Friday 27 March 2009
HEALTH MANAGEMENT: NSW LIBERAL/NATIONALS MAKING IT WORK
Garling Inquiry Findings:
“It is clear that the establishment of the eight area health services has caused serious disruption and unrest.”
“I accept the weight of evidence that the governance structure requires significant reform …”
A NSW Liberal/Nationals Government will remove Labor’s failed Area Health Services and replace them with smaller, community-focussed Health Districts to improve management of the State’s health system, NSW Opposition Leader Barry O’Farrell and Shadow Minister for Health Jillian Skinner said today.
Mr O’Farrell and Mrs Skinner today launched the NSW Liberal/Nationals ‘Management of the NSW Health System: Making it work’, a policy to re-engage and reconnect medical professionals and local communities to help fix health management in NSW. (Read what the health professionals think) (And what Labor MPs think about the current Area Health Services)
“The NSW Liberal/Nationals have a practical plan to improve management of the health system which will result in better hospital and community health services being provided to the public,” Mr O’Farrell said.
“Labor’s Area Health Services have failed. It’s time to remove them and reorganise health management in NSW,” he said.
“It’s essential if the Garling Inquiry reforms are to be achieved. Without it there can only be ‘business as usual’: more promises, different titles but no real change.
“We will break up Labor’s huge, unpopular and inefficient Area Health Services and create a flatter administrative structure by setting up new smaller Health Districts.”
The NSW Liberal/Nationals six step plan to improve health services by refocussing the management of the department across NSW will:
- Remove Labor’s huge and out-of-touch Area Health Services and create smaller, community-focussed Health Districts;
- Appoint Boards to the Health Districts and make them accountable to their community;
- Restore the decision-making power of Hospital General Managers and give authority and decision making back to expert clinicians;
- Further develop clinical networks to link medical experts across the State;
- Appoint qualified medical practitioners as Executive Clinical Directors in each Health District; and
- Publish information about health service management including budget allocations, spending, medical errors, infections and other patient outcomes;
Mrs Skinner said Health Districts will be large enough to deliver a comprehensive range of health programs, both community and hospital based, but small enough to maintain links with local communities and clinicians.
“Our health management policy is about returning power to the people,” she said.
“Health Districts will provide a seamless range of health care services to people who need them, whether they involve hospital treatment or community-based primary health care services provided by general practitioners, pharmacists or other allied health professionals.
“This policy is all about getting administrators and managers out of ivory towers and putting them on the frontline to support our health workforce.
“It is about putting patients first – by removing the huge, inefficient Area Health Services and creating a flatter administrative structure based on districts that cover hospitals and other health services in a particular region.
“Health District Board members will be appointed on merit, following local advertisements seeking people with medical expertise, financial and risk management skills, as well as being in good standing in local communities.
“NSW has the most skilled medical workforce in Australia. They want to be involved in the management of our health system, and under our policy they will be.
“Developing clinical networks that link experts in a particular field will provide a stronger health system capable of the best quality care.
“We will publish information about health service management including budget allocations, spending, the capacity of an institution to undertake treatments at any given time, outcomes in terms of patient care including medical errors and infections. An agency independent from NSW Health will be established to collect and report on data designed to drive improvements to patient care.
“Labor’s system has created an ‘us’ and ‘them’ mentality between medical professionals and administrators, our policy will work towards breaking down those barriers and fostering greater cooperation and understanding that will lead to quality care and better services.
“Labor has had 14 years to get health management right, and they’ve failed miserably.
“I thank the many people I have consulted in developing this policy and look forward to continuing to work with them on other solutions to make our health system work.
“It’s time to start the change to deliver quality care and dignity to patients in NSW,” Mrs Skinner said.
What Medical Professionals are saying about ‘Making it Work’
"I am totally supportive of the Document as it stands."
Professor Stephen Hunyor
Professor of Medicine, University of Sydney
* * * * *
"The NSW Opposition has clearly analysed the report of Special Commissioner Peter Garling into Acute Health Care in NSW carefully, and recognised the value of many of its recommendations. The report “Making it Work” represents a worthy alternative approach to the problems plaguing the NSW Hospital system, and deserves due consideration.
Some of the key points made by Garling – better engagement of clinicians, more authority for clinician managers, improved engagement of the community, and a body independent of NSW Health to collect and distribute data pertaining to public hospitals – have been highlighted by the working paper “Making it Work”. The Opposition has pledged to institute these changes if it wins office.
This puts considerable pressure on the Government to respond to the Garling report in a substantive and comprehensive way. The danger is that the Government will use the current financial crisis to consign the work of Garling to the bottom drawer. The NSW Public Hospital system can ill-afford any further delay in reform in the system, or the last vestiges of goodwill from the state’s many dedicated health staff are likely to evaporate."
Professor Brad Frankum,
Professor of Clinical Education, University of Western Sydney,
Clinical Immunologist and General Physician.
* * * * *
Dear Jillian,
Thank you for the opportunity to examine your paper detailing a number of key reforms the Coalition would implement to improve the public hospital system in NSW and address many of the major concerns raised by Commissioner Garling and his team. I support all your suggestions and am particularly pleased that you recognise the crucial importance of restoring an appropriate degree of influence for clinicians, the champions of the public hospital system, in the running of their institutes. Senior clinicians want a closer working relationship with managers that have decision making authority so that once again a partnership improves safety, quality and staff morale. Without addressing the problems you are tackling here I fear we will see a major leakage of clinicians from our hospitals making an already serious workforce shortage that much worse. We hope the government, on review of the Garling report will come to the same conclusions now forwarded by you.
Yours sincerely
Professor John Dwyer
Founding President of the Australian Health Care Reform Alliance
* * * * *
"I refer to the document from the NSW Liberal/Nationals Coalition entitled “Management of the NSW Health System – Making it Work”.
"The principles outlined represent some important and necessary reforms in the NSW Health system. They give due regard to the evidence and recommendations of the recent Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals (Garling Report).
"For too long doctors and nurses have been frustrated at their apparent disenfranchisement in the decision making processes effecting patient services. This has lead to a demoralisation. So the commitment to decentralise patient service management and to actively seek to involve front line health professionals is particularly welcome.
"Transparency and information provision are key not only to good governance but also to give clinicians and managers the basis for continuous improvement. It is also necessary for public accountability. In this regard the commitments in availability of information should also be supported.
"
Overall, the principles outlined should result in a more responsive health service in which both clinical and administrative professionals are in an environment better able to do their jobs for the benefit of health service delivery in NSW.
Dr David Adler
Director, Prime Health Management
(Formerly Deputy Medical Secretary NSW AMA, National Vice President Australian Private Hospitals Association, Member National Health Medical Research Council)
* * * * *
"It is clear that the structure under which the care of the ill in New South Wales could be improved. The current Area Health Services are too large to allow locally responsive clinically appropriate care. The focus on the needs of the patient has been lost as has the faith and trust of the clinical care givers with the management system.
"The general thrust of the Coalition’s proposed policy addresses a number of the systemic problems currently in place. Smaller structures focused on the communities they serve with governance responsibility held by a “Board” of properly skilled individuals could well assist in reversing the apparent free fall we seem to be seeing in New South Wales hospitals at present. With appropriately supported local clinical leadership state wide craft group networks could then effectively disseminate the tools for even better clinical care. However, all of this could only occur in the presence of up to date accurate and honest reporting of patient outcome data."
Yours sincerely
Dr Andrew Keegan
Former NSW AMA President
Adjunct Associate Professor
Nepean Clinical School
University of Sydney
What Labor MPs say about their Area Health Services
“Well I think the difficulty here is Steve, there are issues when you’re dealing with an area the size, in the Greater Western Area Health Service’s case, an area the size of Germany.”
John Della Bosca, Labor Health Minister on 2UE’s Steve Price Show.
6/2/09
* * * * *
“I’m not backing away from my feelings that we should be breaking Greater Western Area Health Service up.”
Gerard Martin, State Labor Member for Bathurst quoted in the Western Advocate 13/11/2008
* * * * *
“I certainly believe that State Government hasn’t done a good job holding up its end and the Greater Southern Area Health Service certainly leaves a lot to be desired in terms of transparency, process and consultation… The Greater Southern Area Health Service needs to be more connected to the community to work through health solutions and better outcomes.”
Mike Kelly, Federal Labor Member for Eden Monaro quoted in the Eden Magnet 19/2/2009
* * * * *
“When one delves into health delivery by Hunter New England Health one cannot but notice that the top-heavy bureaucracy looks at service delivery cuts to save money rather than streamlining management tiers to deliver better service.”
Kerry Hickey, State Labor Member for Cessnock quoted in Parliamentary Hansard 4/3/2009