Wednesday, October 6, 2010

Red book finds rub with Rudd

SMH - Mark Metherell
October 7, 2010

The federal Treasury has signalled its unease with elements of the Rudd government's health reform plans that were supported by the Prime Minister, Julia Gillard.

In its ''red book'' of policy analyses presented to the incoming government, Treasury doubts whether the reforms can begin on schedule and whether the national hospital funding changes can proceed without Western Australia.

The WA government has shown no sign it is prepared to accept a central part of the plan that requires the states to give up a third of their GST revenue in return for the Commonwealth's 60 per cent funding of public hospitals.

Advertisement: Story continues below The document also warns that the federal and state governments will need to make ''intensive efforts'' to ensure the proposed transfer of primary care services from the states to Canberra begins on time in July.

The chapter of the red book dealing with the health reforms contains censored sections apparently dealing with the financing of the changes, and a paragraph on ''sensitivities'' of implementing the change.

It refers to two areas where Canberra would like to take over full funding control - mental health services and aged care - saying there were reform ''pressures'' which would add to the task of implementing changes.

As well, it points to delays in introducing uniform measures to gauge quality and safety in public hospitals and health services, saying the ''new national performance and accountability framework will be particularly important for system efficiency and sustainability''.

Thursday, September 30, 2010

HEAL Media Release - Local Health Networks

October 1st 2010

HEAL spokesperson, Janet Mays, has expressed cautious support for the Local Health Network (LHNs) structure recently announced by the NSW State Government, as part of the National Health Reform Agreement, saying that any move to deliver better patient care and strengthen local decision making must be applauded. However, HEAL is asking what has really changed for Mountains residents?

“Both Mountains hospitals have been included in the newly formed Nepean Blue Mountains network, which also comprises Nepean, Hawkesbury, Lithgow and Portland hospitals. This grouping makes geographic sense, but one has to ask how will service provision really change for Mountains residents?”

“A smaller bureaucracy is obviously good, but the hub and spoke model that requires Mountains residents to travel to Nepean hospital for so many services remains”.

HEAL is also concerned that both Blue Mountains hospitals are included in a greater Sydney metropolitan network, signalling no change to the rural classification issue that has been one of the major reasons cited for the inability to attract and retain clinicians at BMDAMH.

“We have been seeking rural classification for Blue Mountains hospital for a long time as a way of ensuring that higher entitlements are paid to clinicians. Higher pay structures would at least give our community a fighting chance in terms of recruiting much needed staff and delivering more services locally” she added.

The new 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.

Ms Mays concluded “we look forward to understanding more about the new Local Health Network structure and its implications. HEAL’s focus will be on ensuring that Mountains residents get their fair share of funding for both of our hospitals and that Mountains residents are provided with equitable access to quality health care – in the community or in hospital”.

Sunday, August 15, 2010

Anger over lack of medical internships

SMH - Kate Benson
August 10, 2010

NSW medical students are demanding the federal government stop increasing university places after more than 100 graduates failed to get internships in public hospitals this week.

The crisis comes three years after the government increased university places to solve the state's crippling shortage of doctors, but failed to employ extra staff in NSW hospital to supervise interns.

About 115 international students, who each paid more than $200,000 for their degrees, were told yesterday they would have to wait until Friday for final offers but there was little chance they would be employed, forcing many of them to return home.

''The intern year is a 12-month period of postgraduate training that is required for general medical registration,'' the president of the Sydney University Medical Society, Jon Noonan, said. ''Without it, a medical degree is not worth the paper it is printed on.

"At this point last year more than two-thirds of locally trained internationals had been offered an internship within NSW. The fact that none have been placed has come as a shock to our colleagues, who had been repeatedly reassured they would be taken care of,'' he said.

A spokeswoman for the Institute of Medical Education and Training, which allocates internships, said 747 positions were available this year, more than enough for the state's 685 graduates, but NSW had been swamped by applicants from other states.

Last year, when the same problem occurred, the government invoked a priority system because it did not have enough money to offer internships to all graduates wanting to work in NSW.

Under that system, international students trained in NSW are only offered positions once all Australians and New Zealanders trained in Australia and overseas-trained applicants are employed, a decision that has angered the Australian Medical Students Association.

''We have a government which provides huge incentives to get these doctors back once they have left [Australia] and it seems illogical to me to do so when we have people who've been trained here to our standards,'' its president, Ross Roberts-Thomson, said.

''A medical degree qualifies you for nothing but an internship. If you don't get an internship, you essentially have a piece of paper which allows you to drive a taxi - or not even that.''

Mr Noonan agreed, saying it defied logic that state and federal governments would shut the door on Australian-trained international students while relying on foreign-trained doctors to fill gaps in the health workforce.

Mr Noonan said his group wanted the state government to guarantee internships to all graduates in NSW and join with other states to adopt a consistent and co-ordinated framework for intern allocations.

Two years ago, the Minister for Health, Nicola Roxon, said she was aware clinical training places were ''a pressure point within the system'' but the government had no plans to cut university places for medical students.

''This was a crisis that was always going to happen,'' the former chief executive of the Australian Medical Association, Bill Coote, said yesterday.

''There has been very rapid growth in the number of medical schools and the expansion of existing schools - and there is the parallel issue of how medical schools have been allowed to attract full-fee paying students to subsidise their activities when we can't provide all graduates with appropriate training.''

Wednesday, August 4, 2010

Radical surgery for area health services

August 5, 2010 - 10:36AM

The way healthcare is delivered to patients in NSW will change under a state government plan which aims to ensure hospitals can better respond to local needs.

Area health services, which now run NSW hospitals and have been criticised for red tape, will be broken up to help deliver that care.

Seventeen local health networks will replace the eight area health services.

The NSW government will this morning release a discussion paper detailing its response to the national health reforms proposed by the Council of Australian Governments in April.

The Herald understands the following hospitals will be "paired", to share resources and equipment, under new local health network boundaries:

- Campbelltown and Liverpool

- Concord and Royal Prince Alfred

- Blacktown and Westmead

- Nepean and Blue Mountains and Lithgow

- Bathurst and Orange

Hunter New England Area Health Service, which includes John Hunter Hospital, will remain with the same boundaries.

The Premier, Kristina Keneally, and the Minister for Health, Carmel Tebbutt, are releasing the discussion paper at Royal Prince Alfred.

Ms Keneally said the changes would deliver an extra $1.2 billion in funding to the NSW health system over four years and lead to 488 beds being opened in 2010/11.

Saturday, July 31, 2010

Invitation to Public Health Forum - August 10th 2010

Sydney West Area Health Advisory Council is holding a community forum about public health services in the Blue Mountains Local Government Area and Western Sydney.

The forum is an opportunity for anyone who would like to talk about health services in the Blue Mountains and western Sydney.

When: Tuesday, August 10th 2010
Venue: BMDAMH Conference Room, Education Unit
Time 6.00pm - 7.00pm

Everyone is welcome

Thursday, July 29, 2010

Hospital's CT scanner breaks again

July 30, 2010

Patients at Blue Mountains hospital have been put at risk after vital scanning equipment broke down, doctors say.

The computed tomography (CT) scanner - used to diagnose everything from fractures to cancer - was broken for more than a week. Doctors at the Katoomba hospital said the scanner was so old it had been considered obsolete since 2008, and it had broken down more than once.

While it was broken doctors had to transfer patients - potentially including emergency patients - to Nepean Hospital, an hour's drive away in Penrith. But a spokeswoman for the Sydney West Area Health Service said only four people had been transferred to Nepean and none were emergency patients.

A visiting medical officer at the hospital, who did not wish to be named, said the broken CT scanner delayed patient diagnoses: ''It affects patient management and safety.'' The chairman of AMA NSW's hospital practice committee, Brian Owler, said it should be replaced immediately.
Some staff and some in the community have criticised Blue Mountains hospital saying it is not given resources to function fully.

The Blue Mountains deputy mayor, Janet Mays, said the hospital was ''being downgraded essentially to a first-aid post''.

The area health spokeswoman said there were plans to replace the scanner by the end of the year.

Monday, May 10, 2010

Controversial Sydney West Area Health chief resigns

Parramatta Advertiser
May 4th 2010

SYDNEY West Area Health Service chief executive Prof Steven Boyages resigned last week amid controversy over his handling of the job.

Prof Boyages had been in the top job of the area health service, which includes Westmead and Auburn hospitals, for 10 years.

His tenure was dogged by controversy over debts to suppliers and by dissent among senior doctors and nurses over his management style.

Prof Boyages was not available for comment before the Advertiser’s deadline but it has been reported he will transfer to the newly created NSW Clinical Education and Training Institute.

The Advertiser had been told by senior clinicians in recent times that Prof Boyages, an endocrinologist, was not considered a good manager.

“He’s a brilliant clinician but not such a good administrator,’’ one senior specialist told the Advertiser.

Prof Boyages was still working as an endocrinologist while running the area health service.

NSW Health director general Debora Picone has been quoted as saying that Prof Boyages had ``as many supporters as detractors’’

Thursday, March 18, 2010

Hospitals in city's west fear Rudd's changes


STRUGGLING western Sydney hospitals, already among the most cash-strapped in the state, could stand to lose about $130 million in funding under the Prime Minister's hospital reform plan, NSW Health Department analysis suggests.

The area's high and growing population, combined with its relatively lower per-capita provision of hospital beds and services, would mean that it would be disadvantaged under such a formula, according to figures circulated to doctors.

As nurses from the Sydney West Area Health Service yesterday demonstrated against long-term staff freezes which they say are compromising patient care, the departmental calculations show that any shift to so-called activity-based funding could force the area's hospitals to take a further hit.

Under the modelling - based on the 2008-09 financial year and conducted to predict the consequences of activity-based funding - Westmead Hospital, the state's largest, would be worst affected, losing $83 million a year.

The formula sets a fixed price for individual types of treatment and that fee is paid for every patient actually treated. Under the version proposed by the federal government - about which the Premier, Kristina Keneally, has expressed the strongest doubts of any state leader - a uniform "efficient price" would be set nationwide, and Canberra would provide 60 per cent of this directly. Hospitals are now funded mainly under block grants negotiated with NSW Health.

But Patrick Cregan, the chairman of NSW Health's Surgical Services Taskforce, said the concept was inherently prejudiced against hospitals serving larger populations, because emergencies represented a higher proportion of their work. This in turn meant they could not perform elective procedures in sufficiently high numbers to reap economies of scale that would allow them to reduce their costs.

Hospitals that treat patients more cheaply benefit under the model, because they can keep and reinvest the difference between their own expenditure and the higher fee reimbursed by government.

Dr Cregan said this would entrench the position of well-resourced centres of excellence in affluent areas, and further reduce hospital access in western Sydney. "That sort of inequity is going to be locked in," he told the Herald.

"You can't gear up [to do large numbers of elective procedures]. Hospitals are going to lose money, and potentially lots of money."

More than 800 nurses rallied outside seven hospitals in western Sydney yesterday to protest against unsafe staffing levels, including one maternity unit which cannot find midwives for more than 420 shifts this month.

Nepean Hospital, where about 4300 babies are born each year, needs another 20 full-time midwives to fill shifts on the antenatal, postnatal and delivery wards, and in the neonatal intensive care unit. ''We will have a death there soon because it is hugely unsafe,'' said Sally Tracy, a professor of midwifery research at the University of Sydney. ''There is huge dissatisfaction. Midwives do not want to work there.''

More than 120 people at the Lithgow rally were told about half its hospital beds were shut due to staffing shortages.

''I've been in the health system for 30 years and this is the worst I have ever seen it,'' said union representative Marny Thomas. The opposition health spokeswoman, Jillian Skinner, said ''nurses were fed up to the back teeth''. The rally at Nepean Hospital was told there were about 30 nurse vacancies but the NSW Health website admitted to only three, she said.

Wednesday, March 3, 2010

The death knell for small hospitals

By Simon Benson and Sue Dunlevy
From: The Daily Telegraph
March 04, 2010 12:00AM

NSW Health officials warned that as many as 100 smaller community hospitals may become financially unviable under a new payment-per-service model unveiled in Prime Minister Kevin Rudd's hospital reform plan yesterday.

Professor Bob Farnsworth, chair of the Sydney Illawarra Area Health Service's health advisory council, said Mr Rudd's reforms were "appalling" and "potentially a disaster" for NSW.

"It is taking healthcare in NSW back 20 years," said Professor Farnsworth, who is also the director of surgery at Prince of Wales Hospital.

"This was a great opportunity to come up with a logical, efficient and effective single-funding system for healthcare. Some of our hospitals will struggle to operate under case mix funding. All our small regional hospitals are very much at risk."

Senior NSW Government sources said as many as 100 regional and rural hospitals could become unviable.

Under what Mr Rudd described as the biggest change to Australian healthcare since Medicare, the Federal Government will become the major funder of hospital services, which will be run by local managers.

The Commonwealth will take $90 billion over five years - $50 billion over the first three - in GST revenue from the states to fund a new National Health and Hospital network.

Mr Rudd will no longer provide states with money to run their hospitals, instead he will directly fund the local hospital networks, boosting the Commonwealth's share from 35 per cent to 60 per cent.

The new funding system will remove the current caps placed on hospital budgets. A price will be set for each service, with the Federal Government paying 60 per cent of that.

This price will cover the "efficient" cost of hospital services and states such as NSW, which provide inefficient services, will have to subsidise those extra costs from state budgets.

"The Australian Government's decision to take on the dominant funding role for the entire public hospital system is designed to end the blame game, to eliminate waste and to shoulder the funding burden of the rapidly rising health costs of the future," Mr Rudd said yesterday.

Senior NSW Government sources said the plan would not put any more money into the health system.

They said the 100 hospitals across regional and rural NSW would be financially unviable under the casemix system, which allocated funding on a per-procedure basis, because the volume of medical procedures in small hospitals was too low.

"The State Government will have to make a decision as to whether it can continue to subsidise these hospitals or close them," they said.

Greater Western Area Health Service health advisory chair Dr Steve Fleckhoe fears for the future of 44 hospitals in his western NSW region.

"I am absolutely sure that the small hospitals . . . could not possibly fit into a casemixed model," he said. "It worries the heck out of me. The worry was always that an efficiency model would be applied that didn't take into account other circumstances."

Mr Rudd's office said the reforms would not force any hospitals to close.

His office guaranteed that medical services to regional hospitals in NSW would be retained and assessed by the proposed new independent umpire.

"There will be loadings to recognise the needs of people in regional Australia," a spokesman said.

Mr Rudd will also move to take over from the states' primary care services, such as community health centres, mother and baby clinics, drug and alcohol services and community based mental health services.

The changes will start to be introduced in 2011 but voters will have to re-elect Mr Rudd twice before the new system takes full effect in 2013-14.

"There is a lot in these proposals that has the potential to significantly improve our hospital services," said Australian Medical Association president Andrew Pesce, but he said NSW hospitals might lose if the payment-per-service system did not take into account care and training costs.

Thursday, February 18, 2010

Yes Minister!

Feb 19th 2010

Carmel Tebbutt, the NSW Minister for Health, penned an article for yesterday's SMH attacking Tony Abbott's local Health Boards proposal.

I was pleased to see the article from the Minster for two reasons.

Firstly, it confirms the existence of the Minister. I had started to wonder because she has never responded to a single piece of correspondence from HEAL.

And secondly, she shares HEAL's view on healthcare! Perhaps she has been reading our correspondence after all.

For instance, the Minster states:

"We must focus on providing patients with the right care, in the most appropriate setting and in cost-effective ways. The system should be easy to navigate and equitable".

She goes on to say that:

"We must also better distribute health professionals so people can get treatment irrespective of where they live".

That's right Carmel - equitable healthcare, people receiving treatment irrespective of where they live and care in the most appropriate setting. That resonates for HEAL, so what exactly are you doing about BMDAMH? Why do service levels continue to decline and why do you fail to respond to taxpayers about this matter?

To read the full article go to our Media section. The Minister's article is entitled "Health fix needs a lot more than local boards".

Tuesday, February 16, 2010

An all too familiar story..................

NSW Health apologises to Blue Mountains mothers
17 Feb, 2010 09:47 AM

NSW Health has apologised to expectant mothers for not notifying them in advance of temporary closures of Katoomba Hospital’s maternity unit and advised “occasional” closures will continue to occur due to a shortage of medical specialists.

Birthing services at the hospital were shut down on January 15, January 20 and for an extended period between January 26 and February 1 due to an anaesthetist and/or paediatrician shortage.

Sydney West Area Health Service (SWAHS) western cluster general manager Kevin Hedge told the Gazette on Monday “unfortunately, it would appear that not all women (due to give birth in mid to late January) received advanced notice of the disruptions to birthing services (at Katoomba Hospital)”.

“This is unacceptable and the hospital would like to sincerely apologise for any distress that this has caused.

“Hospital staff will ensure that communication is improved and that women are advised in advance in the event of any future disruptions to birthing services,” he said.

“In the event of any disruptions to birthing services, (Katoomba) Hospital staff will facilitate safe transfer to birthing services at Nepean or Lithgow hospitals, in consultation with prospective mothers, to ensure safe care for them and their babies.”

Last October an anaesthetist and nine supporting medical staff were recruited at Katoomba Hospital after the hospital’s maternity ward was closed for one quarter of all days in the first four months of 2009.

Mr Hedge said the hospital continues to do all it can to minimise any disruptions to birthing services, but added “the global shortage of some medical specialists, including anaesthetists, continues to pose a challenge in staffing the hospital’s maternity services consistently”.

Blue Mountains Hospital Equity and Access Lobby (HEAL) spokesperson Janet Mays expressed concern at the maternity unit closures and a recent spate of bed closures at Katoomba Hospital.

“We understand three beds were closed in the hospital’s mental health unit since December 29, eight beds remain closed in the rehabilitation unit and a further eight beds are closed in the children’s ward,” said Ms Mays.

“The hospital is a vital part of the social and economic fabric of our community and HEAL will keep highlighting these issues to help ensure the need for locally provided basic primary healthcare services remains top of mind for our State decision makers.”

Thursday, February 11, 2010

HEAL Media Release - Hospital Bed Closures Cause Concern

February 11th 2010

HEAL spokesperson, Janet Mays has expressed concern at the recent spate of bed closures at Blue Mountains District Anzac Memorial Hospital (BMDAMH).

“We understand that 3 beds have been closed in the Mental Health Unit since December 29th, 8 beds remain closed in the Rehabilitation Unit and a further 8 beds are closed in the Children’s Ward”.

“We are further concerned by reports that the switchboard and administrative functions at Springwood hospital have been closed and moved to Katoomba hospital and by the fact that maternity services have again been interrupted at BMDAMH. Whichever way you spin it, we are witnessing the decline of hospital services in the Blue Mountains”.

Ms Mays said that she was delighted to see a recent letter to the Gazette praising the staff and service provided by BMDAMH. “HEAL has always maintained that our hospital, if allowed to function, is fabulous. The described level of service (in the letter) needs however to be made available to all Blue Mountains residents. Sadly, for many Blue Mountains families, local hospital care is a thing of the past due to the nature of the health condition or the time of day that they require treatment.”

HEAL has requested a meeting with Sydney West Area Health Service (SWAHS) representatives to discuss the current bed closures. “We keenly await advice from SWAHS regarding a meeting time and date. Our message to SWAHS is please work with the community and tell us what is happening at the hospital” said Ms Mays.

“BMDAMH is a vital part of the social and economic fabric of our community. HEAL will keep highlighting the issues at BMDAMH to help ensure that the need for locally provided basic primary healthcare services remains top of mind for our State decision makers”.