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General Purpose Standing Committee No. 2

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About this Item
Subjects -  Parliamentary Committees: New South Wales: General Purpose; Hospitals: Campbelltown Hospital; Hospitals: Camden Hospitals
Speakers - Griffin The Hon Kayee; Parker The Hon Robyn; Fazio The Hon Amanda; Wong The Hon Dr Peter; Chesterfield-Evans The Hon Dr Arthur; Forsythe The Hon Patricia; Primrose The Hon Peter
Business - Committee, Report


    GENERAL PURPOSE STANDING COMMITTEE NO. 2
Page: 11630


    Report: Complaints Handling Within NSW Health

    Debate resumed from 22 September.

    The Hon. KAYEE GRIFFIN [2.43 p.m.]: Normally it would give me great pleasure to speak in support of a committee report that I believe has the potential to play a valuable role in the improvement of complaints handling within the New South Wales health system. However, my comments are tempered by the negative publicity that surrounded the release of the report. I will say more about that later. I will focus my comments on the positive work of General Purpose Standing Committee No. 2 when inquiring into those matters. I acknowledge the hard work of the committee secretariat during this inquiry and commend them for the high standard of research and support that they provided to all the members of the committee. I am sure all committee members acted with great diligence in taking evidence and in the following deliberations.

    The committee was assisted by the large number of detailed submissions that were received, by the quality of evidence provided by witnesses from within the health system, by external experts and also by being able to utilise the work of concurrent related inquiries. The evidence given by the nurse informants and patients who had unfortunate experiences with the health system were generally compelling. I would be remiss if I did not mention the high level of co-operation that was provided by NSW Health, which gave the committee a detailed understanding of the internal workings of that department. Three Government members of the committee, the Hon. Peter Primrose, the Hon. Christine Robertson and the Hon. Amanda Fazio, did not always agree with the recommendations included in the draft report and furnished a statement of dissent, which I urge honourable members to read as an agenda to the report. One of the main areas in which Government members did not agree with the report was in relation to statewide comparisons of complaints handling.

    The committee heard extensive evidence from the staff and management at South Western Sydney Area Health Service [SWSAHS], some evidence about complaints handling mechanisms from senior management at Central Sydney Area Health Service and limited evidence about innovations in the Hunter. In view of that, and taking into consideration the issues raised in the submissions received, I believe the assertions made about the situation statewide cannot be supported and should have been removed from the report if the report is to be seen as credible and evidence based. The vast bulk of clinicians and staff at SWSAHS are good at their jobs and patient outcomes were generally also good. Issues particular to SWSAHS that required addressing included a combination of avoidable incidents, poor treatment of staff and no culture of open disclosure. Along with those particular issues is the need to acknowledge that errors and adverse incidents will always occur within any health system. Undoubtedly, there are serious cultural and system-related problems concerning complaints handling in south-west Sydney. The committee found that complaints handling systems could be improved across the entire State and noted that the department has instituted a comprehensive program to do that.

    The treatment of nurse informants by the former management of South Western Sydney Area Health Service was inadequate and demonstrated that even though the process that had been put in place by NSW Health for complaints handling was a good system, it will not work when managers opt to cover up poor patient outcomes and to victimise those staff members who legitimately raise complaints and concerns. The treatment of the theatre nurses who appeared before the committee was appalling and that was reported upon by the Health Care Complaints Commission [HCCC]. The committee supported the recommendation of the HCCC that "the Department of Health reviews the disciplinary action and processes taken by Macarthur Health Service against the four nurses who underwent formal disciplinary action as a matter of urgency." Those nurses, who were highly trained and should have been regarded as valuable assets, were denied natural justice and were in effect drummed out of the health system by the treatment they received from local managers.

    It is unfortunate that an attempt was made to criticise the New South Wales Nurses Association for the way in which it allegedly responded to requests for assistance from some of the nurse informants. Those attempts were based on some evidence given by witnesses. The Nurses Association provided a supplementary submission on 26 March 2004, which indicated that at the time one of the witnesses contacted the association for assistance—14 June 2002—she was not a member of the association and did not join it until 12 July 2002. The General Secretary of the New South Wales Nurses Association, Mr Holmes, advised that assistance was being provided to all members in the special commission of inquiry. Further, Mr Holmes stated that the association had been hampered in providing assistance to some of the nurse informants as they engaged their own legal advisors. When they approached the association again after dispensing with their private legal advice, the association provided assistance.

    Of the 19 recommendations contained in the report, only two were opposed by Government members of the committee. The other recommendations make positive suggestions and I would comment specifically on a few of those. It was recommended that the Minister for Health raise the following matters with his counterparts on the Australian Health Ministers' Advisory Council: whether the criteria used by the Australian Council on Healthcare Standards in its accreditation surveys of health services is an appropriate measure of quality; the possible elevation of complaints handling in the Evaluation and Quality Improvement Program, conducted by the Australian Council on Healthcare Standards; incorporation of the Open Disclosure Standard in the current version of the Evaluation and Quality Improvement Program conducted by the Australian Council on Healthcare Standards; and the provision of an annual update on the implementation of the Open Disclosure Standard for the first two years following its incorporation into the Evaluation and Quality Improvement Program conducted by the Australian Council on Healthcare Standards. In relation to the training and ongoing professional development of health workers the committee recommended:

    That NSW Health discuss with the relevant health professional bodies in New South Wales to ensure that all training programs incorporate competencies regarding quality and safety issues, including the Open Disclosure Standard, as part of the registration process.

    That evidence of ongoing professional development in these issues should be an essential requirement of registration …

    That as part of their performance agreements all health managers in NSW undergo training in quality and safety principles, including the Open Disclosure Standard, and that this become an essential requirement of their continued employment.

    A lot of discussion occurred in relation to the accreditation process in the Macarthur Area Health Service at the time when adverse events were taking place and when staff were attempting to raise complaints about quality of care. The committee recommended:

    That a suitable mechanism be identified by NSW Health to ensure the results of accreditation surveys conducted by the Australian Council on Healthcare Standards be provided to the Department within two weeks of their completion.

    That NSW Health publish all accreditation reports prepared by the Australian Council on Healthcare Standards and any rectification reviews prepared by health services in response to these reports.

    Professor Barraclough told the inquiry about the safety improvement program already instituted by the Institute of Clinical Excellence, which has led to a dramatic increase in the reporting of severe adverse events to the Department of Health and to individual health areas. Professor Barraclough said:

    This is what we aim to do: We aim for a dramatic increase in reporting so that we can know where problems exist and so that the vulnerabilities can be corrected.
    The establishment of the Clinical Excellence Commission is an important and positive step forward in the improvement of health care standards in New South Wales and the improvement in complaints handling mechanisms. It became clear during the inquiry that many members of the public had unrealistic expectations of the New South Wales health system. The committee made a number of recommendation regarding the Clinical Excellence Commission, including:

    That the proposed Clinical Excellence Commission in conjunction with NSW Health undertake an extensive public education campaign to inform the community about:

    _ simple steps to make health complaints

    _ the nature and extent of adverse events in the health care system

    _ realistic expectations of health care

    _ changes to the regulatory framework for health care complaints and consumer rights …

    That the NSW Clinical Excellence Commission conduct a study on the feasibility of introducing mandatory reporting of all or certain classes of incidents to health service management and to the Department of Health.

    That NSW Health ensure that in all area health services each clinical team should have regular review meetings on a protocol set up by management and audited by the Clinical Excellence Commission.

    I conclude my remarks by commending the report to the House and once again acknowledging the work done by both the secretariat and members of the committee.

    The Hon. ROBYN PARKER [2.53 p.m.]: Many honourable members would be aware that the inquiry into health care complaints was undertaken in an environment in which many other inquiries were being conducted. This inquiry was established because of the need to look at systemic problems—a gap that was established in a number of other inquiries that were being conducted. This inquiry was established because of the courage and determination of some whistleblower nurses who raised concerns and who were determined in their advocacy for the people of New South Wales and for the health system. I admire their courage and determination in bringing those issues to the fore and in creating a situation in which they could not be ignored or put off.

    The committee was given an opportunity to take on board those concerns, to address systemic problems and to come up with outcomes that would lead to a better health system. Health care and medicine are not perfect sciences. There is always an opportunity for things to go wrong in the health area; that is the nature of health care. However, when mistakes happen and things go wrong it is in no-one's interest to ignore or hide those incidents. Mistakes can occur at an individual level and at a systemic level. Those whistleblower nurses had the courage of their conviction. We all need the courage of our conviction to acknowledge adverse events, to take them on board and to do something about improving the safety and wellbeing of patients in the health system.

    I said earlier that I was grateful that those nurse informants brought these issues to the fore, particularly in relation to the Camden and Campbelltown hospitals. If they had not done so, the problems that were occurring at the time would still be occurring. The committee undertook a large task in an environment in which there was a great deal of interest in what occurred. I pay tribute to committee members and to secretariat staff for their incredible commitment to their task. As a result of this inquiry we wanted to establish a better complaints handling system and the ability to communicate with people in NSW Health, patients, health care professionals and members of the community. All those issues were addressed.

    Witnesses who gave evidence to the committee often referred to sad and traumatic events that had occurred in their lives. All honourable members should be grateful to them for referring to things that had gone wrong and had not been dealt with. Those experiences will enable us to create an environment of learning. We can learn from their experiences and thus improve the health system for the betterment of others. In large part that has required a cultural change and it has resulted in an increase in resources for Camden and Campbelltown hospitals. We heard a great deal of evidence about the opening of Camden maternity ward—the political expediency of opening it when it was clear from a number of medical professionals that it was inappropriate to do so. However, I acknowledge that resources have now been allocated to Camden and Campbelltown hospitals.

    We have evidence of similar incidents that have occurred across New South Wales and those problems must be addressed. The most important factors in patient safety relate to being open about health care incidents and adverse events, creating an appropriate complaints handling system and being willing to learn from mistakes. I said earlier that this inquiry was concerned mainly about complaints that had been made by health professionals. However, I acknowledge that some of the issues that were raised in evidence and submissions were also relevant to consumer complaints.

    Health professionals are reluctant to report adverse events and delays in investigating complaints, and certain managers respond inappropriately when complaints are received. The recommendations in this report will also improve complaints-handling procedures for consumer complainants. Key outcomes of this inquiry were all about building the best possible complaints- handling system, understanding complainants, developing sound solutions, establishing that those solutions were in place and establishing a culture of learning.

    If the number of reported incidents increases as a result, that might be a positive sign: A service that is concerned about patient safety should not hide problems but bring them to the fore. But effective complaints handling is not just about having the correct systems in place; it is about the culture and attitudes of managers and staff throughout the health care system. All health care staff—from the top to the bottom of NSW Health—must make sure that there is open disclosure, not cover-ups and denials. They must acknowledge mistakes, take advice on board and change attitudes so that effective communication is possible and issues are dealt with appropriately. We do not want to create a no-blame environment—when professional misconduct occurs blame must be apportioned appropriately. However, we must focus on the system when there is a systemic problem, not point the finger at individuals.

    I acknowledge the courageous efforts of the whistleblower nurses and the outstanding work of many professionals in the health care system, who make every effort to do their very best for patients. They are committed professionals. Sometimes the system lets them down, sometimes their organisation lets them down and sometimes the Carr Government lets them down by not providing enough resources and funding and by making decisions based on politics, not need. I think this report has gone some way towards addressing some systemic problems and acknowledging our need for communication and the courage of the whistleblower nurses who brought these issues into the open and forced them to be addressed. I thank other Committee members and the secretariat for their incredible work in compiling the report, and I think its outcomes will be well received. I look forward to reviewing the progress and implementation of these recommendations.

    The Hon. AMANDA FAZIO [3.03 p.m.]: My speech follows on from the remarks of the Hon. Kayee Griffin. I also point out that the Hon. Christine Robertson, who is very interested in this report, is unable to participate in this take-note debate. Government members of General Purpose Standing Committee No. 2 strongly opposed two of the report's recommendations, which I will detail now. Recommendation No. 9 states:

    That NSW Health publish comparative data of adverse events in Area Health Services across New South Wales in Annual Reports and on its Website.

    I oppose that recommendation because I believe there is no way of comparing the number of serious incidents, deaths and so on across the health system in New South Wales as no two hospitals or health facilities are the same. This recommendation could lead to a false impression about the standards of care available at health facilities and could skew demands for care in an unwarranted and unsubstantiated way. Facilities that do not have a culture of open disclosure and low reporting rates would automatically appear to be the best, thereby promoting false confidence among health consumers. Hospitals that were scrupulously honest about reporting could be perceived to be the worst, which would be a disincentive for an open culture of learning. Additionally, we must ask: Should the number of incidents be the measure or is the appropriateness and timeliness of the response the critical issue? Recommendation No. 10 states:

    That the New South Wales Government convene a summit on medical adverse events within the next 12 months.

    I also oppose this recommendation. The proposed benefits or outcomes of holding such a summit were not discussed and the recommendation was not supported by evidence received. I believe a recommendation that called on the New South Wales Minister for Health to raise with his counterparts on the Australian Health Ministers' Advisory Council the concept of holding a national conference on clinical excellence would have been far more constructive.

    The committee also heard a lot of evidence about existing barriers that inhibit the development of a culture of openness and learning within the health system. The major cultural barriers to effective complaints handling are twofold. First, the hierarchical structures within the health system—both inside the different schools of professionals and between them—need to be recognised and the power imbalances redressed before those lower in the hierarchy will feel free to raise concerns about patient care attributable to their superiors. Secondly, the general reluctance of health professionals to report adverse incidents must be overcome. Dr Llewellyn, a Health Services Union member, gave some interesting evidence to the committee, and stated in his written submission:

    Most junior doctors are threatened about voicing criticism in front of more senior clinicians. They automatically assume that because of their position, the senior clinician has more knowledge and more authority. Personal career paths may be threatened or perceived to be threatened by speaking up or speaking out of turn.

    We acknowledged the frictions between doctors, nurses and other health professionals regarding reporting and open disclosure and the role of NSW Health in encouraging open cultures and environments. We also noted the role of relevant professional organisations, including colleges, registration boards and so on, to change this culture through their education programs. I believe NSW Health should trial ways of breaking the hierarchical barriers that currently work against a culture of learning through strategies such as the use of teams of professionals, ensuring that junior medical staff are aware of the role delineation, and introducing safeguards to ensure that doctors are accountable for their actions and do not relegate blame to nursing staff.

    It was unfortunate that much of the reporting of the evidence given to the inquiry was so sensationalised. A lot of the evidence given by some of the nursing informants—notably Ms Fraser and Ms Martin—was reported in a very sensational manner yet subsequent evidence given by people to whom they referred that contradicted their version of events was not given any media coverage. At one stage Ms Fraser claimed that there had been a cover-up because she believed she had been given an assurance by the internal audit section of NSW Health that certain complaints would be referred to police. In response, on 19 March the committee heard from Ms Victoria Walker, the auditor concerned, who said:

    I read the transcript and I just thought that it was completely muddled. It was completely false, from my point of view. I never had any view that any specific matters should go to the police. I deal with the police in another part of my administration. We deal with the police on criminal matters. They are busy people. You do not send them a bundle of emails or allegations until it has been assessed properly that they are criminal matters. No, when I read that in the transcript I was completely puzzled about it. It was not correct.

    The evidence given by Ms Martin about staff attending Medical Emergency Team calls being physically assaulted did not go unchallenged. On 29 March 2004 Ms Jennifer Collins advised:

    I have got no information, and no-one ever raised with me that anyone was physically assaulted from raising a METS call.

    It is unfortunate that the media did not print that statement to provide more balanced coverage of the inquiry. It is also most unfortunate that the inquiry was used as a vehicle to attempt to smear the good reputation of Associate Professor Picone. The comments about her were not based in fact and are part of a politically motivated attack on a well-respected senior member of NSW Health. The report did not focus enough attention on the many positive changes that have been implemented at South Western Sydney Area Health Service under the administration of Associate Professor Picone, which have led to faster, more appropriate responses to adverse incidents and improvements in staff morale. These positive changes appear at appendix 3 of the report. It should also be noted that Associate Professor Picone's establishment of the Professional Practice Unit at South Western Sydney Area Health Service and its medico-legal mediation model of grievance handling will be implemented across the State in all area health services.

    The committee spent a considerable amount of time discussing the Camden Maternity Service. The basis of the report's conclusions on this matter rely too heavily on the evidence of Dr Mary Prendergast, who was a member of a consortium of specialists who bid unsuccessfully to provide services to the Camden Maternity Unit, and do not provide an accurate picture of the quality of the service offered. It is disappointing that the committee did not give due recognition to the findings of the Henderson-Smart review of maternity and perinatal services in the South Western Sydney Area Health Service. The review found that Camden hospital was designed to provide antenatal, birthing and postnatal services for women with essentially normal pregnancies—that is, level 3 and level 2 neonatal. Camden hospital has a level 3 maternity unit and a level 2 neonatal unit for normal pregnancies, with appropriate on-call anaesthetic cover and on-call paediatric support. The review team recommended:

    • That this role delineation should continue as long as medical support is available at the required level.

    • Units and hospitals know exactly what patients they are resourced and delineated to care for and when a patient needs to be transferred to a higher-level unit or hospital.

    • Ensuring appropriate access to Area midwifery and neonatal clinical nurse consultants.
    The findings of the review support the decision to operate the service as a low-risk service from the beginning. The committee's conclusion that the maternity unit was reopened for political motives was not based on the evidence before the inquiry. Rather, this conclusion was politically motivated and not soundly based.

    I would also like to discuss the media coverage surrounding the release of the report. In recent times changes have been made to the way in which committees operate to ensure that the chair's foreword accurately reflects the views of the majority of committee members. When this change was instituted I am sure it was not envisaged that when releasing reports committee chairs would wilfully make comments that were not based on the majority view of committee members, and in fact were not based on any evidence given to the committee during the inquiry either by way of submissions received or evidence given at hearings.

    The real damage caused by these comments, as noted by my colleague the Hon. Christine Robertson in her notice of motion on 29 June was that rather than emphasising the very important recommendations of the report, the chair of the committee offended many senior women who work in NSW Health and distracted the media from focusing on the detailed recommendations that will help to improve complaints handling and engender cultural change in the health system. I am, of course, referring to the comments of the committee chair in respect of an "old girls' network". I refer to an article on page 25 of the Daily Telegraph of 25 June 2004. In a two-page spread under the headline "An 'old girls' network' at the heart of health woes" the following comment was made:

    But it was Mr Moyes' comments about the New South Wales health system's "old girls' network", which protected its members in times of trouble, that really caught attention.

    This was but one of many media reports which focussed on this furphy rather than on the report. The term "old girls' network" was never used in the inquiry and no evidence was received that referred to the existence of any such network. The fact that the committee chair publicly named senior health administrators who he claimed were part of this network further compounded the damage that he did to the report of the committee. As the Hon. Christine Robertson stated, there was absolutely no reference in the report to an "old girls' network", the inference is very offensive to women, about 70 per cent of the health work force are women, and only in recent times has there been an increase in the percentage of women in general management within the health sector. It is very regrettable that the reputations of these women health administrators has been brought into question, especially when these statements are the personal comments of the committee chair and represent his personal prejudices.

    The damage has been done to the reputations of these women, but on behalf of the other Government members I apologise to the women named as part of the so-called old girls' network and note that these women have all worked in the health system under both Liberal and Labor governments. As my colleague said at the outset, the report included many positive recommendations and I urge all honourable members to support them. I commend the report to the House, with the exceptions of recommendations 9 and 10. I also place on record my thanks to the committee secretariat and staff for their hard work in this inquiry. It was particularly harrowing for them because some of the people who came to give evidence to the committee, both nursing informants and people who had been the subject of adverse incidents within the hospital system, were very emotional when they appeared before the committee. They were very uncertain about appearing before the committee and needed a lot of reassurance from the staff about their rights and the way in which they would be treated.

    I also thank those people for being brave enough to come forward, in what for many of them were very emotional and difficult times, to state publicly where they thought the health system had let them down, where they thought they had done the right thing by raising objections and complaints with their supervisors, and where, in a number of cases, they were clearly inappropriately dealt with, victimised and in some cases drummed out of the health system. I extend my apologies to those people as well because I believe that they have a valuable role to play in the health system if they decide to come back into it.

    The Hon. Dr PETER WONG [3.13 p.m.]: I congratulate the committee on its report. I agree with most of the recommendations in the report. I note the chair stated in his foreword:

    While the Committee has identified serious problems regarding complaint management at Campbelltown and Camden Hospitals, similar problems undoubtedly exist across the health system. NSW Health has some good systems in place to encourage reporting but these will only work if supported by the necessarily cultural change.

    Indeed, I think the chair's statement is quite appropriate. The complaint against mismanagement is not restricted to the Camden and Campbelltown hospitals. In fact, I had quite a few medical college complaints of similar problems in many hospitals. Indeed, as a member of the joint parliamentary committee supervising the Health Care Complaints Commission [HCCC] I inform the House that the committee for a long while had severe concerns about the competency of HCCC and its ability to manage complaints in the past.

    Of course, the Camden and Campbelltown hospitals issue highlighted, apart from its inability to manage individual cases, that the HCCC had no expertise, knowledge or will when a major systemic problem arose, as mentioned in the report. The recent reform of the HCCC has certainly shown good improvement, at least initially. Furthermore, the establishment of the Institute for Clinical Excellence, now known as the New South Wales Clinical Excellence Commission, will further improve the existing situation. I hope what happened in the past in the Camden and Campbelltown hospitals will not be repeated in many of our hospitals. Again, as mentioned by the chair, unless there is a cultural change, unless the Government puts in a lot more effort and funding into our hospital system, the same mistakes can still happen.

    The Hon. Dr ARTHUR CHESTERFIELD-EVANS [3.16 p.m.]: This inquiry is extremely significant because we are witnessing the falling apart of the universal health system in our country, and what has happened to this small group of hospitals on the outskirts of Australia's major city is symptomatic of the decline. I have a 10-step program to fix the Australian health system on my web site, www.chesterfieldevans.com. This inquiry was conducted because some whistleblower nurses, in particular Nola Fraser, were concerned about the quality of health care being delivered in Campbelltown hospital. People in other hospitals have said to me that the standard of medicine is declining in our hospitals for many reasons.

    In late 2001 and during 2002 Nola Fraser took her concerns, which she felt were not being addressed, to the Health Care Complaints Commission [HCCC], the management of the South Western Sydney Area Health Service, and finally to the Minister. The HCCC was not set up for such an extensive inquiry and simply could not cope. It was trying to adopt a systemic approach to identifying problems in a non-blaming fashion, but it was not set up to investigate systemic problems within hospitals. The famous incident occurred when the operating theatre nurse, who had slightly different complaints, although from the same hospital, took her complaints to the Minister and took up much of the time in that interview. Nola Fraser went with her brother, a solicitor, to the Minister and was concerned that while the Minister said, "Yes, I will set up an inquiry," he did not realise the real depth of the problem. When she tried to impress that upon him, according to some accounts he said, "Once the train leaves the station you could lose your house," which gave rise to the question of whether that was threatening. That comment was given a great deal of play in the ICAC hearing.

    The key point was that the whistleblowers, particularly Nola Fraser, took the matter to Alan Jones and to 60 Minutes. Although I had heard rumours of the problem and had been asked to look into it, I had not got around to it until after the 60 Minutes program. I then contacted Nola Fraser and asked for whatever material she had. They were clinical cases of gross mismanagement. I say that as a doctor and stake my reputation on it. That view that those cases were badly managed has been vindicated by the findings of a number of groups looking at them, including the Institute of Clinical Excellence and, I believe, the Walker inquiry. On 12 October 2003, I moved a motion that the select committee be appointed and report by 13 May.

    I told the Government I thought it would go ahead, but it would be better if it was done by a judicial commission. The Government, in response to the motion, set up the Walker inquiry, which tended to look at it very legalistically. Like the Health Care Complaints Commission [HCCC], it was not set up to review individual cases but to look very much at Campbelltown and Camden rather than the system more widely. In a sense Bret Walker, who had faith in torts as a quality control mechanism, was looking at the evidence of other quality control systems, particularly in the oil and aviation industries, where alternatives to torts and recognition of mistakes were found to be a better way of controlling quality. But it was difficult to feed that into his terms of reference, and producing good mechanisms to fix it were difficult. Perhaps that is why ICE, the Institute of Clinical Excellence, was transmogrified into the Clinical Excellence Commission. If the fear of blaming and shaming continues it will be difficult to get that up and running, which is a major issue.

    When General Purpose Standing Committee No. 2 examined the issue the Opposition wanted to examine everything in health, which was noble but ultimately impossible, and the Government wanted to look at nothing very much. The compromise I suggested was that we look at complaints handling, which is reflected in the terms of reference. In a sense we looked at complaints handling within the health system because the whistleblower nurses have had such a hard time and the HCCC was not regarded as a solution as it was not working. But there was a great bias towards Campbelltown and Camden hospitals because of the problems they had experienced. Camden Hospital had been a cottage hospital on the periphery of Sydney and its provision of obstetric services had been controversial. I believe it was given obstetric services for political reasons. Obstetricians at Campbelltown, which is relatively close—about 20 minutes in non-peak periods—thought that it was silly to have two obstetric units so close together. It is all very well to say it is a midwife unit, which is fine for non-acute deliveries, but if the hospital has an obstetrics unit it must have a 24-hour functional operating system that can perform caesareans at short notice and provide resuscitation for babies.

    Campbelltown remains open under the contract, which involves expensive consultation by two or three obstetricians who provide 24-hour care. It is the worst of all worlds because even though it is a comprehensive service the cost per healthy non-risk delivery is very expensive due to the cost of maintaining a Rolls Royce service. Staffing problems in the health system are worse on the periphery. This is a problem not only for Newcastle but everywhere, except in the major teaching hospitals. However it can create a problem for the major teaching hospitals because of the buck-passing from the public system to the private system to try to offset costs. There are now four sources of funds: the private health insurance system, the individual patient or relatives, the State system, and the Federal system. Buck-passing by both the State and Federal governments has been a major driver of policy and has resulted in our not getting a comprehensive health system. As John Menadue commented when he was asked to look at the health system, nobody is in charge, which makes it very difficult to achieve quality.

    People from the Illawarra have said to me, "Gosh, we're glad you didn't do a Campbelltown on us. We would have been in big trouble." It is interesting to note that the Medical Error Action Group, an amateur group that survives on the smell of an oily rag, says things like, "Campbelltown Hospital certainly is not the worst." Jennifer Collins, the Chief Executive Officer, was highly criticised. In my dissenting report I compared her response with that of Owen James, who, when asked to close Wallsend Hospital when he was head of Hunter Health, said, "No, I will not close Wallsend Hospital because if I do that Hunter Health will have the longest waiting lists in the State." Hunter Health was subject to three corruption inquiries in six months, which found absolutely nothing, but Owen James was sacked anyway. Wallsend Hospital was then closed. As Owen James predicted, the Hunter region then had the longest waiting lists in the State. He pointed out that he could not deliver results because he was building John Hunter Hospital, the largest hospital being built in the State. There was an earthquake in the middle of the building program, but despite that he had come in within a few per cent of budget. He came back to an earlier hearing of General Purpose Standing Committee No. 2 to salvage his reputation.

    On the other hand I presume that Jennifer Collins accepted the budget cuts and therefore had to defend them. With the budget she had, she felt that she could do no more than hire the staff she had. If the level of staff expertise was less than what she wanted there was not a lot she could do about it. If she was then harsh on her staff it was because she was the ham in the sandwich. Although the point the whistleblower nurses made, particularly Nola Fraser, was that with the same money and more astute management, better outcomes could have been achieved. The committee, dare one say, was something of a bunfight. It is all very well to gloss over these things, but it could have been considerably more hard hitting. Nevertheless, the committee achieved major resource changes. I seek to table my two letters to the Walker inquiry, which show some of my concerns. I would like to speak briefly to my dissenting report. I seek leave to seek an extension of time of five minutes. [Extension of time agreed to.]

    The report could have been more wide-ranging had it not been so politically sensitive. I wrote a dissenting report, which I did not do lightly. I would have liked a more consenting report. In my experience in the British National Health Service I had seen a very poorly managed service where the bureaucracy had lost touch totally with the grassroots. Indeed, in many cases they had moved physically from working in the hospital to working in offices separate from the hospital. They had taken over some of the nice little country hospitals as offices miles from where the action was, and made major decisions without any contact with grassroots services. From my observations in Britain in the 1970s and my observations in health service in the early 1980s, New South Wales was considerably better, but the bureaucracy was being strengthened at the expense of face-to-face medicine—the bedside having the political power within the system. That trend has been accentuated. I have asked the Minister to look at the number of people who have clinical jobs as opposed to administrative jobs with no clinical contact. It is a problem.

    Fiona Tito, who chaired the Federal Government's very famous Professional Indemnity Review of 1994, had a background in safety management in industry. She asked, "How many adverse medical events are there in the health system?" If that question cannot be answer then we really must get a system that will give us an answer. If we cannot get an answer to how many adverse medical events there are then we cannot measure progress, we cannot see where those events come from, and we will not know how to fix them. In the legal model, which has been a huge and ongoing problem, everything is hidden and nothing is admitted. Although it was defined by the Walker report, he still criticised sufficient numbers of people to make it difficult, particularly for the HCCC. I am not sure that we have advanced very much in that regard. I would like to give an analysis of the Walker report, but I have not yet had a chance to do that. The important question that has to be considered is how administration can be quality controlled. There is no analogy between that issue and the medical and nursing boards. The assumption that it is either the doctors' or nurses' fault is not reasonable. To say that all of it is the administrator's fault, when the administrator may or may not have medical knowledge and may or may not have an adequate budget to do what he or she is being asked to do, is another question altogether.

    Medical service providers must be responsible to the communities they serve. Hospital boards, which are all appointed by the Minister, could become "yes" boards. The danger inherent in that is that chief executive officers loyal to the Minister would suppress hospital boards and they would again become highly compliant. Upward management of an economically stressed administration leads to an emphasis on making the figures look good while suppressing problems. Grassroots reporting needs to be improved in the provision of medical services. The report's recommendations relating to clinical excellence will, hopefully, address that issue, but improvement has to be achieved at the grassroots level. I do not think that grassroots reporting can be imposed from above. A lack of fear among medical practitioners is very important in achieving an improved outcome. Medical indemnity must be dealt with as part of those improvements.

    The Nurses Association was of little assistance to whistleblowing nurses. It is difficult not to see union and political ties overriding a duty to quality. Brett Holmes's statement that the deed of release was routine practice was simply not backed up by evidence from the department. The deed of release certainly looked very much like a deal between the management and unions, and that effectively meant that the unions would agree to management sacking the nurses if management did not say that the nurses were incompetent, thus preserving the ability of whistleblowers to obtain other employment. It may have suited unions and management to be rid of whistleblowers. The Australian Council of Health Care Standards needs to be subjected to closer scrutiny because it gave the Campbelltown Hospital a glowing report, despite the events that were occurring. That is not satisfactory.

    Of concern also is the fact that whistleblowers are given such a hard time. Whistleblower nurses are still being hung out to dry. Their future in nursing is probably beyond hope. This is the fate of people who had incredible courage against incredible odds to stand up to a system that was not delivering good care. Frankly, I believe their complaints relate to the system as a whole. I thank the committee staff, who did very well in a fairly adversarial frame work. I conclude by putting in a plug for the Utah model of medical indemnity insurance.

    The Hon. PATRICIA FORSYTHE [3.31 p.m.]: The committee owes a huge debt to the many people who wrote submissions and who in other ways participated in the inquiry. The committee received a total of 71 submissions and heard from 70 witnesses in 8 hearings. It is interesting to note that 17 submissions were sent in confidence or partially in confidence, and that I believe says something about the culture of NSW Health. We owe a huge debt to the brave doctors and nurses who put their careers on the line to ensure that their concerns about aspects of the administration of the public health system in New South Wales were brought into the open so that the prevailing culture of cover-up could be challenged and addressed. The community of New South Wales owes those people a huge debt. The committee will be able to repay that debt only if we are able to assure ourselves when the outcome of the committee's work is reviewed later this year that the culture of cover-up and denial has been challenged and changed. The committee looks forward to the Government's response, which is due within six months of the tabling of the report.

    The committee made 19 recommendations. Never again should the prevailing culture be one of politics first and people and their lives and careers second. No-one could be other than moved by some of the evidence that the committee heard. The time I have been allocated to speak in this debate cannot do justice to the many issues that confronted the committee. The inquiry was my first exposure to the Health portfolio, despite my many years of service in this House. The Health portfolio is not one in which I have previously done any work, so I came to the inquiry with an objective view. It was interesting to note how many of my committee colleagues placed on the record at the outset their previous involvement with NSW Health in a variety of ways. I saw my role on the committee purely objectively, but it was certainly not my first exposure to politics or to an examination of the New South Wales bureaucracy.

    While the committee was unable to focus on the point I am about to make, I could not help but think throughout the inquiry, particularly as I listened to evidence from nurses employed by the South Western Sydney Area Health Service, that an underlying factor in all of the problems that emerged is that at the time the incidents that were the subject of the inquiry took place, the then Minister for Health was the local State Parliament representative for the area and that that was a prevailing aspect of the culture. As I said, much is owed to doctors and particularly nurses who had the courage to blow the whistle on aspects of health administration in this State. They did so at great cost to their own positions, as the Hon. Dr Arthur Chesterfield-Evans mentioned a few moments ago in his contribution to this debate.

    The committee devoted an entire section of the report to the impact of whistleblowers, in paragraphs 4.65 to 4.69 inclusive. I will quote very briefly from the report because the committee noted that whistleblowers have a vital role to play in the development of an open and effective public sector. One of the nurses stated that the impact of being a whistleblower on her and her colleagues was that they had lost sleep, homes, friends, faith in the system and, in some cases, even family. I place that on the record because quite often members, as they go about their work on committees, forget the human factor and personal cost involved in public sector reform. In the case of complaints handling within NSW Health, the Government forgot the human cost. The Government tried to demonise the nurses who had come forward, and tried to make them, rather than the message they were bringing, the issue. As is so often the case with this Government, it shoots the messenger and does not listen to the message.

    Unless this Government listens to the message, nothing will change. Regardless of not being able to hold positions they previously held within NSW Health, the nurses involved should take pride in having been able to force some changes, despite the fact that those changes are not commensurate with all the hard work and effort that they have put in. Among changes that have occurred are those that have taken place within the Health Care Complaints Commission [HCCC]. However, it is evident that there is still some way to go in the achievement of change. That is obvious from what occurred during question time earlier today. The committee particularly noted that the Protected Disclosures Act 1994 as it relates to the Health Care Complaints Commission does not afford whistleblowers an appropriate level of protection, given the type of evidence from people I would describe as nurse whistleblowers. Paragraph 4.31 of the report states:

    The former [Health Care Complaints Commission] HCCC Commissioner, Ms Amanda Adrian pointed out that the Commission officers were obliged to warn the nurses that if they provided documents to the HCCC, they may not be protected under the protected disclosure legislation.

    The committee therefore recommended in recommendation 17:

    The Health Care Complaints Act 1993 and the Protected Disclosures Act 1994 be amended to protect the identity of whistleblowers when they require it and to provide protected disclosure safeguards for health practitioners, including nurses in both the public and private sectors.

    A measure of the Government's response to this report and to the evidence given by brave doctors and nurses is whether the Government is prepared to provide the level of protection suggested in recommendation 17. The evidence and the actions of the Government are tantamount to an admission that the actions of the HCCC throughout 2003 represented an inappropriate level of inquiry into the complaints made by the nurses. Subsequently, significant changes were made, not the least of which was that throughout the period of the inquiry the HCCC commissioner was moved on, and that was appropriate.

    In the short time that remains for my speech I wish to flag other important aspects of the report, particularly those relating to resources. Behind all the so-called adverse events is the fact that clearly there are shortages of resources in the South Western Sydney Area Health Service and in the Macarthur region in particular. Earlier the Hon. Dr Arthur Chesterfield-Evans referred to the provision of resources. I note that after the Opposition called for the inquiry, and while evidence was being taken, the Government announced in January 2004 a $7.1 million enhancement of resources for the South Western Sydney Area Health Service. Even if the Government was not prepared to say that it had got it wrong and that the nurses had got it right, by its actions it has now acknowledged that the nurses have highlighted significant problems within the system.

    Earlier I talked about politics, and politics was at its most evident when the committee was dealing with decisions about resourcing the Camden Maternity Service. Paragraphs 5.47 to 5.54 cover the failure of the Government to properly resource the Camden Maternity Service. Paragraph 5.50 states that the committee heard from doctors and nurses who were concerned that the maternity service had been funded and who said that it would have been better had resources been allocated to Campbelltown hospital. In the lead-up to the March 2003 State election the Government was determined to win the seat of Camden and took a political decision on what should have been a fundamental health issue: the resourcing of the Camden Maternity Service.
    I will not go into the detail of the conclusions reached by the committee. Suffice it to say that doctors and nurses made it very clear that inadequate resources were allocated for what was expected at the Camden facility; too little was spread too far to the detriment of patients in Camden and Campbelltown. The chairman of the committee was asked a question when he tabled the report and responded by referring to an old girls' network. Later in the day he referred to an old boys' network. Both comments were applicable to the conclusions he drew. I sum up that response by saying that a health club was operating in New South Wales. One need only listen to the witnesses, and hear of their career backgrounds, to understand that most of them have worked together for years, sometimes in the union, sometimes in management, sometimes on the hospital floor. So, whether they can be said to be members of a network or a club, the fact is they— [Time expired.]

    The Hon. PETER PRIMROSE [3.41 p.m.]: I was pleased to play a part in the inquiry conducted by General Purpose Standing Committee No. 2 into complaints handling within NSW Health. As other committee members have said in this debate, the inquiry was worthwhile on a number of fronts. All members of the committee, despite their opposing perspectives on a number of aspects and different experiences in the health system, all took a deep interest in the inquiry. I thank the committee secretariat for their sterling job in managing the volume of information received. Most importantly I congratulate and thank those who took the time and made an effort to contribute to the inquiry. I turn now to the substantive part of the report.

    Pursuant to standing orders debate interrupted.


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