Hands off our hospital

DOCTORS across the shire are profoundly concerned that proposed state budget reforms to the health system under the guise of fiscal accountability will result in the loss or reduction of local services and jobs, with the Mansfield District Hospital under threat of amalgamation if costs don’t come down. In the recent budget, health service delivery across the state came under the microscope, with hospitals and health service providers tasked with adhering strictly to government-enforced budgets and targets. However this represents a challenge as many services across the state currently run in deficit. Operational costs have risen on average 9.8 per cent per annum for the last five years, with funding only covering day-to-day costs leaving little to replace outdated equipment, introduce needed services or recruit specialists and additional staff. Taking this into account, the Australian Medical Association of Victoria has queried how government funding has been costed to allow hospitals to meet future demand alongside delivering high-quality patient care and worker entitlements. Touting a five-year investment of $8.8 billion in the health sector, Minister for Health Mary-Anne Thomas believes the government’s plan will deliver this financial certainty and drive the focus on to frontline services. “It is important we look at how the system is organised to ensure we are delivering the very best health care, closer to home, for Victorian patients where they live,” said Ms Thomas. Victoria currently has 76 health services. Ms Thomas believes this results in a system where care is fractured and fragmented. Under the government’s plan, the 76 would be reduced to 12 with six services in metropolitan Melbourne and regional Victoria divided into six sub-regions. The Mansfield District Hospital would fall under the jurisdiction of Hume. “This would bring Victoria into line with both New South Wales and Queensland who have around 16 or 17 health services across each state,” Ms Thomas said. However this is in contradiction to a report released by the state's own Department of Health in 2015. The department commissioned an assessment of Victoria’s model of governance in regards to health services with the review finding that giving hospitals autonomy at a local level was working well with the approach to governance producing an engaged local community. Of note, the approach was recognised for enabling “the recruitment and retention of experienced chief executives, contributing to a culture of innovation and agility that has been underpinned by organisational stability”. Yet despite these findings, it is speculated that regional health care providers and hospitals – like the Mansfield District Hospital - will lose autonomy under the government's plan. This will lead to a sharing of services under forced amalgamations or “strengthened partnerships” as the government reforms the structure and governance of Victoria’s health system ostensibly to deliver a more efficient and effective model of “world-class care”. On a local level, it potentially means the dissolution of our local hospital board and the removal of the executive committee. “Our hospital is part of the fabric of our community – it’s very important that local people are involved in a governance role,” said local GP, Dr Will Twycross. “We are incredibly fortunate at the Mansfield District Hospital to have a board of highly skilled individuals along with a strong and innovative Executive who all share the common goal of wanting the hospital to be the very best it can be. “The government’s plan puts all that at risk, because suddenly the community’s voice in what is needed is not there anymore.” And with the plan set to be legislated as early as July, Dr Twycross is fearful that we may be just two months away from an 150-year-old institution – the hospital board – being swept away. “A community feels confidence when local government, health services and education – the three big public sector enterprises – are well run, innovative, and locally controlled,” he said. Dr Twycross believes this security will be eroded if amalgamations occur, and local roles become redundant as governance is relinquished to a regional centre hours away. “Having a remote board would waste money, time and effort, and ultimately lead to a loss of morale, as has happened with the amalgamated board in the Grampians,” he said. Stretching from Ballarat to Horsham and beyond, Grampians Health is an example of numerous health services amalgamated, with hospitals in Ballarat, Stawell, Horsham, Edenhope and Dimboola merging under the one governance in late 2021. Underperforming on all targets with a reduction in services and an operating deficit that has increased three-fold, Northern Grampians Shire councillors passed a vote of “no confidence” in Grampians Health, calling on the state government to intervene. “It’s shown that amalgamation isn’t the solution,” said Dr Twycross. “Amalgamating hospital boards may have a role for large city hospitals, but not in the country.” Dr Twycross along with his colleagues across both medical practices in Mansfield, believe that at a local level amalgamation will result in the inevitable loss of acute services in areas such as theatre, urgent care and maternity, as services become consolidated and centralised, and funds are diverted. “We may well lose some of our GPs as negotiating contracts becomes cumbersome,” he said. “We will lose some of the community impetus in respect to donations and bequests, as that sense of local ownership no longer exists. “And more importantly we will lose that very intimate link between the community and the hospital that enables innovation. “There is no way that great initiatives such as ReStart and the Mansfield Respond Project would get a start under an amalgamated board. “What may not be understood by the health department, is that innovative programmes like these involve the hospital partnering with local government, schools, churches, the courts and police.” Dr Twycross is urging the state government to not underestimate the importance of community input and self-determination, with projects able to be actioned on a local level without getting bogged down in bureaucracy. “Centralisation of services can also leave large parts of the population exposed when emergencies happen, whether they are at Mt Buller, in the High Country, on the lake, or closer to town," he said. “A skilled and engaged local medical and nursing workforce is the community’s safety net.” State Member for Eildon Cindy McLeish believes that cuts and threats of large-scale amalgamations exemplify the disregard Labor has for rural and regional communities. “It is inevitable that services will be cut, and vulnerable and sick regional Victorians - including those in Mansfield and surrounds - will need to travel for services once provided in their home towns,” Ms McLeish said. “The Mansfield community has worked hard to maintain great service levels at the hospital and this can be undone in a moment with a signature by the minister. “These funding cuts by stealth are the real-world consequence of the government’s financial mismanagement and it is patients across rural and regional Victoria who will suffer.” The lack of transparency has health professionals across the region justifiably concerned, with Ms McLeish confirming that Yea, Alexandra, Seymour and Benalla hospitals will also be impacted. And despite reassurance that regional communities will be consulted prior to any merger process the state government’s independent advisory committee are already in the final stages of delivering the Health Services Plan. GPs across the Mansfield Shire state that consultation with local stakeholders has not eventuated, and with hospital boards and executives across the state required to sign confidential disclosure agreements information is limited. The effective gagging of hospitals across the state has mobilised our local GPs to speak up, with a rally organised for June 15 with both state and federal members in attendance. Over the coming weeks, the doctors will also be gathering signatures on a petition opposing any forced amalgamations. “I’m 100 per cent confident that we’re going to get the necessary 2000 signatures which will enable the petition to be raised in the Legislative Assembly," said Dr Twycross. Alongside holding public meetings and drafting a petition, every general practitioner in the shire has also contributed financially towards a campaign in support of the hospital board and its executive. "As the town's GPs we want residents to know we are taking action. "We need as a community to defend our hospital, its staff and our community's ownership of its health services."

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