Prominent Illawarra doctor Geoffrey Murray was one of 27 doctors who signed off on a letter to the Mercury criticising the Baird government proposal last month.

The letter sparked heated debate in NSW Parliament’s Question Time on November 17, when Labor quizzed Health Minister Jillian Skinner over the doctors’ concerns.

In a new letter, Dr Murray this week further detailed his concerns that ‘’vulnerable’’ patients would suffer under a public-private partnership, or PPP, at Shellharbour.

‘’When public funding runs out the elderly, the disabled and the homeless psychiatric patients will be discharged prematurely before community supports are put in place,’’ he said.

‘’They will physically restrain agitated dementia patients rather than pay for individualised nursing care. They will use a few technicians to manage dialysis patients rather than adequately staff the dialysis unit with professional nurses.

‘’This is precisely how American Medicare and Medicaid funded patients are managed in their hospitals.’’

In September Ms Skinner announced that Shellharbour, Bowral, Goulburn, Wyong and Maitland hospitals would be redeveloped under a public-private model. Expressions of interest from private providers to design, build and operate these hospitals closed in October, with the government forging ahead with PPPs at all but Goulburn hospital.

‘’The Department of Health has been highly secretive about their plans,’’ Dr Murray said. 

He said PPPs could work in health – with the PET scanner at Wollongong Hospital one example – but not for direct patient care.

‘’It is possible for a private operator to build a hospital and even run parts of it – but getting them to deliver direct care of patients is where this plan is ethically flawed,’’ he said. ‘’There will always be this constant tension of trying to extract profits but at the same time provide proper care, and these two things are not really compatible.’’

Dr Murray, director of rehabilitation services at Port Kembla Hospital, added that while public patients would be treated for free under the plan, the issue was the ‘’quality’’ of that care.

‘’Public patients will have to be admitted but it’s the quality of treatment, and the time they get in hospital, that won’t necessarily be what they need,’’ he said.

Dr Divina Brillante, a cardiologist, also expressed concerns in a letter to the Mercury. ‘’Shellharbour Hospital has a crucial role in providing the healthcare needs of a growing community and needs to remain under the public domain to avoid compromise of healthcare and potential loss of lives,’’ she said.

Around 500 doctors, nurses and other hospital staff attended a major rally against the plan in Shellharbour on November 6. Their unions – Australian Salaried Medical Officers Federation, NSW Nurses and Midwives Association and Health Services Union – have vowed to continue industrial action.

On Friday the HSU led a rally outside Parliamentary Secretary for the Illawarra Gareth Ward’s Kiama office, handing in almost 1000 letters opposing the move.

‘’We want to ensure Shellharbour Hospital remains a full public health facility, not a two-tiered system run for profit,’’ HSU campaign manager Adam Hall said.

Meantime NSWNMA general secretary Brett Holmes said further rallies, and public forums, were planned for the new year: ‘’Our main concern is the way these privatisations will affect patient care in the long run, as no large private hospital operator has been prepared to agree to nurse-to-patient ratios anywhere in NSW.’’

However an Illawarra Shoalhaven Local Health District spokeswoman said that under a PPP, Shellharbour Hospital would continue to meet the same strict quality and performance standards that now applied.

‘’Non-government operators will have the same obligations as public hospital operators. Any contract entered into to deliver health services to the public will include performance criteria benchmarked to existing standards,’’ she said.

The spokeswoman said both public and private patients would access the new hospital the same way they did now: ‘’Patients will be prioritised and assessed based on clinical need.’’

The LHD was rolling out a ‘’comprehensive’’ community and staff consultation program around the changes.

LETTERS OF OPPOSITION

Dr Geoff Murray:

The NSW Government is engaged in a process of contracting a private corporation to deliver direct care to patients at Shellharbour Hospital and other public hospitals. This model has failed repeatedly in other states and at Port Macquarie.

The model is also ethically flawed. Government funding for public hospitals is always scarce. The motivation of a private corporation to extract profit from scarce hospital funds conflicts with their duty of care to those who would undercut their profits – vulnerable public patients.

To extract profits, a private corporation operating Shellharbour Hospital will cut costs of care to our vulnerable patients. When public funding runs out the elderly, the disabled and the homeless psychiatric patients will be discharged prematurely before community supports are put in place. They will physically restrain agitated dementia patients rather than pay for individualised nursing care. They will use a few technicians to manage dialysis patients rather than adequately staff the dialysis unit with professional nurses. This is precisely how American Medicare and Medicaid funded patients are managed in their hospitals.

Chronically unwell patients typically require longer hospital stays. Those without health insurance will be discharged prematurely when their public funding runs out. These patients will soon learn to bypass the privatised Shellharbour Hospital and attend the already overcrowded Wollongong Hospital.

To extract profits from scarce public funding a private corporation will cut the costs of quality assurance activities. They will cut costs of the important public duty of training junior medical officers. They will cut costs by compromising patient safety. When patient safety fails, the Department of Health will gladly off-load accountability for adverse events to a corporation that is accountable only to its shareholders.

A private corporation will need to extract up to $20 million a year from Shellharbour Hospital in order to recover their capital investment and draw an operating profit. The Department of Health claims the service delivered by a private corporation at Shellharbour Hospital will be better. How can a private corporation extract this large amount of money and also deliver better care? They can’t. So how will the Department of Health sell to the public their false claim of better care?

Shellharbour Hospital desperately needs an Intensive Care Unit (ICU) to operate effectively in the future. For some unfathomable reason the plans for the publically funded Shellharbour Hospital does not include an ICU until a time in the distant future. The Department of Health can now sell their plan by extolling the virtues of a private corporation that will install an ICU.

The Department of Health has been highly secretive about their plans. They blindsided this health district’s CE with their privitization announcement. They will not disclose who the private corporations are that lodged expressions of interest. They give the disturbing reason that it is commercial in confidence information. The secretive behaviour of the Department of Health must be acutely embarrassing to our local health board who promised us openness.

The Minister for Health revealed her dogmatic belief in wholesale privatisation of public hospitals in her address to the American Chamber of Commerce on March 7, 2014. Then a week before the 2015 NSW State election the minister announced public funding for a redeveloped Shellharbour Hospital in their next term of office. Surprise! Surprise! Postelection, she reverts back to the American model for our hospitals that she foreshadowed in her 2014 address to the American Chamber of Commerce.

Privitisation of public hospitals deserves vigorous public debate but this issue has been cunningly flown under the radar by the government. So it is now up to hospital staff to speak out against the perils of privatising our public hospitals.

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Dr Divina Brillante:

I am a private citizen with the privileged role of providing medical services both in a public and private setting to the people of Shellharbour and surrounds.

The privatisation of an essential service such as our public health system goes against the indoctrinated prima facie moral commitments by health professionals of respect for autonomy, beneficence, non-maleficence, and justice. Shellharbour Public Hospital has a crucial role in providing the healthcare needs of a growing community and needs to remain under the public domain to avoid compromise of health care and potential loss of lives.

Shellharbour Public Hospital provides outpatient consultation services in multiple different specialties (cardiology, plastic surgery, gynaecology, endocrinology, etc) and other services such as haemodialysis, radiology, surgical procedures, etc for the general public, and particularly those unable to afford private fees. In addition, the mental health unit at Shellharbour Hospital provides care to those who are caught in the vicious cycle of adverse social circumstances and their mental disorder. These patients range in age from adolescents to the elderly. What will happen to these services in a privatised system? Are people going to have to do “without” because they cannot afford necessary health care?

Shellharbour Hospital is a teaching hospital providing education at all levels of healthcare personnel. This provides insurance to the community that trainers (doctors, nurses, etc ) and trainees alike, are abreast with the constant changes and advances in medicine, and therefore ensure that a world class standard of care is delivered. Education is not income generating and is therefore unlikely to be a priority in a privatised system. This raises concern regarding the governance and the standard of care able to be delivered by a privatised system. Who will be held accountable for sub-standard care and will there be a process in place to address such concerns?

Shellharbour Hospital is part of a network of hospitals working interdependently. Sub-acute patients from Wollongong Hospital who are awaiting a more permanent placement (eg nursing home) or who are needing more care prior to discharge (eg protracted course of multiple antibiotics) are relocated to Shellharbour Hospital.

In addition, the Shellharbour Public hospital provides a safety net for patients who deteriorate whilst receiving care at Kiama Hospital and Shellharbour Private Hospital. How will this work in a privatised system, or are we going to rely more heavily on the next public hospital down the road to take on the burden?

The Shellharbour Hospital Emergency Department provides Emergency care to a large area of the Illawarra. The closest hospital with emergency care south of Shellharbour is Nowra Hospital (60km). This will put pressure on an already pressured Emergency Department at Wollongong and Nowra Hospital, and will put residents in a similar position to a remote rural location, putting lives at unnecessary risk.

A significant proportion of the community are not aware that Shellharbour Hospital is being privatised, nor do they have insight as to how this would impact on them. It is an injustice and a repudiation of their basic right that the decision has been made for them. It puts an already vulnerable population at risk of morbidity and mortality, as necessary health care becomes increasingly inaccessible.

We need to keep Shellharbour Hospital under the supervision of the government and its resources. The private sector does not have the capacity to be accountable for the operation of this essential service. Privatisation is not the quick fix answer to the process and consultation needed to address the reform required by the health system. We have learnt this from the recent past. Let us move forward towards planning and coming up with a better solution.