SWSLHN + SLHN = SSWAHS

The NSW State Government's approach to health, immediately after the election, gets a big tick from Socrates for terminating the incumbent Director General of Health, Ms Debra Picone.

Her departure is possibly the first of many who will depart from a Health Department, populated as it was by the previous government and Minister, of political appointees who had their snouts in the trough to obtain the best outcome for themselves and their pet projects.

Now to the last thing the previous NSW government did before it was shown the door in March. On the 1st of January 2011, the Health Minister announced that the new Local Health Networks (LHNs) had commenced in NSW. This meant that the previous Area Health Services had, in many cases, been divided into (marginally) smaller LHNs.

For us in the Southern Highlands it simply reverted back to the partition of SSWAHS into the old Central Sydney AHS and the old South West Sydney AHS, with this time, an additional layer of bureaucratic governance with a CEO overseeing a cluster of such LHNs.

Now here was the catch. Previously the old SSWAHS had streamed their clinical services to provide their specialist services across the entire jurisdiction of the SSWAHS. This meant, for example, that cancer services, cardiac services, mental health services, etc, would be provided to, and be accessible by, all residents in the SSWAHS.

After initially stating that the Area-wide clinical services will still provide access to all the residents of the old SSWAHS it now seems that the current administration of the Sydney LHN (the old Central Sydney AHS) is suggesting that they have sole right to all the clinical services within the Sydney LHN jurisdiction. Put simply, that means no resident of the Southern Highlands can expect to have access to the clinical services located at Concord Hospital, Royal Prince Alfred Hospital, Sydney Hospital, Balmain Hospital and St Vincent's Hospital.

This may seem very little loss to residents in the Southern Highlands as we still have access to Campbelltown Hospital, Camden Hospital, Liverpool Hospital and Bankstown Hospital as well as our own Bowral Hospital. The reality is, however, there are not a sufficient range of medical specialties in Bowral, and Camden Hospitals and the distance to Bankstown Hospital is considerable.

So, for example, suppose someone in the Southern Highlands requires treatment and residential care for an acute mental illness. Bowral Hospital has a couple of beds available for people with a sub-acute episode which does not require involuntary treatment. The beds are embedded within the whole complement of available beds in the hospital so they could be available, but then again, they may not. And what if the person requires an involuntary treatment and admission?

In the old SSWAHS people from the Southern Highlands requiring specialist treatment in one of the old clinical streams went first to Campbelltown Hospital and then to Liverpool, Concord, RPAH and Bankstown hospitals wherever the specialist beds were available. With the new LHNs our residents will be limited to Campbelltown, Liverpool and Bankstown hospitals.

Another feature of the old SSWAHS was that the local health funding for Bowral Hospital and its Community Health Services was drawn back into the specialist Clinical Divisions to fund, among other things, the budget over-runs of the big northern hospitals. It was also used to fund the budget over-runs and other capital costs associated with the building and renovations of the big northern hospitals. At the same time, Bowral Hospital survived on the donations and fund-raising of the local people, businesses and community groups to fund our two renal dialysis chairs and the refurbishment of the children's ward.

It is, perhaps, not unexpected that a SSWAHS Executive, that was appointed by the previous NSW Labor government, was drawn mainly from the old Central Sydney AHS. After all the previous Labor Minister for Health has her seat in Marrickville - central to Central Sydney AHS. The SSWAHS CEO, his Deputy and most of the Directors and Executive members all came from Central Sydney AHS. Some, but not all have headed back to the Sydney LHN taking with them the bulk of the funding and the capital works developments of Concord Hospital and RPAH.

As I have said in the blog many times, SSWAHS administration has overlooked Bowral Hospital and the Southern Highlands, probably because it was seen as a "safe" Liberal seat. Now that we have a new Liberal/National coalition government we appear to be again overlooked because we are an even "safer" Liberal seat!

By now some of you may be wondering why the title of this blog posting has changed to SWSLHN + SLHN = SSWAHS. Well, it does seem as the wheel may have turned full circle again. An informant has told me that the Federal Labor government is unhappy about the additional layer of bureaucracy imposed on the NSW health system with the LHNs and the LHN Cluster overseers. It would appear that even prior to the dismal showing of the NSW Labor government in March they had been advised to revert back to the super Area Health Services. Hence, the Southern Highlands will likely come under a re-formed SSWAHS but, hopefully, without the Executive misfits who always found it hard to look beyond Campbelltown.

Socrates, ever the optimist, is hoping that the new coalition government, and their new Director-General for Health, will not only accept the advice of the Commonwealth but also ensure that any new NSW health structure will take into consideration the possibility of local members having a greater say in their local hospitals, and that funding be commensurate to ensure that the hospital and community health services can provide the services required by the local people, locally.

SSWAHS - Dr Victor Storm and those problems of files lost in the public domain!

Socrates's internet trawl to find even more evidence of the stumbling efforts of SSWAHS to manage even the simplest tasks came up with this gripping expose by "The Age" newspaper about the time when Dr Storm was doing his best to organise the transfer of the Rozelle "asylum" to his new Concord "asylum" - the one that he thought the Liberal Party should not build in 2002!

Private files put on street for all to read

Matthew Moore "The Age"
Freedom of Information Editor
May 6, 2008

PLASTIC wheelie bins full of confidential documents were left outside Rozelle Hospital in a last-minute rush to move the hospital to its new site at Concord.

Staff records, including details of criminal convictions and personal medical histories, were jammed into the bins along with minutes of meetings and disciplinary proceedings.

A letter lying at the top of one of the bins details an altercation in January 1991 between a cleaner and his supervisor, who had asked him to clean some windows.

"Mr A [name deleted] … threw a garbage tin of rubbish on the ground and also said he would kill Mr S … [name deleted]," an exasperated manager notes.

Other documents detail the property staff members have failed to return over decades.

Records from the Child Support Agency detailing maintenance deductions the hospital was required to make for individual employees are also included in the thousand of pages of personal documents.

Anyone wandering through the open hospital grounds, popular with dog walkers, was free to leaf through decades of documents left in the driveway of the administrative and information building, which closed its doors at the site last week.

Half a dozen wheelie bins left in the driveway of the administration block were locked but six others were open or secured only with adhesive tape applied by desperate staff members unable to get enough bins to secure documents they knew to be confidential. Two of those bins carried notes headed "Confidential documents".

The notes, written by a staff doctor, Graeme Halliday, said: "To Whom It May Concern, Ive been requesting confidential paper bins for at least a week before the hospital closed but could not get any. Transport kindly delivered these on Thursday May 1st, but I didnt realise until I had filled them - they are in fact not for the disposal of confidential documents. Quite happy to return to help transfer these to confidential bins if someone can help me obtain these."

Yesterday Dr Halliday was furious the bins had been left outside the building and said he had done his best to ensure their contents were properly disposed of.

He said he had worked until midnight on Saturday trying to dispose of documents he had no time to finish packing as he had had a full patient load during preparations for the move.

He had left all the bins locked inside the building on Saturday night and was uncertain who had moved them outside.

Dr Halliday drove immediately to Rozelle Hospital when he heard the documents were outside to ensure they were secured.

In other parts of the hospital grounds staff record cards spilled from torn plastic bags before a compactor truck arrived yesterday afternoon.

The director of mental health for the Sydney South West Area Health Service, Dr Victor Storm, said only two normal bins had been used for confidential waste. The bins had been put outside by accident yesterday morning.

"Both the secure and general waste bins have since been locked away, and a collection is now expected later this week."

I suppose we should be grateful that "only two normal bins had been used for confidential waste."

There, doesn't that make us all feel better? Obviously, Dr Storm and SSWAHS seem to think so.

SSWAHS - Dr Victor Storm, and the backflip of the decade!

Socrates has noted that there has been some more interesting "spin" from Dr Storm, who now presides over his far-flung empire from his new Centre for Mental Health at Concord Hospital. This is his take on the changing world of psychiatry in 2002 when the NSW Liberal Party gave consideration to re-building a new mental health facility on the grounds of the (then) existing Callan Park site at Rozelle. At that time Dr Storm railed against the notion of building a new "asylum" for the mentally ill saying, in part, that "It completely contradicts best practice in mental health care, which supports integration of acute psychiatric care into mainstream general hospitals."

Hmmm! This is strange coming from the person now in charge of "a 400-bed hospital on the (Concord) site (which) would create the biggest stand-alone mental health facility in Australia."

I suppose calling a 400-bed inpatient mental health facility a "Centre" instead of a "Hospital" gets around the embarrasment of having achieved with a NSW Labor Government something that Dr Storm, in 2002, did not want to achieve with a NSW Liberal Government. Ah well! Come March 2011, the political landscape could be quite a different colour.

New 'asylums' no answer to mental illness

By Victor Storm
April 22 2002

A proposal, reported in the Herald, (Psychiatric care gets $80m boost in Lib health plan, April 9) to rebuild a new 400-bed psychiatric facility on the Rozelle Hospital site in Callan Park, in Sydney's inner west, should be ringing alarm bells everywhere.

A 400-bed hospital on the site would create the biggest stand-alone mental health facility in Australia. It completely contradicts best practice in mental health care, which supports integration of acute psychiatric care into mainstream general hospitals. Other Australian states and most other countries are closing their stand-alone facilities and not building new ones. Victoria, for example, no longer has freestanding psychiatric hospitals.

When people attach a huge stigma to mental illness, they prefer to lock away patients behind closed doors. We need to reduce the stigma associated with mental illness, as it affects all of us.

Mental illness is increasing in incidence and in economic cost to society.

The figures are stark. By 2020, major depression will be one of the two most prevalent diseases worldwide. Only cardiovascular disease will exceed it in numbers and in burden to society. Already mental illnesses, excluding drug and alcohol abuse, account for four of the top 10 causes and 30 per cent of the total burden of chronic disability in Australia.

The move of mental health facilities into general hospitals is not new. It has been part of mental health policy in Australia and worldwide since the 1950s. The Richmond report, published in 1983, further accelerated the move towards de-institutionalising care.

The National Mental Health Strategy includes changing the service mix from stand-alone facilities to integrated community and hospital services. It has also brought consumers, carers and clinicians closer together to improve the care given to the public.

At Rozelle Hospital, regarded as one of NSW's lead agencies in mental health-care delivery, we struggle to provide modern and safe care in buildings which date back to the 1920s. Once, thousands of patients were locked away and cared for long term in an asylum.

Many people associate long-term asylum care with tabloid horror stories. Fortunately, the findings of the Royal Commission of Inquiry into Callan Park Mental Hospital are far behind us.

Psychiatric inpatients are very ill. Mental health services all over the world are struggling to cope with patients whose illness is complicated by illicit drug use and sometimes associated violent behaviour.

While this is a challenge for all involved in the care of the mentally ill, the answer is not to reinstate the old asylums. The reasons to move the focus of care away from institutions remain sound.

Most people who live with a chronic mental illness do not want to be quarantined in large 19th-century asylums. They want access to 21st-century care in modern hospitals when they need hospital care, with the ability to live in appropriate housing, like any other citizen, for most of the time. To achieve this we need more quality supported accommodation and group homes throughout metropolitan Sydney and regional NSW.

We propose to upgrade most of our inpatient services at Rozelle service by moving them to new state-of-the-art facilities at Concord. The psycho-geriatric nursing home beds will be moved to another nearby site.

As well as reducing the stigma associated with mental illness, mainstreaming the patients allows us to treat the whole person and to attend to all relevant health problems.

As in all fields of medicine, new and powerful drugs are a major component of the treatment of most ill people. These patients require careful assessment and monitoring. They need access to diagnostic services and to treatment for other illnesses. People with mental illness often neglect their general health and it isn't until they become inpatients that we effectively manage co-existing illness, such as diabetes or hypertension. This overall treatment is best carried out in a general hospital.

We admit 2,200 patients to Rozelle each year. Each month 80 people are admitted to general hospital for care and treatment. We have to transport 100 a month for imaging and other investigations and conduct 1,500 pathology investigations. These investigations should be carried out on one site.

The proposals to move services at Rozelle to the Concord campus go a long way to addressing the hospital treatment needs. Accommodation and support services outside of hospital must also be addressed to provide people with appropriate care options.

Everyone involved in mental health foresees future care as a major challenge.

Dr Victor Storm is a psychiatrist and clinical director of mental health services at Central Sydney Area Health Service.