Friday, November 28, 2008

Hospitals Need Reform Now.

The release of the much anticipated Garling Report may have been pushed off the front pages by the dramatic events overseas, but it is a matter of the greatest importance to the future of public hospitals in New South Wales. The 1100 page report delivers 139 recommendations, and begins with an observation which should not need to be made. Peter Garling writes: “A new culture needs to take root which sees the patient’s needs as the paramount central concern of the system and not the convenience of clinicians and administrators.” The mere fact that this needs to be said shows just how far off the rails the system has run.

Some of the recommendations seem at first glance to be counter-productive. In particular, the proposal to close down Emergency Departments at some hospitals so that resources can be concentrated at others could be seen as a retrograde step. I would have thought that Emergency Medicine should be part of the core business of every public hospital. Isn’t that what a hospital is there for? The same can be said for Maternity Services. Shouldn’t every hospital have the capacity to deliver babies, so that families don’t have to travel any further than necessary when a baby is on the way?

Of course, I am not the one who has visited 61 hospitals, read through 1200 written submissions and listened to 628 witnesses. Mr. Garling has, and he is in a position to have considered the matter thoroughly. His report also reflects the reality that there is a shortage of both doctors and nurses. Any Emergency Department can only operate effectively if it is adequately staffed, and with the shortage of medical professionals it might simply be impossible for every hospital to have a fully functioning Emergency Department. In that context, Mr. Garling’s recommendation may well be the most appropriate solution, at least until such time as more doctors and nurses can be trained.

The Garling report addresses not only the nuts and bolts of the Hospital System, but also the broader issues. Most notably, it addresses the culture of bullying which has been identified by previous investigations. Many of the problems emanate from the sheer pressure that exists to deliver an acceptable standard of service in an environment of limited resources and tight budgets. As the stress increases so does the likelihood of frustration and shortened tempers. In such an environment is it really any surprise that the report says bullying has become “endemic” in the system.

Mr. Garling has delivered a list of specific recommendations to address the shortcomings of our hospital system, and a timetable for them to be introduced. Now the ball is in the court of the New South Wales Minister for Health John Della Bosca, who has indicated that the government will formulate a response by March next year. The only trouble with that is that some of Mr. Garling’s reforms have been recommended to be implemented well before then.

As an initial response from government, that’s hardly encouraging.

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