September 1 - 7, 2019: Issue 419


Pittwater residents’ fears about hospital services confirmed at Parliamentary Inquiry's first public hearing date

Photo: Chairman of SMVHC Parry Thomas and SMVHC Secretary Sue Martin before the hearing. Supplied.

Pittwater residents’ fears about local hospital services were confirmed by doctors at the first hearing of a Parliamentary Inquiry into the new Northern Beaches Hospital on Monday.

The NSW Upper House inquiry is investigating the hospital and its impact on Mona Vale and Manly Hospitals as well as the community.

Save Mona Vale Hospital chairman Parry Thomas said he was appalled to hear how the hospital was being run.

“The management and problems there underline the importance of our primary campaign objectives to get emergency, surgery, maternity, ICU and other acute services returned to Mona Vale Hospital,” Mr Thomas said.

Australian Salaried Medical Officers Federation of Australia president Dr Tony Sara told the inquiry committee the hospital’s private operator, Healthscope, had prioritised elective surgery over emergencies for the first month after the hospital opened on October 30.

He was not prepared to say categorically that this does not happen anymore.

And Healthscope state manager of NSW and ACT hospitals Stephen Gameran revealed that 17 patients had spent more than 24 hours in emergency at NBH during the first month of operations.

This was despite one of Healthscope’s key performance indicators being the amount of time patients spend in emergency.

Additionally, Dr Sara, who works in the South Eastern Sydney Local Health District, said the hospital had opened with empty stores in line with a “Just in time” supply policy, which he pointed out was inappropriate for a major hospital.

“Just in time is when you run out of a package of bandages or syringes then you order them from the supplier, whereas a big public hospital will have those things in the basement and intravenous [IV] fluid will maybe be in the pharmacy in the basement,” Dr Sara said.

“What they built was a private hospital and it had the tenor and the operations of a private hospital, not the tenor and the operations of a public hospital.”

North Sydney Local Health District chief executive Deborah Willcox said Mona Vale and Manly Hospital policies, procedures, protocols and models of care had been shared with Healthscope.

However, Dr Sara said medicos could not find them and NBH's policy committee had written only six new policies.

Worried by this lack of medical guidance, Dr Sara said that he had offered policies from one of the SESLHD's hospitals to Healthscope. However, his offer was rejected by the management.

Healthscope interim medical services director Simon Wood revealed that there have been at least two sentinel events at the hospital since it opened – clinically adverse events (or “near misses”) that health care systems try to avoid. This compares to 18 across the whole of the state last year.

No details of these events were revealed, although media reported one of them as involving a cancer patient having the wrong section of his bowel removed in June.

Evidence from Dr Sara suggested that serious problems still remain at the hospital with the electronic medical records system and the pathology provider, ACL, which could not provide proper anatomical pathology reports and accurately label all results.

“They are set up for a private hospital where it is light and easy and everything will be fine and … as of only a few weeks ago the pathology laboratory is still unable to do what is required for a public hospital,” Dr Sara said.

Dr Sara also said NBH was set up as a “two tier system”, although this was rejected by Ms Willcox.  

Areas with different levels of care included interventional cardiology, neurosurgery and intensive care, the last of which the hospital provided to private patients at a Level 5 and public at Level 4, he said.

Wards were no longer segregated for public or private patients, although junior doctors, who are paid by NSW Health to treat public patients, find they are doing overtime that includes treating private patients - because they feel they have a duty of care to assist when no other doctor is around to help them. 

Additionally, Healthscope would like them to clock on and off for shifts – a practice that represents the adversarial relationship the company had created, Dr Sara said.

“The junior doctors were told that they would have to tap-on and tap-off when they came to work and when they left,” he said.

“That does not happen anywhere else. Given the hours that young doctors do, in terms of unrostered overtime, they are never going to be there for less time than they are paid for.”

At the same time, the company had informed the junior medicos that they were locking them out of their common room and sleeping quarters.

Healthscope refuted claims from a number of submissions that its staff push patients to use their private health insurance rather than admit them as public patients.

But Mr Thomas pointed to the hospital deed that says the hospital is required to maximise the number of patients using private health insurance.

Evidence from NSW Health seemed to indicate it has very little insight into actual conditions at the hospital, although Ms Willcox said she spoke on the phone each day and met with management every fortnight.

She said her job was to manage the contract to purchase public patient services on behalf of NSW Health and ensure Healthscope met its legal obligations.

“In my role I do not have day-to-day management responsibility for the operations of the hospital in areas such as staffing, resources, planning or direct patient care,” Ms Willcox said.

However, she thought the problems at NBH were now resolved, saying that Healthscope is “working hard to provide a stellar performance”.

Interim CEO Northern Beaches Hospital Richard Royle said that by mid-July, over 80 per cent of patients rated the overall quality of treatment and care at the hospital as "very good", which was 11 per cent higher than in the first month of opening.

Mr Royle apologised for problems at the hospital and noted it had billed the government at a reduced rate as a result of the issues.

“The fact that the problems encountered during the early days of the hospital's operations were more significant than should have been the case is a failure on the part of our company, and for that we apologise,” he said.

However, Dr Sara said there was a need for much greater oversight of NBH, for it to be brought into government hands and integrated into the Northern Sydney Local Health District.

Six out of eight Australian hospitals run as Public Private Partnerships (PPP) had already failed and the likelihood was that the same would happen at NBH, he said.

The PPP model could never provide equivalent safety and services for the same cost as a public hospital, he said.

“It’s not possible to serve patients and shareholders at the same time,” Dr Sara said.

Mr Thomas thanked the 40 or more Save Mona Vale Hospital supporters who attending Monday’s hearing and said he thought it went well.

“We had an opportunity to put our case effectively and the questioning indicated that most of the MPs on the inquiry committee had an understanding of the issues,” he said.

Mr Thomas also paid tribute to other witnesses from the local community at the hearing.

Phil Walker, from the informal group Friends of Mona Vale Hospital, presented evidence from his freedom of information requests into the construction of the new hospital – in particular raising questions about the safety of its cladding and the external fire stairs.

Helena Mooney, from Friends of Northern Beaches Maternity Services, outlined the problems with the private model of obstetric care adopted by the hospital – especially the high rate of interventions at other Healthscope run hospitals. (Statistics for NBH will not be available until the end of next year).

Further hearings at NSW Parliament House will take place on September 23, October 1, and November 5. 

To read the full Hansard from the hearing visit: HERE

Report by Save Mona Vale Hospital Committee