Submission No 200 INQUIRY INTO OPERATION AND MANAGEMENT OF THE NORTHERN BEACHES HOSPITAL Organisation: NSW Nurses and Mid Wives' Association Date Received: 26 July 2019 Submission by the New South Wales Nurses and Midwives’ Association (in conjunction with the Australian Nursing and Midwifery Federation NSW Branch) NSW Legislative Council, Portfolio Committee No 2 Inquiry into the operation and management of the Northern Beaches Hospital 26 July 2019 Our ref: EF/15/0009 The Hon Greg Donnelly MLC Committee Chair Legislative Council Portfolio Committee No 2 Attention: Director, Portfolio Committee No 2 - Health and Community Services Email: [email protected] Re: Inquiry into the operation and management of the Northern Beaches Hospital The New South Wales Nurses and Midwives’ Association, along with the Australian Nursing and Midwifery Federation NSW Branch (‘Association’) are the registered unions (in both the state and federal workplace jurisdiction) for all employees working in nursing and midwifery classifications and roles. The Association provides both industrial and professional support and representation to some 66,000 members in NSW. This ranges, for example, from the provision of information about workplace rights, providing direct support to members (and representation if necessary) with employers or before industrial or professional courts and tribunals, assistance with appearances before other courts and jurisdictions, as well as negotiating and bargaining on behalf of members with their employers for awards and enterprise agreements. The above has meant that the Association provides membership and therefore such services to nurses and midwives working in either the government or non- government sectors, state and federal. In other words, the Association is the relevant industrial organisation of employees for nurses and midwives whether they work in the NSW Health Service (government sector) or in the Northern Beaches Hospital (private sector). Certainly the Association would welcome the opportunity to provide further evidence, in addition to that contained in our following submission, at any hearing the Committee undertakes. This submission is authorised by the Elected Officers of the Association. JUDITH KIEJDA Acting General Secretary, NSW Nurses and Midwives’ Association Acting Branch Secretary, Australian Nursing and Midwifery Federation NSW Branch 1 NSW Nurses and Midwives’ Association Inquiry into the operation and management of the Northern Beaches Hospital Executive Summary The Association and its members opposed the privatisation of public health services on the Northern Beaches. Not through some absolutist opposition to private health services being available to the public and the privately insured in a complementary way, but one based that the provision of public health service remains a core responsibility of governments that should not be sublet or contracted out. Unfortunately, the feedback from members and the experiences of the community since the end of October 2018 only reinforces the concerns expressed at the time. The level of care and services currently being provided at the Northern Beaches Hospital (NBH) are generally seen as being less than that provided previously at Manly and Mona Vale Hospitals, both qualitatively in the view of members and statistically based on data available from the Bureau of Health Information. Staffing was and remains a critical issue. A lack of staffing, poor skills mix, and a disproportionate reliance on casual and agency staff is causing significant issues, impacting on clinical care and the provision of a safe working environment for nurses and midwives. This is sadly not surprising. In any privatised model, staffing levels and labour costs are all too often the first and most substantial target of cost savings and profit maximisation. This runs counter to the rhetoric at the time the privatisation was announced, that promised much but can now be seen as hollow and unrealised promises. Assurances provided repeatedly by Healthscope regarding its readiness, and that it was fully staffed, equally proved empty and not reflecting the reality. Much was also made that the new privatised hospital would be an integral part of the public health system in Northern Sydney, but the outcomes to date prove otherwise. Sadly, the Local Health District has been reduced to the ‘purchaser’ of public health episodes of care, rather than being directly responsible for the provision of such services. It has become a bystander, waving public monies at Healthscope in an attempt to manage and improve services. Whilst one of the so-called claimed benefits of privatisation is that it shifts (financial and operational) risk to a third party, current experiences again demonstrate that it is ultimately the patients and staff who carry the burden of that risk. Certainly a number of actions and changes are needed urgently to bring about the necessary rectification desperately required. 2 NSW Nurses and Midwives’ Association Inquiry into the operation and management of the Northern Beaches Hospital INDEX Covering letter…………………………………………………………………….. 1 Executive Summary………………………………………………………………. 2 Format of this submission………………………………………………………. 4 (a) the contract and other arrangements establishing the hospital……… 5 (b) changes to the contract and other arrangements since the opening of the hospital………………………………………………………………….. 10 (c) ongoing arrangements for the operation and maintenance of the hospital………………………………………………………………………….. 11 (d) standards of service provision and care at the hospital………………. 13 (e) staffing arrangements and staffing changes at the hospital………….. 24 (f) the impact of the hospital on surrounding communities and health facilities, particularly Mona Vale Hospital, Manly Hospital and Royal North Shore Hospital…………………………………………………………. 34 (g) the merits of public private partnership arrangements for the provision of health care………………………………………………………. 36 (h) any other related matter……………………………………………………… 40 Survey methodology …………………………………………………………….. 43 3 NSW Nurses and Midwives’ Association Inquiry into the operation and management of the Northern Beaches Hospital Format of this submission The following submission by the New South Wales Nurses and Midwives’ Association, along with the Australian Nursing and Midwifery Federation NSW Branch (‘Association’) draws upon a myriad of experiences leading up to the transfer of services and staff from Manly and Mona Vale Hospitals to Northern Beaches Hospital (‘NBH’) and the now near nine months since the opening of NBH. More specifically, the Association notified members of the inquiry to be undertaken by Portfolio Committee No 2 of the NSW Legislative Council and encouraged feedback via a survey asking questions targeted primarily towards two of the terms of reference (‘ToR’) announced - namely (d) “standards of service provision and care at the hospital” and (e) “staffing arrangements and staffing changes at the hospital”. The Association has assembled its feedback in this submission as per the most relevant ToR, albeit some feedback would sit comfortably within several. Accordingly, the Association has not sought to unnecessarily repeat or replicate feedback that straddle several ToR. Rather, it has concentrated on ensuring relevant information and feedback has at least been marshalled once in the submission. Equally, a number of members gave experiences or examples that were similar in nature, and the Association has adopted the view of ensuring these views are expressed via the statistical feedback presented from the survey questions or by providing one such anecdote or example, with duplication of similar experiences resisted. Accordingly, it should not be assumed as a result that the narratives or examples provided are isolated. Finally, the Association has taken the view to provide these experiences or commentary without identifying the member. In this way privacy has been preserved, and it encouraged the participation and receipt of feedback from members who were fearful of making public comments. 4 NSW Nurses and Midwives’ Association Inquiry into the operation and management of the Northern Beaches Hospital (a) the contract and other arrangements establishing the hospital THE ESTABLISHMENT OF THE NORTHERN BEACHES HOSPITAL The announcement and what was promised … Without any prior warning, the then Minister for Health, the Hon Jillian Skinner MP, announced on 2 May 2013 1 that an expression of interest process was to be established for “… the private sector to design, construct, operate and maintain a world class hospital on Sydney’s northern beaches.” 2 The Minister further claimed that the private provider would use “… leading digital technologies to deliver the highest quality care … the operator will … deliver public services and the hospital will remain part of the clinical network of the Northern Sydney Local Health District.” 3 “I am excited our outstanding staff will have the opportunity to work in a fabulous new facility, which will in turn attract new staff of the highest calibre.” Minister for Health, the Hon Jillian Skinner MP, 2 May 2013 The new operator, was announced as being Healthscope on 29 October 2014, 4 following a “rigorous evaluation process”.5 “I have long had a dream about a state-of-the-art hospital which uses the latest technology and attracts the best clinicians to deliver care for the people of the Northern Beaches … This will mean exciting opportunities for the current,