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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; Hospitals: Camden
Speakers - Primrose The Hon Peter; Burnswoods The Hon Jan; Deputy-President (The Hon Patricia Forsythe); Lynn The Hon Charlie; West The Hon Ian
Business - Committee, Report


    GENERAL PURPOSE STANDING COMMITTEE NO. 2
Page: 12037


    Report: Complaints Handling within NSW Health

    Debate resumed from 20 October.

    The Hon. PETER PRIMROSE [2.30 p.m.]: Continuing from my contribution last week, chapter 2 of the report provides an overview of quality and safety in health care that has developed in Australia, and particularly in New South Wales, over the last 30 years, and the details are provided on page 5. The chapter describes the key initiatives that have been introduced in response to the need for a greater understanding of the intrinsic risks of health care. Chapter 3 examines cultural issues relevant to complaints handling, including taboos surrounding incident reporting amongst health care professionals, especially doctors. Advocates of a "no blame approach to medical error" argue that focusing on individual culpability discourages incident reporting. However, as the report notes, some commentators believe that the pendulum has swung too far away from professional accountability, with serious implications for patient safety. The final portion of the chapter seeks to identify ways to overcome some of the cultural values to incident reporting.

    Recent events in the South Western Sydney Area Health Service have illustrated what happens when health workers perceive they are unable to use formal channels for incident reporting. Chapter 4 refers to the impact of whistleblowing on informants, patients, colleagues and communities. Chapter 5 refers to the relationship between resources and adverse events. While cultural issues are at the heart of patient safety, the report notes that it is important to acknowledge the link between financial and clinical resources regarding the incidence of adverse events. The final chapter, chapter 6, makes a number of conclusions, including a provisional assessment of some of the proposed changes to the quality and safety agenda and the regulation of health complaints in New South Wales.

    One of the issues I found most interesting during the inquiry was one that I imagine would normally seem blatantly obvious. I refer to the heading "What do patients want when something goes wrong?" on page 3 of the report. I recall discussing with committee members how important this issue was, and we all agreed that it should go near the front of the report. As the report states, research indicates that when something goes wrong with their health care, patients want to know about it. The report cites a number of pieces of research that outline what, in my view, would normally appear to be blatantly obvious but which I believe to be a fundamental aspect and conclusion of the report. Professor Stewart Dunn, of the Department of Psychological Medicine at the University of Sydney and Director of ErroMed, made the following point in his evidence:

    The interpretation of all literature about what patients want when things go wrong is, "Please tell us what is happening?"

    In the health system this is usually referred to as open disclosure: proactively providing patients or families with a full explanation of the causes of their condition and entering discussions with patients about their future care and treatment implications. The provision of timely and frank information about an adverse event not only helps patients come to terms with their situation but, if properly managed, may reduce the likelihood that they will take legal action, contradicting the generally held view that admitting mistakes is likely to lead to litigation.

    NSW Health acknowledged that many of the complaints arising from Campbelltown and Camden hospitals were due to poor communication by doctors to families about the patient's condition and treatment. NSW Health also indicated that communication is a key area in which improvements need to be made and that it is committed to this, which was acknowledged by the committee. During the inquiry the committee heard of many instances whereby either NSW Health or health professionals were believed to have failed to communicate effectively with relatives affected by adverse events. As numerous case studies presented in the report show, the failure to adequately consult with or inform patients or their families about their treatment can have far-reaching and damaging consequences.

    As I indicated last week, committee members engaged in a lot of discussion and agreed on many aspects. However, some members, including myself, could not agree with the majority on some aspects. The Hon. Amanda Fazio, the Hon. Christine Robertson and I issued statements of dissent in which we indicated a number of concerns, a couple of which I will outline. With regard to chapter 3, we strongly opposed paragraphs 3.65 to 3.69 and recommendation No. 9. We argued that there is no way of making the number of serious incidents, deaths and so on, comparable across the health system in New South Wales because no two hospitals or health facilities are the same. We further argued that the recommendation could lead to a false impression about the standards of care available in respective health facilities, and could skew demands for care in an unwarranted and unsubstantiated way. Facilities that do not have an open culture of disclosure, with low reporting rates, would automatically appear to be the best, thereby promoting false confidence on the part of 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.

    [Interruption]

    We asked, additionally, should the number of incidents be the measure, or is the appropriateness and timeliness of the response the critical issue? For the benefit of those who are interested in reading my contribution, I should mention that the Opposition is seeking to interject while I am outlining the report. What concerns me is that, clearly, some members of the Opposition who are interjecting have not read the report. I urge them to take the matter seriously and read the report.

    The Hon. Amanda Fazio, the Hon. Christine Robertson and I also strongly opposed recommendation No. 10. The proposed benefits or outcomes of holding such a summit were not discussed, and were not supported by the evidence the committee received. A recommendation "That the NSW Minister for Health raise with his counterparts on the Australian Health Ministers' Advisory Council the concept of holding a national conference on clinical excellence" would have been more constructive. As I said last week, I thank everyone involved in the inquiry, even those with whom I disagreed. I believe it was an appropriate and very interesting inquiry that has led to a number of valuable recommendations, even though, as I have indicated, I do not agree with all of them.

    Last week during his contribution to the debate the Hon. Dr Arthur Chesterfield-Evans foreshadowed seeking leave to table some letters but at the conclusion of his contribution he did not formally seek leave. The Hon. Dr Arthur Chesterfield-Evans has asked me to seek leave to table the letters on his behalf, and I do.

    Leave granted.

    Documents tabled.

    I thank members for their interest.

    The Hon. JAN BURNSWOODS [2.40 p.m.]: I want to say a few words about this interesting inquiry, not because I was a member of the committee or was proxied on—because I was not—or because it is an area that I have a great deal of expertise in, but I just wanted to make some comments—

    [Interruption]

    If members of the House did not speak on things that they lacked expertise in, Mr Gay, I think most of us would make very, very short speeches.

    The Hon. Duncan Gay: Speak for yourself, not for others.

    The Hon. JAN BURNSWOODS: I would think there would be a few more people around here who traditionally make longer speeches than I do that that might also apply to.

    The DEPUTY-PRESIDENT (The Hon. Patricia Forsythe): Order! There is too much interjection.

    The Hon. JAN BURNSWOODS: As I said, I want to make some comments on the report on complaints handling within NSW Health and on some of the broader issues in relation to our health system. Some interesting comments have been made by different members of the committee from their different points of view, and there are a number of very good recommendations in this report. In some respects I think it stands as an example of inquiries that perhaps start off in a quite partisan way and then the committee members work well together to produce a variety of reports.

    For instance, I note that the Hon. Peter Primrose has drawn our attention to some of the recommendations that he opposed, basically because he and other members did not agree with them, but also because in some cases the recommendations had not been properly discussed by the committee. It is partly in that context that I refer to some of the remarks made by the Hon. Christine Robertson before she was unfortunately injured and has since been on leave. Those remarks are not in relation to the report itself because, as Christine has made very clear, having had a great deal of expertise in the health area and having participated to a considerable extent in this inquiry, she considers the recommendations as very important and, I think, like the Hon Peter Primrose, has expressed her support for most of them. However, she was very concerned—as were a number of us, particularly women members of the House—at some of the remarks made by the chair of the committee in the media conference when he tabled the report. Of particular concern were his remarks, which were then quite widely reported, in which he described the health system as having been run by "an old girls' network".

    A number of people, including Christine and several others, have made the comment that this is a pretty offensive description, and obviously it is particularly offensive for women. But they expressed also their grave concern that in all of the variety of evidence taken by the committee, in all of the quite serious and very thoughtful attempts to examine the role of the whistleblowers, the evidence for and against some of the allegations that were being made, the problems faced particularly by new and expanding hospitals in growth areas—

    [Quorum formed.]

    I have always wanted to use the phrase "As I was saying before I was so rudely interrupted", and I have finally got my chance. I was joining with Christine Robertson in expressing concern about the sexist, biased and unfortunate remarks, totally unrepresentative of the report, made by the chairperson in tabling the report and in the media conferences. I will leave it at that but I believe that committee chairs need to be most careful in the way they present reports for which they have responsibility. In this case Reverend the Hon. Dr Gordon Moyes did not exercise his responsibility appropriately and I would certainly ask him to be a little more careful in future about the way in which he speaks about women.

    I also wish to comment on the dissenting statements in the report: one made by the Hon. Dr Arthur Chesterfield-Evans and one in the name of the Government members of the committee. As I said before, and as is made very clear in the opening paragraph of the statement of dissent, the Government members took a very positive approach to the inquiry and their amendments were proposed with the intention of improving the complaints handling processes in NSW Health and trying to engender an open culture of learning within NSW Health rather than political pointscoring. The Government members then go on to make a number of comments about the evidence, and so on.

    I want to refer briefly to recommendations 9 and 10, which were strongly opposed. In recommendation 9 the members argued that there is no way of comparing the number of serious incidents, deaths, et cetera, across the health system in New South Wales as no two hospitals or health facilities are the same. The members went on at some length to draw attention to the naiveté of that particular recommendation. Recommendation 10—and this is the recommendation that the Hon Peter Primrose referred to at the end of his contribution—was strongly opposed because the proposed benefits or outcomes of holding a summit were not discussed at all, were not supported by the evidence received and, therefore, the members considered that the recommendation was inappropriately placed in the report.

    There are a number of comments specifically about chapters 4 and 5 of the report and some comments in general that I would like to make regarding the findings. To quote the last paragraph of that dissenting statement:

    The findings of the Review support the decision to operate the service as a low-risk service from the beginning. The Committee did not conclude that the maternity unit was re-opened for political motives based on the evidence before the inquiry. Rather this conclusion was politically motivated and not soundly based.

    It is unfortunate that that level of disagreement amongst committee members survived to the end.

    [Quorum formed.]

    [Time expired.]

    The Hon. CHARLIE LYNN [2.50 p.m.]: I speak on the report of General Purpose Standing Committee No. 2 entitled "Complaints Handling within NSW Health". I note that in relation to patient safety within the South Western Sydney Area Health Service, prior to this report there were at least six other inquiries. They were the special commission of inquiry into Campbelltown and Camden hospitals headed by Bret Walker, SC; the New South Wales Coroner's investigation into 22 patient deaths at Campbelltown and Camden hospitals; the ICAC investigation into claims of victimisation by the brave nurse informants and the conduct of the former Minister for Health, Craig Knowles; a review by the Cabinet Office looking at legislation governing the Health Care Complaints Commission; an investigation by the Health Care Complaints Commission into individual cases of unsafe or inadequate care or treatment at Campbelltown and Camden hospitals; and the joint parliamentary committee on the Health Care Complaints Commission.

    However, this report is different from the above as members of General Purpose Standing Committee No. 2 were concerned that there had been no real examination of systemic issues relevant to complaints handling in the health system. The chair of the committee is quoted as saying, "We want to examine what happens when individuals within the health system raise problems, does it lead to improvements and improved quality of care, or is the treatment experienced by the nurses who raised concerns at Campbelltown and Camden typical of what happens in other areas?" An examination of whether such problems were isolated to Campbelltown and Camden hospitals or were more widespread across the health system then took place. Paragraph 1.17 made the key finding that such problems were widespread. The committee found:

    There were undoubtedly serious cultural and system-related problems concerning complaints handling in South West Sydney. There was, however, no evidence that the way in which complaints were managed in this area health service was any worse than other areas. Evidence about the cultural barriers to incident reporting suggests that similar problems regarding both adverse incidents and complaint handling exist across NSW. We believe these are systemic issues, not problems isolated to one area health service.

    In other words, the health system is riddled with system-related problems and, even worse, cultural problems right across New South Wales. The Government has allowed a culture to develop in hospitals where, despite the procedures in place, they must not be followed or workers will be ridiculed, lose their jobs or be severely harassed. I understand that Labor members on the committee were so embarrassed by this finding that they tried to have it expunged from the final report. This was a review of the complaints handling system within NSW Health, yet in the committee process the Australian Labor Party [ALP] tried to cover up the truth by pretending problems did not exist across the sector but that it was isolated to Campbelltown or Camden hospitals. Therefore, solutions were not necessary. This is the ALP at its heavy-handed best.

    The core of the report recognises that changes do need to occur to allow complaints made by health professionals to be handled in a way that will improve the health care system and not create a culture of retribution and cover-up. The way that the Minister is alleged to have tried to come down heavily on these nurses does him no credit. When he was told that people were dying unnecessarily at Fairfield Hospital he had the nurse removed from her position, instead of trying to rectify or investigate the problem. He initiated a cocktail of thuggery, intimidation and removal. How can nurses in the system be expected to report problems when they are treated with such contempt for caring about their patients?

    Premier Bob Carr should give serious consideration to calling for the resignation of Craig Knowles, although he is no longer the Minister for Health. The health sector needs a system where staff are encouraged to report incidents and learn from mistakes. In most hospitals it is not a question of having systems in place and written down; it is the fear and culture that exist in implementing them. When nurses raised concerns about problems, they were treated with contempt. The system should be designed so that complaints can be accepted, criticism received and, where necessary, improvements made to ensure the best possible health outcomes in our hospitals. Patient care should be improved and we should learn from mistakes at Camden Hospital, in particular. In addition, the Government must provide adequate resources for the running of all our public hospitals.

    I turn now to Camden maternity unit. The report found that the maternity unit was opened without adequate resources or staff. I clearly recall when the unit was opened because it was done as a political stunt during the 2003 State election. In fact, only a week earlier I had written a letter to the media exposing the stunt. We also ran an advertisement stating that Labor could deliver on hospitals but could not deliver babies. The following week the Premier and then candidate for Camden, Geoff Corrigan, suddenly appeared at Camden, put their spin machine into full gear, held a press conference, which was on the front page of the Daily Telegraph—a superb media stunt, which resulted in Councillor Geoff Corrigan, Mayor of Camden, being elected as the member for Camden. The Government knew it had to cover-up the deficiency in the unit. It was common belief that the Minister demanded the reopening of the unit before the last State election, against all medical advice. He ordered that budgets be cut in other areas to ensure that waiting list targets were met. It is unacceptable that a maternity unit could be forced to open without adequate resources and staff, and is a clear demonstration of the value the former Minister placed on patient care as opposed to political advantage.

    With respect to the Chair's original question about what happens when individuals within the health system raise problems and whether it leads to improvements in the quality of care or whether the treatment experienced by those nurses at Campbelltown and Camden were typical of what happens in other areas, the sad and simple answer is yes. Those nurses were bullied directly by the Minister; some were intimated and some were encouraged not to report problems. In this case, enough is enough. The people of New South Wales need reliable, fully resourced hospitals, with mechanisms in place to deal with problems when they occur. It is time for the era of cover-up and lies in the complaints handing system in NSW Health to end.

    The Hon. IAN WEST [2.59 p.m.]: I speak on report 17 of General Purpose Standing Committee No. 2 entitled "Complaints Handling within NSW Health", dated June 2004. The reference goes to the question of the culture of learning and the willingness to share information about errors and system failures, and an assessment of whether the system encourages open and active decision making and improvement in clinical care. The committee, in its deliberations, looked at a number of issues, which are set out in the report, and the various submissions and witness lists incorporated in the report.

    I shall refer to a number of matters in the various chapters of the report, particularly the issues canvassed by the Hon. Amanda Fazio, the Hon. Peter Primrose and the Hon. Christine Robertson. First, we do not believe that evidence was received to support the statewide comparisons contained in the report and we sought to delete those particular references. The committee heard extensive evidence from staff and management at South Western Sydney Area Health Service, 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 this, and taking into consideration the issues raised in submissions received, the assertions made throughout the report about the situation statewide cannot be supported and should be removed from the report if the report is to be seen as a credible and evidence-based report.

    I concur with the Hon. Amanda Fazio, the Hon. Peter Primrose and the Hon. Christine Robertson in their strong opposition to paragraphs 3.65 and 3.69 and recommendation 9 in chapter 3 of the report. There is no way of making the number of serious incidences, deaths, et cetera comparable across the health system in New South Wales as no hospital or health facility has the same particular considerations. Paragraphs 3.65 and 3.69 and recommendation 9 in chapter 3 could clearly lead to a false impression about the standards of care available in the respective health facilities and could skew demands for care in an unwarranted and unsubstantiated way. Facilities that do not have an open culture of disclosure, with low reporting rates, would automatically appear to be the best, thereby promoting false confidence by 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. In addition, should the number of incidents be the measure, or is the appropriateness and timeliness of the response the critical issue? I concur with the Hon. Amanda Fazio, the Hon. Peter Primrose and the Hon. Christine Robertson in strongly opposing recommendation 10. The proposed benefits or outcomes of holding such a summit as proposed in recommendation 10 were not discussed, and it was not supported by the evidence presented to the committee. A recommendation that the New South Wales Minister for Health raise with his counterparts on the Australian Health Ministers Advisory Council the concept of holding a national conference on clinical excellence would have been a much more constructive proposition.

    I submit that paragraph 4.35 in chapter 4 should be deleted as evidence was not received that would justify the assertions made. The comments of Giselle Simmons in paragraph 4.47 should be deleted from the report. When compared to the in-camera evidence of nurses Owen and Quinn, two of the nurse informants who took their concerns directly to the Minister, Ms Simmons' comments do not appear to be representative of the Minister's response. Table 1.2 shows that Minister Knowles referred the matters raised by the nurse informants to the director-general on the very same day that he met with them, thereby triggering the investigation process by NSW Health and the Health Care Complaints Commission. This clearly demonstrates immediate response action undertaken by the former Minister in this case.

    The comments in paragraph 4.6 of chapter 4 relating to the regrettable death of Mrs Yakub should be removed as this particular section of the report deals with patient deaths at Liverpool Hospital and Mrs Yakub was not a patient at Liverpool Hospital. Further, the comments relating to Associate Professor Picone are not based on fact and are part of a politically motivated attack on a well-respected senior member of NSW Health. This also applies to the unwarranted comments about her in the first sentence of paragraph 4.75, which reads:

    The Committee is deeply concerned that Associate Professor Picone—

    [Time for debate expired.]

    Motion agreed to.


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