SSWAHS = SWSLHD + SLHD and the Medicare Locals - 62

 The big sell(out)! - SSWGP Link + SHDGP

At various times, and in previous posts, Socrates has made reference to the relationship formed between the Macarthur Division of General Practice (now the Sydney South West GP Link) and the Southern Highlands Division of General Practice. For the former, the collaboration is about its further expansionist aims. For the latter, it is all about making sure that some people remain employed. 

But....... does it mean that people in the Southern Highlands will get an improved health service? This is the crucial question to which we have not had an answer simply because we have not had the level of community consultation and public meetings - or the involvement of all the non-government organisations, or the local private and public healthcare providers, or the health consumers in our local community - that the Federal Department of Health and Ageing (DoHA) had required prior to the lodgement of any application by the Macarthur-Southern Highlands consortium. 

It is little point in suggesting that the Southern Highland's meek and mild health consumers and health practitioners and NGOs should be happy that the consortium would inform everyone of the details after the event. That still does not comply in any way with the DoHA mandated requirements prescribed in the documentation for submitting for funding of a Medicare Local.

Is BIGGER simply the BEST? How can a consortium, which will control some 700+  GPs over some 320+ practices, possibly provide, or even broker, the most effective and efficient health service to the 40,000+ people of the Southern Highlands?

From its own website description, the Sydney South West GP Link demonstrates and boasts that it is a business seeking "to trade nationally and internationally" and has expansionist aims. 

Do the health consumers in the Southern Highlands really want to compete with other health consumers in the national or international arena?  I think not!

 

History of the Division

"Macarthur Division of General Practice (MDGP) was established in August 1993 as an unincorporated association known at that time as Campbelltown Division of General Practice.

"MDGP was incorporated in 1994 as Macarthur Division of General Practice Inc.

"MDGP's first premises were in Campbelltown Hospital where the Division functioned essentially as part of the Campbelltown Health Service.

"In 1995, MDGP moved to office premises in the Campbelltown CBD area and to the present building in 1996.

"MDGP was also preceded by the unincorporated Macarthur General Practice Association (MGPA) whose main purpose was to provide an educational service for local GPs.

This body continued until 1998 when its role was formally taken over by MDGP.

"MDGP became a registered Company Limited by Guarantee as of 27th June 2005.

This enables the business to trade nationally and internationally as the company evolves.

"As of 1^st July 2009, MDGP was successful in an open tender process, to run General Practice support services in the Liverpool and Fairfield regions. This effectively expanded the business of our support services to the Local Government Areas (LGAs) of Liverpool, Fairfield, Campbelltown, Camden and Wollondilly. Our catchment now includes some 600 General Practitioners working in over 280 practices across this large region.

"With our expansion, our members and stakeholders suggested a name change to better reflect the geographical regions we covered. 

"Also in late 2010 the Southern Highlands Division of General Practice (SHDGP) expressed a wish to merge with us in recognition that both organisations could better serve their members under one umbrella. 

"With these issues in mind, at an extra ordinary general meeting held on 30th June 2011, our Division changed its name to Sydney South West GP Link effective from 1st July 2011. 

"We continue to work with SHDGP to progress the merger."

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 59

Southern Highlands Division of GPs - Is this its last Hurrah?

A strange thing happened on the way to the Forum a few weeks ago! Sighted coming out of Springett's Arcade into the Oxley Mall carpark was a very distracted CEO of the Southern Highlands Division of General Practice, Dr Warwick Ruscoe. No doubt he was trying to work out if he will have a job (or a Division) after July 1st, 2012.


It has been interesting to follow the fall and fall of the SHDGP and its diehard Chair and CEO. I notice that even the Sydney South West GP Link (formerly the Macarthur Division of General Practice) is being very peripheral in its reference to any possible association with the Southern Highlands Division. Like an afterthought, the reference is tacked on the end of their latest news on their website. Possibly much like their expectation of what they think they can bring to the Southern Highlands.

In his September 2011 SHDGP Newsletter column the CEO says: "Successful applicants to establish Medicare Locals in rounds 2 and 3 are expected to be notified in October or November, for implementation in either January or July 2012." Hope springs eternal in his breast, it seems. Fortunately, the CEO has kept it a very brief comment this time round. Perhaps Dr Ruscoe has seen the fickle finger of fate writing on the wall of his office.


However, the Chair (Dr Vince Roche) of the SHDGP Board was a bit more forthright in the same September Newsletter - well perhaps a lot more forthright in his comments! He says: "In my last piece in May, I wrote that “the pace of threatened Primary Care reform quickens!” I would qualify this now with the further words “for some”!" This was possibly a reference to their failed attempt at convincing that the combined Macarthur-Southern Highlands Medicare Local submission should have been one of the Round One successes. Is this sour grapes? 

Dr Roche states in the Newsletter: "A great deal of time and energy has been invested by Warwick, Sally and myself in getting our Medicare Local (ML) proposal – in conjunction with the Macarthur Division of General Practice (now known as SSW GP Link) – ready for the second application deadline in July. Huge efforts were made to have Bankstown GP Division join Southern Highlands Division and GP Link in this proposal, as Bankstown lies in the ML footprint determined by the Federal Government. However, at the last moment, negotiations fell through and Bankstown again lodged an independent proposal."

What is not stated is that the Bankstown GP Division rejected the advances of the Macarthur-Southern Highlands consortium because they felt that itwas not in the best interests of their consumers. They knew this because they had frequent and extensive community forums with consumers, NGOs and public and private health providers. They also felt that the Macarthur-Southern Highlands proposal did not understand the social demography of their population, nor did it respect the GP and other healthcare providers in the Bankstown area.


Says Dr Roche: "The first 19 MLs were announced in June – and four in NSW. Why four? A cynical observer might postulate that one went to an urban ML (Western Sydney ML), one regional (Hunter Urban ML), one rural (Murrumbidgee ML) and one to an Independent MP's seat (New England ML)." Perhaps the only cynical observer is Dr Roche. Perhaps those four NSW Medicare Locals simply put in the best submissions by complying with all the criteria that the Commonwealth had required. Something which the SHDGP did not.

"The federal Government will announce the successful bidders in October or November, and these MLs will become operational from January or July 2012", says Dr Roche. Alarmingly, Dr Roche is suggesting a: real need to bring GPs from the Divisions into cooperation and participation as leaders in the new MLs, and that experience serving in Divisions over the previous 18 years had created skills in governance, service delivery and population health that few other potential ML Board members drawn from other branches of healthcare would have in the short term." This is the sort of self-promotion which seems to have been the cause of the failure of the Macarthur-Southern Highlands sortie into the Bankstown GP Division's jurisdiction.

Perhaps, the people of the Southern Highlands can do without the entrepreurship and empire building of the Macarthur (SSW GP Link)-Southern Highlands consortium. Let's just depend upon the GP Practices to continue to deliver all the services we need.

SSWAHS = SWSLHN + SLHN and the NSW State Election - 2

What has the NSW Coalition promised for health?

March 27, 2011 – 2:31 pm, by Melissa Sweet - Croakey on Crikey

"What will the change of Government mean for health in NSW?

"These are the headlines of what has been promised, according to the incoming Health Minister Jillian Skinner’s website.

• An extra 1,390 beds and 2,475 more nurses for the NSW health system. This includes 550 more beds and 275 more nurses over-and-above those currently promised by Labor at an additional cost of $340 million

• Increased funding for chronic disease management by $57 million to improve sufferers’ quality of life and drive down unnecessary hospital admissions.

• Establishment of a NSW Mental Health Commission, based on best practice models around the world, including the Western Australian Mental Health Commission. It will also provide quarantined and accountable funding for mental health expenditure; and establish three specialist units within the Mental Health Commission to better manage the experience of mental health patients and carers, divert mental health patients away from the prison system, and help ensure a smooth operation of the Mental Health Review Tribunal.

• Development of a state-wide NSW Pain Management Plan to ease the burden of suffers of chronic pain, improve their quality of life and help them re-enter the workforce. They will also maintain existing pain management and research programs across NSW.

• Establishment of an Office of Preventative Health. Located in South West Sydney, the office will have a state-wide focus and be established in partnership with the University of Western Sydney.

• A NSW Liberals & Nationals Government will fix hospitals (a promise that will no doubt come back to bite!) by investing over $3 billion in health infrastructure over the next term of government. The $3 billion investment includes an injection of an additional $885 million to fast track hospital upgrades, redevelopments and other health infrastructure priorities over the next four years, as well as the existing health infrastructure projects in the State Budget.

• A NSW Liberals & Nationals Government will appoint Peter Wills AC to help develop a 10-Year Medical Research Strategic Plan for NSW. They will also boost medical research in NSW by $20 million to drive innovation aimed at providing better patient care.

• A NSW Liberals & Nationals Government will commit $10 million to provide local health checks and improved management of chronic diseases is expected to dramatically improve the health of those at risk of, or who suffer from conditions such as diabetes, asthma, obesity and cardiovascular disease.

• A new Telehealth Technology Centre – devised and driven by doctors and their patients will be set up at Nepean Hospital under a Libnerals & Nationals Government in NSW.

• The NSW Liberals & Nationals have announced plans to increase funding for drug and alchol treatment – the first new money for respected bodies successfully treating addictions since the 1999 drug summit.

• The NSW Liberals & Nationals have released a policy outlining its intention to increase funding for the IPTAAS scheme by 50% – an extra $28million over four years.

• NSW Liberals & Nationals will deliver change to close the gap, an article Jillian wrote for the AMA’s medical journal. It was published in NSW Doctor in May 2010.

• A speech Jillian gave to the Australian Industry Information Association in April on e-health

• The Coalition’s plans to reform the management of the public health system are outlined in a document called ‘Making it Work’ released in March 2009.

***

"Meanwhile, we shall wait to see the implications for national health reform. No doubt some senior health bureaucrats are also wondering about their jobs…"

These promises seem very promising but, as far as the Southern Highlands community is concerned, they are short on detail as how these promises will result in improved health services and provide a more substantial, new and enhanced public hospital to meet the needs of our expanding and ageing population. Unfortunately, we may have to wait another four years to find out.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 11

In my previous posting I noted the negative response from the general practitioners in the Blue Mountains in regard to their non-representation on the Board of the Nepean-Blue Mountains Local Health Network. Here is an abbreviated part of what they had to say:

Katoomba out in cold on hospital board: specialist

BY SHANE DESIATNIK
Blue Mountains Gazette
23 Mar, 2011 09:55 AM

"Australian Medical Association (AMA) Blue Mountains district representative Dr John England has raised questions over the makeup of the Nepean/Blue Mountains Local Hospital Network board (LHN) established in January, claiming it is virtually a Nepean Hospital establishment.

“The consensus at the meeting was that we don’t know anyone [on the Nepean/Blue Mountains LHN board] except Dr James Bramley, who is based at Nepean Hospital but does relief and occasional weekend work at Katoomba Hospital,” Dr England said.

“Nobody really represents Blue Mountains hospitals [on the board] — that is the truth. “You know the saying, the big dog eats all the food.

“We hope that in the future there will be actually people who work full-time at Katoomba Hospital appointed to the board.

“But what I really think is needed is that doctors appointed to Nepean Hospital should have to work at least one day per fortnight at Katoomba Hospital as part of their contracts.”

These statements made me interested to find out something about the SWSLHN Board members and just what they had in the way of qualification to be able to manage the delivery of health services from Fairfield to Bowral.

Here is the published list for the SWSLHN: Professor Phillip Harris AM (Chair); Mr Timothy Bryan; Ms Carolyn Burlew; Ms Christine Carriage; Professor Brad Frankum; Dr Kathryn Gibson; Mr Mark Johnson; Professor Margot Kearns; Dr Jens Kilian; Ms Debbie Roberts; and Professor Jeremy Wilson.

With the magic of Google it is simply amazing what one can find out about people!

Professor Phillip Harris is, among other appointments, Head of Cardiology at the Royal Prince Alfred Hospital (not in the SWSLHN);

Mr Timothy Bryan is a bit of a mystery as it appears he hasn't done much in his life, yet - though there was a convict with the same name who was given his ticket-of-leave in the Colony of NSW at Mudgee on 30th of April 1850!

Ms Carolyn Burlew is the Vice President of the Institute of Public Administration Australia (NSW Division) and has an impressive pedigree of working for the NSW Government and its various Departments. Ms Burlew currently has another 7 positions on various Boards and other ventures in addition to her place on the SWSLHN Board;

Ms Christine Carriage is an Indigenous Project Officer and has a career in helping to improve the health of Aboriginal communities through the "Close the Gap" program;

Professor Brad Frankum is Professor of Clinical Education at the University of Western Sydney's Medical School and also is a specialist in the field of immunology. He has been used in the Macarthur area to inspire school students to consider a career in medicine and he is sufficiently a realist to state: that there is a real battle approaching with the access to, and distribution of, health care. At the Macarthur Anglican School he noted: "Western Sydney gets ripped off with health services". Well, I just hope that Brad Frankum can set his sights upon the more rural parts of the SWSLHN when he begins to argue for more health resources.

Dr Kathryn Gibson (not to be confused with Dr Katherine Gibson of the UWS) is the Head of the Rheumatology/Immunology Unit of the Liverpool Hospital as well as being an Associate Professor in the Medical School.

Mr Mark Johnson could be the same Mark Johnson (AO) who, until July 2008 was the Deputy Chairman of the Maquarie Infrastructure Group (MIG), which in 2007 made a loss of $1.7 billion. Nevertheless, he does have some powerful credentials in his pedigree with a law degree (Melb) and an MBA from Harvard. It has been stated that he is one of the most widely respected, accomplished, and experienced corporate advisers in Australia. Gee! I hope I got the right guy here! If I have, then I imagine that Mr Mark Johnson AO will be distracted by being on the Board of Westfield and the 3 other Advisory Boards for the Australian Government.

Professor Margot Kearns is Pro Vice Chancellor and Executive Dean of Nursing at the University of Notre Dame in Sydney which had its first graduating class in December 2008. The photos of her seem to indicate a maternal and caring person. Hopefully, Professor Kearns will be cognizant of the needs of the nursing staff in the more remote and rural areas of the SWSLHN.

Dr Jens Guenter Kilian is the Director of Cardiology at Bankstown Hospital and also Conjoint Senior Lecturer in Medicine at the University of Sydney. He studied medicine at the University of Melbourne and has qualifications from there in medicine and surgery. Dr Kilian obtained his degrees in 1998 and has been working as a staff specialist in cardiology since October 2006.

Ms Debbie Roberts is the CEO of Youth Solutions, a Macarthur-based NGO which, obviously enough, seeks to improve the health and well-being of young people in the Macarthur area. However, I do know that Youth Solutions has also taken an interest in what happens to the youth of the Southern Highlands.

Professor Jeremy Wilson graduated in medicine from the University of Sydney in 1974. He specialised in Gastroenterology at Concord and Prince of Wales hospitals. At the latter he tinkered a little with drug and alcohol services and it was here that he aspired to create the first of his Very Big Buildings to celebrate his work. Unfortunately, he didn't get his way and so he took off to America with his bat and ball, to undertake research as a Visiting Fellow at the Mount Sinai School of Medicine. Upon his return to Sydney he was appointed as a Conjoint Senior Lecturer of School of Community Medicine at the UNSW and became Associate Professor of Medicine in 1997. Following a surge of appointments to Bankstown-Lidcombe Hospitals and the newly established SWS Clinical School he became Professor and Director of Medicine at Liverpool Hospital. While Professor Wilson is a renowned pancreatologist, he is more renowned in the old SSWAHS as the lead developer of "The Way Forward" document in which the SSWAHS divided itself into divisions of clinical streams. He was renowned for being one of the most senior SSWAHS to completely forget about Bowral Hospital and the community health services in the Southern Highlands. At least, out of that debacle he did manage to wrangle another of his Very Big Buildings at Liverpool Hospital.

So what does this little expose tell us? Well we appear to be no better off in the SWSLHN than our friends up in the Blue Mountains.

No representation by the significant health care providers in the community - the general practitioners. No real health consumers representing the mainstream community members. No real opportunity to engage in public discussion or consultation, with the bulk of the Board consisting of academics and senior clinicians who have mixed roles. Those who are not clinicians or academics are equally tasked with multiple positions in multiple organisations.

Somehow this whole exercise of appointing a Board to govern the activities of a Local Health Network seems to be a cynical exercise in developing a framework structure for a hollow organisation. Maybe returning to the autonomy of a Board for a local hospital will be the only way local health services will get the resources and funding they need. Is the current trend just another way for the senior specialists getting the machines that go "ping" at the expense of the basic clinical and health needs of the communities the health service is meant to serve?

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 7

It would seem that the long arm of the Southern Highlands Division of General Practice has reached up to the Bankstown GP Division's Twitter page. Ah well! I guess it had to be expected that the self-protectionist executive and Board of the Southern Highland Division would seek to, like King Lear, hold back the tide of growing criticism from its members and others in the community.

What is there of which to be critical, one might ask? Well let's examine what the role and function is of any Medicare Local as defined by the Federal Government and reported by Grant McArthur in last weekend's Herald-Sun:

"Medicare Locals are intended to be primary care networks in charge of planning and delivering health services in their area, with GPs, allied health, nurses and pharmacists possibly sitting on their boards.

"The Federal Government is yet to outline whether it will manage day-to-day services and doctor rosters, or if it will take a more administrative or advisory role."

And this was the reported comment of the Victorian Government's Health Minister in the same article:

"We think it is unfortunate that the Commonwealth has not been very precise about the role of Medicare Locals," state Health Minister David Davis said. "They have said they want to do more after-hours GP work, but exactly how they implement that has not been laid out.

Even blind Freddy can see that this does require community and health provider consultations at best and, at least, to be involved in informing the community as to what the "semi-autonomous" Southern Highlands/Wollondilly Medicare Local will look like, and what services, if any, it will provide.

Again, a search of the local press, the Division's own website, and that of the Macarthur Division reveals nothing forthcoming from the CEO and Board of the Southern Highlands Division of General Practice. If information has been merely trickled from top down to the local GPs who are members of the Division then that process hardly constitutes being a "primary care network(s) in charge of planning and delivering health services in their area".

This then begs the question: "When will Dr Ruscoe and the Board of the Southern Highlands Division of General Practice become open and transparent about their plans for the delivery of health services in the Southern Highlands and the Wollondilly communities?"

I'm told that at one meeting, late last year, of Mental Health Professionals in the Southern Highlands a suggestion was made that Dr Ruscoe be invited, to a subsequent meeting, to discuss the evolution of the Medicare Locals in the Southern Highlands. The response from the GPs present at the meeting was that there are other people of more interest than Dr Ruscoe who could be invited to speak at subsequent meetings. One could consider from this comment that even members of the Division believe that Dr Ruscoe is more of a legend in his own mind than in the minds of others.

Certainly the absence, already, of any public comment about the local version of the proposed Medicare Local could mean that Dr Ruscoe may have been a speechless invited speaker! So, who is this man who seems to wield such power and influence? Perhaps Socrates's next posting should bring some clarity to this question.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 4

What is expected of the Medicare Locals? In summary the following principles are the key points required of any organisation that holds itself up as an appropriate organisation to receive the Federal funding to manage a Medicare Local.

"The overarching objective of MLs is to ‘coordinate primary health care delivery to address local needs and service gaps’. The guidelines set out the functions of MLs, including the expectations of the Government, according to the following ‘strategic objectives’:

• Improve the patient journey through developing integrated and coordinated services
• Provide support to clinicians and service providers to improve patient care
• Identification of the health needs of local areas and development of locally focused and responsive services
• Facilitation on the implementation and successful performance of primary health care initiatives and programs
• Be efficient and accountable with strong governance and effective management"

Has the Southern Highlands Division of General Practice ever been able to offer "integrated and coordinated services"? What support has it ever offered clinicians and service providers to improve patient care? How has the Division's CEO and Board gone about identifying local health needs and the development of locally focused and responsive health services? Has the CEO or the Board ever participated in any public community forum or meeting to gain any impression of the local needs? Apart from the government funded programs and initiatives what primary health care has the Division ever promoted outside the organisational structure of the Division? Where is the proof that the Southern Highlands Division of General Practice has been efficient and accountable of the Federal and State funding with which it has been provided in past years? If it is an honorable and honest Board and CEO perhaps they can explain why the government funded mental health programs have been limited because the money provided has been diverted towards the Division employing its own staff. Does this suggest good governance and financial management? The only answer for any of these questions and for any response attributable to the "strategic directions" enumerated by the Federal government for Medicare Locals is a universal "No!"

and

"MLs are expected to ‘provide more integrated care’ and ‘ensure more responsive local GP and primary health care services’. These examples point to the importance of the interface between MLs and the Commonwealth and MLs and the States if they are to achieve their objectives. Integration at the local level is also likely to be critical. The goodwill of external organisations and individuals, over which the ML has little or no control, and the availability of incentives to encourage organisations to participate in the MLs will be important.

Although the first group of MLs are likely to be drawn from ‘high functioning’ Divisions of General Practice, many of which have had experience in negotiating some of these issues, as MLs their role is much broader.

To fulfil the Government’s long term objective for MLs to provide a ‘coordinated package of care’ and act as fund holders for primary care, an agreed definition of what constitutes primary health care and sufficient empowerment of MLs would seem to be necessary pre-requisites."

One has to ask whether the historical record of the Southern Highlands Division of General Practice meets even the basic requirements for these "strategic directions" and "expectations" enumerated in these foregoing quotes from Canberra.

Has the Southern Highlands Division of General Practice been a "high functioning" Division? Has it been able to work with other health and welfare based organisations in the Southern Highlands? Has it ever been able to "provide a coordinated package of care" to meet the whole of life health needs of the local community? Has the Southern Highlands Division of General Practice ever held consultations with any NGO or representative community group about the health need requirements of the local community? How integrated have they been with their local community and the other health service providers? The truth is that the the CEO and the Board of the Southern Highlands Division of General Practice would have a resounding "No" or "None" marked against each of these questions on the Division's report card.

Yet, by default and for no other reason, the Federal and State governments could be sending about $2 million dollars per year of taxpayers money to the Southern Highlands Division of General Practice to spend in providing boutique services and programs through the Division's organisational structure in an attempt to enhance its own status, while local GP practices attempt to maintain the health and well-being of the Southern Highlands community.

God help us all if the Southern Highlands Division of General Practice remains controlled by that failure of a medical administrator. This area will either get no funding, or will not be able to retain any funding provided by the Federal and/or State governments.

SSWAHS = SWSLHN + SLHN and the NSW State Election

Well one can't help but notice that the first of the electoral posters have begun to decorate the highways and the by-ways of the Southern Highlands. First of the candidates peering out at us commoners is the Liberal candidate, Pru Goward. Scraping in by just a few votes in the last election she was not quite the attraction the Liberal organisation had been expecting. Especially after she was parachuted into the safe seat to the dismay of some of the local Party contenders including the previous member's "gofor", and the CEO of the Southern Highlands Division of General Practice who, I'm reliably informed, had loftier aspirations.

While it's still early days and the Labor candidate is yet to be anointed the local field is showing a dearth of willing hands to nominate. Clearly, Labor is going to the Opposition benches in the next election and, on the basis of polls, the Liberals will make a meal of the electoral seats up for grabs. But should we break out the sparkling wines and cold beers (or even Southern Comfort!) to celebrate? After all what have the Liberals been offering to do for the health services to date: Well not much more than what has been done already by the Labor Federal and State governments.

When we have had public meetings about health services in the Southern Highlands, Pru Goward has wheeled in Jillian Skinner (Opposition spokesperson on Health) who has played to the crowd and whipped up their enthusiasm but then left them to charge the SSWAHS barricades. There has been very little follow-up by Jillian Skinner or Pru Goward to ensure that their support is felt in the local community. This does seem to suggest that, when in power, a NSW Liberal government's good intentions might just as likely disappear in the smoke and mirrors show produced by any incumbent government.

Yes, it is still early days, but so far we have heard and seen more about health changes from the current State Labor government than we have seen from the Liberal opposition.

Last election, besides the two major parties we had the Greens and the Independents. I recall that Pru Goward was nearly beaten by an Independent, Paul Stephenson, Mayor of Goulburn at the time.

So far, only one Independent candidate has been identified. Rob Parker, a local Civil Engineer has responded to John Hatton's call to have more parliamentary governance through Independent members in the NSW Parliament. With his wife being a local general practitioner I'm hoping that if Mr Parker does succeed in this electoral seat, he will have his wife nudging his elbow every time there is a need to do something to improve the local health service in order to be able to provide the optimal service for this community. A new hospital in the Southern Highlands to provide the range of health services provided elsewhere would be a great start!

This year, Socrates, like others in this community will be listening with interest to the promises that all budding politicians make. Having been around for a number of years and helped vote in (and out) several State and Federal governments over those years, I have acquired a nose for the smell of smoke and bullshit. This year's NSW State election could see me break with tradition and avoid casting a vote for either major parties in favour for the Independents or the Greens.

To all Party contenders and Independents: Show me what you are prepared to do for the Southern Highlands community in the next parliamentary term, rather than what you promised to do in the last one but didn't manage to achieve (because of the GFC or droughts or flooding rain). If you say you can deliver better health and better health facilities in the Southern Highlands in the next parliamentary term show the proof before the election date. Then, and only then, will I vote for you.

SSWAHS = SWSLHN + SLHN and the Medicare Locals

Well it seems that it's not just the natives who are rebellious within the re-branded monoliths of the Sydney Local Health Network and the South West Sydney Local Health Network, but the northern GPs are up in arms because they appear to have been forcibly married to the southern GPs in this redevelopment of the health services. The article to follow comes from a meeting of the northern coalition in November 2010.

On the other hand, the Southern Highlands Division of General Practice has been remarkably silent about the transition, appearing now as they do as a "branch" of the Macarthur Division of General Practice which, effectively, now extends from Fairfield through to the Southern Highlands.

There have been no announcements on the Southern Highlands Division's website about the proposed liaison with the Macarthur Division. One wonders whether the Southern Highland's 63 or so GPs have had any say in the matter of where they want to be lodged and how they want to be represented on the Board of the Macarthur Division of General Practice.

The normally vocal Chief Executive and the Board Chairman of the Southern Highlands Division have been remarkably coy about what they are planning. Perhaps, it has become secret Board business. The Division's "Highland Doctor" has not been published (publicly) since July 2010 so either the area's GPs are being kept in the dark, along with rest of us, or they have felt the local Division has been so ineffective that they don't care about what happens to it.

Obviously, those GPs in the far north of the new Medicare Local do care and this is what they have to say:

GPs reject giant health bureaucracy in South West Sydney

by the South West Sydney Health Coalition - 05/11/2010

A report, prepared by Cranny and Associates proposes a giant bureaucracy in south west Sydney, ranging from Bowral to Bankstown.

Under proposed changes, family doctors influence over local issues would be silenced, putting at risk the promised benefits of government reforms to family medicine.

On the evening of November 4, over 150 GPs, health,and community leaders met at the Bankstown Sports Club to launch the South West Sydney Health Coalition, to call on the government to reject the proposal for a single giant health bureaucracy.

Mr Alan Ashton MP and Mr Tony Stewart MP attended the launch.

Community leaders included Dr. Ken Cho, from the Fairfield Liverpool Association of Medical Practitioners, Dr. Vinh Bin Lieu of the Vietnamese Australian Medical Association, Mr. Harry Allie, of the ATSI Advisory Committee Bankstown City Council, Mr. Si Banks of the Pharmacy Guild, Ms. Randa Kattan of the Arab Council of Australia, Dr.N.C.Patel of the Australian Indian Medical Graduates Association, Ms. Gunjan Tripathi from the Cancer Council, as well as the CEO of the Macarthur Division of General Practice, Mr. Rene Pennock.

At the launch, Dr Jim Gillespie first spoke about proposed changes to hospitals and family medicine. He described how communities now have an opportunity to shape their future health.

The Coalition was then launched by Dr. Sue Harnett, Chair of the Bankstown GP Division.

“We have real concerns that Bankstown, Fairfield and Liverpool are going to miss out on the benefits of family medicine reform,” said Dr. Harnett.

“The Cranny Report proposed much smaller locally connected organisations, “Medicare Locals,” in the wealthier parts of Sydney, and a giant disconnected Medicare Local for the economically deprived, ethnically diverse and fastest growing south western Sydney region,” she said.

“A single giant bureaucracy won’t fix the health problems in Bankstown, Fairfield and Liverpool - some of the most diverse and disadvantaged parts of Sydney.”

“Two smaller Medicare Locals are the only solution – a South West Sydney Medicare Local covering the natural grouping of Bankstown Fairfield and Liverpool, and a Macarthur – Southern Highlands Medicare Local, serving the fast-growing suburbs south of Liverpool”, said Dr. Harnett.

“Given that the government is now looking for local ideas, we have a once in a lifetime chance to change health for the better,” said Dr. Harnett. “This means family doctors working more closely with hospitals, other health professionals, local government, and actively engage the strengths of our many diverse community organisations.”

“We now call on families, individuals, health professionals and community organisations to join us, to contact their local MPs, and together, to shape the future of health in south west Sydney.”

This raises an interesting point for the residents of the Southern Highlands. Do they want to be in a Mega Medicare Local (from Fairfield to Bundanoon) in which the population is so skewed in age as well as in cultures, or do they think it would be any better to be connected as a branch with the Macarthur Medicare Local in which the population is equally skewed in age and cultures.

I find it abysmal, though not surprising, that Dr Warwick Ruscoe and Dr Vince Roche and their fellow Board members of the Southern Highlands Division of General Practice have not bothered to see what local residents have to say about this marriage they propose. Surely the patients who are the health consumers do have a right to make their views heard. Where has there been any public discussion about a significant effect that such amalgamations will have on their patients. Dr Ruscoe your silence has been deafening.

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 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) :-)