discussing the coote/kasper report

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Editor: The aim of all items displayed on this page is not to attract opinions on dreams SOHInc cannot achieve. Rather, the aim is to publicise the contents of the Coote/Kasper Report in ways that might arouse public discussion in search of pro-active initiatives to combat the current issues we face as we strive to Save Pambula Hospital. Join the discussion on Facebook or Twitter.

1.00am Wednesday 28 July 2010

Wrestling with the current health debate.

With a federal election looming and state voting required soon after, participating at this time in the health debate is like sliding with bare feet down a double sided razor.

That debate is in turmoil. The subject lacks clarity. Discussion surrounding it lacks identifiable direction. Potential participants are quickly confused. Finding solid ground from which to launch any question to any politician is difficult. 

Here are some attempts that illustrate that point:

• Do the Gillard/Roxon National Health Reforms promise anything more, or less, or different from the Rudd/Roxon National Health Reforms?
• Does the federal Liberal Party believe health care should be left to the States?
• Has the Federal Coalition formulated any national view on management of Australia's health care?
• To what extent will the Gillard/Roxon National Health Reforms be managed across NSW by the Keneally/Obeid-Tripodi triumvirate?
• Will the O’Farrell/Skinner/Constance team cooperate with the federal ALP to implement the Gillard/Roxon National Health Reforms in NSW?
• With little yet said on health by the federal Liberal Party is the O’Farrell/Skinner/Constance team planning its own state-wide fix for health care provision?

Action and argument portrayed in the media over the next few weeks will perhaps help answer some of these questions.

Perhaps not.

With the big picture being so complex we can likely achieve our best results if we focus attention on how the health debate is played out locally. We should all hope that those who will be acting and arguing in our back-yard have read the advice offered by Coote and Kasper. Those authors looked critically and with care at health and hospital care in our district and recommended the following.

 3.25. Taking the informed views of clinicians and the costs of hospital operations into account, our recommendation is to retain and cultivate the following facilities within a Pambula hospital of some 30 beds

• a 24-hour/7-day after hours emergency department with experienced staff,
• a functioning children’s ward,
• a unit with four acute-care beds, where patients can be monitored;
• an adequate number of acute beds for conditions which can be managed by local clinicians,
• sufficient numbers of long-stay beds for people waiting placement, and
• an adjoining rehabilitation unit of 12 beds

Advancing boldly beyond these recomendations the community has demanded restoration of all public health services lost at Pambula since the public dental service was terminated. The community knows it needs a functioning operating theatre, regular surgical lists at least sufficient to cope with proven needs that existed in 2007 and, a fully functional maternity unit.

The failed, "purse-before-patient" policies dictated over the past five years by Greater Southern Area Health Services on behalf of the NSW Government have created the present health care disaster all citizens of the Bega Valley Shire must now tolerate daily.

The Coote/Kasper recommendations, when combined with popular demand, describe a solution that would re-establish safe and sustainable health and hospital care across our Shire and beyond.

So the most useful question to be asked in the current debate is, "Which political party, or combination of political parties claiming to truly represent Eden-Monaro/Bega voters, will promise to convert that described solution into a reality?"

Only when the Coote/Kasper recommendations are met, and these community demands are satisfied will the unbearable extra burden placed on staff and resources at Bega Hospital be relieved. Only then will both Bega and Pambula Hospitals be able properly to perform their service functions.

9.19am Monday 13 July 2010

A Transitional Rehabilitation Unit

Any South Coast resident who has spent time in RILU will recognise the value of recommendations from the Coote/Kasper Report regarding the need for rehabilitation facilities at Pambula Hospital.

RILU is the Rehabilitation and Independent Living Unit that is part of the Aged Care and Rehabilitation Service based at Canberra Hospital.

As its major  contribution to good health across our quarter of NSW, RILU services the needs of patients who need transitional care while regaining their independence before returning home.

Patients are guided through early rehabilitation in a home like environment. The unit includes wheelchair accessible kitchen, laundry, bathrooms and dining areas.

Bill Coote and Wolfgang Kasper refer to rehabilitation facilities on eight occasions through their Report. On the first of these, while introducing their detailed argument they report;

“There is an urgent need for additional health-care facilities on the Pambula site, most notably for a transitional rehabilitation unit treating (mostly elderly) patients who return to the area after major surgery or a stroke, but who cannot yet return to their own homes. Such a facility would be a cost-effective way to ease bed shortages and would be consistent with broader trends in health policy thinking”. p7.

This is a do-able project that should appeal to the Pambula community, a community that is rapidly gaining a well earned reputation as one that “gets things done”. 

Three respected local builders, questioned last week about the cost of building two modest three bedroom homes on flat land inside the Pambula Hospital precinct each believed they could be completed inside $400,000. On those estimates the 12 bed facility recommended by Coote and Kasper (p.36) could likely be built for around $800,000.

Given the size of both the Surf Club and Swimming Pool projects, achieving this Coote/Kasper challenge would be a breeze.

The Coote/Kasper Report, “Health and Hospital Care at Pambula” is available here.

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5.04pm Friday 09 July 2010

The Shape of Hospital Boards

Several various models for health and hospital care are presently being touted in the public domain. Coming just prior to two elections the debate as to which model is best gains critical importance.

Advice offered by Bill Coote and Wolfgang Kasper in their recent report “Health and Hospital Care at Pambula” sheds light on that debate.

 Paragraph 3.24 on page 36 of the Report reads:

“3.24. An important conclusion from the strong and uniform complaints about the management of the hospital and the attitudes and policies of the Greater Southern Area Heath Service for the future of a hospital at Pambula is this: The entire topdown planning approach and its implementation by command and intimidation makes it impossible to maintain a community-friendly, cost-effective service. The heart-felt grievances of the frontline staff need to be heard by the local community, the shire Council and our elected representatives. It is in our community’s interest that matters return to the friendly co-operation that was habitual during most of the history of Pambula hospital. Improvement does not seem possible by marginal tinkering with the administrative system. It requires that the local community, in its very own interest, makes every effort to opt out of the centralised system of topdown command and control.”

The Coote/ Kasper position does not flow from trenchant parochialism.  Nor is it the result of an isolationist perspective. The authors have come to it through exhaustive examination both of the status-quo, and of know and proven management alternatives.

Critics of their view will say Coote and Kasper are for local boards and that local boards failed before.

If that is so then let us discover why they failed, apply the wisdom of hindsight to avoid past weaknesses, and move forward to a new and improved version.

Careful consideration of models currently being touted show that centralized management and regional management both provide second-rate ways forward.

The Coote/Kasper Report, “Health and Hospital Care at Pambula” is available here.

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12.17pm Friday 2 July 2010

Incentives for nurses and midwives to come to Pambula?

In a detailed discussion on the availability of suitably qualified general nursing staff in rural areas Coote and Kasper come to the conclusion that:

"It may therefore be desirable for the many rural and remote communities in Australia to lobby for more education of generalists and for governments to create incentives for the efficient provision of generalist health care in non-metropolitan regions." p37

While rural communities wait for such lobying to take effect, or for such incentives to be put in place, perhaps SOHInc. could apply for a federal or state grant to build 2 three bedroom houses on current hospital land, east of the PDH back verandah.

These houses could be offered at minimal rent, or rent free. They could act as an incentive, encouraging midwives and/or appropriately qualified nurses to come to Pambula to live and work at Pambula District Hospital, thereby overcoming the main GSAHS objection to the restoration of maternity.

Occupancy of these houses could be limited to 12 months while tenants arranged private housing in the area. After 5 years the program could end and houses could be handed over to whichever body controlled management of the hospital at that time. If filled by new nurses or midwives each year this plan could bring at least 10 new health professionals to our area in five years. This program would afford each tenant an incentive of up to (200X52) $10,400.

Considered in the light of the following announcement reported yesterday, this idea is not ridiculous and is well within the realm of the achievable.

Thursday 01 July 2010 - ABC News.

Doctors could receive $120k to go bush

City doctors will be offered up to $120,000 in relocation payments under a new scheme to attract them to regional and remote areas - posted 6.12pm

As recently reported on one local TV news broadcast the Pambula community is "fast becoming a community that knows how to get things done".

The Coote/Kasper Report, “Health and Hospital Care at Pambula” is available here.

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8.23pm Wednesday 30 June 2010

Congratulations Nicole Tate

It was pleasing to read in all three Valley newspapers how Nicole Tate, recently confirmed Director of Nursing and Midwifery in the Bega Valley, plans to strengthen espirit-de-corps amongst hospital staff across the Bega Valley.

Among the many revelations exposed by Bill Coote and Wolfgang Kasper in their recent publication “Health and Hospital Care at Pambula” readers are walked through the real causes of serious work-place discontent, especially at Pambula Hospital.

Paragraph 3.23 on page 35 of the Report reads:

“3.23. Although the intent of this report is to look forward and not to belabour old or present grudges, we feel obliged to record that virtually everyone engaged in delivering frontline patient care at PDH complained about the style of management. Staff are treated shabbily, and remonstrations and constructive suggestions by clinical staff are routinely dismissed by the administrators. (The complaints echoed many of the criticisms documented in the report about the NSW hospital system by Peter Garling, SC in 2008. It appears to the interviewers that, at least at Pambula, none of the urgent recommendations on staff administration in the Garling Report
have been resolved.)”

Any management style that fails to empower staff; employs archaic control tactics such as vindictive rostering; or avoids collegiality, preferring intimidation as a process to keep staff uninformed and docile is bound to generate work-place discontent.

Congratulations Nicole!  Your plan is to be highly commended. Success will boost Pambula District Hospital to again become a place where staff can develop a real sense of pride in their profession and personal satisfaction through serving in the way they love best.

The Coote/Kasper Report, “Health and Hospital Care at Pambula” is available here.

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