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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: Mona Vale Hospital; Inquiries
Speakers - Robertson The Hon Christine; Chesterfield-Evans The Hon Dr Arthur; Forsythe The Hon Patricia
Business - Committee, Report, Motion


    GENERAL PURPOSE STANDING COMMITTEE NO. 2
Page: 21192


    Report: Operation of Mona Vale Hospital

    Debate resumed from 9 November 2005.

    The Hon. CHRISTINE ROBERTSON [2.32 p.m.]: The report on the operation of Mona Vale Hospital reflects a lot of the work carried out by general purpose standing committees, which have great difficulty achieving positive outcomes. Despite the tone of polite concern expressed by some members who contributed to this debate, the ulterior motive for holding this inquiry in the first place was never far from the surface. This inquiry was about planning for the future health care of the people of northern Sydney. There is a basic premise about role delineation and what individual hospitals can and cannot do. A big part of the quality program is not having major problems occurring in hospitals that do not have, and never will have, the level of service and clinical procedures required by some sick people. That level of service includes some kinds of surgery, perhaps for an intubated person who is unconscious and requires intensive care, or a sick child who needs a level of treatment that can be provided only by an individual hospital.

    The available level of service is an incredibly important component of country health care planning. Every time an inquiry of this type is carried out we further put at risk work that general practitioners, health service providers and communities are doing in country areas to try to ensure that appropriate services are available. Hospitals are divided into community hospitals, district hospitals and referral hospitals, which are mostly metropolitan for obvious reasons. They require a core and a high level of expertise in order for those services to be delivered. It took quite a while for the committee to work out exactly where the issues were sourced and I am not sure whether that was ever identified. The committee has not documented that source but it did identify certain clinicians, in the Mona Vale area for example, who wanted to do fairly high-level procedures in their hospital—procedures that they had carried out for many years.

    When dealing with this topic it is important also to recognise the changes to quality in health. No longer are appendectomies undertaken at Berry hospital, which did those operations when I was a child. An appendectomy requires anaesthetic administered by an anaesthetist and backup services to ensure that nothing goes wrong. That can no longer happen in smaller community hospitals, which have a very special function. I return to what happens in city hospitals. The same function is carried out in community or district hospitals as is carried out in the city, that is, to assess and provide initial care. It is essential that hospitals know exactly where a patient has to go to get the service that he or she requires. Doctors and nurses must know where those services are available and the hospital administration has to be mindful of what it can deliver.

    During this inquiry a local government group and a community group informed the committee that they understood role delineation, that they had undertaken that task at Mona Vale Hospital and that they were going to resolve all the committee's problems. This inquiry was not about the Government; it was about a lot of very interesting pressure groups, both clinical and community, and the work done by individuals to divide that community. During debate on this report it was interesting to hear that the Government had divided the community. The Government was not there with its support groups to ensure that the community maintained its divisions.

    Another issue that was raised related to community consultation. It appears from the evidence and from the report that there was a great deal of community consultation. It was not necessarily about what people wanted to hear or what satisfied them, but there was a great deal of community consultation. The committee received recommendations regarding community consultation, which have been outlined in the dissenting report. I believe the dissenting report is more accurate in working through those issues. Particular factions and groups within those communities ensured that it was incredibly difficult for the committee to achieve an outcome.

    The health service, which played the role of both consultant and health service, carried out massive community consultation. No matter where one enters the health service the same outcome is achieved. If one enters the health service in Mona Vale Hospital with a level two emergency—Mona Vale Hospital has only an emergency theatre and a high-dependency unit for intensive care—and one requires major surgery and intensive care from doctors and clinicians, one needs to know that it is possible to be transferred to Royal North Shore Hospital, which provides the necessary services. The planning processes that are being worked through in northern Sydney are very detailed. It is fortunate that some time ago New South Wales produced a major metropolitan health plan that health services are working towards.

    That plan outlines what services will be provided in various areas. In some cases it means that transplant units will not be available in every tertiary hospital but will be at a hospital with the highest level of expertise. When all those levels of expertise are combined the outcome is beneficial for patients. The same thing happens in district and community hospitals as different levels of service are provided by each area health service. Health planning in no way discredits any of those levels of service. The services provided in a community hospital or in an accident and emergency service are for assessment and maintenance in order to transfer to the next level of service. That is just as important as a tertiary hospital.

    Throughout the committee's inquiry it was inferred that that was not so. Several witnesses—most of them clinicians but some had been involved in the metropolitan health plan and were responsible for deciding what levels of service should be provided by individual hospitals in the North Shore area—told the committee what level of service should be provided and where. They spoke about the right doctors and the right back-up services not being available. That does not mean we should not construct buildings that will not fit them in; it means we have to have clinicians who adequately deliver those services.

    The committee heard from some very fine members of the community—I mean all of them; I am not making a value judgement on where they came from—who honestly believed that what they were saying was how it should be. We heard from clinicians who most definitely wanted to have in their patch what they believed was appropriate to enable them to deliver the services they wanted to deliver. It was a very mixed, mishmash of evidence in the long run. In my opinion the committee was very hard-working; we worked well together and managed to avoid any hostility. We spoke to each other and discussed the issues and I believe that each member of the committee understood and accepted the points of view expressed by other committee members. There was no animosity in relation to the way that the committee operated.

    Our regret is that the committee did not produce a document that would reinforce good health services for the future of the people of northern Sydney. In a way we produced some divisive recommendations that reinforced the problems that already exist in the northern Sydney communities. I come from the country and I accept that places such as Tamworth and Armidale work together when it is convenient to do so but basically do not like each other and make sure that people know we do not. It was interesting to work with a community in Sydney, where the suburbs are doing much the same thing; where politicians and the communities endeavoured to ensure that they were each the most important.

    The committee made recommendations about preferred sites that, in fact, we did not have the skills base to deliver on. If not recommendations, there were inferences that perhaps this or that would be the best site. I believe that in respect of some of this committee work we did not have the skills to deliver our recommendations. I urge honourable members to read the entire report, including the dissenting report.

    The Hon. Dr ARTHUR CHESTERFIELD-EVANS [2.42 p.m.]: This was a very significant inquiry into services offered by hospitals on the northern beaches. The problem with the northern beaches area is that, although it not a long distance geographically from its major hospital—which is the Royal North Shore Hospital—the transport from the peninsula is poor. It is well known that there should be tracked transport, probably across the Spit Bridge or perhaps linking in with the Chatswood rail line so that people from the northern beaches can get to the Royal North Shore Hospital.

    There is little doubt that the Government—through the former Northern Sydney Area Health Service, now known as the Northern and Central Coast Area Health Service—wanted to consolidate Mona Vale and Manly hospitals on a new site. The preferred site seems to have been Dee Why, which has the disadvantage that it is a quite small site, is quite rocky, is in the shopping centre and already has a traffic bottleneck that would get considerably worse if there had to be additional parking and hospital facilities on the site.

    The Save Mona Vale Hospital group made no bones about its agenda. It wants to save its hospital. It is a magnificent hospital on the coast, associated with a golf course and on a fairly large amount of land. I think the group's fear that the Government's agenda is to sell the land is valid. There is no dispute that the Manly Hospital site is not a good place for a general hospital. It is away from the main stream of traffic, is on a peninsula, on top of a hill, and is quite difficult to access because the bus service is not good. One point that was continually made during the inquiry was that all hospitals now cannot offer all services. There was a great deal of discussion about the level of service and functions that can be offered.

    Hospitals in the public sector seemed to say, "Well, it does not have critical mass. If we cannot staff the intensive care unit, we will have to close it down." Meanwhile, around them a galaxy of small private hospitals with way below the theoretical mass needed for a public hospital, and with nothing like the intensive care staffing of the public hospital, are doing very nicely, thank you. I believe that the arguments that hospitals must be closed simply do not hold water, but there does need to be an intelligent division of function. That is certainly true if a hospital is to offer intensive care services and 24-hour surgery—which, of course, is needed if it offers obstetrics. We have now reached the point where people do not tolerate deaths in childbirth. They want to know that if they need an emergency caesarean it can be performed. That can only be done if anaesthetists and operating theatre staff are based there and are ready to go almost at a moments notice.

    While it would be desirable to have a single hospital on the peninsula, I think it would also be possible to have Mona Vale Hospital as the hospital and improve the transport from Manly to the North Shore. I am of the view that the Government does not want to think beyond that. The health system thinks within its silo and the Government's transport planning is within a completely different silo. The health people say, "Assuming that the transport from Manly to the North Shore remains as bad as it is now, therefore we have to build one hospital rather than two." Rather than retain Mona Vale Hospital and take Manly people to Royal North Shore Hospital, which could happen only if there were decent transport, the health system planning assumes that it is impossible to go from the bottom end of the peninsula to the North Shore.

    It might be said that Royal North Shore Hospital is at capacity. I believe that the site has been extremely badly managed. The hospital has gone into decay at an almost extraordinary level. This sort of neglect is very worrying. In a sense, the committee was faced with considered recommendations about why a hospital was needed for the peninsula, but within a frame of reference of transport constraints set by a government that engages in very poor transport planning. In my view that framework influenced the committee's report.

    The Government's consultation process was flawed. The Government did not want to know what the Save Mona Vale Hospital people wanted. That is understandable. The Government knew that the Save Mona Vale Hospital people wanted to save Mona Vale Hospital. It knew that they wanted to build one hospital instead of two. Given that you cannot staff two intensive care units, and that if you are to offer 24-hour services you are better off with one hospital than two, I think the Government had undertaken enough consultation within that framework to know that it was not going to get consensus and it therefore withdrew from the consultation process. In a sense one can understand that.

    There were some aspects of the committee hearings that were very worrying. Why Neverfail Springwater Limited, which I understand is a branch of Amatil, ceased to supply bottled water to Manly Hospital because NSW Health had not paid its bill was a source of some anxiety. Departments that do not pay their bills are the bane of a private contractor's existence. It is certainly worrying that the Government operates so close to the bone. An expert who does cardiac testing on behalf of general practitioners at Mona Vale Hospital told the committee that any bill of more than $7 must be forwarded to the chief executive officer, who travels from Nowra three days a week to manage the hospital. She said she had to wait until the next financial year to purchase the paper she needed to send letters to GPs about the cardiac testing she had performed. As I said earlier, a water company withdrew its product because the area health service was a bad debtor. I think that speaks volumes about the state of the health service in New South Wales and how precarious the situation is.

    We talk about waiting lists and triaging—which is rationing by another name—but this is another problem. Intensive care staff have performed some absolute heroics, working extraordinarily long hours, in an effort to meet the service deficit. It is not clear where the new hospital should be sited on the northern beaches. No-one suggests establishing a decent tram service across The Spit, although I gather that the tunnels extend to Neutral Bay so the trams could be reactivated. That would be a realistic public transport option for travelling from the lower end of the peninsula to a rebuilt North Shore hospital. But that option was played down during the inquiry.

    The committee recommended saving Mona Vale Hospital and preventing the Government's sale of the site on which it stands. But the Government has made no commitment to preserving the site, and that is extremely disappointing. Residents on the northern part of the peninsula believe the Government is not doing enough to resolve this matter. Indeed, they felt so strongly about this issue that they elected Alex McTaggart as the member for Pittwater. The people of Manly are not quite so passionate about this matter. They acknowledge that Manly hospital must be replaced and they are looking for an alternative hospital site. I think they would prefer that site to be on the peninsular, which is an understandable reaction. In a sense, Manly residents have internalised the poor transport services that are a legacy of this Government.

    It was suggested in the media that I had asked personal questions of a witness during a committee hearing. One witness claimed to speak for a community group and I asked about her relationship with people from the hospital, who were speaking with the naked interests of Manly hospital in mind. I certainly did not intend to ask personal questions; I was simply attempting to ascertain the relationship between the staff of Manly hospital and the representatives of the community group concerned, which, from memory, was called Better and Equitable Access to Community and Hospital Services. The inquiry was most interesting. It is important to integrate hospital and transport planning. [Time expired.]

    The Hon. PATRICIA FORSYTHE [2.52 p.m.], in reply: I thank all members of General Purpose Standing Committee No. 2 who have contributed to the take-note debate on the operation of Mona Vale Hospital. This is report No. 19 of the committee, and I think all committee members made a contribution to it. I found the Hon. Christine Robertson's remarks most interesting. Committee members are aware of the intense and passionate interest she takes in health issues, arising from her professional background. We value her input and her gentle reminders when we appear not to grasp what she considers to be matters of fundamental policy. However, the lecture today perhaps went a fraction too far. I think committee members understand role delineation. We appreciate that all hospitals cannot offer all things to all people—even at Mona Vale and on the northern beaches as a whole.

    Notwithstanding that, this Government has made no real commitment to progressing this issue. There has been a lot of talk and consultation but, despite its cost—the consultation process extends back to about 2000—talk is cheap compared with investing in upgrading existing hospitals or constructing new ones. The Government has almost consulted this issue to death. Despite the best efforts of the excellent staff at Mona Vale Hospital, it is almost a case of death by neglect at that facility. The hospital lacks fundamental resources and the Pittwater community, the auxiliary and so on have been forced to raise funds to provide basic hospital equipment and services. Those people are most concerned about the future of the hospital.

    That is why in its final recommendation the committee is seeking a real commitment from the Government regarding the future of the Mona Vale site. What is to happen not only to the hospital but to the land on which it sits? That issue is as topical today as it was when we accepted the reference in December 2004 and when the committee tabled its report in May last year. The people of Pittwater are most concerned that the Government has a hidden agenda and wants to sell the Mona Vale Hospital site. But they will not stand for it. I made that point in an adjournment speech in the House only last week, and I reiterate it this afternoon.

    As to role delineation, I remind the Hon. Christine Robertson that the committee considered what residents from each local government area thought about the preferred location of a general hospital on the northern beaches. Some 82 per cent of Pittwater residents overwhelmingly endorsed the Mona Vale site, as did 24 per cent of residents of the Warringah local government area and 7 per cent of the Manly local government area. That means that 35 per cent of the northern beaches community support the Mona Vale site. Some 28 per cent supported the proposal to site a hospital at Brookvale and 25 per cent favoured a Frenchs Forest site.

    We acknowledge that northern beaches residents are not unanimous in their view about a future site. The Liberal-Nationals Coalition generally accepts that one level-five hospital and one complementary hospital are needed. However, we make it clear to the Government that the future use of the Mona Vale Hospital land is integral to any final decisions that are taken on this matter. Its purpose must be health related. We believe also that Mona Vale Hospital should be upgraded. Millions of dollars should be spent on the emergency department and the many other facilities that the community believes it deserves.

    The Hon. Christine Robertson used the work "divisive". Although a minority report was produced—I acknowledge that—I believe that committee members have learned to work well together. Our responses focused on the issues and our report is issues based. All members made a contribution to the inquiry. I know that the Government is not a fan of general purpose standing committees: it would prefer to do whatever it wants without any so-called "interference" from Parliament. But the fact is that these committees make a contribution. They enable us to hear from those in the community who have valid points of view. I think it is good when developing public policy to give expression to the views not merely of bureaucrats—we heard from numerous officers of NSW Health and Northern Sydney Central Coast Health—but of all those with an interest in the issue. The committee heard evidence from clinicians, medical specialists, nurses and others with a general interest in this matter.

    In this debate our committee has shown its interest in the issues specific to the Mona Vale Hospital site many of which are relevant about the siting of hospitals and the delivery of health services right across the State. I share with my rural colleague members of Parliament the Hon. Christine Robertson, the Hon. Melinda Pavey and the Hon. Tony Catanzariti, who was not able to contribute to the debate, a strong understanding of the delivery of health service to get the best hospital services across vast distances and to small population centres. They bring a particular perspective to the debate around Mona Vale Hospital as they are well aware of issues to do with other hospitals. I thank all honourable members of the committee, and I ask the House to appropriately take note of the operation of the Mona Vale Hospital report of General Purpose Standing Committee No. 2.

    Motion agreed to.


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