Do We Need a Patients Bill of Rights

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Do We Need a Patients Bill of Rights
Responsibilities?

• Kidney Foundation Symposium
• Saturday, November 2, 2002
• Dr. Carolyn Bennett, M.P.

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Rights ?

• Or Rights
• AND
• Responsibilities

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Right

• a thing one may morally or legally claim the
  state of being entitled to a privilege or
  immunity or authority to act Concise Oxford

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Responsibility

• liable to be called to account for ones
  actions Concise Oxford

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Presumption

• Health care in Canada may not be an actual
  right but is the duty and obligation of a
  caring society. Sister Nuala Kenny

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Quiz

• Which of the following is NOT a principle of the
  Canada Health Act?
• A) Portability
• B) Accessibility
• C) Comprehensive
• D) High Quality Care
• E) Publicly Funded
• F) Universality

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Measuring Quality

• Accountability
• Transparency

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Process for Protecting Rights

• Complaints based eg. Human Rights Commission
• Audit CPSO, New Zealand

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(No Transcript)
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Vision statement for Health CareKill or Cure ?

• Emphasize that patients expect to be treated with
  respect
• Health care providers must be able to do their
  jobs with pride knowing that they are
  participating in a world-class system that is
  constantly improved as it responds to the
  evolving need of Canadians
• Providers must be appreciated and properly
  remunerated

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Vision statement for Health CareKill or Cure ?

• The ability to function to my full physical and
  mental capacity
• A long-term commitment to health promotion and
  disease prevention health research
• Guaranteed access to high-quality care in a
  timely fashion
• A real say in setting, evaluating, and monitoring
  National Health Service Standards

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Patients Rights in New ZealandRon Paterson,
Health Disability Commissioner

• Background Report of the Cervical Cancer
  Inquiry 1988
• Shift in public attitudes challenged
  traditional approach of beneficence and
  paternalism
• Led to reforms of the medical disciplinary
  process
• 1994 independent statutory Ombudsman created
  the Health Disability Commissioner
• Develop enforce a Code of Consumers Rights
• Designed to promote and protect the rights of
  health consumers facilitate the fair, simple,
  speedy and efficient resolution of complaints
• The Code of Health and Disability Services
  Consumers Rights came into force in 1996 and
  sets out legally enforceable rights of consumers
  and corresponding duties of providers

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 1
• This establishes the duties and obligations of
  providers to comply with the Code, to ensure they
  promote awareness of it to consumers and enable
  consumers to exercise their rights.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 2
• This details the 10 rights of consumers and
  duties of providers.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Right 1 the right to be treated with respect
• Right 2 the right to freedom from
  discrimination, coercion, harassment, and
  exploitation
• Right 3 the right to dignity and independence
• Right 4 the right to services of an appropriate
  standard
• Right 5 the right to effective communication

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Right 6 the right to be fully informed
• Right 7 the right to make an informed choice
  and give informed consent
• Right 8 the right to support
• Right 9 rights in respect of teaching or
  research
• Right 10 the right to complain

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 3
• Sets out provider compliance requirements and
  states that where the rights cannot be met then
  the onus is on the provider to show that it was
  reasonable in the circumstances not to have done
  so.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 3 (contd)
• This reasonableness test will be applied and
  developed over time. It is expected that over
  time, greater compliance will be demanded of
  providers. This clause gives some flexibility in
  terms of a gradual implementation of these
  rights.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 4
• Establishes certain definitions where these are
  appropriate and elaborates on some of the
  definitions in the Act.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 5
• Notes that in meeting the rights no provider is
  required to break any other New Zealand law.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• Clause 6
• Ensures that all existing rights outside of the
  regulation still apply.

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• The Code therefore covers all registered health
  professionals, such as doctors, nurses, dentists,
  etc, and in addition brings a level of
  accountability to all those who might be
  considered outside the mainstream of medical
  practice, e.g. naturopaths, homeopaths,
  acupuncturists etc.
• As well as applying to individual providers, it
  also applies to hospitals and other health and
  disability institutions and allows the
  Commissioner to enquire into systems issues
  across professional boundaries.
  

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The Code of Health Disability Services
Consumers Rights (N.Z.)

• The obligation under the Code is to take
  "reasonable actions in the circumstances to give
  effect to the rights, and comply with the duties"
  in the Code.
• The onus is on providers to show that such action
  has been taken.
• The Code does not override other legislation and
  nothing in the Code requires providers to act in
  breach of a duty or obligation imposed by any
  enactment..

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(No Transcript)
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Summary of Bill of Rights

• Timely and accurate diagnosis
• Timely access to specialty care
• Information about arthritis and about their
  arthritis care
• Informed consent regarding treatment decisions
• Access to medications and other treatments
• Participate fully in society (including
  self-care, leisure and work pursuits)
• Research
• Representation

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Summary of Bill of Rights

• Pursue healthy lifestyles
• Become knowledgeable about their arthritis
  treatment plans
• Actively participate in decisions about their
  arthritis care
• Cooperate fully with mutually accepted courses of
  treatment

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CMA A Prescription for Sustainability

• June of 2002 called for a Canadian Health
  Charter that
• articulates a shared vision of Canadas health
  system
• Commits governments to plan and coordinate their
  efforts to ensure that Canadians have timely
  access to a common basket of core health services
  regardless of where they live

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CMA A Prescription for Sustainability (contd)

• sets out the roles, rights and responsibilities
  of patients, health care providers and governments

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CMA - Canadian Health Charter

• Broader in scope than a patients bill of rights.
  It would commit governments to work
  collaboratively towards a national plan that
  includes
• A common basket of core health care services to
  be made available to all Canadians under uniform
  terms and conditions

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CMA - Canadian Health Charter (contd)

• National benchmarks for timeliness, accessibility
  and quality of health care
• Investments in health system resources, including
  health human resources, information technology,
  and capital infrastructure
• National goals and targets to improve the health
  of Canadians.

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CMA - Rights and ResponsibilitiesPatients/Citize
ns

• Rights
• Access to timely, quality care
• Recourse to alternatives if public system fails
  to meet guarantee
• Choice of health care provider
• Security and confidentiality of personal health
  information

• Responsibilities
• Responsible use of services
• Financial contribution via taxes and patient
  cost-sharing

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CMA - Rights and ResponsibilitiesProviders

• Rights
• Reasonable compensation with dispute resolution
• Choice in the mode of practice and payment
• Professional autonomy and clinical independence

• Responsibilities
• Advocate on behalf of patients
• Prudent management of resources
• Collaboration across disciplines

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CMA - Rights and ResponsibilitiesProviders
(contd)

• Rights
• Access to resources needed to provide timely care
• Consultation / participation in decision-making
  at all levels

• Responsibilities
• Providing high quality, evidence-based care
• Uphold standards of professional practive
• Prudent use of resources

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CMA - Rights and ResponsibilitiesGovernments

• Rights
• Define scope of coverage
• Set budget
• Set goals and priorities
• Access information necessary to measure system
  performance

• Responsibilities
• Provide adequate, stable funding
• Set expectations or guarantee for timeliness and
  quality of care
• Report publicly on the performance of the health
  care system
• Respect for

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The Kirby Report The Health Care Guarantee

• A health care guarantee would ensure that for
  every type of major procedure or treatment, a
  maximum waiting time would be established and
  patients would be entitled to receive service
  within that time frame.

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The Kirby Report The Health Care Guarantee
(contd)

• For each type of major procedure or treatment, a
  maximum needs-based waiting time should be
  established and made public.
• When this maximum waiting time is reached, the
  insurer (government) should pay for the patient
  to immediately receive the procedure or treatment
  in another jurisdiction including, if necessary,
  another country (e.g. the United States). This
  is called the Health Care Guarantee.

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The NHS PlanA plan for investmentA plan for
reform

• Reacting to a lack of national standards,
  old-fashioned demarcations between staff and
  barriers between services, a lack of clear
  incentives and levers to improve performance, and
  an over-centralisation and disempowered patients.

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The NHS PlanPromises - Patient Empowerment

• Letters about an individual patients care will
  be copied to the patient
• Patients views on local health services will
  help deice how much cash they get
• Patient advocates will be set up in every
  hospital
• If operations are cancelled on the day they are
  due to take place the patient will be able to
  choose another date within 28 days or the
  hospital will pay for it to be carried out at
  another hospital of the patients choosing
• Patients surveys and forums to help services
  become more patient oriented.

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The NHS PlanPromises Deals with Private
Providers

• By 2004 patients will be able to have a GP
  appointment within 48 hours and there will be up
  to 1,000 specialist GPs taking referrals from
  fellow GPs
• Long waits in accident and emergency departments
  will be ended
• By the end of 2005 the maximum waiting time for
  an outpatient appointment will be three months
  and for inpatients, six months.

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The NHS PlanPromises Cancer, Heart Disease and
Mental Health treatment

• A big expansion in cancer screening programmes
• An end to the postcode lottery in the prescribing
  of cancer drugs
• Shorter waits for heart operations
• Hundreds of mental health teams to provide an
  immediate response to crises.

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The NHS PlanPromises Seniors Health

• Nursing care in nursing home will be free
• By 2004 a 900 million package of new
  intermediate care services to allow older people
  to live more independent lives
• National standards for caring for older people to
  ensure that ageism is not tolerated
• Breast screening to cover all women aged 65 to 70
  years
• Personal care plans for elderly people and their
  care-givers.

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The NHS PlanPromises National Inequalities
Target

• Increase and improve primary care in deprived
  areas
• Introduce screening programmes for women and
  children
• Step up smoking cessation services
• Improve the diets for young children by making
  fruit freely available in schools for 4-6 year
  olds.

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Good Health Through Good Governance A
Submission to the Commission on the Future of
Health Care in Canada from  The Good Health
Through Good Governance Working Group
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Need for Good Governance

• Lack of patient involvement in significant
  decisions in the health care system - leads to
  diminishing confidence and trust.
• Lack of pan-Canadian governance structure - leads
  to duplication and limits opportunities for
  learning.
• Lack of knowledge sharing and innovation and the
  perverse absence of incentives
• Isolated information and feedback systems - leads
  to duplicated procedures, lack of portability of
  health records, and missed opportunities for
  quality improvement.

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Key Elements for Good Health

• System does not need total overhaul, but rather
  key adjustments and a formal recognition of the
  determinants of health.
• Patients are the central reason for the health
  care system - they must be meaningfully engaged
  and treated as partners.
• Health infostructure is a key enabler for
  integration of health care and public health,
  improved data systems and governance.
• Good governance provides connectivity,
  leadership, innovation and accountability across
  the country.

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Recommendations

• Ensure that the governance of health is fair,
  transparent and actively involves citizens to
  ensure the ongoing confidence of all Canadians.
• Establish a common set of principles for the
  governance of public health and health care at
  all levels that reflect a learning culture and
  the feedback inherent in a complex adaptive
  system.

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Recommendations (contd)

• Make patient empowerment a priority. The goal is
  to enable all Canadians to make better choices
  regarding their health situations and behaviour,
  use the health care system wisely, ask informed
  questions of practitioners, and compare their
  care to clinical guidelines.

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Recommendations (contd)

• Create an inclusive, transparent and ongoing
  process for debating what is medically
  necessary, whats covered and whats not, using
  principles of accountability for reasonableness.
  Give more emphasis to prevention and health
  promotion. Citizens would be involved in
  priority setting and review of outcomes.

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Recommendations (contd)

• Devise with the genuine participation of citizens
  a living charter of pan-Canadian standards
  regarding expectations of our public health and
  health care systems, as well as specific goals
  and targets for improving the health status of
  all Canadians. The possibility of a Heath
  Commissioner as an officer of Parliament and
  responsible for the Charter should be considered.