Social Justice Programs – An Opportunity for a Patient Engagement and Health Literacy Expansion

Now that Location Rules have been made more certain through enabling legislation, it provides a level of certainty in respect of investing in services which would provide a community benefit, that in turn, could eventually be funded through government along the already familiar experience of a public/private partnership.
i2P has previously expressed the opinion that Location Rules need to be re-purposed and move to a program of social justice that could initiate conversations to help increasingly affected populations experiencing mental health pressures from a range of abusive perpetrators (go to Location Rules Need to be Re-Purposed).

The most serious of these issues involve domestic violence and sexual assault of children and adults. Some children faced with domestic violence suffer the effects of domestic violence every year. 
Pharmacy, because of its Location Rules, has a network of relatively even numbers of pharmacies dispersed to service the maximum number of people – those who need help or those that would seek a neutral access point for assistance.
This has also been previously discussed in an article titled “Pro Bono Pharmacy Services Create a Social Dividend”.

What i2P is further suggesting is that not only should the Location Rules be re-purposed, but also the traditional pro bono services that pharmacy has always provided, be re-purposed towards a social justice agenda.

In the transition towards a social justice agenda, pharmacists need to adjust to this process by:
* Placing a value on existing free service provision and incorporate that value as a listed amount in a formal budget.

* Re-allocate the time that has been spent in providing traditional advice on minor ailments and convert it to a paid service. Payers will be private patients or third party payers such as government or private health funds.
This will provide the “head room” to allow an investment in a social justice program.

* In a marketing sense, the social justice program becomes a primary method for patient engagement and must provide a return on investment through stimulating Health Literacy consultations.
i2P has also written about this concept becoming the major fee generating service in the article titled “Health Literacy – a Valid Direction for Community Pharmacy“.
Health Literacy is now a primary focus by government because higher health literacy rates equate to a lesser usage of government subsidised health services.
It can also be used to stimulate existing Self Care programs.
Health literacy combined with patient advocacy is a potent combination leading to patients being able to take full responsibility for their personal health.

* The Australian Productivity Commission has already recommended to the Australian government that pharmacists be “decoupled” from the dispensing process.
While that raises a range of issues, it also opens the door to replacing or reducing dispensing fees (and have technicians take increased legal responsibility) with Health Literacy consultations becoming a more productive use of a pharmacist’s knowledge base.
This process has already been commented on in an article titled “The Productivity Commission Recommendation to Decouple Pharmacists from Dispensing Mirrors a Progressive Scottish Community Pharmacy Culture

* Social justice programs often involve the provision and free access to legal practitioners and it is the legal profession that often initiates such programs.
The reason being that correlation has been found with people who require legal services are often found to be chronically ill, particularly in mental health.
Reduce the legal problem and you reduce the need for high cost health sercices.
The opportunity here is for pharmacy to develop partnerships with legal practitioners attached to these programs as well as access grants and recurrent funding through these organisations.

* Without a doubt, pharmacy has been front and centre in delivering Health Literacy programs for a very long time.
Just think back and remember the slogan “Ask your pharmacist” and how it has featured in many PR campaigns organised by the Pharmacy Guild.
The slogan generated many informal conversations that stimulated a patient engagement process – highly valued by the recipients.
i2P has also discussed this phenomenon in an article “Pharmacists are Primary in Healthcare and its Economics

* While there is an urgent need for Community Pharmacy culture to be re-written, most changes will only involve adjustments to re-frame what is already being done.
Culture change in a profession can only be performed by its duly elected leadership personnel.
Stimulation to create change can only be provided by the members of a lead organisation.
Direction can be stimulated by thought leader commentators (like i2P) but the ultimate responsibility for framing culture lies with the leadership.
The rate of cultural change has not kept up with community expectations due to external pressures created by special interest lobby groups.
This pressure is now recognised as causing a collective condition titled “The Spectator Syndrome” and i2P explains this problem through Jon Rappoport, a US-based investigative journalist, who has written an article in this edition titled “The Fear of Success”.
It is hoped that you will take the time to read it to gain insights.
That there is an expanding need for Social Justice Programs is highlighted by the NSW state government (and other state governments) that are establishing helpline and resource centres within a number of communities, to cope with the epidemic of elder abuse.If you need legal help, you should get it from elderly planning attorneys
In NSW they are getting the message out through providing guest speakers to community organisations. If people need Marietta lawyers for estate planning and their help, they can get it from here. 
Recently, I listened to such a speaker through the local Probus Club of which I am a member.
At the completion of the address I was able to speak privately with the presenter and asked for an opinion as to whether a community pharmacy network could be actively involved with such a program.
This person expressed very positively that community pharmacy could provide access to a Social Justice program because of location, trained personnel and because the abused person would probably already have an existing relationship with a pharmacy.
The presenter stated that she would follow through with the idea through discussion with her executives.

In pharmacy, we often see or hear of elder abuse of people in their own homes or as residents of a nursing home.
Perpetrators are quite often other family members, carers or service providers and elders in receipt of abuse often deteriorate in their mental health. In such situations, it is best to consult lawyers helping with living trusts cases to protect the rights and interests of the elderly.

Pharmacists are already in contact with significant numbers of elderly people because of their medical requirements.
It would be a simple process to establish a Social Justice program to embrace this vulnerable population.

The service we are suggesting that would come under a Social Justice banner is simply a triage service that involves providing a convenient community pharmacy access point so that an elderly person can be privately interviewed (or their carer or concerned relative) so that they liaison can be established with appropriate people or organisations that can assist.
It might also involve a bit of advocacy on behalf of that person if any “roadblocks” occur along the way.

Research suggests that currently there are 50,000 elderly people in NSW that have experienced some form of abuse.
It is also estimated that only one in five cases of elderly abuse is actually reported and that the majority of abusers are trusted family members, neighbours, friends, paid carers or service providers.

The type of abuse experienced can involve:
* Psychological abuse
* Financial abuse
* Neglect
* Social abuse
* Physical abuse
* Sexual abuse
The NSW Elder Abuse Helpline will provide information, support and referrals (including free legal advice) to those in need.

There is also an emergency service for those with a high or imminent risk of harm.
All services are confidential and translators and interpreters are also available.
The telephone number is 1800 628 221 and the website is located at

The signs to look out for include:

* Did another person gain benefit at the expense of the older person?
* Was independent legal advice obtained?
* Was it in the best interests of the older person?
* Was financial wellbeing compromised?
* Are bills being unpaid when funds should be adequate?
* Are there large withdrawals without explanation
* Has personal property disappeared without explanation?
* Is the older person confused, and have a lack of knowledge about finances?
* Are there any financial records?
* Did any bank withdrawals occur from bank accounts without the older person’s knowledge?
* Was an older person’s signature forged on a cheque?
* Was a signature forged on transfers of property?
* Was money borrowed against equity in the home?
* Were there any gift of assets to others including transfer of property?
* Were there changes to wills?
* Was there an appointment of a Power of Attorney?
* Was authority created to access bank accounts?
* Does the older person have bruising?
* Does the older person appear fearful?
* Is the older person kept isolated from family or friends?
* Is the older person being denied the right to make their own decisions?
* Is the older person being threatened with eviction or removal to a nursing home?
* Is the older person being intimidated or harassed?
* Is the older person being denied access to needed services?
* Is the older person being denied access to physical, medical or emotional needs support?
* Is the older person being slapped, hit, pushed or restrained in any degree?
* Is the older person receiving unwanted sexual approaches, experiencing indecent or inappropriate touching?
* Is the older person being threatened to be hurt or have damage to their belongings?

The above is not necessarily a complete list, but does act as a guide.
Pharmacists already provide a range of services and contact with the elderly population group and are uniquely positioned in the community to link into a Social Justice network.
This demographic is still expanding – so too will problems associated with this group.

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