Retired by the ballot box
MDOs, as ‘mutuals’, say they are owned by their member doctors and seek to serve them well. When (the minority of) members take part in elections, is their say ‘euphemised’ by rhetoric? When MDA members recently voted Dr Maher onto the MDA Board to replace Dr Capolingua at the MDA National mutual board elections, we received a media release that announced Dr Capolingua had retired from the board. As this seemed different to being voted off by policyholders at an election, we investigated, to find that the MDA National constitution talks of board members whose three-year term expires as “retiring”. If you stand for re-election and fail you are retired! We think member powers deserve more consideration. Its’ a bit like saying the only nominee for a position is “elected unopposed” when no election amongst the broad membership is held.
Who you gonna call?
The MDA National report, printed in Melbourne, delivers the usual financials and profiles of organisation heavies. As well as emphasising growth (12%) and a sound financial position ($15m surplus), MDA National’s stated point of difference is its education and hands-on help for doctors. Interestingly, only 25% of those seeking clinical advice had ethical dilemmas in mind; and GPs were ahead of surgeons, and doctors in training in seeking general medico-legal advice (48%, 15%, and 10%, respectively). When it came to actual cases dealt with, GPs (41%) were ahead of surgeons (22%), anaesthetists (7%), O&G made only 4%, while ED doctors were alongside dermatologists (1%). The all-important Cases Committee for WA, which influences how MDA takes on your problems, is comprised of Dr Rod Moore, A/Prof Max Baumwol, Dr Fiona Bettenay, Dr Reg Bullen, A/Prof Rosanna Capolingua, Dr Michael Gannon, C/Prof Guy van Hazel, Dr Tim Jeffrey, Dr Andrew Miller, C/Prof Alan Skirving and A/Prof David Watson. The composition of this committee will not be changing.
Ramsay’s Kevin Cass-Ryall, Peter Mott and Mrs Anne Leach
Ode to a Nightingale
While the opening of the new Anne Leach wing at Hollywood Private Hospital has made it the second biggest hospital in WA with 750 beds after FSH (783 beds), it was to its roots it turned to for its name. At a ceremony just before Christmas the wing was officially dedicated to nurse Anne Leach, who saw war service in the Middle East in the 1940s and then became sister-in-charge of Hollywood Repatriation Hospital, which Ramsay Health bought in 1994. It continues to care for military veterans’ health. Mrs Leach, who is now 101 years old, was the guest of honour at the event, which was also attended by the Health Minister Dr Kim Hames, RSL state president Mr Graham Edwards, Ramsay chair Michael Siddle, CEO of Ramsay Australia Danny Sim, and hosted by Hollywood CEO Mr Peter Mott. The new wing has added 30 beds and six theatres to the hospital.
IMGs specialist training
Last year, we asked Government to provide numbers of IMGs working in public hospitals in WA. This was prompted by the complaints of the lack of specialist training places for WA graduates. As simplistic as it seems, we chose the number of IMG senior registrars per discipline, as an indicator of those likely to occupy a training post. The breakdown of IMGs per discipline shows IMG senior registrars in brackets: General Medicine 160 (6); Emergency Medicine 133 (11); Anaesthetics & Pain Medicine 62 (41); Intensive Care 44 (14); Medical Administration 43 (1); Psychiatry 37 (8); General Surgery 31 (3); General Practice 22 (7); Neonatal Medicine 21 (9); and O&G 21 (1). This comes at a time when there is a general decline of limited IMG registrations, though areas of need are a different matter.
State of our workforce
In December the AIHW published its annual workforce report which showed only slight increases from 2013 figures. The last head count was 8343 doctors in WA, 2768 of them GPs and 2810 specialists. Where the stats get interesting is in the gender and age profiles. More women are training to be specialists – in 2014 52% of the positions were filled by women, but there is still a long way to go for parity once fully fledged. In 2014 women accounted for 27.8% of specialists. In general practice it’s 39.8%. And the profession is getting older. There is only 13.8% under the age of 30, not surprisingly 51.9% of those are in the hospital system and 33.7% are in specialist training. General Practice has 36.5% of its workforce over the age of 55. Just over half the specialists in WA worked in the public sector (1389 FTE positions).
GPs still in the Chain
In our earlier conversation with Medical Director of Silver Chain’s Home Hospital (HH), Dr Daryl Kroschel, he detailed WA Health’s contract with them to care for early-release patients from hospital. Who else used HH services, we asked. It receives at least 60 referrals a month from GPs and residential aged care facilities, the most common entry point from the community into HH. Treatments included cellulitis, lacerations, skin tears, wounds, constipation, acute urinary retention, catheter issues including suprapubic, chest infections and exacerbations of COPD, cellulitis, IV hydrations and PEG tube re-insertions. HH will conduct GP education events in 2016.
Silver Chain growth
Still on Silver Chain, its 2014-15 annual report is out and its popularity is clearly growing, especially its home hospital services, as government seeks to cut down avoidable hospital admissions. In fact, Board Chair Anne Skipper says that 30% of hospital admissions are unnecessary. Does Silver Chain do it better? About 41% of income comes as HACC grants ($102m), 36% from State Health ($89m), and 10% as other Commonwealth grants. About 1% of income is donations ($3.3m) and Silver Chain raises $23m in care fees. On the expenditure side, 79% of costs are for the 3200 employees (with 7% as “other”, the next biggest category). In WA: the Hospice Care service says 69% of its clients die at home; and about 50% of services are wound care for which nursing staff spend an average 33 minutes, every 19 days per client, averaging 19.3 visits. While this fills the year nicely for each client, we would like to know the daily travel time for staff in their 1080 vehicles and the time efficiency of visits.
Top heavy with heavies
Healthway legislation was caught up in political argy bargy at the end of last year, so a frustrated Dr Kim Hames wants readers to know that “The passage of the Western Australian Health Promotion Foundation Bill 2015 will be a top priority when Parliament resumes in February.” The interim board of the DG of Health, Dr David Weisz (with his nominee Prof Bryant Stokes), Mr Duncan Ord, DG of the DCA, Ms Emma White, DG of Child Protection and Family Support, Mr Ron Alexander, DG of Sport & Recreation, and Ms Ricky Burges, CEO of WALGA, will continue, possibly at the Minister’s pleasure. Under the legislation, the board will be reduced from 11 to seven and appointed by the Minister. Rumours of a more community-based group appear to have been grossly exaggerated!
Money well spent
The world is more transparent thanks to the magic of the internet. We were contacted by a researcher who accessed papers which showed the consultant fees paid to Banscott Health Consulting (headed by previous DG of WA Health, Alan Bansemer). This is what we found. The company, which was established in 2002, has received $3.5m for 18 or so contracts from the Department of Health spanning 2007-13, which seem to be Commonwealth, some awarded by restricted tender. There are no aspersions cast that the Government didn’t get value for money.
His commissioned reports for the Commonwealth that call for reforms include one on mental health in the NT (Building Healthier Communities), and the more recent Delivery of Health Services in Tasmania in response to long waitlists and access blocks and after a $325m Commonwealth injection. Alan was a distinguished career public servant, coming with an economics and business background from Adelaide. He was DG of Health here from 1995-2001. His 2001 retirement was lauded by Health Minister Bob Kucera after six years as DG, about a year after he appointed Dr David Russell-Weisz as the inaugural Director of Medical Services for the North West.
Alan served eight years as the Deputy Secretary to the Commonwealth Government Department of Human Services and Health, and was chair of the Medicare Schedule Review Board and General Practice Consultative Committee. He also advised the Australian Health Ministers’ Advisory Council, Health Insurance Commission (now Medicare Australia) and the Australian Institute of Health and Welfare among others. Then there is his breeding of stud horses at his Namerik stud in the Serpentine.