Friday, April 06, 2012

From tragedy to farce:  NSW hospitals

In the last 15 years, there have been four major revisions of the governance structure of NSW Health in a futile effort to address longstanding dissatisfaction with the centralised Area Health Service administrative system.

Originally, there had been 23 metropolitan and 23 country area health services in the mid-1980s. The Carr government cut the number to nine and eight respectively in 1997.

In 2005, then Minister for Health Morris Iemma further cut the number of area health services from 17 to just eight, covering the entire state.

Under all configurations the same complaints have been made: management is too remote and bureaucratic and local management of public hospitals needs to be restored.

The 2007 Garling report reiterated these criticisms and recommended that managerial authority be devolved to the local level. But before the NSW Labor government could act, state initiatives were swamped by the Rudd-Gillard government’s national health reform agenda.

In return for extra Commonwealth funding, states and territories agreed to establish Local Hospital Networks (LHNs). In NSW, this meant 17 Local Health Networks replaced NSW’s eight Area Health Services. This re-established a structure virtually identical to one that had been discredited and abolished a few years before.

In the year since its election, the O’Farrell Coalition government has managed to turn tragedy into farce.

The centrepiece of the O’Farrell government’s health policy is yet another largely cosmetic administrative reorganisation. This has re-established an administrative system consisting of the same number of Local Health Districts (LHDs) with precisely the same boundaries as the Local Health Networks the Keneally Labor government established in 2010.

Both the state and federal governments are still eager to claim that their ‘reforms’ have put local communities back in charge of health services. To understand how chimerical this is, you have to understand that NSW Health has retained its position as ‘state-wide system manager.’

Ultimate responsibility for service planning, and most critically, control over state-wide industrial relations in health remain centralised in the remit of the state health department.

Command and control management by NSW Health will also remain the norm, with the department retaining a high level of involvement in operational matters to prevent Local Health Districts from blowing their budgets.

This key point is overlooked amid all the talk from both sides of politics about restoring local management. This rhetoric is meaningless unless their policy insists on stringent financial accountability.

Hospital administration was centralised in the mid-1980s to establish greater financial control over the system. Prior to the introduction of the area system, the local boards that ran public hospitals were prone to overrun their budgets and then lobby government for a bail-out from the NSW Treasury. They could do this with relative impunity because their financial accountability was diffuse – and because financial risk (or ultimate responsibility for their debts) was held by the state government.

If the governance riddle is to be solved, then health policy needs to combine genuine local management with real financial accountability by challenging the greatest taboo of all. The privatisation of the delivery of public health services needs to be embraced by policymakers as part of a comprehensive micro-economic reform agenda.


Qld. Engineers split over flood inquiry's referral of colleagues to half-asleep watchdog

QUEENSLAND engineers have split over the flood inquiry's referral of three flood engineers to the Crime and Misconduct Commission for their conduct during the 2011 disaster.

The peak professional body, Engineers Australia, which represents about 19,000 Queensland engineers, has come out in defence of its three members, but some senior engineers, including one whose home was flooded, said its stance was "ill-advised".

The Courier-Mail can reveal that two weeks after the CMC referral investigators have yet to approach Wivenhoe Dam operator Seqwater, which holds crucial evidence of the engineers' actions.

Steven Goh, chairman of the Queensland division of peak body Engineers Australia, told members in a letter last week that he and EA's executive director Ian McEwan had "been in contact with the members directly involved to express our personal encouragement for them at what must be a very stressful period".

But chartered engineer Wayne Land, an EA member whose Chelmer home was damaged in the floods, said Mr Goh's and Mr McEwan's support for the flood engineers was "ill-advised".

"I think they should stay out of it. I really don't see what they can add," he said.

"It's a legal matter and it's inappropriate for the professional body to be helping them."

Hydrologist Max Winders, who warned in January of unresolved problems with the dams' operating manual, has also written to Mr Goh to complain.

"While I understand your concern about the reputations of the three engineers referred to the CMC, further inquiry would show that several other engineers should share the responsibility of what happened," he wrote.

"There were bureaucrats from other disciplines who should bear most of the responsibility.

"I suggest that EA should stand aside from what is likely to be a complex legal process unless it has new evidence to offer rather than opinions".

Mr Goh said the dam engineers had not been convicted of any charges and the CMC had not found they acted inappropriately in managing the dam.

"Every individual deserves the right to be considered innocent unless proved otherwise," he said.

EA has set up a subcommittee to review the inquiry's final report. "Any comments or feedback from members will be considered," Mr Goh said.

The CMC said it was still "reviewing" the referral from the floods inquiry of dam engineers Terry Malone, John Tibaldi and Robert Ayre over the alleged falsification of records of what they did in January 2011.

A senior Seqwater source said the company was surprised it had not yet received any requests for information from the CMC.


'Protection racket' shielding MP: Tony Abbott

TONY Abbott says Fair Work Australia's failure to provide prosecutors with a brief of evidence on the Health Services Union may be part of a deliberate "obstruction of justice" orchestrated by allies of the Gillard government.

The Opposition Leader said that if after waiting over three years for the workplace watchdog to complete its investigation into the HSU and Labor MP Craig Thomson's alleged misuse of union credit cards and funds, no charges were pursued, it would send an “appalling message” to the Australian people.

“I think the public are concluding that basically a protection racket has been at work here inside officialdom to look after Craig Thomson and the Gillard government,” Mr Abbott told Sydney's 2GB.

Julia Gillard today rejected the Coalition claims, saying Fair Work Australia worked independently of government.

The Coalition is demanding action after FWA's 1100-page report into allegations of financial mismanagement by the HSU and its former federal secretary, Mr Thomson, was yesterday referred to the Commonwealth Director of Public Prosecutions.

The report details 181 contraventions of workplace laws and HSU rules by three former or current HSU officials and a fourth person, none of whose names have been released.

However CDPP Chris Craigie, SC, said the FWA report is not a brief of evidence from which charges can be laid, and the CDPP is not able to conduct its own criminal investigation. It is considering what action to take next.

Mr Thomson said today he was “encouraged” by the latest developments in the saga.

The Coalition has now called for FWA to compile a brief of evidence and, if necessary, hire lawyers to do the job.

“A whole lot of bureaucratic devices seem to have been employed to ensure that this investigation could never come to a successful conclusion and a successful prosecution,” said Mr Abbott said.

“You'd have to conclude on the basis of what we know that Fair Work Australia has never wanted this investigation to lead to a possible prosecution.

“It's almost as if they have deliberately gone about this in a way that would ensure that no successful prosecution could ever take place.

“If, after all of this, the whole thing hits a brick wall, I think you have to come to the conclusion that there has been an obstruction of justice orchestrated by friends of the current government, that there has been a perversion of the course of justice orchestrated by friends of the current government.”

FWA general manager Bernadette O'Neill said yesterday she had referred the report to the CDPP as specified in the Fair Work (Registered Organisations) Act, and according to legal advice.

Ms Gillard brushed off any suggestions FWA was trying to protect the government by concealing any wrongdoing by Mr Thomson, whose departure from parliament would threaten Labor slim's parliamentary majority.  She said the workplace watchdog was wholly independent. [Even if it is run by old Labor mates]

FWA's investigation centred on financial mismanagement in the HSU national office during the years Mr Thomson was national secretary, from 2002 to 2007, and specific allegations that he used his union credit card on more than $100,000 of private spending, including on prostitutes.


Could we refill the Great Artesian Basin with floodwater?

    If we can tap the Artesian Basin to take water out, why can't we pump water back into it in times of flood?

It's a temptingly simple idea that in times of flood we can inject surplus water back into the Great Artesian Basin.

But while reinjection is technically feasible, the trick is to collect that water and inject it into the right locations, and the sheer size of the artesian basin makes that difficult, says Dr Vincent Post, from the National Centre for Groundwater Research and Training.

The Great Artesian Basin underlies 22 per cent of the continent stretching across Queensland to the south east corner of the Northern Territory, north east corner of South Australia and northern New South Wales.

But it is not just one big underground lake. The water is confined and pressurised within a massive geological formation of porous sandstone, known as an aquifer, where it flows and is stored in different ways.

When a bore is sunk in an aquifer, artesian water flows to the surface and can be extracted. But when looking for places to extract water, and for that matter to re-inject it, Post says its necessary to look for rock layers that have high storage capacity, but are also permeable enough to transmit the water.

"The water needs to be able to move through the rock because otherwise you can push or pull all you want but the water isn't going anywhere."

Aquifers are recharged when rainfall and streamflow infiltrates down through exposed permeable rock and refills the underground storage spaces. Water moves through sandstone extremely slowly, at a rate of between one and five metres a year.

Radioactive dating indicates that some of the water in the Basin is over one million years old, but it's still uncertain exactly where it comes from and where it goes to.

"The classic model says recharge happens mainly along the eastern border of the Basin," says Post, "The question is does that water from the Great Dividing Range make it south to Lake Eyre in one uninterrupted flow system, or does the Basin consist of various compartments that each have separate recharge and discharge areas?" He says there is some evidence of more localised recharge in a recent study of the Finke River in central Australia, which showed changes after wet winters and floods.

Pressure problems

Underground water has been in demand since the first bore was sunk at Bourke in New South Wales in 1878. More recently mining activity has added hugely to that demand. So can scientists come up with an equation that shows whether we are taking out more water than is flowing in?

"In principle we could," says Post. "[But] much of the area that it underlies is not densely populated, so there are very few observation wells or places where there is the necessary infrastructure to take measurements."

Without more information about recharge areas and rates it isn't possible for scientists to come up with a meaningful equation.

But scientists are concerned by the declining pressure of water in the Basin, which can be measured by the state of the mound springs in northern South Australia, where water is forced naturally to the surface.

"With any aquifer the size of the Great Artesian basin, the age of the water is so old, and it flows slowly and recharges slowly, so if you take something out it will take a very long time, maybe thousands of years, for the water levels to restore to their original levels."

As with all water problems, he says, it's not a matter of there being too little water, but the distribution in space and time that's causing the problems.

"If it rains in Queensland and the water levels are dropping in South Australia then no one is going to pay for a pipeline to ship all that stormwater from Queensland to South Australia and reinject it there. And there's not a lot of merit in injecting it into the aquifer in Queensland when water levels are critical in South Australia because it might take a million years to get there."


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