Murwillumbah Health Service

Mr THOMAS GEORGE (Lismore) [12.55 p.m.]: I move:

That this House:

(1) condemns the Government’s downgrading of health services in Murwillumbah;

(2) notes that this downgrading involves moving 3 senior positions, the Executive Officer, Deputy Director of Nursing, and Quality and Safety Manager, to Tweed and that a proposal is in place to combine the children’s ward with the adult surgical unit to reduce staffing costs;

(3) further notes that this decision disregards the fact that Murwillumbah Hospital services 30,000 people who live to the west and south-west of the town and are already travelling up to more than an hour to access this service; and

(4) calls on the Government, Minister for Health and the North Coast Area Health Service to immediately reconsider the consequences of these decisions and the risks that will be placed on Murwillumbah residents as a result of these ill-advised changes.

It is 12 months to the day since I gave notice of this motion and thank goodness it has come up today or it would have fallen off the notice paper and I would not have had the opportunity to highlight these concerns. Let us not worry about the 12 months preceding my giving notice of motion; let us worry about what has happened in relation to this issue in the past 12 months.

It is ironic that the chief executive officer of the North Coast Area Health Service was on ABC radio this morning making comments about Murwillumbah District Hospital. The Minister was kind enough to receive a deputation in September 2007 and as a result she initiated an inquiry. The Murwillumbah District Hospital Support Committee wrote to the Minister on 22 January 2008 to put on record some of the matters discussed at a 7 December meeting between representatives of the Murwillumbah District Hospital, Chris Crawford and the North Coast Area Health Service. The first issue they wanted to put in writing was the statement by the North Coast Area Health Service that Murwillumbah District Hospital [MDH] was financially inefficient. The response was:

It was acknowledged by Mr Crawford that the issue of financial efficiency is one of management, and that Mr Crawford as the regional CEO accepted responsibility for the financial management of the MDH as part of Tweed area health service delivery.

The second issue raised was of benchmarking of Murwillumbah hospital. The response was:

It was agreed that the C2 grouping for MDH was inappropriate, and as such created an incorrect assessment of the financial performance and efficiency of MDH.

Thirdly, Mr Crawford and Ms Hogan were asked: What criteria is used to assess the level of services required or provided by a hospital—in this case the Murwillumbah District Hospital—and is it based on population and age demographics? Mr Crawford responded that the local population of Murwillumbah was 10,000. The fact is that there are 19,000 people within a 10-kilometre radius of Murwillumbah, which is the Australian Bureau of Statistics data, not ours. Murwillumbah District Hospital services the greater southern region of the shire, which has a population of 30,000 people. The question was asked: Does the future management and operation of Murwillumbah District Hospital take into account future population growth? Mr Crawford was given an update on the predicted growth of Murwillumbah where 500 residential lots are zoned and in the process of being developed. Mr Crawford seemed unaware of local developments driving population growth in the region. I refer to comments that were made in the letter to the Minister. Other issues were raised, which have been well and truly documented.

A special commission of inquiry into acute care services in New South Wales public hospitals was held and the Murwillumbah District Hospital support committee made a submission on 28 April 2008. The support committee highlighted statistics in its submission. The population of the Tweed shire is 80,000, of which 28,000 are over 55 years—I am in that bracket—and there are a further 40,000 to 50,000 people in the Tweed catchments area north of the New South Wales-Queensland border. The support committee recognised that Tweed hospital is clearly the major hospital in the area and that it provides the higher levels of acute health services. The Murwillumbah hospital is substantially underutilised, especially the operating theatre and surgical ward. There is a 35 per cent usage of the operating theatre. In the past few years, prior to me representing Murwillumbah, $2 million to $2.5 million was spent on the operating theatre. It would be better than any other operating theatre I have seen in the south of the electorate—and it has 35 per cent usage. The hospital is in A1 condition. I am embarrassed to say that the Lismore Base Hospital is not as good as the Murwillumbah District Hospital with respect to the building and its preservation.

Mr Geoff Provest: Cost-cutting.

Mr THOMAS GEORGE: This is purely a cost-cutting exercise. I have previously seen it happen with Casino, Nimbin and Kyogle hospitals. Services are cut back so people go to other areas. Statistics are then used to wind back the hospital. The only reason the service is not provided at the hospital is because it was taken away. The support committee believes that as a result of poor management of the North Coast Area Health Service there seems to have been a downgrading of these hospitals. This was fully covered in the letter to the Minister. The support committee is a responsible group that has worked hard for the community. It recommended greater utilisation of available operating theatre times at Murwillumbah to reduce waiting lists at the Tweed hospital and to free up beds. For example, most elective orthopaedic surgery could be performed at Murwillumbah, which has an excellent assessment and rehabilitation ward.

Another concern the group had is—in its terms—the misuse of funds from asset sale. I hate using those words, but I am reading what is written in front of me. There were concerns within the community regarding $213,000 from the sale of the Ewing House. According to her letter, Ms Noreen Hay, the Parliamentary Secretary for Health, said that the money had been spent on airconditioning and $176,000 that was going to be spent on six palliative care beds is now dependent on determination of the review process. The group advised:

My investigations confirmed that the money was not spent on air-conditioning and the matter of $176,000 for palliative care beds being dependent on the review process is bunkum and a further ploy by the area health service to hang on to the $213,000 from the sale of the Ewing property. That money was taken out of Murwillumbah Hospital funds and transferred into the north coast area centre's general fund. The palliative care beds is a matter that could have started immediately after the sale in 2006. I am informed that there was someone chosen to take on the task, but like so many other needs for personal opportunities to fill staff vacancies, they have still not occurred.

The member for Tweed and the member for Ballina will highlight problems associated with the proposed wind-back of hospital services at Murwillumbah. I am pleased to have their support for my motion. People in their electorates travel to and are serviced by the Murwillumbah hospital, especially in the obstetric service. The member for Tweed will comment on the Murwillumbah maternity unit. I will raise some other issues during my reply to the debate.

Mr PHILLIP COSTA (Wollondilly) [1.07 p.m.]: I compliment Murwillumbah hospital, which is an outstanding hospital. My wife is a diabetic and we attended the hospital the last time we travelled north. I advise the House that Murwillumbah District Hospital is not being downgraded. There has been no decision to amalgamate the Tweed and Murwillumbah hospitals and there are no plans to close the Murwillumbah hospital children's ward. The North Coast Area Health Service advises that the Tweed-Byron network has recently combined the management and elective surgery booking systems of the Murwillumbah and Tweed hospital operating theatres. This was done after consultation with staff with the aim of enabling the operating theatres at both hospitals to work in a more streamlined fashion and deliver the best possible patient care.

Bringing the management of the two hospital operating theatres together is consistent with the integration of surgical services across the Tweed shire. There have been many enhancements in recent times, including $3.4 million worth of capital works enhancements and upgrades to both operating theatres. In 2006-07 2,120 operations were performed. Extra funding has been allocated to the hospital to enable more operations to be undertaken. The emergency department is now staffed by full-time on-site doctors. In addition, recent purchases of new medical equipment total $266,000 and include items such as an obstetrics ultrasound, defibrillator, operating theatre equipment and replacement of the general X-ray room.

All hospitals need to operate efficiently so that the amount of health care delivered per dollar can be maximised for the benefit of the communities they serve. Therefore, in consultation with doctors and nurses, the services provided by Murwillumbah hospital are being reviewed to see how they can operate more efficiently. External consultants have been commissioned to undertake this review. Following input from local stakeholders, the draft report recommendations are currently being considered by the Murwillumbah hospital review steering committee. To reinforce its commitment to maintaining obstetric services at Murwillumbah hospital the recruitment process for a second obstetrician position has been undertaken and management has made an offer, which has been accepted by the successful applicant. That is good news for the Tweed. The doctors area of need status is currently being considered by the College of Obstetricians and Gynaecologists and a final decision is expected in the next few months.

Murwillumbah hospital, as part of the North Coast Area Health Service, will benefit from the Iemma Government's $717 million investment to improve health services and hospital care for patients in the North Coast area of New South Wales. This health budget allocation for the North Coast Area Health Service is $36.7 million more than the allocation for last year, and part of a record statewide health budget of $13.15 billion. This Government is getting on with delivering services. Let me reassure the House that the Iemma Government is committed to providing the Murwillumbah community with health services that it clearly needs.

Mr GEOFF PROVEST (Tweed) [1.10 p.m.]: As well as being 100 per cent for the Tweed, I am 100 per cent behind the member for Lismore on this issue. The Iemma Government's decision to downgrade Murwillumbah hospital is nothing short of a disgrace. Chris Crawford, the chief executive officer of the North Coast Area Health Service, said on North Coast ABC radio this morning that the reason Murwillumbah hospital was being downgraded was that its costs were too high and that it was inefficient, which is an appalling statement. The old maternity ward enabled the hospital to deliver medium-risk and low-risk babies, but the new maternity ward will enable the birth only of low-risk babies in a limited time frame between 8.00 a.m. and 5.00 p.m. on Mondays to Thursdays. Women's health cannot be compared with hospital running costs.

How can we determine when a baby will be born? Chris Crawford said that this would result in decreased costs—from around $700,000 to $800,000 under the old model to around $220,000 under the new model. However, those figures are fundamentally flawed, as hospital delivery times will be reduced, and travel costs to the Tweed or the costs of doctors and midwives have not been taken into account. Last year Murwillumbah hospital had between 300 and 400 births. That catchment area is one of the fastest growing catchment areas in the country, but it is not feasible to send the extra patients to Tweed hospital. The Garling inquiry heard evidence to the effect that Tweed hospital, which is already operating at 108 per cent capacity, is unable to handle the overflow from Murwillumbah hospital.

Tweed hospital has already lost one maternity bed and it is now resorting to the use of a tearoom in which to deliver babies. Given that the birth rate in the Tweed electorate has doubled, how could Murwillumbah hospital meet that further demand? I am advised that the Save the Murwillumbah Hospital Group met in Sydney. The Minister for Health and Chris Crawford attended that meeting, which was organised by the good member for Lismore. In a lengthy submission the group condemned the hospital downgrade and sought the rationale for the decision by the Northern Rivers Health Service. I am advised that, as yet, no response has been received from the Minister for Health or Chris Crawford, even though that meeting was held in September 2007.

I have spoken at length to senior doctors from Murwillumbah hospital and they have given me some damning evidence against this reckless decision. They advised me that the basis for the review was the fact that Murwillumbah hospital spent $2.7 million above the benchmark of its peer hospital. That is where the fault lies. Murwillumbah is a C2 category hospital, which means it has been compared to hospitals such as Ballina, Macksville and Cowra, which have smaller catchments, perform less complicated surgery, and have smaller budgets. Murwillumbah hospital's $17.5 million budget is the largest in the peer group and the next biggest budget is only $11 million. In the words of doctors who work at the hospital:

It is completely inappropriate to compare Murwillumbah with C2 category hospitals. Given its catchment size and budget, it should be part of the C1 peer group hospitals.

The doctors also said:

It is sheer madness to cut the resources of Murwillumbah Hospital. It is located in one of the fastest growing regions in the country, where the population will double over the next decade. It makes absolutely no sense at all.

On 5 July a rally will be held to support Murwillumbah hospital. The last time a rally was held in Murwillumbah about 400 people attended. We expect several thousand people to attend the upcoming rally. The member for Lismore and I will take part in the rally and march with locals from my electorate—from Pottsville, from Cabarita and from Hastings Point. People from those areas all use Murwillumbah hospital. Chris Crawford's comments are disgraceful and disparaging of the hard-working members of staff at Murwillumbah hospital. It seems that Chris Crawford has again been telling porkies. He told the Minister for Health that the airconditioning units at Murwillumbah hospital had been fixed—an issue referred to by the Minister for Health in her recent press release.

Those airconditioning units have not been fixed; Chris Crawford has been lying to his superiors and he did not tell the Minister for Health the truth about this matter. Chris Crawford should stand aside while an independent inquiry assesses his financial management of Murwillumbah hospital. As the member for Lismore said, money has been transferred out of the hospital's account. Chris Crawford is on the record as saying that it was an accounting error. Many tens of thousands of dollars raised by local people have gone missing. Local people and people in the Tweed desperately need this hospital. As I said earlier, I am 100 per cent for the Tweed and I am also 100 per cent behind the motion moved by the member for Lismore.

Mr DONALD PAGE (Ballina—Deputy Leader of The Nationals) [1.15 p.m.]: I support the motion moved by the member for Lismore, which condemns any downgrading of Murwillumbah hospital. As the shadow Minister for the North Coast, I advise members that the Murwillumbah hospital catchment area is one of the biggest and fastest growing catchment areas in New South Wales. The proposed downgrading of the maternity unit will result in that unit operating only between the hours of 8.00 a.m. and 5.00 p.m. on Mondays to Thursdays, with other births being referred to Tweed Heads hospital. However, Tweed Heads hospital is already operating at around 108 per cent capacity. In other words, Tweed Heads hospital does not have the capacity to accommodate these additional births, and they should continue to be accommodated at Murwillumbah hospital.

The rationale for the downgrade is that it is a C2 category hospital that has overspent its budget by $2.7 million. However, compared to other C2 hospitals, Murwillumbah hospital has a much larger catchment area and many people believe that it should be a C1 category hospital. I understand that Murwillumbah hospital has a budget of about $17.5 million, whereas the next largest C2 category hospital has a budget of about $11 million. As Murwillumbah is the biggest C2 category hospital it could be argued that it should be categorised as a C1 hospital. As the motion of the member for Lismore indicates, Murwillumbah hospital serves a catchment of 30,000 people who live to the west and to the south-west of Murwillumbah, and who have to travel up to an hour to access the hospital.

I assure the Government that the community will not take lightly the downgrading of Murwillumbah hospital. The member for Tweed said earlier that a big rally is to be held next weekend in protest against this proposed downgrade. The chairman of the Murwillumbah Hospital Support Committee is on the public record as stating that he is opposed to the proposed downgrade. I quote from a statement that he issued recently:

The Murwillumbah Maternity Units supplies a 24 hour a day, 7 day a week Obstetric service for both normal obstetrics and emergency obstetrics including Caesarean Sections. It is the belief of the Doctors in Murwillumbah and the Hospital staff that this 24 hour seven day a week service should continue. Alternative proposals for this service DO NOT allow for the continuation of emergency obstetrics and Caesarean sections out of normal working hours, the new hours are to be Monday to Thursday. This means that if an unexpected complication occurs for a woman in late pregnancy, including women in labour, then that patient will need to be transferred urgently via ambulance to the Tweed Heads Hospital for Caesarean Section or other interventions as required.

Staff at the hospital believe that this is an unsafe system and will put some women at increased and unnecessary risk.

That statement by the chairman of the Murwillumbah Hospital Support Committee clearly indicates that this unacceptable proposal will put at risk the lives of babies and mothers who have to have caesarean sections in the latter part of their pregnancy. The biggest concern I have relates to the fact that the North Coast Area Health Service appears to have been given internal advice that indicates no downgrade should occur. I wish to quote from a document prepared by the North Coast Area Health Service—a Murwillumbah District Hospital operational response to a review of the Department of Obstetrics and Gynaecological Services. Under the heading "General Comments" regarding the report, its contents and recommendations affecting the area, it states:

We advocate strengthening the Obstetric Service at Murwillumbah District Hospital rather than weakening it.

The summary states:

The Medical and Midwife team at MDH acknowledge that change has to calm and are very willing to discuss any changes to its role delineation that maybe countenanced by the NCAHS, or expert advisors that it may employ. However, they will not support the destruction of an obstetric service that provides quality outcomes and which is overwhelmingly well regarded by the community that it serves. The current model proposed by the MDH Review is seen as one that will not be welcomed by the community and, in fact, will place a birthing mothers at risk.

The proposed system will not save significant money and, in fact, may be more expensive and will undoubtedly impact on the quality of obstetric care currently being supplied.

These comments are from the North Coast Area Health Service. It is recommending not to proceed with the agenda of downgrading Murwillumbah health services.

Mr STEVE CANSDELL (Clarence) [1.20 p.m.]: I shall be brief in my support for the motion moved by the member for Lismore condemning the Government's downgrading of health services in Murwillumbah. Much has been said about the Murwillumbah District Hospital. The member for Lismore is concerned that the downgrading of services involves moving three senior positions—the executive officer, the deputy director of nursing, and the quality and safety manager—to Tweed hospital. A further proposal is to combine the children's ward with an adult surgical unit to reduce staffing costs. This is another way of condemning and penalising country New South Wales health services to prop up problems in Sydney. Unfortunately, the 2008-09 budget did not have to provide much to my electorate because the Federal Government—thank goodness—came through with $82 million for Grafton Base Hospital and $5 million for a proposed superclinic.

However, after the election promises in March 2007 we expected a health clinic at Yamba, but no money was provided. There was talk of upgrading the accident and emergency unit at Grafton hospital but, again, no money was provided. However, once again the Feds came through with some money but the State needs to back it up with some of its money. Maclean District Hospital accident and emergency unit needs urgent work not only to provide better service but also to provide a more secure workplace for hospital staff and medicos. While I am referring to my electorate, Murwillumbah hospital staff should look closely at the gradual downgrading of Campbell Hospital at Coraki. Once the downgrading process starts it continues until it reaches the point where the hospital is closed. Campbell Hospital at Coraki is on the verge of closure after being downgraded from 26 beds to 16 and it now faces the possibility of combining with the local nursing home to provide six accident and emergency beds. What a shame!

Returning to the downgrading of Murwillumbah District Hospital, Chris Crawford, has to represent the area rather than the Government. Of course, the Government employed him in this region, but he is paid to supply and provide good health care for the area. If that involves extra costs, he must fight harder and recommend more funding for these vital services to country New South Wales, especially for maternity units. The proposal is to remove specialist care from Murwillumbah to another hospital. The North Coast aged population will have to travel an extra 30 or 40 kilometres to Tweed Heads for specialist medical services—an almost untenable distance for many of them. Many of them will decide to stay at home and not follow up with good medical treatment and, consequently, suffer from that decision. I conclude my remarks by condemning this Government for ignoring country and rural health services.

Mr THOMAS GEORGE (Lismore) [1.23 p.m.], in reply: I thank the members representing the electorates of Wollondilly, Tweed, Ballina and Clarence for their contributions on this important motion. I look forward to reading the speech of the member for Wollondilly in Hansard because it sounded quite good. He outlined what the Government is doing and said that these services will not be wound back. No-one will be more pleased than Ian Ross and the Save the Murwillumbah Hospital Support Committee. The proposed changes to the obstetrics services were highlighted by all members who spoke in this debate. Currently the maternity unit at Murwillumbah hospital cares for about 350 to 400 women giving birth every year. If the Government wants to get anyone offside, try getting offside mothers who are about to give birth!

They will be in Murwillumbah on Saturday 5 July to take part in a March commencing at St Patrick's sportsground and proceeding up and down the main street to the town clock, where speakers will inform the gathering of the proposed changes and seek further community support. The Murwillumbah maternity unit provides a 24-hour, 7-days-a-week obstetric service, including caesarean sections. The doctors and hospital staff of Murwillumbah hospital believe this service should continue. No negotiations will be considered to discontinue the service. Other members referred to the summary of a document released by the North Coast Area Health Service. The summary, in part, states:

The Medical and Midwife team at MDH acknowledge that change has to come and are very willing to discuss any changes to its role delineation that maybe countenanced by the NCAHS, or expert advisors that it may employ. However, they will not support the destruction of an obstetric service that provides quality outcomes and which is overwhelmingly well regarded by the community that it serves.

Recently, a group of mothers from the Tweed electorate visited me. These women reside close to Tweed hospital, but had chosen Murwillumbah District Hospital for the birth of their children because it provides such a good service. Another point raised in the debate was that the costs of Murwillumbah District Hospital are too high. I remind everyone in this House and everyone who reads Hansard that the Lismore rehabilitation unit was closed because it was too expensive compared to St Vincent's Hospital. We are now told that even though it is a rehabilitation unit, the inefficiencies and costs of Murwillumbah are too high.

The member for Ballina highlighted that Murwillumbah hospital is in the wrong peer group. The Staff Medical Council and the Support Murwillumbah District Hospital group have asked: Why has no attempt been made to place Murwillumbah in the appropriate peer group? It is because statistics are used to back decisions, and that is how decisions are made within the area health service. Statistics can be used to anyone's advantage, which is what has happened in this instance. I merely want to make the Minister for Health aware that the Murwillumbah community will not accept any cutbacks and will continue to fight them by marching in support of the Murwillumbah District Hospital.

Question—That the motion be agreed to—put.

The House divided.

Question resolved in the negative.

Motion negatived.

[The Speaker left the chair at 1.36 p.m. The House resumed at 2.15 p.m.]