Children’s hospitals review finds financial, bullying issues

An independent governance review of Sydney's two children's hospitals has unearthed a litany of issues including a lack of funding and alleged unchecked "bullying" behaviour. 

The review, led by the former head of Melbourne's Royal Children's Hospital professor Kathy Alexander, also said a clearer statewide strategy for paediatric care was needed, especially for "rare or high risk interventions".

It comes amid a bitter east-west feud between the Sydney Children's Hospital Randwick and The Children's Hospital at Westmead over a lack of cardiac services.

Randwick doctors have warned "children will die" if cardiac resources are prioritised to its sister facility.

They voted to leave the Sydney Children's Hospital Network (SCHN) - which runs the two facilities - in May however the review has recommended the hospitals should continue to work together.

Sydney Children's Hospital Randwick voted to leave the network but a review recommended they continue to work together.
Sydney Children's Hospital Randwick voted to leave the network but a review recommended they continue to work together.

It noted the need for a "networked approach to the delivery of paediatric care … is even more relevant in 2019 than it was in 2010", particularly at the "extreme subspecialty end of the spectrum" for skill development.

The review also found that "financial issues appear to be contributing to and compounding" the current problems at the SCHN".

"Children's Hospitals Australasia benchmarking data shows significant differences between the Australian States in the level of funding for paediatric care, with SCHN being 14% lower in cost than its nearest counterpart interstate," it noted.

"It will be important to investigate the adequacy of the NSW funding model to adequately address the particular costs of care required for children."

Alarmingly, a "number of submissions" made to the independent review panel flagged concerns around "unchecked intimidating or 'bullying' behaviour of quite senior medical, nursing and administration managers".

"There is a view that this kind of behaviour is not addressed," it added.

The review also found there was a lack of trust between The Children’s Hospital at Westmead and the Sydney Children's Hospital Randwick. Picture: AAP Image/Jordan Shields
The review also found there was a lack of trust between The Children’s Hospital at Westmead and the Sydney Children's Hospital Randwick. Picture: AAP Image/Jordan Shields

Further, it highlighted there were "different cultures in each hospital and the differences are now compounded by a lack of trust between the hospitals".

The review also criticised the board's oversight of cardiac surgery problems, which was identified as an "emerging risk" in 2017 before being upgraded to a "strategic risk".

It said that despite both the "clinical and reputational risk" regarding the issue, a mitigation strategy was delegated to the CEO "with apparently limited oversight by the board" until the issue was raised in the media.

The review did not focus on cardiac services which it said were being "determined through a separate process".

A SCHN doctor who asked not to be named said: "The elephant in the room is cardiac - that's always been our core concern and it's barely been touched."

NSW Health will also hold a roundtable discussion with senior doctors, nurses and allied health staff involved in paediatric services from across the state later on July 27 in a bid to find a solution.



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