation 5

The Committee recommends that the ACT Government take appropriate steps, as part of specific contract provisions, to require contracting entities delivering services on behalf of the Territory to ensure, relative to the size of each contract, that: (i) public interest disclosure policies and procedures are developed, implemented and appropriate steps taken to monitor compliance; and (ii) an employee code of conduct is developed, promoted and appropriate steps are taken to monitor compliance.

Action Not applicable
Status In progress

 

Inquiry into the Appropriation Bill 2016–17 and Appropriation (Office of the Legislative Assembly) Bill 2016–17
Reporting Entity Select Committee on Estimates 2016-17
Report Number 1
Report Title Inquiry into the Appropriation Bill 2016-17 and Appropriation (Office of the Legislative Assembly) Bill 2016-17
Link to report Not applicable
Government Response Title As at 30 June 2016 the inquiry is ongoing
Recommendation Number and Summary of Recommendation Not applicable
Action Not applicable
Status Ongoing