Convene a working party – but not just any party – a can-do party.
I would convene a working party with a maximum of four members from each interest group. Ideally representative of the broader community profile and with a mix of field experience and service administration. The greater Geelong & Surf coast profile shows it should have a 50/50 mix of sexes, 50/50 mix of clinician/professional skills and clients, and be representative of the community at large being 17% with disability, 21% under 18yo, 17% 18yo-29yo, 22% 30yo-44yo, 24% 45yo- 64yo, 14% 65yo-84yo, and finally2% 85yo+ with a mix of ethnicity.
The working party would include, working down from the most immediate pointy end: –
- Ambulance & Community Responders
Police & Security
Fire & Rescue Vic, & SES
Public & Private:
State & Federal Health Dept
Set a priority.
From the Group 1) perspective above, they might prioritise a second fully functioning Emergency Department at Corio at an allocation like the vacant former Norlane High School site in Cox Road. Yes, there is an electricity terminal nearby, but if it is safe for residents, it is safe for staff and short-term patients. This location is ‘green field’ vacant, Govt owned, in the centre of a future growth zone and pressing immediate need, set back from dangerous industry like Viva, close to where support staff live, and on the Ring Road with rapid links both to Melbourne hospitals and the Western District.
Ambulances have been ‘ramping’ for years, unable to discharge critical patients into EMD’s due to a lack of hospital capacity in the Geelong CBD. These crews are very talented but do not have the resources to save the quality of life an EMD does. Time is critical. While they are stopped the two crew wait and the Ambulance is out of service. The public is at risk with longer response times or additional crews called in with additional ambulances, which again get ramped, and costs go up.
Alternatively, the government should look at paying the private sector EMD’s at St John of God (CBD) or Epworth (Waurn Ponds) to take patients at a fee scale between the existing public rate and their desired private rate. In both above models the patients would eventually be transferred to the Geelong Hospital once stable. Not for profit service providers are available for this transfer work.
It is said the new Barwon Health Northern facility on the corner of Cox Road & Princes Highway has literally been a money pit, with a substantial amount of government money going into filling in the old leaking Corio pool site (one of COGG’s list of poor pool contract construction issues). And is getting little use. It has been said the Nurse Practitioner model, where the Nurse is so highly skilled, they can perform many of the functions of a doctor, has not been well utilised by the local community and may well close. Alternatively, the private GP practice opposite them at Cox Rd and Princes Hwy always has a line outside it at 7am. This area needs another 24/7 GP and pharmacy if it does not get an EMD.
The former Corio Community Health Centre within the Corio Village car park was a fantastic move by the community in its day, but its priorities must address the actual needs of today in this super convenient location. The myriad of private service providers operating in repurposed houses around it send a message as to what is missing, but these are poorer communities that cannot afford co-contribution payments. Without free options they put of treatments and conditions worsen dramatically, like children have all their teeth removed because of Coke a cola decay.
Where is the equity for the Anakie Road shopping centre? And the new private development next to Bunnings in Norlane is another signal there is inadequate public health service in this most disadvantaged area. The Government will ultimately pay more by having these services provided by private practitioners billing the Government and many in the community cannot afford the Gap fees.
The Wathaurong centre near the Bunnings is a great example of a service identifying and attempting to service the targeted needs of their community. I will say more on this in another initiative.
Funding the initiatives.
So how are these types of initiatives funded?
A large health services like Barwon Health is a serious business. It had 74,730 emergency Dept presentations last year, did 21,161 operations, delivered 2,8354 babies, and jabbed us for COVID 107,218 times. Its headcount was 8,001 full/part-time/casual people (which is 7,301 more than Viva).
On average the Full Time Equivalent (FTE) of these staff consist of:
2,102 Nursing and
528 Medical Officers (82 Medical Officers, 397 ‘Hospital’ Medical Officers & 123 ‘Sessional’ Medical Officers) and
2,237 Support staff (801 Administration & Clerical, 437 Medical Support Services, 571 Hotel & Allied Services, 428 Ancillary Support Services)
That looks like almost one support staff per actual front line medical skilled worker.
Giving the coal face workers the tools.
People at the coal face are best equipped to make real life business improvements however often in health, education and childcare fields of endeavor, the Awards penalise the ‘vocational calling’ by offering lower pay and conditions compared to other industries where there is a ‘career’ based more on financial reward and incentives.
Now combining the FTE figures with the need to assist real life business improvements, I feel there is an opportunity to offer all clinicians the equivalent of a Certificate IV – Health Administration, where the modules are taught on-site on suitable days and on-line 24/7 and structured around Barwon Health’s actual system and procedures. Where the money comes from, how it is budgeted, competing priorities, Geelong health, socio, ethnic & economic demographics, internal budget templates, Awards & interpretation, payroll, supply processes, debt collection, equipment management, catering, domestic services, inter-department relationships, complements & complaints, privacy, FOI, incident reporting, sentinel incidents, MOVAIT safety and Code responses, accreditation, capital works and asset maintenance, donations & foundations, post-employment surveys, Board of Management, role of Government, patients, and carers. I don’t expect admin staff to become clinicians, however if clinician better understood how the administrative cogs worked behind them, they could enhance the system and be better tooled up to present cases to the Board etc. for improvements to client care and their own roles.
Once this model is developed it costs very little to run if in a digital media and most registered training organizations should be able to install Barwon Health specific examples into an off the shelf Cert IV model. The certificate would be recognisable throughout the industry. Some of the best health department managers have come from within the clinical staff with a wealth of experience and just needed a little polish in Excel and local administration protocols. The inverse applies to applicants with lots of letters after their name, bit limited real experience. Their academic achievement, more a desire to enhance the organisations’ own perceived prestige by association.
Know where your money is coming from.
With any health service you need to start with how much money are you getting in, who you are receiving it from, and their expected outcomes. From there you can look at the community’s actual need, not just what you have historically delivered to them. (Some hospitals have performed very well financially specialising in say hip operations; however, the community needed much more). WEIS if the major income model for hospital and is broadly based on the type of procedure the patient requires and the number of days they typically stay in wards, but there are a many other income streams from State and Federal Governments. Many if these silos of funds are very specific in their targeted health responses and historically motivated by a political whim around election time. $10m for this for 3 years, $2m for that immediately, $123m conditional on joint finding from the other Govt, $5m for operating costs but not the cars or computers, $600m for a Capital building grant but only if you hand the Govt the land it will be built on etc. To get a feel for just how many of these little income steams here are, look at the Barwon Health website and open the Service directories – most link back to individual Govt recurrent and non-recurrent grants.
If Geelong only has the one public hospital the WEIS model for acute hospitals might be fine enough, but all the others need to be transparently reviewed with a fine-toothed comb. They should be distributed on a pro-rata populations basis to the community they are intended for. Too often grants are set this way, but a health service will absorb them for other purposed in a different zone and deliver almost nothing for the intended target. Arbitrary performance targets should be seriously reviewed to reflect actual client outcomes, not just rolling over historical notional figures.
Report relevant KPI’s with analysis.
Health service websites should demonstrate in real time KPI’s the community desire, not just select the most glowing for publication in the Annual Report.
Barwon Health’s Annual Report shows:
- Patient transfers from ambulance to emergency – Target 90% with 40min Actual 71%
Why? And just how long were these patients waiting and what implications were there on their health outcomes. It is not about blaming Barwon Health but giving it the public support to pressure Govt for a better funded model.
- Triage Category 1 to 5 emergency patients seen – Target 80% (only) Actual 63%
within clinically recommended time.
- Emergency patients with a length of stay in the emergency – Target 81% Actual 59%
Dept of less than 4 hours.
With 74,730 EMD admissions in a year, that is a lot of people not being cared for properly.
- Number of patient’s admitted from the elective surgery list -Target 9,726 Actual 7,895
21,161 operations were preformed, so this represents 1/3rd, therefore 2/3rd was non-elective emergency – so we are back to the ambulance and EMD issues again. Of the 74,730 EMD presentations, 1/5th required surgery. They need to get out of ambulances and into theatre asap.
You get the picture, or rather you don’t because you must read between the lines.
And when you look at other funding types and 2020/21 activity, they don’t include ‘Targets’ or year on year comparisons at all.
Bored with Boards?
This is an organisation that spend almost $1billion a year ($920,171,000) on our care last financial year and we need to know it’s Board is focused on delivering what we need, not just that it was busy. We all need to engage with what they are doing with our money and the service we will one day need ourselves.
And all health Boards (Hospitals, Nursing Homes, Community Health Services, Cemetery Trusts, NGO’s, Foundations etc. should have a 50/50 mix of sexes, 50/50 mix of clinician/professional skills and clients, and be representative of the community at large being 17% with disability, 21% under 18yo, 17% 18yo-29yo, 22% 30yo-44yo, 24% 45yo- 64yo, 14% 65yo-84yo, and finally2% 85yo+ with a mix of ethnicity. It is not all about being a remunerated member or on a shiny big Board table once a month, it is about service the community. Boards have only one control lever – to appoint or dismiss the CEO. But they can design systems and procedures based on their combined skills and experience to help ensure good governance and stewardship with every daily activity.
And good CEOs would welcome that because it helps them retain their and staff focus, harness interested parties’ contribution and prove their performance bonuses.
Far Share & Equitable Grant Allocations.
So far, we have looked at the income capped from Federal and State sources. This needs to be equitably distributed base on the percentage of population at that geographic location. Greater Geelong (before adding Surf coast etc.) is 4% of the Victorian population and it should get 4% of the health money.
Plus, we need to factor in State comparisons of relative disadvantage. Post codes like 3214 are especially disadvantaged and will remain so since they are often the primary destination for new migrants to Geelong and the poor state of housing and other community infrastructure. Plus, industry factors like the heavy airborne pollution from Viva, the Phosphate coy, MC Herds and heavy industry in general across the area, coupled with the types of work the residents are forced to engage in like manual labour, menial tasks cleaning with chemical like white king, vehicle repairs, floor polishing heavy vibrating handheld machines and chemicals, chemicals, chemicals etc. There is very little personal safety awareness in some multicultural low trained sectors.
It is suggested the aged care sector suffered the worst of this systemic neglect when minimally trained aged care workers were offered Commonwealth training at the commencement of COVID in infection control. Although the Commonwealth expounded, ‘they trained them all’, record worker infections from the community, introduced COVID into homes and patients died. If the training was adequate this cross infection would not have occurred at anywhere near this rate. It has been suggested the ‘training’ was an on-line module anyone could tick off as completed, even if the trainee was not participating.
The above covers Government funding, now we look at compensable patients – those paid for by DVA, TAC, Worksafe, NDIS etc. and Health Insurance funds. All technical and a separate review.
Once we know that incomes are secured, we focus our attentions on expenditure. Firstly, the non-critical areas of support services like Supply & Procurement. How are those decisions made within the 3-point rule Quality, Time, and Cost, plus keeping backup suppliers in the wings in case something changes? How often do they confirm the 3 points are still selecting the best overall, or is it “I’ve known John for 20 years and he’s a good guy and we go to the same box at the footy…”?
How are decisions about choice of product or supplier made and evidenced. If there is an aid or equipment or drug that a specific clinician request outside the norms, where is the evidence from a clinical review panel. Sometimes people want pre-lubricated gold tipped catheters at $10 a unit, when a self-lubricating catheter at $1.20 will function just as well and retain equity in the community.
And progressively you work your way through the overheads. Like the best deal for postage, internet, water, rates, electricity, gas, waste collection, security, copy paper, copy machines, vehicles and servicing, computers, fruit juice bottles, etc. etc. Public hospitals could have a great resource of shared knowledge of procurement and even a greater buying power collectively (not as a single Govt buying agency). You get the picture. Each time you save money it is a saving for every year going forward and results in more clients being seen for health needs.
Unmaintained and under used assets.
Why are there sites like the former Renal Dialysis facility in Lt Fyans Street vacant for years after a relatively recent hugely expensive fit-out of the former Geelong Community Health Service site?
Why are so many of the building at the rear of the McKellar Centre unmaintained with rusted storm water systems letting water in to further render a building un-usable. All assets should have a budget for program maintenance and entities do not have a mindset that “I don’t know what to do with it now, so the sooner it decays, the sooner we can ask for a Govt grant to build a new one that looks modern”
Now, onto other targeted areas.
Task staff to consider the inter relationships between illness / admissions and the cause and effect. If there are higher presentations of say ‘Nang’ abuse from post code 3214 in the age bracket of 15yo-18yo males not attending school. What could be the link and how could we address it or refer it on to either have the appropriate authorities. Then find the supplier and remove the stock or require photo it, or ABN, or sell only one canister at a time, coupled with police patrols and an education program for schools, students, shops, rubbish collectors, cake suppliers, hazardous goods administrators, State Govt, outreach workers, churches, first responders, EMD, etc. etc. All designed to address the emerging issue and quell it asap, not just let some media use it as shock headline to sell papers and ads.
This was a simple example but there are many more complex and life altering examples passing through EMD’s every day like fetal abuse, child abuse, domestic abuse, elder abuse, self-abuse and the increased prevalence of ADHD and some categories of infant disabilities. Perhaps tasking Uni Students studying medicine, nursing, allied health, health administration, business management or undertaking a PhD etc. to participate in reviews at the University Hospital could be beneficial for all as staff see how it is currently performed and students gain a real-world example.
29% of our population was born overseas. We continue to use Latin derived elitist terms in medicine.
Why do we have signs for Compounding Pharmacies rather than Chemist.
Look at the Barwon Health website and look at the Services.
If you weren’t from a health background or been in the hospital before, would you know:
Oncology rather than Cancer treatment.
Palliative Care rather than Final Months Care.
Ophthalmology rather than Eye doctor.
Renal dialysis rather than Kidney Treatment.
Malignant from benign.
Pediatric, Antenatal, Inpatient, Outpatient, Anesthesia, Cardiology, Chemotherapy, Radiotherapy, Hematology, Apheresis, Medical Imaging, Densitometry, Adolescent, Dysplasia, Hydrotherapy General Medicine, Orthopedic, Pharmacy, Renal & Dialysis, Transit Lounge, Neuroscience, Spasticity, Pathology, Urology, Psychiatry, Psychology, Clozapine Program, Acute, Acquired Brain Injury, Cardiac, Continence, Neuroscience, Oncology, Podiatry, Vestibular rehab???
Not such common words in the phrase books of Croatian, Indian, Italian, Macedonian, Malaysian, Mandarin, Persian-Dari, Philippine, Sri Lankan, Vietnamese, and many of the non-migrant Geelong homes either.
And why does the Barwon Health service listing for ‘Infectious Diseases and Immunisation and Refugee Health Clinic” have all in one listing as if to imply the Refugees are bringing in infectious diseases.
Even all the people who received COVID vaccination supposedly give ‘informed consent’ when they had no idea what that the immunization nurses were talking about regarding “Have you had …. Or this reaction…” and anaphylaxes.
And why do the specialist all leave the wards before the carers arrive to discuss treatments.
29% of our population was born overseas.
How do the food services meals on wards meet Croatian, Indian, Italian, Macedonian, Malaysian, Mandarin, Persian-Dari, Philippine, Sri Lankan, Vietnamese preferred dietary needs and those many of the non-migrant Geelong residents also?
And what about vegetarians, carnivores, vegans, anorexics?
If a patient does not eat a meal because they don’t like it, staff can erroneously record ‘food refused’ which could impact their treatment. Families are not officially allowed to bring food in, but do, with the best intentions.
I would ask Adam Liaw to do an Australian version of what Jamie Oliver did for UK Schools. I would ask for his ideas on Hospital & Aged care foods. Nutrition, value, fresh content, wastage, culturally sensitive, variety, condition at the time it arrives at the clients table , dietary sensitive (vegetarian, vegan, celiac, diabetic, carnivore, bulimic etc.), quantity or portion sizes (use of multiple small dishes to fill a traditionally large eater rather than oversized portions), food reuse (Left over Sunday roast becomes Monday’s Souvlaki, of Tuesday’s Shepard’s Pie or Wednesday’s Spag Bol, Thursday’s Nacho Sauce, or Friday’s Curry, – or was it donated to food relief charity)
I would promote his ABC Radio interview from Saturday 30/04/2022 to help everyone understand why we crave sugar.
There has been a progressive increased acuity in the general wards. People that previously have stayed in the ICU are transferred to wards much earlier – needing more attentive care than historical ratios and reduced team orientated training can support. View Barwon Health incident logs, Sentinel events, Code calls and Work Safe claims for evidence. Good luck not good management is often the only thing saving people for serious injury.
The University-trained career nurse model provides better theoretical skills, but less team orientated, less mandatory rotating shift work. Former Hospital trained vocational nurse model provided better shift work experience, fellow trainee team member support and hands on skills. In pressure situations, some nurses feel they are left to their devises too often as situations and workloads escalate and unmet tasks are passed across to the oncoming shift or meal & personal hygiene etc. are left for loved ones to perform.
There are more ‘Specials’ on wards needing 1 on 1 attentions. More eating disorders, more violent, more escapers, more sneaky smokers, more drug affected, more dementia wanderers, more diabetics needing blood gas monitors, more dual diagnosis, more blood infections with altered mental states. They need to consider the practicalities of appropriate staff numbers that more up and down across the whole hospital as the workload dictates. Like we do on construction major sites. Not just a fixed ration, but a fluid hourly workforce. It is all much tougher than senior managers, Boards, funders and politicians ever imagine. They should be made to spend at least a single Saturday night in an EMP and then a general ward in Geelong for taste of their medicine or lack of it. They cannot cherry pick these initiatives and say “Yes let’s make staff work across all sites” – it must be properly established with advanced training, system and procedures, and support for workers who acknowledge it is not something they feel capably or safe doing.
And for many of these mostly women working the corridors, what do they go home to? An empty Unit. A house full of needy kids wanting a meal, clothes washed, a bedtime story and a hug before juggling the kids drop offs and friends, or shared care. A partner working sunrise to sunset in a trade or office somewhere klms away. They need real supports who know in a real nursing world, it is not just major incidents that need a ‘debrief’, but the gradual buildup of barnacles dragging them down that need to be scrapped off occasionally, too. Perhaps a form of employee only/member only Facebook where common topics and coping options can be shared – with confidentiality for both patient details and staff identity. A little way to avoid burnout, career change, PTSD, wine medications, relationship breakdown. I know when my wife with 20yrs experience in EMD’s across metro, rural and indigenous communities listen to a pup nurse tell their horror story of the week, it brings back memories of the past, mostly good, and they both pull up their big girls’ undies and get on with it for another day.
All admin workers should review their Award classification and the actual daily tasks their employer is asking of them. Most Awards indicate the level of task and skill aptitude necessary in the individual levels or grades. In most Awards, you only need to perform any part of that higher function for part of a shift to be entitled to that higher rate of pay for the whole shift. So, like the Nurses example about, form support group, resolve your issues and come back recharged to improve the internal processes of the health system and generate better outcomes for the community. You know what the public mostly complain about daily. Find a place to direct those complaints and investigate methods to fix them.
Unintended Risks of Rights of Passage Should Not Mean the Risk of Death
Trial a mandate that all ‘Major Events’ in Geelong have a free facility to diagnose drug content. Currently, there is an inverse penalty for promoters to do this. It has been said that the organizers behind the 30/04/22 ‘Groove the Move’ in Bendigo wanted to have them, but if they did, they then faced prohibitive insurance costs. What price do they place on a young person’s life in exchange? It has been suggested the insurers viewed having the drug analysis technology as giving evidence of the existence of drugs at the event. The result was no drug analysis and XX overdoses at Bendigo Health and richer drug dealers showing off to more of the 1%ers and kids following that business model. Structural barriers.
Trial a mandate that when these drug testing machines are not in use at events, they are rotated around licenced venues across Geelong and results published daily. In keeping with the responsible service of alcohol requirements of liquor licences, temporarily install alcohol detection machines in these venues with clients required to blow under 0.05 before being able to order 1 drink. Don’t evict people over 0.05, but ‘better manage’ the situation you created. If they are ugly when they are in clear site in a well lite room, how much worse might they be out on a street with no witnesses? To further reduce the risk of incidental harm, I would suggest that venues also send staff around neighbouring streets and laneways before opening just to clear up any potential spur of the moment weapons, such as bricks, fallen pickets, bottle or glass etc. Again, the rates of machine test results should be published daily
Have defib machines located in all locations and venues where XXX number of people gather, and an emergency response location code tagged.
And while we are at it – keep EMD presentations down by:
Look at requiring the goose neck of tow bars to be removed when not in use, and likewise bull bars on city registered vehicles. These might protect a 4WD driver, but they disproportionately reduce the survival rate of the driver of an oncoming or side impact vehicle.
Determine whether all scooters can either be used-on public roads with registration and helmets etc. or on footpaths at lowers speeds, and both only during daylight hours since they do not have lighting. And users either need to have a driver’s licence or have completed the theory component of the Victorian Learners Permit to prove awareness of road rules etc.
Require all health insurers to present policies in a like for like way to enable exact comparisons and provide figures on claims, variety, client age, Hospital cost, out of pocket, region by region & state by state, National population overlay, accepted, rejected, time lags and other KPI’s important to consumers.
Require photo ID to be recorded/photographed/scanned for all purchases of Knives, Nang’s, Spray Paint, Tobacco, Alcohol. because these items are especially being abused by the 1%, to the detriment of the 99%. Just as we have with other things that have emerged as being shown to kill or permanently injure like cars & guns.
Increase the legal smoking age by one year each year. This was forwarded to ALL politicians a year ago and only 2 responded. New Zealand are now introducing it.
(As sent to ALL politicians almost a year ago with no reply) Legal Smoking Age – 8 May 2021
2000 and 21 initiative
I am looking for your bi-partisan support to introduce Legislation to increase the legal smoking age by one year – each year. No good comes from the sale of addictive toxic cigarettes, yet Australian Government officials let young people start it the day they turn 18, while the wider community pay the price in health care and lost productivity etc. The Government recognized toxic nicotine in e-Cigarettes as a dangerous poison within The Poisons Standards and outlawed them. This proposal does not restrict current smokers over 21 or reduce tobacco company sales from current levels.
It would be legislation that would cost almost nothing to implement and be simple to administer. Vendors would need to see relevant photo ID. An Australian’s birth date would need to be before 2000 to purchase, possess or smoke tobacco. Overseas visitors would need to show the tourist visa in their Passport to purchase one 20 cigarette packet per transaction for personal use. Current smokers between 18 and 21yo could apply for an annual exemption sticker to be affixed to their photo ID as they do with address changes on the back of a Driver’s Licence.
A key here is to activate the Legislation before 31 December 2021 so that the minimum smoking age ticks up by one year on 1 January 2022 and the ease of looking for birth dates before 2000 continues.
- Tobacco is the leading preventable cause of death (1 in 8) and disease in Australia.
- Smoking kills over 21,000 Australians each year. The illness can be prolonged and painful.
- Smoking limits activity and productivity. Lost productivity and worker absence is estimated at $5B, and $2B for family member care.
- Tobacco taxes do not cover the $6.3B cost of related health care. Health resources diverted to the 1.7M smoker related admissions, reduce services to others especially during periods like Covid pandemics and vaccine immunisations. Covid has a greater impact on people with pre-existing respiratory conditions.
- Cigarettes cost $24 for a 20 packet and the average smoker uses 12.3 daily. That is $5,387 a year for 11.6% of the population and a huge percentage of welfare or pension recipient disposable income. This is the average – however many smoke more. This financial impost leads to even greater socio-economic disadvantage and reliance on support services.
- 2/3rds of smoker die directly because of their smoking and live on average 10 years less. For a current retiree that equates to just 6 years retirement on average before death.
- Most people who have tried smoking drugs like Ice and Cannabis were tobacco smokers first. Meth now contributes to more road fatalities than alcohol. A disproportionally high percentage of people with drug/alcohol and mental health dual diagnosis were also smokers first.
- The last Census showed 18yo’s represent 1.22% of Australia’s population of 25.36 million, equal to 309,600 people. Research shows three out of four 18yo’s have never smoked. However, of the 25% that try smoking, 46% of them continue. That amounts to 46,409 new smokers each year becoming addicted and commencing a terrible future and worse end. If you do not change the current Law, an 18yo smoker who becomes addicted today, will see over 1,155,000 fellow Australians die from smoking, throughout their own lifetime.
(Research by www1.RACGP.org.au/newsgp/professional/smoking-costs-australia-close-to-137-billion 23/12/2019
National Drug Research Institute, Curtin Uni. www.ndri.curtin.edu.au/ndri/media/documents/publications/T273.pdf May 2019 & others)
Please let me know your support or evidence for failing to support the proposal by 31 May 2021 (World Health Organisation “World No Tobacco Day 2021”) since I intend to commence a local and national multimedia campaign publicising who specifically has not shown support for the proposal. D Dillon PO Box 692 Belmont VIC 3216 email@example.com