Something seems to be awfully wrong with the NSW Hospital System.
The Garling Commission – led by Peter Garling SC has now been taking evidence since early March, 2008 having had an initial session about a month earlier. He has now visited a reasonable number of hospitals and the litany of complaints seems to just get louder and more strident.
The transcripts and program are available here:
http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_index
A sample of the coverage to date:
RNSH staff, bereaved, plea for change
JANE IGOE
Wednesday 9 April, 2008 4:01pm
THE man charged with attempting to fix the state's ailing public health system Peter Garling SC took his place in the driver's seat at the Royal North Shore Hospital last Wednesday as the Government's special commission of inquiry returned for a second hearing.
Mr Garling came to the hospital on March 20 when he was told by senior clinicians that they were on a "knife edge" and would not stay at the hospital unless there was "real change".
The inquiry comes on the heels of a number of disasters in the state's public health system, including the death at the hospital of 16-year-old Vanessa Anderson.
The Anderson family has appeared before a Parliamentary inquiry into the hospital, a coronial inquiry and now a special commission of inquiry into acute care services in NSW.
More here:
http://www.mosmandaily.com.au/article/2008/04/09/1920_news.html
And
Doctors gagged at hospital inquiry
Natasha Wallace Health Reporter
April 11, 2008
JUNIOR doctors at Westmead Hospital have been gagged over evidence they gave at an inquiry about a lack of training, chronic computer problems in gaining access to test results and a directive not to claim overtime despite working 12-hour days.
As the registrars Lisa Phipps and Timothy Tan left the public hospital inquiry yesterday, they were hastily ushered away from the media by a senior administration staff member, who told them to stop speaking. She would not identify herself.
The Opposition spokeswoman on health, Jillian Skinner, said: "This episode shows bullying is still rife within NSW Health."
On Tuesday nurses from Nepean Hospital were also told not to speak to media but were later given permission after the Herald asked for an explanation.
Dr Phipps presented the special commission of inquiry into acute care services with a memo instructing junior doctors not to claim overtime unless it related to an emergency situation.
"It seems the way that we are getting around safe working hours is to say, 'Oh, you can work these hours; just don't claim it,' so it goes undocumented," she said.
…..
The acting director of pathology services, Jerry Koutts, said a $5 million shortfall in spending on infrastructure made it inefficient. The big problem clinicians faced was getting bureaucrats to make a decision.
"Everyone's covering their arse, basically, and not making a decision, and we just go through these layers of hierarchy where no one is prepared to make a decision in case something goes wrong. Morale has never been lower."
Professor Koutts said he had been acting director for four years as nobody wanted the job because clinicians were given responsibility for patient care without the necessary authority. "They're saying I won't put up with that crap."
Having an accountant with no medical background [Bernard Deady] as the director of clinical operations for the Sydney West Area Health Service was "the equivalent of appointing an accountant to be the conductor of your orchestra".
The inquiry is due to hear evidence at Wollongong Hospital on Monday.
More here:
http://www.smh.com.au/news/national/doctors-gagged-at-hospital-inquiry/2008/04/10/1207420587485.html
And
Doctor tells of RNSH 'sweatbox'
Article from the Daily Telegraph
March 14, 2008 11:24am
A SENIOR cardiologist at Sydney's Royal North Shore Hospital has told an inquiry he is forced to see patients in a "40-degree sweatbox".
Professor Stephen Hunyor said bricks had been falling from the hospital's external walls, a floor in a medical records room had collapsed and there were airconditioning problems.
"The airconditioning was out for 12 months," Prof Hunyor said of problems within his office area.
He was giving evidence to the inquiry into the NSW health system, which is holding a public hearing today at the hospital.
"I could tell you about the toilet in my unit which also serves as a shower because when it rains you cop it in the neck."
Prof Hunyor said the airconditioning issues had also impacted on "temperature sensitive" experiments, effectively rendering the work useless.
He said the hospital was also seeing its best medical specialists moving over to the private system because of the poor infrastructure and conditions in the public system.
"Morale is a crucial issue at the moment, many of the good specialists are fleeing to the private system. Twenty years ago that wasn't an option," he said.
More here:
http://www.news.com.au/dailytelegraph/story/0,22049,23373603-5006009,00.html
And
Most medicos have thought of quitting public hospitals
Natasha Wallace Health Reporter
March 29, 2008
PUBLIC hospitals are on the brink of collapse, with a new study revealing almost two-thirds of doctors and nurses have seriously considered quitting in the past year because they are exhausted and disaffected, a leading workplace researcher has said.
The director of the University of Sydney's Workplace Research Centre, John Buchanan, said yesterday it was "astounding" that the study showed just 17 per cent of doctors trusted management, compared with an industry average of 71 per cent.
The study, conducted this month of 2860 doctors and nurses and due for release tomorrow, showed 52 per cent "usually or "always" felt exhausted at work - only 6 per cent answered "rarely or never". The majority of doctors (80 per cent) said the number of beds or services to meet patient demand was either "poor" or "inadequate" and more than two-thirds (69 per cent) said there were not enough staff to supervise and train juniors.
Emergency departments were hardest hit, with medical staff working extremely long hours and "straining under serious inadequacies in resources".
The study was submitted yesterday to the Special Commission of Inquiry by Peter Garling, SC, into acute care services at NSW public hospitals.
More here:
And
Time for action before more lives are lost: Mayor - Call for Government to step in
Mayor Greg Matthews wants Dubbo’s crumbling health system repaired before more lives are lost.
Hot on the heels of local comment to the Statewide Garling public hospital commission, Cr Matthews is calling for a new Dubbo Base Hospital, additional staff, more money for patient care, the dismantling of Greater Western Area Health Service (GWAHS) and the return of community accountability through a local health board system.
And if the Iemma Government can’t come up with the goods Cr Matthews thinks the Rudd Government may have to step in.
The Garling Commission last week heard Dubbo Base Hospital horror stories.
At the top of the list was Angela Mallouhi, the local teenager who died when a brain tumour was misdiagnosed.
Senior surgeon Dr Dean Fisher lifted the lid on substandard facilities, unsafe medical practices, bed shortages and a culture of bullying. Ray Blunden recounted the trauma of his stomach falling out of his abdomen following surgery.
More here:
And
Doctors call for change
Friday 11 April, 2008 12:01am
THE merger between the Central Coast and Northern Sydney health areas has been a disaster and hospital boards need to be reinstated.
Garry Nieuwkamp, a member of the Hospital Reform Group who has also been the head of Wyong Hospital's emergency department since 1996, has called for the change.
As part of the reform group Dr Nieuwkamp was one of 17 senior clinicians and academics to put his name to a submission made to the Garling Commission into the delivery of acute care in NSW hospitals.
The list included doctors from Royal North Shore, Tweed Heads, Westmead, John Hunter and Newcastle hospitals.
The submission demanded clinicians be involved in decision making at all levels.
More here:
http://www.expressadvocate.com.au/article/2008/04/11/5766_news.html
And
Health meeting 'kept quiet'
By Angela Roche 
THE NSW Opposition Leader Barry O’Farrell urged Tamworth residents to have their voices heard when the special inquiry into the State’s health system visits Tamworth next week.
Mr O’Farrell yesterday toured the region, and visited Tamworth Hospital to publicise the Garling Special Commission of Inquiry into the State’s health system.
The inquiry was formed after a series of horror stories in the media last year regarding health system blunders.
In its early stages the inquiry and publicity centred largely on Sydney hospitals.
The Garling Commission will sit at Tamworth on March 25 from 1:30pm to 5pm, and in Armidale on March 26 from 9am to 2pm, for one-day public hearings into New England hospitals.
Mr O’Farrell suggested the State Government was treating regional Australians like “second class citizens” by allowing health services to decline.
He said he hoped any recommendations would be implemented.
More here:
http://tamworth.yourguide.com.au/articles/1205746.html?src=topstories
I spent some time reading the transcript from Royal North Shore (where I worked from 1976 to 1993) on the weekend and I have to say I, while I knew some of the clinicians giving evidence, I was totally un-prepared for their obvious anger and frustration.
The very senior and highly experience clinicians have obviously reached their wit’s end.
Why?
I really think all I am seeing is explicable with a single explanation. The key clinicians are being expected to be responsible and accountable for the care of patients while they are not being given the resources and control of their professional circumstances to make the patient outcomes they are seeking possible.
This disempowerment was actually starting towards the end of my time at RNSH. Working as the Director of Accident and Emergency there I could not spend even $20 of hospital funds without going through some administrator, but was held accountable for the clinical operation and performance of a department which employed over 100 nursing staff and 20+ doctors and had a budget (over which I had NO say) of at least $5.0 million even back in 1986.
It is notable that when later I was seconded to the NSW Department of Health Head Office as an Acting Executive Director I could approve the expenditure literally millions over my sole signature. The difference in being able to get things done was just amazing.
Looking back I must have been crazy to work on those earlier stupid RNSH terms. Unless with responsibility and accountability there comes control of a budget, staffing and other resources the balance of power is clearly ridiculous and disempowering for clinicians and ultimately totally frustrating. The petty paper work just drives you mad!
It seems to me the attempt to have administrators take the administrative load off senior clinical managers has simply gone too far and has led to disempowerment and frustration.
I wonder how Peter Garling SC is going to fix this? I fear a real barrier for him may the spectacular incompetence of the present NSW State Government and the present NSW Health Minister – who clearly does not, in my view, have a clue!
Health IT could help - but there is no evidence the present Minister even knows what it offers, let alone the difference it could make. This said it is good to see the number of witnesses who are saying the IT systems are a mess that needs to be fixed.
David.
1 comment:
David,
And just how do you think that IT-driven integration across the health system is going to work on top of such a mess? I know of several projects that have gone nowhere, over a period of ten years or more, simply because there is no money for them.
None of this new information, it's just that the system functions less and less well the longer these things go on.
Is this solvable under the current Federalist division of responsibility, with NSW always being the fall guy when the states divide up money from Canberra?
Even Henry Parkes knew the answer to that one.
Lets not even mention the farce of GP after-hours clinics saving the day when GPs themselves are becoming an endangered species, through the workforce planning failures of the early 90s and them being relentlessly screwed through bulk-billing.
Even Morris Iemma supported handing the lot over to Canberra when he was NSW health minister. Abbott toyed with the idea, but soon realised it was too hot to handle.
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