‘We were abused and called baby killers’: How politics took a hospital to the brink
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The endings are rarely happy when a hospital finds itself at the heart of a political fight.
But that is the fate of Northern Beaches Hospital. When it opened in 2018, it was meant to be a new vision of how the private sector’s innovation and efficiency could be harnessed to provide public hospital care.
Today, the private operator Healthscope is crippled by debt and the Sydney hospital itself is subject to a parliamentary inquiry, sparked in part by the death of two-year-old Joe Massa last year, who was allegedly wrongly triaged after presenting to ED.
Below is AusDoc interview’s with Professor Keith Burgess, head of respiratory and chair of the hospital’s medical staff council.
As you will discover, what went wrong in the public-private partnership is more complex than the political finger-pointing may attempt to suggest.
“We would like people to stop picking on us for things that are out of our control,” he says.
AusDoc: You were there at the very beginning, before the hospital was built. You’ve seen the optimism turn very sour.
Professor Keith Burgess: I was working at Manly Hospital back in 1993, and as chairman of the medical staff council, I drew all of the staff together and discussed the idea that Manly/Mona Vale should be replaced by a central hospital.
Of course, it took the government 25 years to achieve that.
When the idea of Northern Beaches was agreed, we assumed it would be a public hospital.
But even when we realised it was going to be built and run through a public-private partnership, we were still optimistic.
As long as we got a big hospital with a critical mass of patients, a critical mass of staff and a critical mass of equipment, then it was not going to be an issue for us.
AusDoc: The idea in the headlines is that this was about big business, the private sector, being more obsessed with chasing profits than patient care.
But your view is that Healthscope cannot be singled out for blame?
Professor Burgess: The facility, at least the public part of Northern Beaches, was and still is underfunded.
For me, the reason was that the project was undermined by the health ministry and the local health district from the beginning…
Healthscope was also to blame, however. It’s also been part of the problem. For instance, they chose a terrible IT system, clunky computers and terrible software.
But that doesn’t alter the fact that the public component of the hospital was underfunded from the get-go.
AusDoc: Having been built by Healthscope, the hospital opened in 2018 with around 290 public and 195 private beds, 14 operating theatres, four procedural rooms and a 50-space ED.
It was a multi-million dollar facility. At what point did problems become apparent to you and the rest of the staff?
Professor Burgess: On day one.
Healthscope had people on site for a month before the opening, but they didn’t seem to do anything useful.
The shelves were not stocked, the basic equipment was missing, drugs were not on the wards.
But everyone pitched in and we made it work.
As time went by, we kept complaining to the administration. They kept promising improvements, and the improvements usually came too slowly and were never really enough.
I suspect the problem lay in Healthscope’s administration back in Melbourne, not the local people who were trying to do a good job with what [they] were given.
They have been constrained by circumstances. Through the lifetime of the hospital we’ve drifted along, forced to settle with what we’ve got.
The lack of resourcing coming from the State Government meant there [were] too few junior medical staff.
Their profile was also very junior. The nursing staff, again, are relatively junior, lacking that senior profile.
With allied health staff — there are just too few of them.
Ironically, we have a lot of senior consultants. Part of the reason for that is that there are lots of patients, lots of equipment, so we’ve got critical mass.
But it’s been very hard on the junior medical staff, some of whom have been reduced to tears at times.
It’s been tough on the nursing staff and allied health, who all want to do a good job, but they are being stretched to the limit.
And it is related to the funding issue.
Because I want to emphasise this point — Northern Beaches is a good hospital doing good work.
I’m proud to have worked there. But the funding issue has meant over the last six years, the demands on us have just about killed us.
Everyone has been going above and beyond. As a result, there have been a very few medical misadventures, certainly no more than you find at every big hospital offering complex care.
The problem we face is that it currently suits the State Government to emphasise disasters at Northern Beaches for their own political ends.
But as I said, they’re part of the problem. They’ve had two years to put some more money into it or do something about the staffing issues, the under-resourcing, and they haven’t.
AusDoc: As you mentioned, people talk about the IT system as a monumental failure. It was brought in by Healthscope. How bad was it?
Professor Burgess: It was the major gripe for the doctors. The computers were clunky. The software was novel. Telstra had generated it, but it had a lot of bugs.
The obsession with security meant that you needed a 12-character password, which is fine, except you needed the 12-character password to get into the computer, then another 12-character password to get into the operating system, and then into the medical record.
So, it could take five to 15 minutes to actually access the medical record of the patient.
If you went to another ward and logged on to a different computer, you had to do the same process again.
Yes, there were mobile computers, but often there were blackspots in the wi-fi, so that in some corridors or rooms they wouldn’t work.
These were all problems at the very beginning, and over time, they have been addressed to some extent, but it is still not perfect.
AusDoc: The other major concern was the lack of integration with the rest of the public hospital system. As a public-private partnership hospital, you seemed isolated and alone. Is that right?
Professor Burgess: We asked Healthscope: ‘Could we have the same operating system as the public system so there was interoperability?’
But there were serious problems. The public system didn’t want us accessing their public system medical records.
Our patients have often been to the other public hospitals, as you would expect.
But as a clinician you sometimes could get the information, sometimes you couldn’t.
So again, we drifted along you know, nudging the administration as best we could.
But when change is limited, you get into a sort of low morale phase where you just think: ‘This is our life, and it can’t be any better.’
It’s a horrible situation to find yourself in.
AusDoc: So senior medical staff decided to take up the fight. Can you explain what happened?
Professor Burgess: Yes, staff kept doing a good job as best they could. But then about 18 months ago, some of us got interested in the medical staff council and said, ‘Let’s see if we can be proactive and do something.’
We were preparing to go with a campaign to sensitise the public and our political masters to the situation we were in.
Then, fortuitously, the auditor-general decided to hold an inquiry, so we made a submission. Subsequently, that has led to a submission to the parliamentary inquiry which is now underway.
The community is entitled to hospital access with comparable care that they would get in any other public hospital. That is point one.
Point two is that there’s a collective responsibility for the current substandard resourcing.
We blame the previous government for not paying attention to what they were doing.
The current government has also had two years to do something — and they too have done nothing.
The underfunding could be fixed with an increase for public patients of about 10-15%. If the state kicked in 15% more, Northern Beaches would work very well.
One of the suggestions we’ve made in our submission to the parliamentary inquiry is to rewrite the original deed between Healthscope and the NSW Government and increase the funding needed.
That would be the cheapest option for the State Government.
But the state has now decided to go down a different path. It’s suggesting taking the hospital over; at least the public part, with Healthscope saying it wants to hold on to the private component, which is 200 beds.
But there are some logistical issues here. If the state wants the 280 public beds, it needs to remember there’s only one kitchen, there’s only one ED, one staff body currently working under different awards.
How do you tease those two parts from an integrated hospital? It is not obvious to anybody, including the ministry, as far as I can see.
When it comes to staff working, a split would not affect the doctors so much, but nursing staff, if they’re in the private component, will be paid according to [a] private award.
In the public component, there will be higher staff numbers because of mandated ratios introduced by the NSW Government. And the nurses would be on the state award, which is much more generous than the private nursing award.
So how is that going to work if they want to split the hospital?
AusDoc: The solution for Healthscope is to hand back the public hospital and ditch its contract to provide public services. Is that part of the fix in your mind?
Professor Burgess: Whether it’s a fix is unclear. The current arrangements are a double-edged sword for both sides, for Healthscope and the State Government.
NSW Health and the local health district have been able to put a stick in the spokes of Healthscope by the way they framed the original deed.
On the other hand, Healthscope have put a stick in the spokes of the State Government because the State Government can’t easily get out of the contract without paying a lot of money, which clearly, given their financial troubles, they can’t afford to do.
As a result, they are both locked in an embrace.
Added to that is that you have Healthscope’s creditors driving a hard bargain to get as much money as they can out of the state for their shareholders.
AusDoc: You have some sympathy with Healthscope given the original deed they signed. The audit report raised questions about whether it could ever deliver what NSW Health was demanding, given the money.
Professor Burgess: People may not be aware, but the local health district agrees in advance for the coming financial year that they will pay you so much to do so much work.
The problem is the work comes through the ED, and you can’t control that. You can’t just on 1 June say: ‘Sorry, we’ve used up all our money for the next 30 days. Nobody can come in.’
So people come in through ED and Healthscope pays for them to be treated but they don’t get reimbursed.
So that’s part of ‘the undermining’ I referred to. If the State Government just funded the public patient care at that point, then we would be fine.
The public-private partnership gives flexibility to the bed capacity of the hospital and some efficiencies in terms of just having one kitchen, one ED, one staff body looking after public and private patients.
There are potential benefits. But fundamentally, as we say in our submission, we’re agnostic about who runs the hospital.
We don’t care if it’s Healthscope with some extra funding or the state, just that it’s properly funded.
AusDoc: Are there risks with a state takeover?
Professor Burgess: If the state takes over the whole hospital and makes it a public hospital, then I can’t see how they will do anything except cut the number of beds.
We are very fearful that they will make the budget work by reducing services.
Perhaps they take both oncology and dialysis out of the hospital, reduce the sort of complexity of the surgical work that’s done, and then say to patients that they will have to go to Royal North Shore Hospital.
But what does that mean?
We are fearful that the people of the Northern Beaches get shortchanged.
AusDoc: How did you get involved in the medical staff council?
Professor Burgess: I was head of the respiratory department for the first two years, and I thought somebody else should be involved with the council. But I was just watching people getting ground down and I thought I should make a contribution.
It was hugely stressful for the junior doctors often not having a registrar to supervise them, or the registrar who was supervising them changing every day.
There was also the extra work on the senior consultants because we weren’t given residents or registrars for ward rounds on weekends.
In the public system that doesn’t happen in a hospital of our size. Nobody at Royal North Shore would do a ward round without a couple of hangers-on.
Whereas here, we were expected to do it.
It ended up being slow and inefficient and to be honest, it’s insulting. But that’s the way it’s been.
AusDoc: The death of Joe Massa last year has, fairly or not, come to symbolise the hospital’s deeper troubles. How were staff affected? The fallout has been immense.
Professor Burgess: They took it very badly, the ED staff in particular.
If you listen to emergency doctor [Dr Cliff Reid in] the recent ABC program, he said that a number of the staff were abused, with patients and relatives calling them baby killers.
Nobody goes to work trying to do anything like that. And the thing is we don’t know what caused Joe Massa’s death. The coroner has not reported.
But we were ridiculed.
The hospital — the senior doctors anyway — felt that we were being unfairly criticised for things that could happen anywhere and usually do at some point in every hospital.
I’m not making light of what happened, but we were not allowed to defend ourselves.
The [medical staff council] confronted the Healthscope administration and said: ‘You’re not defending us.’
And they said that the issues were before the coroner.
It was basically: ‘We can’t defend you.’
I thought that was very weak.
The morale in the ED hit rock bottom.
Things have improved but we would like people to stop picking on us for things that are out of our control.
AusDoc: Did Healthscope management ever listen to your concerns?
Professor Burgess: There are differences of opinion about that.
I think Dr Patrick Coleman, the nephrologist who was also featured on the ABC’s 7.30 program thinks the answer is no.
My answer is yes, they did, and they did the best they could.
Healthscope have wheedled a bit of cash from time to time out of the ministry and the local health district. Most recently, they have secured some extra money this current financial year to increase resident doctor numbers.
It is still way below what it ought to be, but it’s some improvement.
AusDoc: It’s usually a big decision for any doctor to speak publicly as you have. You don’t always make friends.
Professor Burgess: I’m getting towards the end of my career, I can yell at the minister and nothing will happen to me. Whereas other people, they’re worried.
It’s been hard work. It was only 18 months ago when we sat down with the executive and said: ‘We shouldn’t have to put up with this.’
There are many issues but having interns burst into tears because they can’t cope with the work and they’re unsupervised, to me that is just not acceptable, something is going wrong.
Professor Burgess spoke to Carmel Sparke.
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