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Health Speeches | August 10, 2017

Health Legislation Amendment (Quality And Safety) Bill 2017

Victorian Parliament - 10 August 2017 - Ms KEALY (Lowan) — I rise today to add my contribution to the Health Legislation Amendment (Quality and Safety) Bill 2017. As has been outlined by previous speakers, this bill is largely in response to the horrific news that we had of a cluster of perinatal deaths that occurred at Djerriwarrh Health Services in 2013 and 2014. At the outset I would like to extend my deepest sympathies to the families who were involved in those deaths. It is obviously deeply harrowing not only to lose a child but then to find out that there may have been some negligence in terms of the type of care that was delivered at the time. More specifically, some of the issues related to quality, safety and governance within the health service are of deep concern, and I do offer my sympathies to the families involved in the perinatal deaths.

When we look at this bill there are elements that will improve quality and safety in our health sector. However, I have deep concerns around some elements of the legislation, in particular around the mandatory terms for board members. These are issues that I have raised directly with the health minister. It has been extremely disappointing for the hospitals, the small rural health services and their board members and CEOs that they have been unable to get a direct response to these concerns raised with the minister. They have fallen on deaf ears. It appears that there is this idea that we are going to have improved quality and safety, but there is complete neglect of the concerns that are currently being raised that elements of this bill may actually directly damage and deteriorate governance, particularly in small health services in rural Victoria.

When we look at some of the issues around attracting board members to a health service or to other public sector entities in rural Victoria, it is extremely difficult to do so. We know that this bill does bring in some compensation for board members, which I believe is well overdue and will be welcomed. Up until this point it has been a voluntary position. There is a limited pool in rural communities. As will be known in this chamber, I was the previous CEO of Edenhope and District Memorial Hospital. We had a fantastic board — all volunteers — who put in an enormous amount of time, energy and commitment to improve health services in that region. It was about the copious amount of paperwork that they would have to read and their health literacy, as well as being able to identify people in the community who had the relevant skills to be good governors of a health service — whether they had a business background, a financial background, legal background or links to clinical elements. These people knew what they were talking about. They could provide good insight, and they certainly provided the strategic direction and vision that we required in a community like Edenhope.

Edenhope is a lot different to the health services that are delivered in Bacchus Marsh. It is a lot different to the health services that you see delivered in metropolitan Melbourne. It is a lot different to Ballarat, it is a lot different to bush nursing centres and it is a lot different to what you see even in Horsham at Wimmera Health Care Group. We cannot have one‑size‑fits‑all policy when it comes to governance because we are simply going to end up with a poorer quality of board member. Currently there is a trend that when board members are first appointed to a hospital board they are given a one‑year term. This is basically a ‘try before you buy’ time frame. If we look at having a mandatory maximum three‑year term, we could potentially have a group of people who are serving a maximum of seven years on a board of management.

Hospitals are extremely complex beasts. Their funding comes from many, many different buckets. You need to look at the types of risks you are managing in terms of handling the delivery of different types of patient care — aged care as well as acute care, surgery and maybe some antenatal services. When you are looking at developing GP services, disability services and allied health services, it is extraordinarily complex, and it takes more than five years to get your head around it.

To think that we are going to have board members, including board chairs, who have had a maximum of six years service is frankly astonishing. I cannot understand why the health minister has not identified that we are creating an enormous risk for small rural health services if we are going to have this mandatory three‑year term for board members. I can only suspect that this is a move by Labor to force amalgamations of small rural health services by stealth.

There is no doubt we have got a limited pool of people that we can draw upon to appoint as board members for a small rural health service. This is for a number of reasons. Not everyone wants to serve as a board member. People in rural areas are overcommitted already through their voluntary contributions in the community, whether it is in the local footy and netball club, the school council, Rotary, Apex or Lions clubs, or as a valued volunteer with the CFA, an organisation which this government seems to neglect as well. These people are overcommitted. There are very, very few people in the community we can pull from. We will find that not enough people will apply for these boards. There is no doubt that Labor have set down the path towards forcing amalgamations and taking that local community input away from our rural communities, and that is just plain wrong.

I would like to share some of the feedback that I have received from local board members and CEOs regarding their concerns about these forced amalgamations by stealth that Labor are putting in place. Owen Stephens, CEO at Casterton Memorial Hospital, in an email to me said that his key concerns are that small communities do not have transient populations and therefore have longer term board members. This is natural; we just do not have this constant churn of people to move through. He said that developing a drive‑in, drive‑out mentality for a board of management will not contribute to the structure of small communities with reduced physical, financial and social input, which leads to reduced overall community health outcomes. He also identified that there has been no board or local community consultation by the Department of Health and Human Services and the government on this directive. It is of deep concern that this government has not asked small rural health services, which will be impacted the most, about what might happen in the future if board tenures are reduced to three terms. Owen also noted:

The limited tenure to nine years in a small community will make it nearly impossible over time for that healthcare facility to attract persons that are required by the department and so over time the DHHS will force amalgamations or takeovers.

It is clear that people in rural Victoria in health services can see the writing on the wall.

I also note that Kathryn Hausler, a board member for Edenhope and District Memorial Hospital, wrote:

It takes several years to get a good understanding of this role and we are concerned that the proposed time limit a member can serve means that all that experience, training and knowledge can be very quickly lost. Should this legislation be passed this will leave our board with seven members of which four are serving in their first term.

Labor are already impacting on the governance of Edenhope and District Memorial Hospital.

Annie Osborn, who used to work at the hospital and was a fantastic team leader in the hostel, wrote:

The first proposal being a restriction on the term that a board member can serve with their health service. As a board member serving my first term, I am gradually gaining confidence, knowledge and an understanding of my role by mentoring from my senior board members. In a small rural community it is difficult to attract board members with suitable skills to work in an honorary position with such a huge responsibility. Several current long‑serving board members would be affected; therefore our service would be losing their wealth of knowledge and experience. I firmly believe that the time for board members to serve should be extended.

I have also heard similar points from Christine McCann and David Kennedy of Edenhope and District Memorial Hospital, and I thank them for their input.

It is clear that the Premier has no respect for our voluntary board members. He recently had a trip to Edenhope planned. He agreed that he would hand out service certificates to employees, but refused to hand out certificates to board members, which is appalling. He pulled out of that, unfortunately. He said he was fogged in; there was no fog in the air in Edenhope at the time. Apparently he did not like the idea that the CFA might greet him in Edenhope. It is just more neglect by Labor of our rural health services. This is nothing more than a push by Labor to force amalgamations of our small rural health services, forcing a decline in the services that are delivered. I note that the Premier, when he was Minister for Health, refused to offer any governance training for our board members outside of Melbourne. There is no increased training for governance in our rural and regional areas. If this government were serious about improving health services and improving governance in rural Victoria, they would not go ahead with this mandatory three‑term limit. They would increase training for governance in rural areas.