Sunday, January 06, 2008

Health and Child Safety bureaucracies protect their own "territory" rather than those they are supposed to help

RARELY has an issue progressed from tragedy to mystery to disgust and onward to public controversy with the rapidity of the death of a 10-year-old girl on Bribie Island last week. It began as a holiday eyebrow-raiser, assumed an added sadness when murder was revealed, took on an air of mystery when the child's father was found at Mt Glorious, became nauseatingly horrific when allegations of incestuous rape surfaced and turned into outrage when it became apparent the alleged killer had been released after being treated for mental illness.

Now we have an inquiry into why the system failed an innocent child and into an apparent failure of Queensland Health and the Department of Child Safety to communicate. Still, it took almost a week for Health Minister Stephen Robertson to cut the gordian knot and order his outfit to even start talking to Child Safety if kids are seen to be at risk.

Fortunately, genuine public interest - as opposed to public prurience - has ensured the issue will be investigated by the loftily named Health Quality Assurance Commission rather than disappearing into the mysterious caverns of in-house public service inquiry. Media coyness and legal skittishness have taken second place to common sense. Hopefully, the departments will be struck by the same blinding light rather than skulking behind the traditional wall of confidentiality.

While the underlying causes of the Bribie Island tragedy are probably complex, the events are simple. It seems the alleged perpetrator was a troubled man who stacked on such an act at a shopping centre that he was taken to Royal Brisbane Hospital and held for two weeks, a considerable time in a hard-pressed frontline facility. An involuntary treatment order is imposed only if there is an "imminent risk that a person may cause harm to himself or herself or someone else" yet he was released into a position of sole responsibility for four children.

It defies belief that during those crucial two weeks his family situation was not apparent. It doubly defies belief that Child Safety was not informed. That department, presumably, would have had at least a passing interest, as the children had been the subject of complaints. But maybe not, given that its "low level" categorisation of the problem was so catastrophically wrong.

When it comes to mental illness (still to be legally tested in this case) a public duty of care overrides fragile concepts of individual responsibility. Mental illness presents major difficulties in diagnosis and treatment. It is doubly difficult in a society cracking up under self-induced stress and in which facilities are disgracefully scarce. In this case, professionals made a bad call that led to Health making a fatal decision not to pass on the information to Child Safety. Mistakes happen and have to be forgiven. However, there can be no forgiveness if this child died simply because a dysfunctional department is bureaucratically eggbound.

It comes as no surprise that the Health Department is again at the centre of a human tragedy. Despite all the headline events of recent years it seems chronically incapable of operating sensibly, efficiently and humanely. Child Safety has such a disastrous record that its very title sometimes seems a cruel misnomer. The fact that 57 children known to the department died in one calendar year speaks for itself. Ironically, both departments are largely staffed by good, intelligent, well-trained and kind people. Yet, they let us down so badly and so regularly.

Successive ministers seem so overawed by the baffling complexities of the Health and Child Safety portfolios they are incapable of kicking bums and banging heads together. In this instance it was a simple case of making them talk to each other. Kindergarten stuff, really.


Nurses turned off by disorganized government hospitals

A third of the experienced nurses lured back to NSW public hospitals under a Government program have left again. Three days after Premier Morris Iemma bragged about the recruitment of a record 1618 new registered nurses, internal government figures show Nursing Reconnect, which was designed to address a lack of experience, is floundering. The figures, obtained by the NSW Opposition under freedom of information laws, show 1647 nurses had returned to the public hospital system under the program since it began in 2002. But 479 of them subsequently left, for other employment or to take time out.

Opposition health spokeswoman Jillian Skinner said the Government had spent more than $6.5 million on Nursing Reconnect, meaning each returning nurse cost more than $4000 in refresher training and administration. "The Government spent $1.9 million recruiting people who subsequently left," Ms Skinner said. "Only 107 nurses have been recruited this year, compared to 807 in 2002. "The cost of Labor's recruitment program is rising while the number of nurses signing up is falling. Nurses won't want to come back to work while [Health Minister] Reba Meagher and the Iemma Government continue to mismanage our hospitals."

On Thursday, Ms Meagher announced the new recruits, saying that Nursing Reconnect had "attracted 1650 nurses back into the profession". But she failed to mention the high attrition rate. Yesterday Ms Meagher said the most common reasons why nurses had left were family commitments and to work elsewhere as nurses. The majority who had rejoined had stayed, she said.

NSW Nurses Association professional officer Annie Butler said improvements to conditions and pay were essential to retain nurses. Their workload had increased as ancillary positions were cut, and the frustration of seemingly minor challenges, like finding enough pillows, was immense.


Hospitals serving junk food

This attack is crazy. People are not in hospital long-term. The important thing for hospital food is for it to be appetizing -- so that patients will eat it and keep their strength up

ARTERY-clogging junk food [Pure ignorance speaking there. Careful research has found NO EFFECT of dietary fat intake on cardiovascular disease] is widely available at hospitals across the state and Queensland Health has no plans to ban it. Despite implementing some of the toughest anti-smoking laws in the country, Queensland Health says it will not follow the lead of Western Australia, which last week moved to rid its hospitals of all unhealthy foods

Queensland's Chief Health Officer, Dr Jeannette Young, admitted serving up food with a low nutritional value at health-care facilities was sending the public the "wrong message". "It is about everything in moderation," Dr Young said. "The problem is we need to provide more alternatives (to calorie-dense, less nutritional foods)."

Under the WA initiative, all unhealthy food and drinks must be removed from hospital and clinic cafeterias and vending machines by January 1 next year. But there are no rules on what food can be sold at Queensland hospitals and some serve up exactly the kinds of food they warn their patients to avoid. Prince Charles Hospital, for example, is one of the top specialist coronary-care facilities in the country - but just 100m from the doors to the cardiac-care unit are artery-clogging snack foods sitting under heat lamps waiting to be eaten, The Sunday Mail discovered last week. Hot chips, burgers, chicken, pizza, various fried snacks and hot dogs were just a few items on the menu at the hospital's Breeze Cafe. A plated meal bought from there featuring a hamburger and fried chips carried hundreds of calories and levels of dangerous saturated fats far in excess of the recommended daily intake.

Ironically, the cafe raises money for medical research, including coronary care. It was a similar story at food outlets and vending machines at other Brisbane hospitals, including the Mater, Princess Alexandra, Prince Charles and the Royal Brisbane and Women's. While all had a healthy option on their menus, the fare on offer is dominated by fried foods and sugary snacks.

Dr Linda Selvey, population health senior director for Queensland Health, said the department would monitor the WA initiative, but would leave the Queensland public to make their own food choices. "Queensland Health has, at this stage, chosen to use a colour-code system as we believe that when Queenslanders are given access to healthy foods, they have shown they can make the correct choices," she said. Under the Queensland plan, all private, commercially-run food outlets in facilities operated by Queensland Health will be required to comply with the department's Better Choice strategy.

Greg Johnson of Diabetes Australia is surprised more is not being done to reduce the availability of unhealthy foods, particularly as it had been proven that obesity is a main factor in Type 2 diabetes. He said 60 per cent of adults and 30 per cent of children and adolescents in Australia were overweight or obese. "We're not a lucky country of healthy athletes," he said.


Educational realism growing

The booming demand for tradesmen has accelerated a disturbing education trend, with the number of male school-leavers applying for university falling for the 10th year in a row. The latest tertiary admission figures reveal that just 38 per cent of university applicants are male, down from more than 42 per cent a decade ago. Pat Smith of the Queensland Tertiary Admissions Centre said the latest figures were worrying. "It's getting worse. It is a drain which is a concern for Queensland tertiary institutions," he said.

The overall number of applicants has also declined by about 1000, with 50,400 students applying for the 1400 courses on offer this year. The fall in male applications over the past few years averages 1355 students annually. Many of the male school-leavers not going on to uni have been lured by the big money on offer in the mining and building industries. Qualified tradesmen in some high-demand areas can earn more than $100,000 by the age of 21.

Gold Coast carpenter Kane Anderson, 18, who graduated from All Saints Anglican School, said he decided in Year 11 his best option was to take up an apprenticeship. "After three years' work, you can earn more than $100,000. Then you can start your own company and it just keeps growing and growing. "A lot of my friends are all doing different trades. Carpentry is one of the most popular. I'll be 21 when I finish, still young and earning good money."

But other young men who have decided against a degree in favour of a wage as an unskilled labourer have been urged by education authorities to reconsider and apply mid-year for university spots. The first round of university offers will be released on Thursday, with seven out of 10 applicants expected to get their first preference. The most popular courses this year are natural and physical sciences (up 16 per cent on last year), engineering (up 14 per cent) and architecture and building (up 8 per cent). Education (down 18 per cent) has experienced the biggest drop....

National Union of Students president Angus McFarland acknowledged school-leavers were faced with difficult decisions. University students could be left with a debt which ranged from $30,000 to $500,000, he said. "It's not surprising that a young man or woman who has the option of going to university and studying for four years or going into a trade and getting $100,000 will make that decision to work."


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