SSWAHS and the Southern Highlands Division of General Practice - An unholy alliance?

SSWAHS has a way of ingratiating itself with subservient organisations by throwing a bit of money their way. This notion of buying friendship is not unknown in political circles. Ancient Athenian and Roman society was notorious for it, and little has changed in the intervening years.

What SSWAHS gets in return are organisations willing to do the work that SSWAHS should be doing for the health and wellbeing of the residents of its empire, and generally, the work is done for a pittance. The other thing SSWAHS obtains is the silence of the organisations it funds. Organisations that might normally be advocates, activists or, the gods forbid, agitators on behalf of the marginalised and vulnerable in the SSWAHS empire bite their lips and remember the cheque is in the mail.

A classic example in SSWAHS is the Southern Highlands Division of General Practice. This Division is supposedly the representative organisation of most of the general practitioners in the Southern Highlands. Their website trumpets more about their links with governments - both state and federal - but mostly about their unusual relationship with SSWAHS from whom they seek both money and glory. This is what they say about SSWAHS:

"External Relations

A sound relationship has been established with the Sydney South West Area Health Service (SSWAHS) which reaches from Camperdown to Wingello covering seven Division areas. These Divisions have a close working relationship with SSWAHS.

Southern Highlands Division has a long established and close working relationship with the Wingecarribee section of the Area Health Service.

This relationship includes:

• a fully integrated diabetes service which is based on the CARDIAB data base
• an integrated program for secondary prevention in ischaemic heart disease to also be based on the CARDIAB data base
• the supply of medical services to the local CAPAC (Community Acute Post Acute Care) and the Palliative Care Program operated by the Area Health Service
• the Division's After Hours Service being designed to reduce the GP patient load on the Bowral Hospital Emergency Department as well as meeting GP and community needs
• regular Liaison Committee Meetings with the Area Health Service representative
• the Division is located in the grounds of Bowral Hospital
• close working relations between GPs and the Community Health Service and the Mental Health Service.

Being a rural area, Division members provide VMO services to the local hospital at Bowral (BDH). This includes 7 GPs providing one admitting officer at all times; four GPs providing low risk obstetric care; one GP surgeon. A number of members act as Medical Officers in the hospital Emergency Department. Members also serve on Area Health Service Committees including standing committees such as Quality Assurance and Clinical Council and various ad hoc committees."

In reading this one would think that this is an organisation that has the interest of all its patients and residents at heart. With such an involvement with SSWAHS and with such a "long established and close working relationship" with SSWAHS, one could be excused for thinking that with all those Highlands general practitioners, and especially those acting as emergency department doctors, Visiting Medical Officers, members of Standing Committees, and working in the Maternity Ward, they would have been advocates for their patients at the "save our hospital and health services" rally a couple of months ago. Apart from an orthopaedic surgeon, already known for his advocacy, there was no obvious representation from local general practitioners and none from their Division, which is situated on the grounds of Bowral Hospital courtesy of SSWAHS. There has been no public outrage from the Southern Highlands Division of General Practice and nor should we expect to see any for they tread the safe path.

Perhaps their Executive Officer and their Board should take the time to review their Division's Mission Statement and decide on whether they truly assist their members to provide the "optimum care to health consumers in the Southern Highlands area." It may be time that the Division and its Board recognize that they also have a responsibility to the residents of the Highlands to advocate more strongly to SSWAHS for the rights of those health consumers to have the treatments they need here - in the Southern Highlands! Perhaps now is the time for the Division to bite the hand that feeds it.

"Mission Statement

The mission of the Southern Highlands Division of General Practice is to assist local general practitioners in providing optimum care to health consumers in the Southern Highlands area."

Is it really so, Executive Director and Board members of the Southern Highlands Division of General Practice?

SSWAHS and their staff.

Now you might think that old Socrates is just gnawing on the bones of SSWAHS with the previous posts on this blog. Happily, I can tell you that there's still a lot of meaty bits on the bones of SSWAHS as we will see in the future.

However, let me be quick to make the point about the SSWAHS staff, particularly those who live and work in the Southern Highlands. Generally, they are faultless - with a work ethic that would shame the SSWAHS executive and bureaucrats in Liverpool and beyond. Apart from the exception of the person described in an earlier post, they do their work and make do with the very little that the SSWAHS administration provides to them.

There are people in both Bowral Hospital and the Community Health Centre who have spent many years engaging with their community, listening to their community and delivering to the best of their abilities the sort of quality health services that local people have expected and needed. In fact, the reason that Bowral Hospital and the community health services have been financially supported by the local community and businesses, to purchase equipment and develop specialist services, has been because of the respect that the community has for their District Hospital and its staff. Nursing, medical, allied health, and hotel services staff have all contributed their best in the care they deliver to their patients.

Too bad the same cannot be said about the executive staff of SSWAHS who rarely, if ever, even visit the Southern Highlands and, when the proverbial faeces hits the fan, they vanish like smoke and leave it to the local General Manager, Denis Thomas, to cop the flack and give the hard answers. Socrates believes that Denis Thomas doesn't get paid enough for his job! SSWAHS has put him out there with a bullseye painted on his back and nothing but an expired Harry Potter wand in his hand.

One consolation the Highlander community can have is that generally all the Wingecarribee staff are usually supportive of each other (apart from a notable exception) and remain determined to provide their best clinical and other support service to the community.

Socrates, at least, will attempt in this democracy to make his vote count in the upcoming elections, both Federal and State, to ensure that Bowral Hospital and its health services get the recognition it deserves and the local management which will give the best direction to our future in the Highlands.

Long may our democratic rights remain, and may our collective votes ensure the future growth of our local community.

And, if the Gods are really listening, perhaps they would like to send a serve of the pox on the SSWAHS Executive. :-))

ICAC and SSWAHS - Mission Impossible?

Now we all know that if anyone, especially those who wish to blow the whistle on corruption, read the newspapers, watch the telly or even listen to the Executive of an Area Health Service like SSWAHS, sees something that looks corrupt and smells corrupt there is a good chance that it is corrupt.

Socrates has been told that a community member from the Highlands wrote to ICAC in November 2009, with a statement that there had been alleged corrupt conduct by a staff member working in the Bowral health services. Basically, the allegations related to the staff member entering on his time sheet that he was on duty at work when he was, in fact, at home painting his house. So, he was effectively being paid by SSWAHS to paint his house instead of working with the health service and doing his job. I guess we all have some idea of just how long it does take to paint a house in Bowral when you're doing it yourself! A second allegation made to ICAC about this same individual was that when rostered on-duty on weekends he sometimes took to a couch and had a nap instead of contacting health consumers or visiting patients in the hospital or the community.

The behaviour of this person looks corrupt and smells corrupt so you'd think that ICAC would be interested in it. Well, no they weren't. The reason given was that the member of the community "had no direct knowledge of the allegations of these complaints", and if the staff member "was intentionally missing work to do something at home, it does not appear to meet the requirement of serious and systemic corrupt conduct." At least the ICAC did decide to refer the matter of the allegations to the AHS "for their information" and action if SSWAHS deemed it appropriate. Oh, dear! I hear you groan. Another of SSWAHS's internal investigations!

Well Socrates does have to uncover his head to them because SSWAHS did send along that pesky investigator of theirs who spoke to a couple of staff who, apparently, were able to confirm the truth of the activities of the staff member described in the letter to ICAC. One of the Vestal Virgins (or was it the Muse?) of the Bowral Temple heard that the SSWAHS investigator's parting comment went something along the lines of "Hmmm! as there is no photographic evidence that these events did take place, I suspect that nothing will come of it". And blow my flute and dance a bacchanalia - he was right!

So next time you attend court before a magistrate tell him or her to forget the statements of eyewitnesses and others and demand to see their photographic proof.

I guess most businesses would be somewhat unwilling to keep employed someone who defrauded the business by falsifying documents like a time sheet and who continued the fraud over some time. Strange isn't it, that recently ICAC spent a lot of time and money investigating a certain NSW politician over her falsification of her staff member's time sheets. So I guess her falsification of time sheets did "appear to meet the requirement of serious and systemic corrupt conduct." Go figure it!

Well if you are so inclined to rort your employer - get a job with SSWAHS. Socrates has heard that they recently made that particular staff member a Manager. I guess it takes one to know one - which is a good line on which to finish this post.

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.