Canberra Health Services CEO Dave Peffer: “We’ve got to be pragmatic about how much we can get done and in what time frame.” Photos: Ian Bushnell.
The timetable for Canberra Health Services’ reform plans at Canberra Hospital has been pushed back as it absorbs another resignation and takes a more conciliatory approach to moving Visiting Medical Officers to new contracts and reorganising how surgery is rostered and theatres allocated.
A proposal for an escalation mechanism to resolve surgeon differences with the contentious operations centre has also been favourably received.
CHS says the changes are needed to save money and head off more budget top-ups, as well as to have surgical patients treated more equitably and faster, in the face of increasing demand at Canberra Hospital.
The ACT Government had to inject an extra $227 million into the health system earlier in the year due to a surge in demand last year, and it wants to make $27 million in savings to make the system sustainable.
Othopaedic surgeons are at the vanguard of discontent about the planned changes, with a fifth surgeon resigning this week. Dr Nicholas Tsai joined department head Professor Paul Smith and Dr Sindy Vrancic and two others in leaving the hospital.
None of the surgeons work full time at the hospital, and Dr Tsai is a colleague of Professor Smith at the private Orthopaedics ACT clinic in Phillip.
It has also been reported that two anaesthetists have left, but this should not be conflated with the current situation. CHS chief executive Dave Peffer said two departures in 12 months in a team 110-strong was not unusual.
Mr Peffer said the department had grown by seven so it was still a bigger department now than it was 12 months ago, but replacements would be sought.
Anesthetists were already on sessional contracts as opposed to the 70 fee-for-service contracts CHS wants to change, he said.
CHS is also keen to have more specialists on staff contracts.
However, Mr Peffer did not deny that losing five orthopaedic surgeons with their experience was difficult.
“The reality is, when you have five highly trained specialists like this depart – they are leaving with a lot of expertise, a lot of experience in building the department here locally – it is a hard thing to replace in the months ahead,” he said.
Head of Vascular Surgery Gert Frahm-Jensen has been proposed as the one to resolve differences between surgeons and the operations centre.
Mr Peffer said the surgeons had given three months’ notice, and the team continued to work as normal with no impact on services, and a recruitment process would be started.
“We’ll be guided by the remaining specialists about where it is they think that we need to expand our skills base, the number of surgeons that we might need for our rosters, and we’ll work as collaboratively as we can. Certainly the offer for dialogue is there to transition patient care between surgeons,” he said.
Mr Peffer acknowledged that CHS had decided to take a step back from some of the changes in light of the pushback from specialists but remained committed to them.
“We’ve got to be pragmatic about how much can we get done and in what time frame, and I think that at this stage, we haven’t drawn on the expertise that’s available to us from our own workforce to the extent that we should have,” he said.
“We’ve been open about the direction of travel, the need to be affordable and the importance of change in the system.
“We remain committed to that, but the way we go about it, the engagement that we’ll seek from the workforce, that’s where people will notice the change.”
On surgery lists, the goal of a pooled list, instead of individual surgeon’s lists, is yet to be achieved, and CHS is making concessions on how the operations centre makes its decisions in the face of claims that the clinical views of surgeons were being overridden.
Mr Peffer said the operations centre was not there to frustrate anyone but provide a reliable service.
On Thursday night, CHS met with surgical heads about the proposed escalation mechanism if there is disagreement about surgical priorities.
Mr Peffer said it was proposed that the clinical director of surgery, Head of Vascular Surgery Gert Frahm-Jensen, break the impasse.
“So a surgeon will make the decision, not someone in the operations center, no one else in administration in the hospital. A surgeon will make the ultimate call about what’s the right thing to do in this situation.”
The meeting was productive, and the proposal was supported by specialty heads, CHS said on Friday.
On VMO contracts, Mr Peffer said most craft groups were at the negotiating table and were putting forth proposals about how the contract should be structured.
“We’re actually pretty close, so I think for many of our VMOs, we’ll be able to land a contract that works for the health service, provides that affordability, but equally supports our surgeons,” he said.
Mr Peffer said CHS was committed to overcoming the cost issues and meeting the commitment to patients being treated as soon as possible
“We’ve been very fortunate with the government investment this year, a significant cash injection to respond to the levels of activity that we’ve seen, but there’s an ongoing question about affordability, and we can’t walk away from that,” he said.
