What are the community’s priorities and concerns when it comes to after hours care? Some useful insights were gleaned from a citizen’s jury held in Tasmania earlier this year, including the need for much better information for the public about what services are available.
Phil Edmondson, CEO of the Tasmania Medicare Local, found the citizen’s jury to be a useful process, hopes to run more of them, and recommends them to other Medicare Locals.
How can the community help plug the gaps in care?
Phil Edmondson writes:
Tasmania leads the Medicare Local world – well at least in one respect! One important part of the Medicare Local strategy is to consult with the local community.
There are all sorts of ways of doing this – many of which are tainted by simply allowing those with vested interests or an axe to grind to have yet more say. Some approaches are not really about the community voice but about letting certain patient or consumer groups have a say. These can have an important role to play but they are not and do not pretend to be representing the community.
It was against this background that the Tasmania Medicare Local decided to use citizens’ juries.
These, as Croakey readers will know from Gavin Mooney’s advocacy of them, involve bringing together a group of randomly selected citizens, having experts present to them on the subject matter to hand and giving them time, as now critically informed citizens, to reflect on what they have heard. Against a background of limited resources they are then asked to make recommendations with respect to policy.
The topic here was after hours care. Earlier this year, 14 jury members from all over Tasmania were brought together on a Friday evening in Launceston with the intent over an informal dinner to get to know each other and the facilitator, Gavin Mooney. The jury sitting then took place on the Saturday.
Presentations from the experts included information about Medicare Locals in general, the Tasmania Medicare Local and after hours care and about some of the issues/gaps/problems currently in after hours care in Tasmania. The presenters were each quizzed in turn by the members of the jury. (Interesting that the jury did not like the name ‘Medicare Local’ – and thought initially it might be where one went to get Medicare repayments!)
In the afternoon the jury was left with the facilitator to reflect and deliberate over principles and priorities. Those that emerged were as follows:
An informed community
Tasmanian citizens need to have much better knowledge of after hours care. The jury thus gave priority to the idea of devoting more resources to informing the Tasmanian community about what after hours services are available and when.
Reassurance and security
While accepting that after hours care is also about treatment, they saw reassurance/security as the kernel and applying to all citizens, whether people use the service or not. However, it is not reassuring to know that the service is there if one cannot afford to use it; financial payments for after hours care should be linked to level of income.
This was a major concern to the jury. There are many groups who were identified as being more vulnerable, more disadvantaged or more at risk. These include the poor; Aboriginal people; the elderly (both in the community and in homes); parents with young children; people with disability; and so on.
The jury sought to combine need, access, equity and vulnerable/disadvantaged under the one equity principle.
A major priority was thus to base policy on the principle of equal access for equal need but recognising that
(1) lack of knowledge of what services are available and when is a barrier;
(2) some people have greater needs than others;
(3) those with greater needs should be subject to positive discrimination;
(4) equality of access means that the height of any barriers to use be the same; and
(5) these barriers comprise such factors as financial costs, distance, transport problems and language and cultural barriers.
Value for money
Phone contact with a nurse was where the After Hours process should start. Doctors should be protected from being involved in cases where their higher level skills were not needed.
To try to reduce inappropriate use, they proposed the addition of the word ‘Urgent’ to After Hours Services.
Improving transport is a priority.
The jury very much welcomed the fact that Tasmania Medicare Local wanted to engage through the citizens’ jury with the community. They were keen that another citizens’ jury be organised in a couple of years’ time to see how things had progressed.
Overall the jury rated the whole process very highly. Yet again, as Gavin indicated as has happened with earlier juries, they felt privileged to be asked to play the role of citizens.
Certainly Tasmania Medicare Local got a lot out of the process and will now proceed to implement the jury’s recommendations.
We will hold more juries on other priority topics and would like to consider whether the process could be applied in a modified manner to formulate jury style consideration from groups of health professionals on selected issues.
Tasmania Medicare Local would recommend the process to other Medicare Locals.
It has, we believe, the strength of getting to the community voice in a way that no other community consultation process can – and at our organisation we can defend the process, a most important consideration.