Friday, February 12, 2010
Bellingen Hospital, Facebook and the costs to the community
Yesterday in Bellingen organises to save hospital I reported on the campaign to save services at Bellingen Hospital.
It's been very interesting watching the unofficial Facebook page formed to support the official campaign site. This was created on Tuesday 9 February. As of this morning, it had 812 fans. That's a very rapid growth in such a short time.
The first challenge in a local campaign of this type is to demonstrate local support. The Facebook provides a tangible measure of this.
The second challenge is to spell out the reasons why people want the particular result, in this case saving the hospital's facilities. The official campaign has been doing this, but the Facebook page provides lots of specific examples. It personalises the general arguments.
It also provides information that can be used directly in scoping need. Let me illustrate this by example.
Health planners work with the statistical data they have. This includes census data and health system data including hospital admissions. They are concerned not just with the now, but also the future. Here they use projections that by their nature reflect the past.
There are several difficulties with this approach: one lies in the weaknesses of the statistics themselves; a second is the inability to identify and properly analyse the on-ground effects of decisions.
Looking at the Facebook comments, the examples might be used to draw up a table of adverse effects.
It is clear from the comments that Bellingen Hospital serves a catchment extending from Ebor in the west to Urunga in the east. This broadly but probably not exactly equates to the LGA boundary. In broad terms, the catchment boundaries are set by the travel time to Bellingen compared to the bigger hospitals in Armidale on the west, Coffs in the east.
The first effect of any reduction in services will be an increase in travel time. This will be differential across the catchment and can be mapped.
Dorrigo, for example, is roughly 29k or 26 minutes by car from Bellingen, 124k or 1hr 40 from Armidale, 66k or one hour from Coffs. So any reduction in Bellingen services means increased travel time for Dorrigo people of 1hr 14 in the case of Armidale, 74 minutes in the case of Coffs. The extra cost to patients can be calculated.
Travel times then need to be adjusted for the availability of public transport for those who do not have cars or who must travel by public transport or, alternatively, taxis. Extra time and costs here can also be roughly estimated. Another health cost may be the failure of people to seek treatment when they should, simply because its too difficult.
Travel times also need to be considered in terms of type of illness or accident. Again, the Facebook pages provides personalised examples to be considered. For example, what happens if your child has a sudden asthma attack?
The extra costs of ambulance travel can also be roughly estimated.
This analysis addresses just the direct costs. There are also broader community costs, including access to other Government services. For example, the supply of social housing may be affected because one of the key criteria here is access to services.
No doubt many of these issues have already been picked up by those fighting to save services at Bellingen Hospital. However, the new Facebook page provides extra evidence.
Finally, one of the points that I always try to make in cases like this is that Government policy focuses on the savings to Government on one side, the broad nature of services on the other. The cost shifting to local communities is rarely taken into full account simply because it is harder to measure.
It's been very interesting watching the unofficial Facebook page formed to support the official campaign site. This was created on Tuesday 9 February. As of this morning, it had 812 fans. That's a very rapid growth in such a short time.
The first challenge in a local campaign of this type is to demonstrate local support. The Facebook provides a tangible measure of this.
The second challenge is to spell out the reasons why people want the particular result, in this case saving the hospital's facilities. The official campaign has been doing this, but the Facebook page provides lots of specific examples. It personalises the general arguments.
It also provides information that can be used directly in scoping need. Let me illustrate this by example.
Health planners work with the statistical data they have. This includes census data and health system data including hospital admissions. They are concerned not just with the now, but also the future. Here they use projections that by their nature reflect the past.
There are several difficulties with this approach: one lies in the weaknesses of the statistics themselves; a second is the inability to identify and properly analyse the on-ground effects of decisions.
Looking at the Facebook comments, the examples might be used to draw up a table of adverse effects.
It is clear from the comments that Bellingen Hospital serves a catchment extending from Ebor in the west to Urunga in the east. This broadly but probably not exactly equates to the LGA boundary. In broad terms, the catchment boundaries are set by the travel time to Bellingen compared to the bigger hospitals in Armidale on the west, Coffs in the east.
The first effect of any reduction in services will be an increase in travel time. This will be differential across the catchment and can be mapped.
Dorrigo, for example, is roughly 29k or 26 minutes by car from Bellingen, 124k or 1hr 40 from Armidale, 66k or one hour from Coffs. So any reduction in Bellingen services means increased travel time for Dorrigo people of 1hr 14 in the case of Armidale, 74 minutes in the case of Coffs. The extra cost to patients can be calculated.
Travel times then need to be adjusted for the availability of public transport for those who do not have cars or who must travel by public transport or, alternatively, taxis. Extra time and costs here can also be roughly estimated. Another health cost may be the failure of people to seek treatment when they should, simply because its too difficult.
Travel times also need to be considered in terms of type of illness or accident. Again, the Facebook pages provides personalised examples to be considered. For example, what happens if your child has a sudden asthma attack?
The extra costs of ambulance travel can also be roughly estimated.
This analysis addresses just the direct costs. There are also broader community costs, including access to other Government services. For example, the supply of social housing may be affected because one of the key criteria here is access to services.
No doubt many of these issues have already been picked up by those fighting to save services at Bellingen Hospital. However, the new Facebook page provides extra evidence.
Finally, one of the points that I always try to make in cases like this is that Government policy focuses on the savings to Government on one side, the broad nature of services on the other. The cost shifting to local communities is rarely taken into full account simply because it is harder to measure.
4 comments:
The public transport, of course, is almost non-existent and taxi services minimal.
The subtle effects are difficult to measure as well. It looks to me like erosion of the riverbank. A wee bit goes and then another - almost unnoticed - until a tree falls into the river because it is no longer deeply rooted , the water course changes and floods break through where they haven't done so before.
I am very much startled at the response, particularly from the young people. I am most impressed.
The whole thing has been quite amazing, one of those viral things.
I do not know who the leaders of the official campaign are. You might get your daughter if you haven't already done so to just check the on-ground position. I suspect that those involved may well be as surprised as the two of us and wondering how to take advantage of the whole thing. Gillian seems to have a direct link.
I may be being over-sensitive, but I wouldn't like to think that we might upset people who have done the initial hard yards.
I will do another method post early next week looking especially at some of the stats and how to use them.
In the meantime, get a few blank sheets of paper and start going through comments looking for patterns. Maternity is one, emergency another. Emergency is not just car crashs or even heart attacks. What about an asthma attack?
In this, look for cases where transfer to Coffs might have added extra strain and danger. Hope that this helps.
Thanks again for your help. Appreciate the posts and feedback and I think sensitivity is very appropriate in this situation. Yrs Lynne.