Thursday, December 24, 2020

Behind the scenes at your Queensland government hospital

If the doctors and nurses seem a bit distracted, here is why. And management are in denial

A Queensland-wide nurses group has taken aim at the Townsville Hospital and Health Service for what it believes is a “systematic” and “longstanding and toxic culture of bullying”.

Recent statistics revealed half of staff surveyed at THHS had witnessed bullying or sexual harassment in the workplace in the past year, the highest rate in the state.

The data was gathered from 77 THHS staff members who participated in the Working for Queensland survey.

The Nurses Professional Association of Queensland wasn’t surprised with the findings, with a spokeswoman saying it had been an issue that had reared its head for some time.

“There’s been a longstanding and toxic culture of bullying in Queensland Health colleagues and members have been reporting to me for some time,” the spokeswoman said.

“Unfortunately, Queensland Health’s bullying culture permeates the whole organisation, from top to bottom. There’s bullying that occurs both up and down the chain of management, and no one is truly protected.

“There absolutely is a statewide toxic bullying epidemic in Queensland Health that exists regardless of geography or seniority.”

The spokeswoman said some previous cases of bullying had a detrimental impact.

“We’ve had many members who have basically been institutionalised as a result of the horrendous bullying they’ve experienced,” she said.

“Members have contacted me directly with their cases, reporting having to be admitted to mental health facilities as a direct result of bullying and harassment suffered at Queensland Health. For some members, this has resulted in lifelong workplace injuries.

“Obviously, this is an extremely complex issue that is deeply embedded in Queensland Health. We note that minister Yvette D’Ath is touring Townsville as a part of her review into systemic bullying. We look forward to supporting her and working with her closely to turn this culture around.”

THHS chair Tony Mooney said there was no place for bullying in the service.

“I am looking forward to welcoming the Minister for Health to Townsville Hospital and Health Service to showcase the fantastic work our 6500 staff do in caring for our community, not to do a review into bullying,” Mr Mooney said.

“There are no active bullying or harassment cases across the Townsville HHS being managed by our industrial relations team. Bullying and harassment will not be tolerated on my watch.”

Mr Mooney said as well as causing distress to others, bullying took away from the great work and care provided by a dedicated workforce.

He said THHS had done significant work to improve workplace culture through mandatory bullying and harassment training, additional one-on-one support offered to resolve workplace issues within teams and to create a mechanism to bring on independent experts to support and review complex cases.

'Balancing act': The problem with COVID mandates

By Julie Leask

Recent developments in the pandemic such as vaccines and the outbreak of COVID-19 on Sydney's northern beaches have prompted calls for governments to mandate public health measures such as vaccination or mask wearing to control the virus.

Mandating certain behaviours to prevent the spread of infectious diseases can be an effective measure in public health. It can bring about behaviour change at-scale and remove the burden on individual decision making. But mandates come with downsides which are often overlooked.

Mandates will always carry a penalty for non-compliance: a fine for not wearing a mask or denial of childcare or family payments for the incompletely vaccinated child. These are serious consequences, particularly for people experiencing disadvantage, who themselves are already more likely to be economically or socially affected by pandemic measures. Yet it is those experiencing disadvantage who are more likely to be fined for COVID-19 rule compliance breaches. For example, in April, Sydney’s poorer Fairfield Local Government Area had just 0.98 per cent of cases but 3.7 per cent of infringements while richer Waverly had 6.7per cent of cases but just 0.79 per cent of infringements.

Mandates lead to interpersonal conflict at the point of enforcement. This is a particular problem if those with roles in implementing the requirement also provide the service because it can undermine the relationship between citizen and service. For example, the driver who turns away unmasked people boarding a bus taking them to an appointment or a doctor refusing to grant a medical exemption for an unvaccinated child will inevitably end up dealing with distressed and sometimes abusive people.

Mandates bring a tonal shift in pandemic control – from solidarity to enforcement. Rules can offer support – it’s sometime easier to just be told to do something. A few people only respond to rules. But they can also undermine intrinsic motivations towards the public co-operation more generally, making behaviour more about what I can and can’t do than what I should do for others. For long-haul behaviours like pandemic control ones, intrinsic motivation is better because it carries across a number of minute and everyday behaviours impossible to police.

Mandates should bring a meaningful additional level of compliance to controlling the spread of a disease. Right now in NSW, some commentators have called for mandatory masks for all of Sydney, at a time when the state is recording reductions in locally acquired new cases, decreasing from a high of 38 on December 19 to 8 cases on December 23. The most important control measures have been rapid identification and isolation of cases and contacts, helping bring this outbreak under control, like NSW did in July after a cluster began in south western Sydney. In Victoria, mandatory masks were hoped to be enough to bring a rising outbreak under control. But within a week it was clear that a prolonged lockdown was also needed.

Mandates require significant resourcing and attention from government departments. Legislation needs to be carefully drafted to account for the range of implications they will bring. There should be a threshold for determining what is, and is not, required and means for determining compliance. This is easier for policing the wearing of masks. For vaccination, Australia uses a national register to determine compliance. But recording error or failure to enter the data means some fully compliant families have wrongly lost family assistance payments under the No Jab No Pay. Mandates need good systems in place to be fair and feasible.

Most of these issues can be justified and managed if the benefits of mandating a behaviour are deemed to outweigh the risks. Right now in Sydney, mask wearing when one cannot distance is strongly recommended. But a mandate to do so would be disproportionate when considering the downsides along with their limited role right now in controlling COVID-19. If we are unlucky enough to see established transmission across Sydney or any other region, that might change.

For now, the measures announced on Wednesday are reasonable – limited numbers inside homes with restrictions around movement of people on the northern beaches where the cluster remains focused. We must remain focused on the most effective measures – testing and isolating if symptomatic, rapid contact tracing, quarantining of contacts, and limiting large gatherings, vigilant hand and respiratory hygiene and wearing masks when social distancing is not possible. Venues need to systematically ensure all customers accurately log their details when entering.

Mandating individual actions to prevent infectious disease spread should only be in place when the shift to mandating will be effective and carries little risk, the requirement is reasonable, feasible to enforce, and well justified. Taken together, this is about weighing the benefits of an action against its risks – something Australians have become adept at doing in 2020 when it comes to infectious diseases.

Hotel quarantine inquiry revealed a deep and shocking truth

Pru Goward

The report of the Coate inquiry into the Victorian hotel quarantine system reveals one deep and shocking truth –no, it’s not that no one made a decision about private security guards, it’s that there was no system. Now it is all too late, and the proud Victorian public service, once the benchmark for all others, is having to be told how to put a crisis response plan together. Public administration 101.

The conclusion, that Mr Nobody made a decision to use private security guards in quarantine hotels, is a metaphor for a much wider cultural problem. Premier Andrews has been quick to point this out, so he already knows that real reform will take more than Justice Jennifer Coate’s carefully crafted recommendations for an improved health emergency management system. What her report fundamentally revealed was the incapacity of the public service leadership to follow orders or anything close to good process. If this malaise is widespread, then reform must be also.

Let’s deal with the private security guards problem first. This is essentially a red herring. Victoria used them, but so did NSW. Under Australian public sector pay arrangements, even the leaner ones that have operated in NSW since 2011, when the incoming O’Farrell government instituted a 2.5 per cent cap on public sector wage rises, police are expensive. Take note of the absence of police in triple-time pay periods. Understandably, the Victorian Police Commissioner wasn’t having his already stretched wages budget trashed further; private security firms seemed an obvious suggestion.

NSW had more capacity to use its police than Victoria (Mick Fuller rarely loses at Expenditure Review Committee) but also grabbed the offer of free Australian Defence Force personnel to augment its efforts. Significantly, it also used private security guards. Why ever not?

It’s the supervision question. Who was telling 20-something-year-old bodybuilder security guards (with an assumed zero knowledge of infection control) what to do and making sure they did not risk their own health? Again, both Victoria and NSW had health officials on site, but the Victorian officials told the inquiry they were there to “co-ordinate” health advice and cavilled at the suggestion that their team leaders were “in charge”. There was no such doubt in NSW; NSW Health was the boss.

Reading the report, which I have done with morbid fascination, is to read a litany of contradicting answers, Keystone Cops falling over each other. It gets down to the decision-making steps and minute-taking at senior executive meetings. As the Coate report reveals, there were none. Because when you follow the rules of meeting procedure, the reason for every decision needs to be documented. This has the added benefit of the group actually making a decision. Sadly, these tedious niceties went out the window.

Finally, there’s the question of who’s running the show. Is it the public service or the elected government? As the report archly documents, the Victorian health minister at the time, Jenny Mikakos, barely understood what was going on and didn’t think to ask. Martin Pakula, Minister for Jobs, Precincts and Regions, didn’t know much either and again, did not ask. Even when a security company that was not on the preferred tenderers’ list got the bulk of the work, the minister didn’t ask. Did the department not think it worth providing an explanation, assuming at some point, this might become a matter of interest to the Auditor-General? By the end of volume two, there was still no explanation for this brazen decision to give millions of dollars to a security firm that hadn’t made the cut.

And what about the secretary of Health and Human Services, Kym Peake, ignoring the Premier’s written instruction to focus solely on the pandemic response? Was there a letter back explaining why he was wrong? No wonder the Premier didn’t refuse her resignation.

It is true ministers are told to stay out of operational matters and there are certainly risks in making decisions that go against departmental advice. In the case of NSW, Gladys Berejiklian’s managerial strengths enable her to drive the decision-making, but all ministers, like board members, have a duty to ask questions. Their ultimate public accountability entitles them to answers and good ministers often provide exactly the informed questioning that tests a decision the public sector, with its very different mindset, may have got wrong.

Ministers also think on their feet. Sydney has the second largest consular corps in the world; the advice was not to hotel quarantine returning diplomats who, under international law, cannot be charged if they refuse to do so. Instead, a minister suggested health officials ring them at home several times a day, every day, to check they are where they said they would be for 14 days.

In my experience, ministers of any political persuasion are conscientious and hard-working, only too well aware that it is they who swing first at the end of a political rope if all goes wrong. Ask Jenny Mikakos … whose ghost should now be heard, demanding public sector reform.

NSW backs Scott Morrison's gas plant as 'critical' for state's renewable ambitions

NSW is smoothing the path for a prominent piece of the federal government's gas-led recovery by granting critical infrastructure status to plans for a Commonwealth-funded gas-fired power station in the Hunter Valley.

Planning Minister Rob Stokes declared the federal government's gas plant proposal as Critical State Significant Infrastructure on Wednesday to standardise and streamline the project assessment process.

"Gas-fired power stations will have a critical role to play in ensuring our energy security as we transition to a low-carbon emissions economy with renewable energy projects such as wind and solar," Mr Stokes said.

"As well, this project could create jobs for up to 600 construction workers and generate around $800 million worth of investment for the local economy."

NSW announced in November a strategy to become a "renewable energy superpower" and stimulate construction of a whopping 12 gigawatts in new wind, solar and pumped-hydro projects.

Prime Minister Scott Morrison and federal Energy and Emissions Reduction Minister Angus Taylor have said they would commission Commonwealth-owned Snowy Hydro to build a 1000 megawatts gas plant to supply dispatchable power into the grid.

Mr Taylor said he did not trust private industry to replace the baseload power which will be lost due the scheduled closure in 2023 of the 1000 megawatt Liddell coal-fired power plant.

If private power generators did not commit before April next year to build a total of 1000 megawatts "government will fill the remaining capacity", but only to fill a shortfall, Mr Taylor said in September. "If industry steps up, we'll step back."

The critical declaration from Mr Stokes lists a gas plant with capacity up to 750 megawatts, which indicates industry is expected to deliver at least 250 megawatts of generation by the deadline.

Energy analysts told this masthead in October that the independent Australian Energy Market Operator had not forecast any shortfall in dispatchable power supply due to the closure of Liddell.

The operator's forecast noted a potential shortfall of just 157 megawatts by 2022, but noted the NSW government had confirmed investment in 170 megawatts of dispatchable batteries.

However, Mr Taylor said 1000 megawatts of extra capacity was required to stop power price rises and that "government has always been clear - we need to see life extension or like-for-like replacement of Liddell".

The power station would be located on the former site of a demolished aluminium smelter at Kurri Kurri in the Hunter Valley.

The NSW state government also this week approved a $500 million underground coal mine proposal in the Hunter Valley.

Malabar Resources' Maxwell mine, located at Jerrys Plains, will produce around 8 million tonnes per annum of metallurgical coal which is used for steel making. The mine is expected to operate for 26 years.

The Independent Planning Commission said in a statement the potential impacts from the Maxwell mine are manageable, and the risks of adverse impacts on the environment are low.

Lock the Gate co-ordinator Georgina Woods said approval of the Maxwell mine "further entrenches an industry with a highly uncertain future" and Hunter Valley communities would "bear the brunt of this government stupidity".




1 comment:

Paul said...

Firstly, women, given access to power will ALWAYS bully each other, but that's not classical bullying, mostly that's just being a bitch. One problem unique to these times though which I have seen first hand many times now is that in the past Nursing occurred within a quasi-military structure in which nurses h coming in had to come up to a high expectation of competence and standards. What has happened now is that "bullying" has come to be defined as "anything that makes you uncomfortable" and this has led to it being used as a weapon against those who would try to correct behaviours and maintain standards because to do so can make someone feel bad about their behaviour or recognize how much they have to learn, and no-one wants to be humbled anymore by seeing where their real place in the structure lies at that time. Made to face their professional inadequacies, they choose, instead of mature self examination and improvement, to exact a revenge of sorts using the system as a tool of payback. A bullying accusation is actually quite hard to validate because it almost always comes down to subjectivity but, like with sexual harassment, the current climate demands that the accuser be believed first-up, therefore the process itself becomes the ordeal and the traditional means of behaviour and standards socialisation becomes frozen out for fear of the cost and time spent fighting a frivolous accusation (and the ones I've seen WERE absolutely frivolous). I have witnessed a real workplace bully in action and its very real when you see it, and very devious, and it came to a head and nothing was really done because she bullied a guy. I've seen the bullying card pulled simply because relationships had broken down or someone had demanded with some force that someone lift their game and do better. Its worse since Aboriginals started being gifted their qualifications by the Unis. They are untouchable and they know it, and its rare to meet one who can stand their ground professionally with their colleagues (I can think of one off the top of my head who straddles her heritage with her profession with a competence that few anywhere can muster but that's very rare).
I personally ran into trouble twice with Filipinos who pulled the race card, but luckily their supreme, undeniable incompetence tripped them up well before it came to that, and I understand the value of the paper trail as a means of self protection. One was in her final assessment at Uni where I was asked to assess students resitting prac exams. She had gotten all the way to the end and hadn't been pulled up on the most basic of mathematical skills: the drug calculation. She could have killed, but through her three years of study, no-one had called her out, and it was clear that all she did was copy the actions of what she saw others doing, instead of learning what was needed. I became the racist bully for refusing to pass her. (it didn't get far because her fail was the same for the re-sit as it was for the original exam, but I guess the point is no-one picked up on this for three years at the Uni).
Actually if someone can be sitting their final prac, but still can't perform the most elementary of drug calcs, it probably says more about the Uni (JCU, of course) than it does about the student.