SSWAHS and its view of how the "Code of Conduct" should be interpreted

Let's take another look at how the SSWAHS executive interprets its "Code of Conduct" when it comes to complaints about its staff.

Here's another gem from the Bowral community members. A complaint is made to the manager of one of the local services about comments they have made to their staff about a community member are inappropriate and contrary to the Fair Trade Act (among others) and could be seen as defamatory. This time the complaint, made on 16 October 2009, is forwarded to SSWAHS Area executive. Socrates has been given a copy of the response to the complainant from someone who goes by the name H.E on behalf of the Director of Corporate Services.

"Dear Mr ........

Subject: Allegations in relation to Mr ..... .......

I refer to your correspondence dated 16 October 2009 in which you allege that you have received reports from unnamed sources to the effect that Mr .... .... (... ....) has expressed opinions in relation to referral processes between the Mental Health Service and yourself in the capacity as a private clinician. The matters raised in your correspondence have been investigated by Area Mental Health Services and I have been informed as follows.

Mr ..... denies having made any statements to staff and/or others in relation to the (sic) whether the Mental Health Services should refer clients to you. I am advised that in accordance with NSW Health Policy, the Mental Health Service has had a long-standing practice of providing clients who require private sector services with the names of a range of clinicians who practise in a geographical area. This information is provided without commentary or opinion being passed by Health Service staff in relation to the skills of any of the clinicians listed. I am also advised that the expectation that this practice continues to be followed was reconfirmed by a senior manager within the Mental Health Service at a recent meeting of the Bowral Mental Health Team.

I would be grateful if you could direct any further concerns that you might have in relation to service interaction between yourself and Bowral Mental Health, and/or the actions of any Health Service staff member, to Mr William Midson (Service Manager, Community Mental Health Wingecarribee/Bowral). Mr Midson can be contacted by email william.midson@sswahs.nsw.gov.au or telephone 4629 5414.

If you have any further questions in relation to this matter please do not hesitate to contact me.

Yours sincerely,

H.E.
pp Jan Whalan
Director of Corporate Services
Date: 23 December 2009

Again, we seem to have the SSWAHS policy of simply asking the person against whom the complaint is made to decide the outcome. Hardly consistent with the Code of Conduct 1.5 Fairness in Decision Making: ..."I will deal with issues, cases of complaints consistently, promptly, openly and fairly".

What a pity that the investigator of the " investigation by Area Mental Health Services" didn't bother to ask any of the staff present at that Tuesday morning staff meeting at which the statement was made by Mr .... , what they were told by him in no uncertain terms. Instead SSWAHS simply relied on Mr ....'s word that "No, I didn't say that." Ah well! At least there was an opportunity to respond according to the H.E. letter: "If you have any further questions ...... please do not hesitate to contact me."

Well, I'm informed that the complainant took up the offer and on 31 December penned another letter to Ms Jan Whalan, Director of Corporate Services. In summary, the letter suggests that the SSWAHS investigator revisit the complaint and speak with other staff (even a consultant psychiatrist) who were present during the meeting at which the statement was made by Mr ..... . It was also suggested that clients of the mental Health Service were not advised that they could be given a list of private practitioners in the area to who they could be referred. It was also noted that a SSWAHS employed psychiatrist in Bowral was making direct referrals of his public patients to a private practitioner in the Bowral area in apparent contravention to the "long-standing practice of providing clients ... with the names of a range of clinicians who practise in a geographical area without commentary or opinion being passed....". This was in contrast to other consultant psychiatrists employed by SSWAHS had been advised that they were not to do so.

I suppose the "If you have any further questions in relation to this matter please do not hesitate to contact me" really didn't say "However, if you do - don't expect a reply". You guessed it - the complainant is still waiting for the response from that second letter.

As a side note to the response from SSWAHS, when the Manager of the Wingecarribee/Bowral Mental Health service was asked for the list of local clinicians which was made available to clients of the Bowral mental health service, the response was that very few clients asked for any list and any that did would simply be told to look up the local Yellow Pages.

I guess this is the classic case of the right hand (SSWAHS) not knowing what the left hand (Bowral MHT) was doing. Perhaps this is a timely lesson for Highlanders using any of the local SSWAHS health services to ask for a list of local clinicians in private practice that they might ask for any continuing service. Just don't depend only on the local Yellow Pages for the answer.

SSWAHS and that "Code of Conduct" it follows.

It's a great line isn't it when an organisation can fall back on the NSW Health's "Code of Conduct" for its defence of how they manage their health services, including any complaint made about those services or senior staff of theirs.

Let's just take as an example the one mentioned in the previous post. A complainant strongly believes that there has been a systemic failure in SSWAHS. They make a complaint known to the CEO of SSWAHS on 16 November 2009 and are advised on 23 December 2009 that the matters raised would be investigated and a written response issued. We now know that either the matter was not investigated or there was nothing to report, because no written response was issued.

Okay, then - let's see what their "Code of Conduct" has to say about that.
Paragraph 1.5 Fairness in decision-making, which is on page 18 of the Code states:

• I will deal with issues, cases or complaints consistently, promptly, openly and fairly.
• Act fairly and reasonably when using any statutory or discretionary power that could affect individuals within or outside NSW Health.
• Avoid any unnecessary delay in making decisions or taking action.
• Take all reasonable steps to ensure that the information I act or decide on is factually correct and relevant.

Paragraph 1.6 Appealing Decisions, also on page 18 states:

• I will promptly inform individuals who are adversely affected by or who wish to challenge a decision, of their rights to object, appeal or obtain a review. I will also inform them how they can exercise those rights.

Hmmm! SSWAHS, do you really think that eight or more months is about being "prompt"? Do you think that not providing any response is "open" or "fair"? Or is it perhaps indicative of avoiding "any unnecessary delay in making decisions or taking action".
And, when an individual does challenge one of your decisions, when do you "promptly inform them.... of their rights to object, appeal or obtain a review"? Perhaps after they die?

SSWAHS and its broken promises...

We've had the spin doctors of SSWAHS working hard recently to disinform the revolting residents of the Southern Highlands. But the fine art of the SSWAHS media unit staff has been in evidence for a much longer time.

Allow me to demonstrate. This is a letter from the CEO of SSWAHS to a local resident who had raised some concerns related to senior administrators in SSWAHS.

"Dear .....,

RE:Complaints about Sydney South West Area Health Service Employees

I refer to your correspondence to me dated 16 November 2009 concerning a complaint about Ms .... ....., dated 16 November 2009 concerning a complaint about Dr .... ......, dated 16 November 2009 concerning a complaint about Mr ... ......

The contents of your correspondence have been noted.

I am advised that Mr Graeme Slade, Designated Senior Complaints Officer Sydney South West Area Health Service sent letters to you on 18 November 2009 and 19 November 2009 advising that your complaints were being investigated and that you would be provided with a written response upon the completion of the investigation.

If you have any questions in relation to this matter please contact Graeme Slade on 9828 5958.

Yours sincerely,
Mike Wallace
Chief Executive
23/12/09"

Reassured that Mr Graeme Slade would be diligently investigating the complaints the recipient of the letter waited ... and waited .... and waited and as of today Socrates has been advised that no written response has been forthcoming, nor has Mr Slade even bothered to contact the complainant about any aspect of those complaints made in November 2009! Perhaps Mr Slade has died, or perhaps he and Mr Wallace think that the complainant has died! That seems to be the preferred option of SSWAHS in dealing with complaints. Outlast the complainants.

It reminds me of the movie "Oh! What a Lovely War" where the British generals kept a tally of the dead and wounded and considered that they were winning because they had less casualties than the Germans.

Sorry to tell you this Mr Wallace - but your complainant is still alive ..... and waiting!

SSWAHS and it's own internal investigations - is that really "governance"?

It's been said about many government departments that the practice of the organisation investigating complaints about it's own senior or other staff is open to abuse. Try referring the complaint to the government watchdog - the Ombudsman's office - and you will simply get a response like "you don't appear to have asked the Area Health Service or the Department to investigate the matter". There is generally a suggestion that you send the issue to the CEO of the organisation or Department (or both) and wait for a response. When a non-response or disputable response comes back, the Ombudsman's office simply suggests that they don't wish to use their scarce resources on such matters. Sound like a brush-off? Well it really happened that way earlier this year. So the question needs to be asked if the Ombudsman's office is really structured to protect the public interest.

On 24 February 2009 a complaint was lodged with a Clinical Director of one of SSWAHS clinical streams. The complaint raised a number of issues related to the perceived conflict of interest and improper conduct by a senior administrator who carried out an investigation in which the administrator appeared to have an inappropriate relationship with the person making a complaint about a SSWAHS service and personnel.

The SSWAHS Clinical Director did not follow usual protocol when receiving the complaint of conflict of interest and improper conduct, instead they ignored it until they were reminded of it on 30th April. On 4th May the Clinical Director wrote to the complainant stating "please be advised that Mr .... has been provided with a copy of your complaint and is being given an opportunity to respond." That was followed by deafening silence until the matter was raised again by a direct approach to the SSWAHS CEO. I wonder how many staff of the SSWAHS get the opportunity to read the complaint made against them and are given the chance to just ignore it? The final comment of the Clinical Director in his 4th May response was: "I will inform you of the outcome of my enquiries, in due course."

The eventual outcome was that the Clinical Director did respond - in December 2009, at which time he repeated that the complaint had been investigated by the person being complained about and they had convinced the Clinical Director that they had not breached the NSW Health Code of Conduct. Oh really?! Perhaps we can save a lot of time and money by simply asking people committing illegal acts if they would like to investigate themselves and determine what sentence they'd like to impose on themselves. Think of the police, judicial and corrective service savings the community would gain. Perhaps the savings could be applied to upgrading Bowral Hospital to reflect the age and growth of the Highlands population.

Anyone can view the NSW Health Code of Conduct on their website. One thing it states is that complaints must be dealt in a transparent and timely manner. Yes SSWAHS, that sounds like the way it was done, doesn't it!

SSWAHS and its brush-off of concerns raised in the Southern Highlands

"Keep it short, make it simple, and say nothing" possibly epitomises the thinking of the senior executive members of any Area Health Service or Departmental bureaucrat. However, SSWAHS has learned to refine it to an art form. If it wasn't so serious an issue one might be tempted to stand and applaud the sort of misinformation and disinformation rolled out by the SSWAHS executive.

At any time an Executive which, having learned the hard lessons from Campbelltown Hospital, and seemingly so principled in the application of "clinical governance" would be expected to have transparency and haste to resolve any conflict they might have or generate. Not so with SSWAHS.

One patient from the Highlands who made a serious allegation of professional misconduct of a staff member was eventually contacted by a senior bureaucrat of the SSWAHS mental health service. That is, they tried to phone the patient, maybe once or twice. They then left a letter for the patient to be given it by the staff at the treating unit. The patient was so offended by the patronising approach of this bureaucrat that they failed to respond to the letter. SSWAHS carried out no investigation of the alleged misconduct while that person remained in their employment. When the staff member resigned SSWAHS then sent the patient a letter stating that since the staff member was no longer their employee they could not do anything about investigating the complaint. There was no reference of the complaint by SSWAHS to the registration board or the HCCC for their information or investigation. Some months later an advocate made a formal complaint to the HCCC about the allegation. The matter was sent to SSWAHS for investigation and comment.

The usual practice was for the SSWAHS to be required to respond to the HCCC within 60 days. At the end of the 60 days SSWAHS asked for an extension. At the end of the following 60 days SSWAHS asked for another extension. Within 14 days they were able to inform the HCCC that they could now finalise the complaint investigation.

Why, you might ask, did it take so long for them to investigate something that they had already investigated previously. Well quite simply, that 130 days was just how long it was for the patient, who had made the original complaint and allegation, to die from an inoperable lung cancer. The patient's terminal condition was well known to SSWAHS because they had been providing treatment and palliative care in Bowral Hospital and community nursing services. Unfortunately, HCCC agreed with SSWAHS that it was now too late for the matter to be resolved.

Call me a cynic.... and maybe there's a glass of hemlock waiting for me in some part of SSWAHS, but really.....! Come on SSWAHS, you certainly know a thing or two about transparency, timeliness and clinical governance.

Lines of communication opening at Bowral Hospital

TRAVIS HOLLAND - SHN

21 Jul, 2010 02:02 PM

"NSW Health bureaucrats and the Parliamentary Secretary for Health have recently written to residents to advise they “regretted” the public might have been misled by recent reports suggesting services would be downgraded.

Each of these letters listed a variety of upgrades and improvements at the hospital.

They each had almost identical wording, despite being signed by different people.

A key claim of these letters was that “many patients have been happy to be referred to other hospitals”.

However, despite repeated requests, SSWAHS has been unable to refer any of these patients to the News to confirm those claims.

Health service short on words

In response to five detailed and specific questions about Mr Illek’s meeting with Denis Thomas, the News received the following two-sentence statement from SSWAHS.

“Bowral Hospital management regularly consults with the local community to receive their feedback on local health services.

“Yesterday’s (Monday) meeting was constructive.”

This information, as reported recently in the Southern Highland News and in the YourTimes monthly, is simply the usual spin put out by the media unit of SSWAHS. Anything that might now go wrong with the lines of communication will, no doubt, be dumped at the door of Denis Thomas, the hardworking General Manager of the Bowral Hospital outpost of the SSWAHS Empire.

Should we be surprised that letters from different people within NSW Health and SSWAHS should be so word perfect with just the names of signatories changed? Write a letter to the Minister or the Minister assisting the Health Minister and you can expect it to be bumped down to a lesser bureaucrat further down the food chain in the SSWAHS for a response that the Minister or some more senior bureaucrat can sign and send.

But don't hold your breath while waiting for something meaningful to come back in response. I know of one instance where a letter complaining about certain health services in the Highlands was sent to the NSW Health Ministers in September 2009 which went without even an acknowledgment to the correspondent. A reminder letter with copies of the earlier letters was again sent in April 2010 with the same result. Again, no response to the current date. The same letters sent to the Director General of Health and the CEO of SSWAHS generated a cursory note from the CEO of SSWAHS stating that a senior investigation officer of the Area would be following up the complaints.

That was on 28th November 2009 and, to date, there has not been any contact from that nominated person to the complainant. One could suggest that before we should expect the opening of the lines of communication between the community and Bowral Hospital we should, at least, expect to see some evidence of the lines of communication opening from the people in SSWAHS who have been so quick to reassure our community that communication lines at Bowral are now open.

I for one choose to remain unconvinced, by the evidence above, that any senior bureaucrat or executive member of SSWAHS is even slightly interested in the health of the Highlanders.

Bowral Hospital and Community Health Services

Bowral Hospital and the people of the Southern Highlands need more local control and management over their hospital and community health services.

The remote, micro-managed, executive control of our local health services by the Liverpool based Sydney South West Area Health Service (SSWAHS) has failed our local people.

SSWAHS has done this by starving our local health services of funding enhancements, specialist services, and infrastructure building programs.

Why and how? SSWAHS has done this by diverting any additional capital and service enhancement funding to their metropolitan based hospitals – Liverpool, Campbelltown, Concord and Royal Prince Alfred Hospitals.

In the meantime they have left the Southern Highlands community to raise their own funds for health services development and essential capital works.

Ø The Renal Appeal by Rotary and the local community has ensured that local people requiring dialysis can receive the necessary treatment at Bowral Hospital. The only problem is the reluctance of SSWAHS to provide the staff to assist in treating local dialysis patients at Bowral Hospital.

Ø The Children’s Ward Appeal by the BDCU and the funding provided by the local community finally embarrassed the SSWAHS Executive to allow the renovation of the Bowral Hospital’s Children’s Ward.

Ø The local community’s response to the two Cancer Walks has provided the resources at the Cancer Support Services based at the SHPH Day Treatment Specialist Centre in Bowral.

Ø The local CanAssist Cancer Support group has raised much of the funding applied to resources and services to palliative care patients at home.

In the meantime, necessary community and hospital health services continue to struggle with the local demand: drug health services, social work services, mental health services, women’s health, sexual assault, palliative care, community nursing, child and family health nursing, child and family psychological services, dental services, aged care services do not have enough resources (mainly staffing) to provide the same level of care to our local community that is provided to, and expected by, the metropolitan communities. Those in the local community who have to wait for these services would confirm this poor state of the local services.

The SSWAHS Executive is suggesting that specialist services can be accessed by our community travelling to Campbelltown or Liverpool. They obviously don’t know of the difficulty of travel to the metropolitan areas from the Southern Highlands! Some of them don’t even know where to find Bowral or have difficulty in travelling any further south than Campbelltown.

Ø To ask sick Highlanders to travel 74+ Km to the hospital at Campbelltown and to wait 4+ hours in the Emergency Department or Outpatients to be seen and treated is appalling, yet typical of the thinking of the bureaucrats who make up the SSWAHS Executive and Clinical Divisions.

Ø Mental health patients requiring involuntary admission to SSWAHS mental health facilities may start at Bowral Hospital but then have to be transported to an already overworked Campbelltown Hospital Emergency Department, and perhaps in many cases be re-transported to Liverpool, or Concord, or RPA hospitals for their treatment. Mental health patients in the community are not being well supported by the current service providers because of the higher priority need to deal with acutely unwell mentally ill people.

Ø Drug health patients requiring specialist detoxification will be required to travel to Fairfield Hospital for their treatment. The two drug health staff members at Bowral are required to provide all assessment and treatment services to the Hospital and the community health centre.

Ø Social work services at the hospital and community health centre have constantly complained that there is a lack of staffing sufficient to meet the needs of both inpatients and those who attend the community health centre. Their role in comforting bereaved families, in supporting victims of road trauma, in supporting mothers of still-born infants, in providing social support to the indigenous community, to the displaced and disadvantaged cannot be met by the current allocation of social workers at Bowral.

Ø Parents waiting for psychological assessments by the Child and Family team at the Bowral Community Health Centre are often waiting for weeks and may even have to self-prioritise their needs against the needs of other families.

Ø Urgent dental treatment at Bowral Community Health Centre is sometimes several weeks wait for local people. The reason is that qualified dentists are in short supply at Bowral, and the administration of their clinical stream is based in Sydney.

Ø The Aged Care Assessment Team (ACAT) struggling with the increased referrals in aged care treatment.

What the SSWAHS Executive does do well is to alienate local private practitioners and to ignore the contribution that local general practitioners, allied health professionals, psychologists, social workers, addictions experts, psychiatrists, counsellors and non-government organisations who can, and do, provide excellent clinical services for the people who attend their practices.

The SSWAHS Executive and Clinical Directors could do more to utilise the local private practitioners in care coordination, ongoing treatment, monitoring health and well-being of the local patients that their limited SSWAHS services are unable to cope with.

Instead, the local SSWAHS services are restricted by their Executive and often fail to be proactively supporting their patients to seek out private practitioners for ongoing care, treatment and support.

Ø Medicare Australia has made it much easier for patients seeking ongoing treatment for chronic disease conditions, for mental illnesses, for pregnancy support and for access to ongoing health services for Indigenous people. This is usually available through their general practitioner, or psychiatrist.

Ø If you are a patient of one of the Hospital or Community Health Centre health services ask them for a list of local private practitioners in your area so that you can inform your general practitioner of your choice.

Finally, what if SSWAHS stays in control of our hospital and community health services? Will it be more of the same? Will they continue to strip away the clinical services that our growing population should be expecting to have local access to?

And if this is the outcome what can we as a local community in the Southern Highlands expect to see?

A Bowral Hospital without specialist services will become an Emergency Department outpost for Campbelltown Hospital. Local maternity, surgical services, inpatient treatment for cardiac and stroke patients will be moved north. Our aged population, which is constantly increasing with retirement villages and the expanding aged care residential facilities, will be travelling north if they require hospital based treatment.

Or perhaps Bowral Hospital will become another Balmain Hospital in the SSWAHS Grand Plan. A Geriatric Hospital denuded of all health services not relevant to aged care.

If this is NOT what YOU want – then become an advocate, an activist, or an agitator. Make your voice heard NOW by SSWAHS!

If you are happy with the current micro-management, control and plans of the SSWAHS Executive and Clinical Directors – then do nothing! But don’t complain in the future if you don’t get the health service at Bowral that you or your family need!

SSWAHS fails the Bowral Health test

With the Federal election imminent and the NSW election early in the new year there must be some disquiet among the corridors of power in Liverpool! With the results of either election the monolith of the Sydney South West Area Health Service is about to be cut down. At least the people of the Southern Highlands will have the satisfaction in knowing that whether the colour of governments changes from red to blue (or remains the same) we will at least have some say in the structure and direction of our local health services.

Whatever the outcome of the elections we in the Highlands will be at last moving forward rather than taking the backward steps imposed upon us by the SSWAHS executive in Liverpool.

You know that you've been in trouble with the local health services and how they were managed when the very people who are meant to manage them cannot even find their way to a town like Bowral. True! One senior manager of one of the clinical streams in SSWAHS missed all those four larger than life RTA signs at the top of Catherine Hill pointing to the off-ramp from the F5 for Bowral and the rest of the Southern Highlands.

While the rest of the SSWAHS creamed off the funding for the health services for the executive staff they imported from the old Central Sydney Area Health Service, and for the machines that go "ping" for the medical and surgical clinical streams, Bowral Hospital was left to the hard work of it's staff and of the local community to raise the funds for the renal dialysis unit and for the refurbishment of the old Children's ward. If the hospital and local area auxiliary groups didn't raise the funds annually for basic equipment in Bowral Hospital we would have never got any clinical machine that went "ping".

The last word of this post is to the CEO and his micro-managing Deputy: the natives of the Southern Highlands are restless and are in revolt (perhaps even revolting) :-)