SSWAHS rebirthed: Will it make any difference to the Southern Highlands?

Well, now we have it – the news that Bowral and the Southern Highlands is back in the clutches of the same crew who have already caused us much grief over the past five years – the SSWAHS Executive.

The Local Health Networks have been announced. The likelihood that there will be little change made at the top levels of the current SSWAHS Executive except for some sideways movement. Socrates, in consulting with the Delphi Oracles, predicts that Mike Wallace current CEO will be given the plum job of managing one of the three Clinical Support Clusters. This will allow his current Deputy, Jan Whalan, to be given the position of the Chief Executive Officer of the rebirthed SSWAHS.

Will anything change? No! Most likely Ms Whalan will be closely following the party line of her mentor Mr Wallace and continue to move the essential services needed by the residents of the Southern Highlands towards Liverpool and Campbelltown Hospitals. There has been no show or recognition by Ms Whalan in the past, since the time she joined Mike Wallace, that she has any understanding of what are the health needs of the Southern Highlanders.

Socrates has no recollection of Ms Whalan ever visiting or engaging in any community forum about what even the most basic services are needed for our population. To use the phrase that typifies any big conglomerate – Ms Whalan seems to be focused on the big end of the SSWAHS empire.

What can we expect from these changes? After all, both the Premier and the Minister have assured all that the Local Health Networks will have representation from clinicians, and community members. It would appear to Socrates that those clinicians who want machines that go “ping” or new buildings to house them will be already be putting their names forward for the few places on these tokenistic committees. The “community members” will be placed in the invidious situation of having to compete with other communities for the health resources that will be on offer. I can imagine that community members on these Committees, in Liverpool or Campbelltown, will be convinced by Ms Whalan and her Executive that the people in the Southern Highlands can travel to Campbelltown and Liverpool hospitals if they have any need for clinical help or treatment.

Bowral health services and the Southern Highlands will continue to be seen as the rural outpost of the metropolitan SSWAHS, serviced by the dedicated band of local clinicians and supported by the local community. Socrates has the vision of, and similarity to, the fabled “lost patrol”. We, in the Southern Highlands are destined to be just wandering round and around, somehow never connecting with the rest of the rebirthed SSWAHS.

SSWAHS – National Health Reform: Strengthening local decision-making – by Socrates

Proposed Local Health Network boundaries finalised, with Australia’s first networks on track to be in place in January 2011 – Media Release by the Premier of NSW – Wednesday 29 September, 2010

The NSW Government today outlined the future shape of our health system, with the announcement of 18 proposed Local Health Networks to strengthen local decision-making and community involvement in health service delivery. The Government intends to introduce legislation in this session of Parliament to enable the networks, and deliver some of the most significant health reforms in a generation. The networks will replace the current eight Area Health Services and have their own budgets, management and accountabilities within their local areas. They will be administered by a Chief Executive and Governing Council that includes local clinicians, health and health care management experts and community representatives.

Local Health Networks are a key plank of the historic national health reforms agreed with the Federal Government in April 2010. These reforms are delivering an extra $1.2 billion in funding to the NSW health system over four years and are contributing to 488 beds being opened in NSW in 2010/11.

In line with the National Health & Hospital Network Agreement, Premier Kristina Keneally will write to Prime Minister Julia Gillard to seek agreement on the boundaries. “This is the latest demonstration of how the NSW Government is leading the way in the national health reforms,” Ms Keneally said. “The boundaries we are outlining today were determined after one of the most extensive consultation processes ever conducted across the NSW health system. “This structure would deliver better patient care, strengthen local decision-making and continue NSW’s work to build a world-class health system. “NSW is on track to have among the first Local Health Networks in Australia, with plans finalised for them to be in place in January and recruitment now underway.”

The 18 networks will be as follows:

• Eight will be geographically based and cover the Sydney metropolitan region;

• Seven will be geographically based and cover rural and regional NSW; and

• Three specialty networks will focus on Children’s Health, Forensic Mental Health, and services delivered by St Vincent’s Health.

The Local Health Network model was developed following extensive consultation with clinicians, health professionals and communities across NSW. That model was put out for consultation in August 2010, via a discussion paper that proposed potential borders and governance arrangements for 17 Local Health Networks. Nearly 400 submissions were received from the public, community groups and health professionals, leading to further improvements to the model being put in place, including:

Establishment of a specialist 18th network that covers the St Vincent’s facilities (St Vincent’s and St Joseph’s hospitals, and Sacred Heart Hospice);

• Putting in place Ministerial directions for each network, including for Blacktown Hospital, the Orana Region and St George, accounting for local feedback and local population health needs.

• Establishing clinical support clusters that will support services such as cancer, renal, mental health, and drug and alcohol programs;

• Expediting discussions to develop cross-border health agreements with the ACT, Victoria, Queensland and South Australia;

• Providing an enhanced role for the Clinical Excellence Commission, to strengthen interaction with clinicians in the new, localised public health structure;

• Establishing formal agreements between Governing Councils and local government (Governing Councils oversee each individual network) to strengthen local government engagement with health services; and

• Continuing a strong role for Local Health Advisory Councils, which will provide local advice to each network’s Governing Council.

“The networks are based on what most clinicians told us would be the most effective way of strengthening local decision-making and delivering high quality care,” Ms Keneally said. “I’m very proud that NSW is leading the nation with these important health reforms. “I would like to thank the hundreds of people from the health system, community groups and individual members of the public who helped design the system we are announcing today.”

Deputy Premier and Minister for Health, Carmel Tebbutt said the original model proposed has been further improved after the wide range of feedback received. “In particular, we have established a specialty network that will cover the facilities of St Vincent’s Public Health Services in Sydney,” Ms Tebbutt said. “This aligns with the approach being taken in other states, and means St Vincent’s facilities and services will be integrated into the health system, rather than split across two networks. “We have also moved to put administrative arrangements in place to ensure a close relationship between the networks, local government and communities.

“The Government will enter a Statement Of Intent with the Local Government and Shires Association, particularly in relation to the Western and Southern Local Health Networks. “And in light of the feedback we have received, we will continue to quarantine mental health funding, meaning it will be used directly for providing mental services. “We will now move quickly to recruit the right balance of local knowledge and medical expertise to manage the new Local Health Networks.”

Each Governing Council will have between 6 and 13 members (including a Chair) depending on the size of the network, complexity of the services to be provided, and other local factors. Expressions of Interest for Chairs of the Local Health Network Governing Councils have been sought, and a selection process is scheduled to take place in October. Advertisements will appear this Saturday, calling for Expressions of Interest for general members of the Network Governing Councils. Recruitment will be finalised in November. Upon finalisation of those appointments, a final round of recruitment will start for Local Health Network Chief Executives, who will be appointed by each Network Governing Council with the approval of the Minister for Health. The networks will be established in January 2011, and the NSW Health system will progressively transition to the new structure over the following 6 to 12 months.

Background Notes National Health Reform

• On 20 April 2010, the Commonwealth reached an historic agreement with States and Territories (except WA) to implement national health reform – National Health and Hospitals Network for Australia’s Future.

• The Agreement will result in major funding and structural changes to the NSW health system that will further improve the quality and accessibility of health services.

• In May, June and July, NSW Health conducted an extensive consultation process with health professionals across the State, seeking their input into developing suitable boundaries for the new Local Health Networks (LHNs) which will replace Area Health Services under the national reform.

• That feedback was used to develop proposed LHN boundaries, outlined in a Discussion Paper released by the NSW Premier on 5 August. This opened a further and final round of consultation which attracted almost 400 submissions.

• Those submissions along with advice from a number of senior clinicians has informed the configuration of a new health system structure in NSW.

The outcome was confirmation of 15 geographically-based LHNs – eight metropolitan and seven regional – and three specialist LHNs, comprising a Children’s Network, Forensic Mental Health and St Vincent’s.

Further elements of the Local Health Network structure:

Blacktown Hospital – Special Recognition

• Some submissions were received calling for Blacktown Hospital to be separated from the Western Sydney Local Health Network because of its large and growing population. Other submissions supported the integration of Blacktown into the Network.

• It was concluded that the new LHN offers the best overall outcome for patients and staff, but acknowledged that special recognition was needed for Blacktown.

• Blacktown will be established as a distinct sector within Western Sydney LHN with its own Service Agreement.

• Blacktown Hospital will have a distinct sector budget within the LHN, as well as additional control over resourcing and accountability.

Orana – Special Recognition

• Some submissions supported a stand-alone LHN for the Orana region in the State’s northwest, rather than including Orana in Central West LHN. However experience indicates that it would be difficult to recruit key clinical staff to a smaller, stand-alone LHN in regional NSW.

• The Government has responded to the submission by establishing a distinct Western Sector budget for the Orana region, as well as a Service Agreement governing specific service levels and capital works planning for Dubbo Hospital.

St George – Special Recognition

• Ministerial directions will be issued requiring the service agreement with South East Sydney to recognise St George/Sutherland as a distinct sector with its own budget, reflecting the successful network and Clinical Council which currently operate.

Clinical Support Clusters

• Submissions acknowledged the importance of maintaining existing clinical service networks that were developed across existing Area Health Service structures.

• However concerns were raised about how the new, smaller LHNs could continue to deliver networked services including mental health, drug and alcohol, renal, cancer and pathology.

• NSW Health and the Government have responded by creating three Clinical Support Clusters that will support inter-LHN networked services across the health system.

• In light of the feedback we have received, we will continue to quarantine mental health funding, meaning it will be used directly for providing mental services.

St Vincent’s Health Network

• A submission from St Vincent’s Health Australia recommended creating a new network based on three of its Sydney health facilities – St Vincent’s Hospital and Sacred Heart Hospice in Darlinghurst, and St Joseph’s Hospital in Auburn.

• Together, these facilities play a significant role in the delivery of publicly-funded acute and sub-acute healthcare services, including cardiology, immunology and virology, cancer, palliative care and rehabilitation. They also make a major contribution to medical research and teaching new generations of clinicians.

• Prior to receiving St Vincent’s submission, the three facilities were to be placed within the geographically-based LHNs of South Eastern Sydney and Western Sydney.

• The Government acknowledges the high degree of integration of St Vincent’s facilities with the public health system and agrees with its submission.

• St Vincent’s existing local management satisfies requirements of the National Health and Hospitals Network Agreement.

• St Vincent’s public health operations will be funded in a similar manner to other LHNs, and subject to the same reporting processes.

Clinical Excellence Commission

• The Clinical Excellence Commission (CEC) was established to ensure public healthcare organisations in NSW maintain high standards of patient care, maintain high levels of accountability, and strive to continuously improve the quality of clinical services.

• A large part of the CEC’s success has been based on unimpeded, two-way flow of information between clinicians, hospitals, Area Health Services and NSW Health.

• The Government recognises that increased localisation and specialisation creates a need for enhanced interaction between the CEC and the new LHNs.

• To ensure the CEC is adequately resourced and connected to the new structure, three Regional Coordinators of Clinical Governance reporting to the CEC will be established.

Next Steps:

• With the LHN boundaries now finalised, the NSW Premier will write to the Prime Minister seeking formal sign-off, as required under the National Health and Hospitals Network Agreement.

• Recruitment has already commenced for Chairs of the LHN Governing Councils.

• An advertisement calling for Expressions of Interest in general membership positions on LHN Governing Councils will appear in newspapers around NSW this Saturday and recruitment will be finalised in November.

• Upon finalisation of appointments to the Governing Councils, a third round of recruitment will commence for LHN Chief Executives.

• It is anticipated that Australia’s first Local Health Networks will be established from January 2011.

Socrates says that it seems that the fate of the Southern Highlands has been determined by the Premier and Minister in this Media Release.

One has to ask the question: “What representations have been made from medical staff or other health staff or the community members from our own region which have been even considered by the Premier or Minister in making their decision about the future of health services in the Southern Highlands”.

The tragedy is quite simply, that we have the same system, the same executive members and the same limited view of the health needs of the people of the Southern Highlands. If the community do not take the initiative to become the advocates and agitators for the health services our population requires we are doomed to the whimseys of those in Liverpool who see no further afield than Campbelltown.

SSWAHS Executive can't keep a good team down! – by Socrates

Bowral Hospital is up to speed – SHN – MORGAN DOWNS 13 Sep, 2010 10:34 AM

Bowral and District Hospital is performing well, according to the latest report of the Bureau of Health Information.

The Bureau’s first edition of Hospital Quarterly (April-June 2010) shows that Bowral and District Hospital’s waiting times for elective surgery are better than the state average, as are the times within which patient treatment should begin in the Emergency Department.

Bowral & District Hospital General Manager, Denis Thomas, said the results reflected the “hard work and dedication of staff”.

“We are pleased that 86 per cent of patients rated their experience in the Emergency Department as good, very good or excellent,” Mr Thomas said.

“From April to June this year the Emergency Department saw more than 4200 patients – 668 of whom were admitted to the Hospital.

“Staff saw all patients – across all categories – within the recommended NSW benchmark timeframes.”

Mr Thomas said Bowral and District Hospital achieved other improvements, including:

• 100 per cent of triage one patients (immediately life threatening) were seen immediately or within two minutes;

• 82 per cent of triage two patients (imminently life threatening) were seen within 10 minutes, two per cent higher than the benchmark;

• 78 per cent of triage three patients (potentially life threatening) were seen within 30 minutes, three per cent more than the benchmark;

• 85 per cent of triage four patients (potentially serious) were seen within one hour, 15 per cent more than the benchmark;

• 98 per cent of triage five (less urgent), were seen within two hours, 28 per cent more than the benchmark.

“I’d like to congratulate all staff, whose tireless efforts help our department continually improve and achieve positive results for our patients,” Mr Thomas said.

Socrates says: “This is the work of the local service and the staff of Bowral Health. My comment to the SSWAHS Executive is – Give Bowral Hospital and their General Manager and his staff the credit for these good results. They did achieve the better than benchmark results because they live locally, believe locally and are more concerned about the health needs of their community than anyone in Liverpool.”

SSWAHS Executive bites the hand that tries to help it. Please explain! – by Socrates

Bowral Hospital renal unit going to waste – SHN – TRAVIS HOLLAND – 02 Apr, 2010 11:17 AM

GOULBURN MP Pru Goward and local renal patients have labelled Bowral Hospital’s Renal Unit a waste.

“The hard fought for renal dialysis service at Bowral Hospital is a patient-free area, sitting idly in the Short Stay Ward,” Ms Goward said.

“What a shocking waste of expensive equipment, not to mention the hard work that went into raising $500,000 to provide this service,” she said.

Highlands resident Michael Richardson, who is in need of renal dialysis three times a week, said he had been “barred” from using the facility.

Mr Richardson was self-dialysing at Bowral until recently, when he developed complications and needed medical supervision.

Since then, the problems had been resolved and Mr Richardson had hoped to return to the local hospital.

But he was upset he had to travel to Campbelltown because he was “not wanted” at Bowral.

Ms Goward said Mr Richardson was the only local patient who had ever been able to use the facilities, despite the unit operating for two years.

In Februrary, the News reported the case of Barbara Clarke, who was forced to travel to Concord Hospital for treatment.

Southern Highlands Renal Appeal chairman Bob Barrett said the community raised $650,000 in the past eight years to establish the renal unit at Bowral Hospital.

He said the Sydney South West Area Health Service (SSWAHS) had asked for only $105,000 of the funds.

“We are rather anxious for them to take the rest,” he said.

Mr Barrett wanted only to see – the funds put to use, paying for equipment that would be used.

“They are turning patients away and saying ‘do it at home’,” he said.

Ms Goward questioned why the Health Service could not provide a renal nurse to staff the unit.

“The Health Minister needs to explain why she will not sanction training for nurses to enable them to assist dialysis patients at Bowral Hospital”, she said.

“There is clearly a need yet, for some reason, the Minister would rather allow expensive equipment to go to waste while patients drive three times a week to Campbelltown for dialysis.”

Mr Richardson’s mother, Margaret, said renal patients such as her son needed medical support from a nurse even if they were able to self-dialyse.

“If an alarm goes off, she’s got to know what that alarm is and what to do,” Mrs Richardson said.

Mr Richardson said patients also needed support to recover blood sugars and liquids during and after the procedure.

Mrs Richardson said lives were being put at risk by the need to travel to Liverpool in emergencies.

“There is no emergency plan for renal patients in the Southern Highlands,” she said.

She questioned why a nurse could not travel from Campbelltown on set days in a trial for local patients.

“They say it is too far for a nurse to travel,” she said. “If it’s too far for a nurse, it’s too far for a patient.”

A SSWAHS spokesman said patients were better off travelling because of the care available at other hospitals.

“Bowral and District Hospital is networked with larger hospitals like Campbelltown, where patients can receive their dialysis in a dedicated unit staffed by renal physicians and specialist nurses.”

Socrates says: “I wonder if the SSWAHS spokesman has ever travelled between their Liverpool SSWAHS base and Bowral. Great reality check for SSWAHS that comment by Mrs Richardson in her final quote above.”

SSWAHS and its neglect of Bowral Health – the Local State Member's view – by Socrates

SOUTHERN HIGHLANDS HEALTH SERVICES: Pru Goward – Member’s question about the Bowral health services. NSW Parliament – 1st June 2009

Ms PRU GOWARD (Goulburn) [5.18 p.m.]: I draw the attention of the House to health services in the Southern Highlands. A fortnight ago the shadow Minister for Health, Jillian Skinner, spent a day in my electorate. She had heard much from me about Bowral hospital and its position at the end of the food chain as far as Sydney South West Area Health Service is concerned, so she was keen to visit and meet local residents and medical personnel to get some firsthand input. In the morning we met with a number of people concerned about the deterioration in service standards at the hospital and, following the application of the member for North Shore to the health Minister we were granted a tour of Bowral hospital with the general manager, Denis Thomas. In the afternoon we attended a public meeting I had called to meet constituents and listen to their concerns. We met a number of staff during our tour and there is no doubt our hospital is blessed by having extremely competent, hardworking and committed people working there.

Bowral Hospital has a very loyal consultative support group made up of community members who act more or less as liaison between the community and the hospital. This is a very good idea, in theory at least, but in practice, the group is bound by confidentiality and, as such, is as much controlled by the New South Wales Government as is the hospital`s general manager. The public meeting was a forum for people to not only voice their concerns but also to put forward suggestions for improving local health services. The meeting was unanimous in its support for, and faith in, the expertise and dedication of the medical staff.

Despite the flagging morale of the career medical officers, whose working conditions were changed without consultation, not a single person at the meeting-and more than 100 people were there-complained about the medical treatment they had received. What they did complain about was the appalling access to services, including the lack of psychiatric beds and the many occasions on which they were turned away and sent elsewhere. Today we heard in this House the shocking story of Gregor Gniewosz, who underwent an amputation as a result of picking up an infection in Liverpool Hospital. He also emerged from the public meeting. I refer also to the hospital`s children`s ward. The Minister for Health circulated a media release in which he stated, correctly I understand, that the new children`s ward at Bowral Hospital was on track for completion later this year. He said:This is a tremendous result for the local community, which has been so supportive in ensuring children and their families have access to a facility that reflects today`s needs. The community has been more than supportive.

That would have to be the understatement of the year. The community forced this refurbishment. The BDCU Children`s Foundation began lobbying for this ward some five years ago. The area health service pontificated, promised, prevaricated and postponed but the foundation continued to raise money in the hope that the Minister for Health and the Sydney South West Area Health Service could eventually be dragged kicking and screaming to a point that it would provide a children`s ward with facilities that would actually contribute to the recovery of ill children. The foundation, which to date has raised $330,000, and everyone in the community who has supported and driven the concept of the new children`s ward have been a great deal more than just supportive. In the same media release, the Minister for Health said:

Local services are very important to the New South Wales community and they are the door to the excellence of the entire health system.

Again, I could not agree more. Why then has there been a determination made by New South Wales Health to direct complicated orthopaedic procedures away from Bowral Hospital? Does the Minister feel that local orthopaedic specialists are not expert enough to deal with complicated procedures or, as is most likely the case, is there a financial reason of some sort for this decision? In a notice circulated by the Ambulance Service, ambulance officers have been informed that Bowral Hospital will no longer deal with orthopaedic assessment for serious fracture injuries such as pelvis, long bones and neck of femur fractures. Ambulance officers will now have to take those patients out of the local area, probably to Liverpool. I understand that neck of femur fractures are most common in the elderly, and with a growing population of elderly residents in the Southern Highlands it beggars belief that they should be shipped out of the area, away from their support network, to a hospital located more than an hour away by car. I will not go into how long it would take to reach Liverpool Hospital by train. That is a subject for another private member`s statement.

Top-of-the-range orthopaedic specialists work at Bowral Hospital. The decision to direct complicated orthopaedic procedures away from Bowral Hospital is offensive to the local service and is an erosion of the specialist facilities we have in Bowral. The community has formed a group that is not beholden to the State Government. It will not be bound by confidentiality. It will include members of the public, medical personnel, allied health personnel and ancillary staff to help lobby the Government. It will be a force to be reckoned with. I congratulate Di Hurdwell, a local resident who stood up at the public meeting and offered to form this pressure group on what I am sure will be a great initiative.

SSWAHS – Perhaps this is the answer to why they "(ex)-terminated" their staff. – by Socrates

Our health system basically ‘broke’
By Clair Weaver and Linda Silmalis From: The Sunday Telegraph February 01, 2009 12:00AM

THE full extent of the disease plaguing the NSW health system can be revealed, with an analysis showing every one of the state’s 220 public hospitals is either battling to pay bills, struggling to attract staff or short of beds.

Experts have told The Sunday Telegraph the health crisis has for the first time permeated the entire state, extending from major Sydney hospitals to rural and regional centres in Moree, Broken Hill and Albury.

Dr Brian Morton, president of the NSW branch of the Australian Medical Association (AMA), said the state of the public health system had plunged to an unprecedented low.

“(The system) is basically broke and all the health services are in trouble,” he said.
Among major problems blighting the system are:

* All of the eight area health services are facing major funding, staffing and supply shortages.

* New fears of deadly superbug outbreaks, as cleaning budgets are slashed across NSW, which already has Australia’s highest rate of hospital-acquired infections.

* NSW Health’s finances are a “significant problem”, according to the Auditor-General’s Office, with a “large number of errors detected during the audit process” as well as missed deadlines.

* Patients being denied basic drugs, medical supplies and quality food because of cost-cutting.

Dr Morton said some public hospitals in central Sydney claimed to have been coping. as recently six to 12 months ago.

“But we have since had them say they have got the same problems, as well, now – it’s across the system,” he said.

The public health scandal, set to derail further the already destabilised Rees government, has prompted a deluge of emails and calls from staff to The Sunday Telegraph.

According to one damning email, standards at one leading NSW hospitals have fallen so low that equipment meant for single use is being re-used.

The explosive email, sent by Northern Sydney Central Coast Area Health Service shared services acting director Anne Green to staff on January 8, followed a pre-audit review at Royal North Shore Hospital.

Ms Green said surveyors found the infection control unit to be “under-resourced”.

“Single use items being re-used; instruments being washed in hand-basins,” the email said. Other problems included untidy, cluttered and “dirty” treatment, drug stores and utility rooms.

Dr Tony Joseph, chairman of the medical staff council at Royal North Shore, said the hospital had slipped from the top 10 per cent in NSW, in accreditation ranking, to the bottom half.

Dr Joseph said that if single-use equipment was being re-used, it would be “a major concern”.

“What they are doing to health services is a disgrace,” he said.

Dr Joseph is worried about patients picking up dangerous, drug-resistant infections because of cutbacks to cleaning.

Last month, the hospital, which constantly struggles with bed shortages, had an outbreak of the life-threatening superbug vancomycin-resistant enterococcus.
Cutbacks to food supplies meant patients would be denied proper nutrition, hindering their recovery, Dr Joseph said.

At Port Macquarie Hospital’s oncology unit last week, patients had to wait in pain after morphine supplies ran out. A similar drama occurred at Dubbo.

“Morphine is not a very expensive drug to buy, so that’s unacceptable,” Dr Joseph said.
At Bowral Hospital, a lift was left broken for six weeks. Rubbish and tea trolleys had to be wheeled past surgeons and patients in operating theatres.

At Bathurst Hospital, a shortage of batteries means anaesthetic pumps cannot be operated. Nurses say they have to buy batteries to run equipment.
Dr Bruce McGarity, medical staff council chairman at Bathurst, said the hospital’s bungled redevelopment was causing problems and staff feared vital repairs would be shelved because of the State’s financial woes.

Delays in paying suppliers have reached critical levels, with businesses blacklisting hospitals.
A pathology supplier has put Westmead Hospital on “credit hold” until its bills are paid.
Doctors at Coffs Harbour Hospital are pleading for extra staff overnight to prevent “unacceptable clinical risk” to patients.

At Dubbo, running out of basic supplies is an “everyday” occurrence.
Dr Dean Fisher, medical staff council chairman at Dubbo, said almost half its doctors were looking for jobs outside the service.

A threatened strike by doctors over unpaid wages was aborted last week, but the Rural Doctors Association (RDA) said the issue remained unresolved.

“The centralised control of hospitals means nobody is accountable,” Liberal health spokeswoman Jillian Skinner said. “We are at … a point where things could get out of control.”

Socrates says: “Do we need to say more? Is 2010 or 2011 going to be any better?”

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

BEN MCCLELLAN AND GEMMA KACZEREPA

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