Archive for September 2010
The Southern Highlands Division of General Practice and the disappearing Mental Health Nurse Incentive Program – by Socrates
Socrates has become aware of the fact that the Southern Highlands Division of General Practice appears to have changed is view on the value of the Mental Health Nurse Incentive Program (MHNIP) which is a Medicare Australia funded program designed to help persons with a severe mental illness receive the care coordination that would allow them to remain at home and out of hospital. It would seem to any reasonable person that this would be a useful initiative for the person with the mental illness, their carers or family members, and for the hospital services.
The MHNIP operates from general practitioners, general practices, private psychiatrists, Divisions of General Practice and from Aboriginal Medical Services who have registered with Medicare Australia as an “eligible organisation”. The registration is simple enough and the Medicare Australia will even offer financial incentives to the “eligible organisations” to establish the MHNIP in the community.
Now, in Australia there are about 800 credentialed mental health nurses (CMHNs) able to to provide these services to patients through the “eligible organisations”. Fortunately, as Socrates has discovered, there are 3 qualified CMHNs in the Southern Highlands, yet only one is being used by any of the eligible organisations here to provide any sort of service to patients of the practices in the Southern Highlands. Perhaps it’s just a coincidence that the one CMHN being used was once an employee of the Southern Highlands Division of General Practice. Socrates, has recently discovered that patients who have been referred to that one CMHN have been told by them that they are unable to provide any additional people with the MHNIP services. Obviously (or hopefully), that information has been passed on to the Southern Highlands Division of General Practice so that they can pass that information on to their members.
Perhaps it is also a coincidence only, that the Southern Highlands Division of General Practice in 2008-09 employed a mental health nurse/psychologist to provide the MHNIP services to their member general practitioners. The aspiring nurse, who was seeking credentialing, was unable to obtain this requisite by the January 2010 deadline so the Southern Highlands Division of General Practice was unable to continue the MHNIP program. However, it would seem that they did continue to employ the nurse because they were also a psychologist and now they offer a “Better Access” counselling service in competition to those psychologists and social workers in private practice.
Now, as far as Socrates is aware, the Southern Highlands Division of General Practice is still an “eligible organisation” or could easily become one again. However, the Division has made no attempt to engage or contract the other CMHNs in the Southern Highlands nor does it appear to have been advocating to their general practice members that they take up this initiative for the benefit of their patients. One could easily draw a conclusion that the Southern Highlands Division of General Practice is taking the view that if they can’t retain or employ a CMHN of their choice, then no-one else should be able.
Strangely, any recent information about the MHNIP which was originally publicly provided by the Southern Highlands Division of General Practice to all, through their “Highlands Doctor” newsletter on their website, was suddenly transferred to the login section of their website for member GPs only. One can only deduce what the general practitioners are being told by the Division’s Executive Officer.
Socrates has been told of one patient who is seeking access to the MHNIP because they have a number of severe mental health conditions that they have been unable to get any sense out of the Southern Highlands Division of General Practice. It is most likely that there are many such people who have been struggling with a severe mental illness but are now being denied a potentially excellent service. Socrates has noted that the Network which advocates for Divisions of General Practice is very supportive of the MHNIP initiative and there is ample proof that it is a win-win situation for all.
So the question needs to be asked: Why does the Southern Highlands Division of General Practice not advocate with its members to implement this Medicare funded initiative for patients with severe mental illnesses? Surely, the Southern Highlands has it’s share of people afflicted with such mental illnesses? Why does the Southern Highlands Division of General Practice not use its “eligible organisation” status to employ, contract or retain our other CMHNs? And what was so secret about the Division’s advice to its general practice members that they felt the need to place that information in the login section of their website. If it is simply the same information that they have freely published in their past issues of the “Highlands Doctor” newsletter why was there a need to place the information in their website which is not accessible to members of the public.
Socrates has previously commented on the MHNIP as an ideal initiative for persons with mental illness and for their carers. Perhaps it is now time for those members of the public to challenge the secretive behaviour of the Southern Highlands Division of General Practice and its Executive
The Director-General of Health and her "meet the people" tour – by Socrates
You may not be aware of this but the Director-General of NSW Health (Debora Picone) has her own blog in which she seeks “Discussions” from staff and community members about the proposed changes in NSW Health from the large AHS Empires to Local Health Networks (LHNs).
If you wish to read the full proposed LHN document this is the website at which it is located: Socrates urges people to have a good look at it. http://www.health.nsw.gov.au/
Now if you want to enter the “discussion” to which we are all invited then I suggest you look at Deb Picone’s blog site at http:// nswhealth.wordpress.com/2010/08/05/release-of-discussion-paper-today/
What you might be struck with (as was old Socrates) is the places to which Ms Picone travelled to have her consultations with staff and community representatives.
* Http://nswhealth.wordpress.com/2010/07/23/allied-health/
* Http://nswhealth.wordpress.com/2010/07/21/lithgow-today/
* Http://nswhealth.wordpress.com/2010/07/16/end-of-the-week-update/
* Http://nswhealth.wordpress.com/2010/07/14/dr-amanda-walker/
* Http://nswhealth.wordpress.com/2010/07/13/report-on-meetings-with-hsu-ama-and-asmof/
* Http://nswhealth.wordpress.com/2010/07/13/meetings-with-amaasmof-and-hsua-today/
* Http://nswhealth.wordpress.com/2010/07/12/report-back-on-listening-visit-to-hornsby-hospital/
* Http://nswhealth.wordpress.com/2010/07/09/been-thinking/
Now, while it’s really nice to know that Ms Picone does like to think – Socrates is doing a bit of head scratching here! So far there’s evidence that Ms Picone has had discussion with Hornsby Hospital staff and community representatives associated with the hospital, and she was planning to visit the Shoalhaven area. So far, Area Health Services outside of the SSWAHS Empire. She even sent a colleague to discuss things with the Lithgow Hospital staff. Another AHS not associated with SSWAHS.
However, we do know that she was feted with that powerpoint presentation (reported in my previous post) by the SSWAHS Executive at some time in her “thinking time”. But did she have any discussion with staff or community members? We know that there was some discussion with DrAmanda Walker who has something to do with Camden and Campbelltown Hospitals (well that’s getting closer to home), but did she have any discussions with staff and community members?
What jumps out in all the discussions seems to be the fairly intense discussion and lobbying with the Industrial Associations for doctors and other ancillary staff – but wait! No mention about the NSW Nurses Association, the professional organisation for the greatest number of the NSW Health’s employed staff. And what about the Australian College of Mental Health Nurses the association which represents many of the mental health nursing staff working in their mental health facilities.
Oh! And in case you have missed it – not one mention of any visit to the Southern Highlands and discussions with the staff and community dependent upon the Bowral Hospital and the community health services, for the maintenance of their health and well-being.
All these tours and discussions have been taking place during July and August. Is it too late? Well I suggest that all Southern Highlands restless natives should get their stylii and wax tablets out and let Ms Picone know what they already think of NSW Health’s idea of discussion and Local Health Networks and SSWAHS and it’s supposed commitment to the people of the Southern Highlands.
Posted by Socrates at 4:00 PM
SSWAHS and it's view of National Health Reform – by Socrates
SSWAHS created such a cute piece of spin for the Director-General of NSW Health to suggest what they might like to do with the Federally imposed carve-up of the current NSW Area Health Empires.
Here they used a powerpoint presentation to suggest the great achievements their Area based Clinical Divisions have launched in the old SSWAHS.
Take for example, their Population Health Area Network:
* Promoting Equity: Monitoring inequalities of health status and health service utilisation; targeted health promotion activities in disadvantaged areas.
* Focus on Primary Prevention: Critical mass enables health promotion activities to reduce risk factors.
* Regional Partnerships: Working with LGAs, Housing NSW, Landcom and other developers on urban development and regeneration.
* Promoting Evidence Based Practice: Healthy Urban Development Checklist.
* Population Health Based Service Planning: Population health principles incorporated into all service and facility plans.
* Capacity Building for Primary and Secondary Prevention: Health promotion traing course; Locational Disadvantage training course.
Now if anyone out there can translate that SSWAHS spin please let me know! But, can anyone see how this is meant to apply to the Southern Highlands with expanding and aging population? What does SSWAHS Population Health take us for – God’s Waiting Room? And can anyone tell us what a “Locational Disadvantage training course” is meant to look like?
The other point to make is that it’s been some years since we had anything like a health promotion staff member in the SSWAHS portion of the Southern Highlands. Again, a vacancy never to be filled. Is the Southern Highlands meant to be an urban or a rural area in the minds of the SSWAHS Executive, or is that little dot to the far south of the SSWAHS map on that cute presentation to the D-G still out of sight of Liverpool.
And here’s the presentation of the achievements of the SSWAHS Mental Health Clinical Network:
* Improved Clinical and Corporate Governance: Standardised policies, procedures and care pathways/guidelines; Centralised application of specialist human resources across a whole network, achieving economies of scale; Timely implementation of state-wide initiatives.
* Improved Human Resource Management: Better recruitment and retention of staff because of clear identification with clinical specialty; Better support to registrar training especially since IMET initiative; Standardised education programs.
* Improved Service Delivery: Ability to support small community teams in rural areas; Access to intensive, Sub-specialist and Tertiary services which could not be resourced at the local or district level; Ability to promptly rotate staff to local services with urgent shortfalls; Improved planning of services and facilities to serve a regional population.
This one I really like (oh yeah!). Clinical and corporate governance. This is the SSWAHS clinical network who failed to answer the complaint of a local woman with terminal cancer until after she had died. Then said they’d tried to speak with her but unfortunately she was dead. Not laughable – just tragic.
This is the same Clinical Network who has still refused to answer some serious complaints about their failure to respond appropriately to complaints, about their service and their service providers, according to the NSW Health Code of Conduct.
This is the same network who, in 2009, had one of their Southern Highlands patients involved in the murder of another of their patients after both patients had been notified to the local service with a request to provide assistance.
Better recruitment and retention of staff is another bit of spin from SSWAHS. This is the organisation which spent an inordinate amount of time terminating, or getting resignations from, a number of clinical staff in their Area Mental Health Network.
Now, they have the temerity to say in their “Improved Service Delivery” that they have achieved the ability to support small community teams in rural areas, and their ability to rotate staff staff to local services with urgent shortfalls. Is that why they have made the Bowral Mental Health Service less effective by making part time their Welfare worker position, their Aboriginal Health worker position, and their Rehabilitation/Recovery Program Coordinator? Perhaps that fits into the plan for the SSWAHS Mental Health Network’s “ability to rotate staff to local services with urgent shortfalls”! It certainly doesn’t fit in with the SSWAHAS Mental Health Network’s “ability to support small community teams in rural areas.”
Again, from the “Improved Service Delivery” item the SSWAHS Mental Health Network states as an achievement “Access to Intensive, Sub-specialist and Tertiary services which could not be resourced at the local or district level.” Well, I guess that if you mean by “access” that the local Southern Highlands Mental Health team still has to argue with Mental Health bed managers every time they have a need to transport someone with an acute mental illness to any of the inpatient facilities mentioned. The patient from the Southern Highlands could, currently, sit in the Emergency Department of Campbelltown Hospital for hours (or days) before being admitted to the hospital’s Psychiatric Emergency Care Centre, or be shuffled around the other various facilities located at Campbelltown Hospital, or Liverpool Hospital, or RPH Hospital, or Concord Hospital.
However, don’t think that’s still a great response because if the proposed slice-up of the current SSWAHS Empire proceeds according to the LHNs that Southern Highlands mental health patient will only have access to the mental health facilities at Campbelltown and Liverpool Hospitals – so the wait just got longer and the Improved Service Delivery just went belly-up!
Go figure it! Perhaps the SSWAHS Mental Health Network should have been concentrating more on which of their so-called “Achievements” would be lost to the Southern Highlands, Macarthur, Wollondilly and Liverpool LGAs and their residents.
Posted by Socrates at 4:50 AM
SSWAHS: Another good reason why the Southern Highlands should avoid Liverpool! – by Socrates
This is a news item from the Southern Highland News which, again reinforces the simple fact that when it comes to hiding behind the shelter of corporate silence the executive of SSWAHS Empire are the masters of obfuscation.
Lady loses leg, health service loses records
13 Jul, 2009 10:21 AM – Southern Highland News
“EVERY morning is a constant reminder.
The pain shoots up her body as she fumbles to put on her prosthetic leg. Gwen Illingworth should be making the most of her old age in the garden or out shopping with friends, but her life was turned upside down when she checked into Liverpool Hospital in November 2006 to have a blood clot treated and ended up losing a leg.
Every time she puts on her leg she remembers her time at Liverpool.
The Mittagong senior citizen’s story is strikingly similar to that of Colo Vale man Gregor Gniewosz.
Like Mr Gniewosz, Mrs Illingworth contracted the staph infection MRSA during her stay at Liverpool and had to have her left leg amputated below the knee.
Ms Illingworth doesn’t want an apology from the hospital but she does want someone to be held accountable so that patients of NSW’s health system don’t suffer the same fate.
It is not just losing her leg that has upset Mrs Illingworth.
Her medical records from December 2006 to January 2007 – the period when she was diagnosed with MRSA and had her leg amputated – are missing and the Sydney South West Area Health Service (SSWAHS) is yet to find them.
The mother of three said that during her stay at Liverpool she was treated poorly by staff and was not given a wheelchair until two days before she was checked out, leaving her bed ridden throughout her stay.
Daughter Louise Veenman said she had to steal an office chair for her mother to get around the hospital.
After seven months waiting for modifications to her bathroom, Mrs Illingworth took her complaints to the NSW Ombudsmen.
Almost immediately, the health service sprang into action and her bathroom was modified within weeks.
More than two years after she stayed at Liverpool Hospital Mrs Illingworth isn’t any closer to achieving a resolution.
Her complaints were referred to the HealthCare Complaints Commission (HCCC), but her case was considered not worthy of investigation.
Instead it was referred to a resolution officer.
Still unsatisfied, Mrs Illingworth said she was considering legal action to get justice.
In a letter she wrote in July 2007 but never sent to the SSWAHS, she outlined her complaints:
- Queries and questions about her condition and health were ignored or brushed off;
- Liverpool Hospital staff were often rude, unsympathetic and unsupportive;
- Staff were not monitoring her condition efficiently or listening to her concerns;
- The infection spread to the bone;
- MRSA was not identified until too late and insufficient monitoring by hospital staff helped this infection go undetected and spread;
- After the infection was detected, Mrs Illingworth wasn’t moved to an isolated room but stayed in a room with three other people;
- Liverpool Hospital did not effectively communicate her condition and requirements to Camden Hospital.
Mrs Illingworth said when she was discharged from rehabilitation at Camden Hospital in 2007 she was given a walking frame 5cm too small, which resulted in injuries to her spine.
When she complained, she was told it was because of the way she was lying.
But Mrs Illingworth hasn’t lost faith in all hospitals and said her stay at St Vincent’s in Darlinghurst in 2008 for a hysterectomy was a completely different story.
“They couldn’t have done enough,” she said.
“I am never going back to Liverpool.”
Being neglected during her two-month stay in Liverpool is Mrs Illingworth’s major gripe.
“If there was a bit more care given, it wouldn’t have happened,” she said.
“If you have an amputation, you don’t leave someone on pure oxygen because you have something else to do.”
The SSWAHS said it treated any concerns from patients very seriously but would not comment on Mrs Illingworth’s stay at Liverpool.
“This matter was referred to the HCCC. The SSWAHS has been co-operating fully with the HCCC to resolve this matter,” a spokesperson said.
“It would be inappropriate for the hospital to provide any further comment at this time.”
Mrs Illingworth said when she was told she was going to lose her leg she felt like she was going to die.
She led an active life before November 2006. Having lost her husband Harry in 2003 she has been left alone to battle on with no explanation why her records can’t be found or why an operation to treat a blood clot saw her lose her leg, mobility and her quality of life.”
Interestingly, this story does have a similarity to one of Socrates earlier posts about the Bundanoon woman whose complaint was not responded to HCCC by SSWAHS until after the woman died from a lung cancer. Then HCCC said that it was too late for them to deal with it.
One has to wonder just how serious something has to be before HCCC investigates a health related complaint? Death or amputation of limbs don’t seem to be good enough reasons it would seem. I wonder if Mrs Illingworth ever got to hear about her records or her complaint from the Ombudsman’s office or SSWAHS? I guess for the SSWAHS Executive, who are great at backslapping each other, the loss of limbs or life in their patients is just collateral damage!
Posted by Socrates at 6:15 PM
SSWAHS and its abuse of correct procedure and policy. Caught out again! – by Socrates
Isn’t this archival media just wonderful. Here is another gem that Socrates has found about the way in which SSWAHS has notoriously treated its staff when they wanted to downsize their organisation.
Employer’s failure to follow policies unreasonable
Article written by Deacons.
“The Commission has ordered Sydney South West Area Health Services (SSWAHS) to pay an employee 26 weeks pay on the ground that his employment was terminated unreasonably during a process of restructure within the organisation. Despite the existence of a voluntary redundancy policy which applied in circumstances of restructure, SSWAHS failed to consider this as an option for the employee and instead attempted to coerce him into accepting positions of lesser grades. When the employee refused to accept these positions the SSWAHS purported to terminate his employment for reasons relating to performance going back 6 years.”
This is not the first time that SSWAHS has used these immoral strategies to force people out of their positions. One instance Socrates has heard about was in late 2008 when one of their bullies (Mr SF) told an Allied Health Professional, who had arranged to see a private client after his work hours at a SSWAHS facility, that he’d be reported to ICAC and the AHP’s Registration Board for Corrupt Conduct. The AHP chose instead to resign – never to be replaced!
Socrates also met another middle manager who worked in the child and adolescent mental health field in Campbelltown. That person was highly respected as a fair and reasonable manager. When a staff member made a complaint that she was “being bullied” by the manager (who was simply asking the person to do their work) the SSWAHS response was to send the same Mr SF to see the manager and threaten them with investigations and reporting to their professional registration board. The manager chose to resign – and, as far as can be ascertained – not replaced.
It seems that 2008 and 2009 was big year for “terminations” in SSWAHS. One senior manager stated confidentially that if they couldn’t get them any other way it would be by using complaints and threats against their professional status, or the “discovery” of something inappropriate in the way in which they used the organisation’s computer network.
Certainly, Ms J W, of SSWAHS was known to micro manage all the discharging and terminations of staff from the organisation. But that was her idea of Clinical Governance in SSWAHS.
Posted by Socrates at 5:28 PM