Wednesday, May 26, 2021

The labyrinth of bureaucracy behind our country hospitals’ horror stories

Dr Aniello Iannuzzi below rightly blames bureaucracy as being behind the hospital problems. But his scattershot approach loses point becuse he fails to concentrate on the key problem: Staff shortages

Wenever I am admitted to a Brisbane private hospital, I am always amazed by the number of staff in my ward. There are always nurses standing around waiting for something to do

So, clearly,staff are available if you pay them what is needed

Specifically, what is needed is to fire enough bureaucrats to pay sufficient nurses

After 25 years as a doctor in rural NSW hospitals, I can attest to the scandals and horror stories emerging from a state parliamentary inquiry into regional, country and remote health services: a teenager with an infected toenail dies of septic shock after being turned away three times from an an emergency department; “tea ladies” check in on newborn babies because there are not enough nurses; doctors threaten to quit en masse because their working conditions are so dangerous.

Naturally, it is the alarming stories from the front line – from the patients, families, doctors and nurses – that capture the headlines. Now we must address the causes.

Chief among them, I have come to learn, is the labyrinthine bureaucracy running NSW Health and the local health districts. The inquiry has come about because communities and health workers are sick and tired of managers in NSW Health and the LHDs stubbornly denying there is a problem.

That is why, when the inquiry came to Wellington, I testified that the principal problem is one of governance. Until that is cleaned up, nothing will improve.

NSW Health’s management structures are bulky and opaque. To progress up the hierarchy, one needs to pledge undying support to the organisation, often needing to bend personal, clinical and ethical standards along the way. When a patient or clinician at the coal face raises a concern, makes a suggestion or files a complaint, management usually activates to ignore, frustrate, bury, lose or deny. It’s like dealing with a big bank, telco or insurance company.

This explains why a CEO of a local health district or senior manager in NSW Health can be technically honest when denying knowledge of adverse patient outcomes, missing medications or the shutting of essential services. The labyrinth has done its work and protected the organisation. Plausible deniability. Spin.

It is at least heartening that the inquiry involves most NSW political parties – because the problems are chronic and systemic and have festered under the watch of Labor and Coalition governments.

No. 1 is understaffing, which puts pressure on rosters and over-reliance on locums and agency staff. There are not enough beds, which causes “bed block”, and there is an inability to divert ambulances when that happens. Administrators are detached from clinical care and managers are overly concerned about ticking boxes for performance indicators rather than ensuring adequately resourced and safe facilities. Investigations meant to analyse system failure are too often weaponised to shift blame onto clinicians, leaving administrators untouched.

To some extent these problems are encountered in cities, but Australia’s geography is cruel. When one runs out of basic antibiotics, there is not a pharmacy supplier in the next suburb or a courier the next day. When a patient drives 100 kilometres to an emergency department to discover there is only a video service, it can be another 100 kilometres or more to a town with a doctor. When a surgery or pharmacy shuts, the ripple effect on a small district’s economy and social capital is devastating.

At the inquiry we heard powerful evidence from Bathurst Council: even in such a large regional city, a lack of health workers has negative economic and social impact. Imagine what it means for a town like Dunedoo, population 750.

We’ve had inquiries before, and recommendations, yet rural health continues to atrophy and the decision-makers are never to blame.

All too often NSW Health assumes good clinical practice can be made more efficient by curtailing or omitting critical steps: making the time to take a patient’s accurate history, perform an adequate examination, consider and investigate the possible diagnoses, and properly inform the patient about the management plan. Hence we see understaffing, poor stocks of medicine and medical equipment and the promotion of telemedicine at the expense of in-person clinicians.

For those of us left in the small hospitals, we turn up to work to find new forms to complete and more data to report. Management’s priority, it often appears, is that staff attend to these tasks ahead of real patient care.

Of course, we need more money, more beds, better medicine and equipment, more staff. The states often blame federal governments for these problems. There is certainly a place for more federal money but we should not exonerate NSW Health on this account. Without better governance the money will remain poorly spent, the equipment misdirected and the clinicians unwilling to work and give their best.

While we always need to recruit more health workers to the bush, there are plenty in the bush who make a conscious decision not to work for NSW Health.

Earlier this year, senior managers of our LHD and the Rural Health Commissioner were in Dunedoo for a community forum organised by the Warrumbungle Shire Council. They suggested the Dunedoo community should be more welcoming to health workers. Oh? So it’s the community’s fault? It was nothing short of insulting and outrageous. All NSW residents should be outraged.


A corrupt corruption watchdog

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The untouchable MacSporran

Serious questions are being raised about the role of the Crime and Corruption Commission in Queensland, and rightly so, writes Des Houghton.

It is hard to see how Crime and Corruption Commission chief Alan MacSporran can survive the legal tempest now swirling around him.

A third adverse report against the crime watchdog lobbed this week at the Parliamentary Crime and Corruption Commission.

And a historic scandal involving a former ALP cabinet minister is coming back to haunt him after revelations the CCC failed to interview key witnesses.

The latest report to challenge the CCC’s “untouchable” status is a 73-page legal tome compiled by three prominent silks who say the CCC exceeded its authority, and worse, in the handling of the Logan council debacle. It discusses how evidence was gathered in compiling fraud charges against seven councillors who were later cleared. The report names names. It is explosive.

The report is a submission from the Local Government Association that I suspect will force the parliament to consider requesting MacSporran stand aside pending a judicial inquiry.

Now is not the time for Annastacia Palaszczuk to attempt to bury it. Indeed, she may welcome a media distraction from her own political inadequacies in hospitals and policing.

The Logan report must be made public, and quickly. The seven councillors who were cleared of fraud were unfairly denied a chance to contest the local government elections. They deserve justice and are owed compensation. And their community deserves answers.

In the past MacSporran has been chastised by the editorial writers for suggesting the CCC had the right to say what newspapers should and should not publish. That was bonkers.

Ill will against the corruption watchdog continues to grow.

Recent CCC critics are a diverse mob and include the esteemed Clerk of the Parliament Neil Laurie, former premier Campbell Newman, popular Gold Coast Mayor Tom Tate, former police commissioner Ian Stewart, and influential Local Government Association Queensland chief Greg Hallam. Can they all be wrong?

Hallam is a man of towering intellectual ability whose advocacy has been measured. He won’t talk.

Newman did. He went in hard, accusing the CCC of pursuing small and “esoteric” investigations and prosecutions while criminal gangs flourished. Mr Newman claims the CCC is “out of control and unaccountable … An organisation with extraordinary powers chasing mouse poop whilst criminal gangs and organised crime have flourished”.

Newman was commenting after the CCC last week released its Investigation Arista report that found the Queensland Police Service “engaged in discriminatory recruitment practices” in a drive for women to make up half of all new police recruits.

“These groups are back in business now quite clearly,” Newman told The Australian. “Why haven’t the CCC done something about either the gangs or the lack of police action?

“Instead, they have spent their time pursuing esoteric prosecutions of local government officials and worrying about gender targets in the QPS.”

Member for Burleigh Heads, Michael Hart, said allegations of corrupt conduct he raised in Parliament in 2018 were not properly investigated by the CCC even though he had provided investigators the names and phone numbers of witnesses and a tape recording.

The saga began when Hart told Parliament: “Of real concern is the allegation that Rob Schwarten had major renovations done to his Rockhampton houses by JM Kelly in 2009 and 2011. In particular, I am told that a JM Kelly contractor painted his Kinka Beach house, known around Rockhampton as the beach hospital, and the cost of that contracting work – about $26,000 – was not paid by Schwarten but was added as a variation to a government contract.

I have heard this from a number of credible people in Central Queensland and both the government and Mr Schwarten have some very serious questions to answer about this. These questions are deserving of a thorough and rigorous examination.”

Schwarten said the allegations were untrue and denies any wrongdoing. The Kelly companies previously denied doing free work for Mr Schwarten.

In a recent submission tabled in Parliament, Hart said the witnesses he provided had not been contacted, even though the CCC assured him they had been.

He told the House he was first contacted by the CCC in February 2019. In October he was told the case was closed.

“The investigation took 11 months and during that time I was unable to speak further in parliament on this issue.

“Eventually it was reported in the media that Mr Schwarten declared he had been cleared by the CCC.”

Hart said there was not a proper investigation.

“I supplied the CCC with a list of names and contact numbers of persons who provided the information which my speeches to the parliament were based on.’’

In a letter dated October 17, 2019, the CCC advised the investigation was closed and that their “inquiries included interviews of witnesses”, he said.

“I have since been contacted by a number of the people on the supplied list who tell me the CCC has not spoken to them at all.’’

So the CCC not only failed to properly investigate serious allegations, it misled the courageous MP who saw it as his duty to raise the alarm. Why did the CCC run dead? MacSporran should be hauled before the parliamentary committee to tell us.


The ‘difficult choice’ new NSW schools’ boss made for her daughter

The new head of NSW’s 2200 public schools says she sends one of her two daughters to a private school because she believes in parents’ rights to make the best decision for their children.

Georgina Harrisson, who was named as the new secretary of the NSW Department of Education on Monday, is a career bureaucrat who has spent 20 years working in government agencies in Australia and the United Kingdom, including the NSW Department of Premier and Cabinet.

This is her first position as the head of a government department. She takes over from former ABC managing director Mark Scott, who will begin as vice-chancellor of the University of Sydney in July. Ms Harrisson said she could “not be happier or more proud” to take on the role.

Ms Harrisson has a daughter in kindergarten at a Sydney public school, but her older daughter attends a high-fee independent school in Sydney’s north. “I’ve made a choice that’s really worked for my own child,” she said.

“I can understand that people would want to know that I am supportive of the system. My youngest daughter is in kindergarten in a public school. I will make the right decision for my own children as every other parent would.

“It’s a difficult choice but one that every parent makes in the interest of their own child.”

Mr Scott’s daughters also attended private schools, but they had graduated by the time he took on the Department of Education position. Both of NSW Education Minister Sarah Mitchell’s daughters attend their local public school.

Ms Harrisson will face significant challenges, such as a shortage of teachers, particularly in key areas such as maths; a student body with complex needs; and a workforce frustrated by low pay, long hours and a lack of career progression.

There are 120,000 staff on her payroll and 850,000 students under her watch.

She faces her first wages negotiation later this year, against a Teachers Federation that is putting significant resources into a campaign to lift salaries and improve conditions, which began with a year-long inquiry by former West Australian premier Geoff Gallop.

“I’m not a teacher and I don’t pretend to be,” Ms Harrisson said. “We are listening to our workforce. They have an affiliation with their employers as much as they do with their representatives and I want to make sure we are out there listening to what teachers say they need.

“The government has a wages’ policy, our role in that is quite clear. There’s a whole load of things in that Gallop report around the where and how teachers are spending their time. We want to ensure we are engaging in constructive dialogue with the federation.

“Ultimately we are accountable to every student in every classroom. I think meeting students’ expectations is our biggest challenge.”

Federation president Angelo Gavrielatos wished Ms Harrisson well and said she faced significant challenges, such as teacher shortages, “crippling workloads” and the under-funding of public schools compared with private schoo




1 comment:

Paul said...

There are always nurses standing around waiting for something to do

So, clearly,staff are available if you pay them what is needed

I had occasion to be a patient at Cairns Private Hospital a while back. Staff standing around certainly doesn't mean they are looking for something to do, and they also have their own award which allows them to pay lower than the Public sector. The Public (where I also became a patient when things got too big) was in every way superior.