APN NewsDesk asked the medical staff councils at Tweed, Lismore, Byron and Grafton whether Northern NSW Local Health District chief executive Chris Crawford should keep his job.
Shadow Health Minister Dr Andrew McDonald last week made public a petition with signatures from 84 senior Northern Rivers clinicians calling for Mr Crawford to be sacked.
The call stemmed from the standing-down of former Lismore Base Hospital obstetrician Dr Glenn Taylor last year when serious accusations, later proved false, were made against him.
The four staff councils hold very different views about Mr Crawford's continued employment, but all agree there are major issues with under-staffing and budgetary constraints.
WHAT THE MEDICAL STAFF COUNCILS SAID:
- LISMORE: Staff not replaced to keep struggling service under budget
- FIGURES: How much is spent on our hospitals
- GRAFTON: Things are improving - slowly
- FIGURES: How healthy is the Northern Rivers?
- TWEED: We're the forgotten cousins
- BYRON: Planned Ewingsdale hospital is a major win
- CRAWFORD'S RESPONSE: Local health service's strong performance speaks for itself
- POLL: Do you have confidence in the Northern Rivers' health system?
LISMORE: Staff not replaced to keep struggling service under budget
LISMORE medical staff council chair Dr Chris Ingall has led the chorus of calls for Chris Crawford to be stood down as CEO of the Northern NSW Local Health District.
He said board chairman Dr Brian Pezzutti told a recent staff council meeting the Northern NSW District was badly under-funded.
Yet somehow, Dr Ingall said, it still managed to come under budget.
"The area is growing and it is under-funded, by the chair of the board's admission, yet it's coming in on budget," Dr Ingall said.
"We see positions which aren't filled for services which aren't being provided.
"If someone goes on maternity leave or quits, their job becomes vacant and it just sits on Chris's desk until June 30 or later."
Mr Crawford said staff salaries were the health district's biggest cost and the fact it was on budget suggested as whole, it had the right number of staff.
"Whether more staff are required in a particular part of the (health district) is determined on a case by case basis," he said.
"This does lead to staffing levels in different areas within (the district) being increased on occasions."
Dr Ingall said coming under budget was an anomaly in the NSW health system.
"In other health services, they would recognise there is an important position that needs to be filled and just go over budget, then Jillian (Skinner) goes to the Treasury to backfill their shortfalls," he said.
"The only other one that (regularly) comes in on budget is Central Sydney.
"Despite being almost the worst demographic, in terms of aged care and low socio-economics, we still come in under budget."
Dr Ingall cited the example of a psychologist vacancy at Lismore Base Hospital's pain management ward which went unfilled "for many months".
HOSPITAL BUDGETS 2014-15
- Ballina Hospital - $27 million (+6.6% bigger budget than previous year)
- Murwillumbah Hospital - $30 million (+5.1%)
- Maclean Hospital - $15.9 million (+4.7%)
- Lismore Base Hospital - $164 million (+4.5%)
- Tweed Hospital - $145 million (+4.3%)
- Casino Hospital - $14.1 million (+3.8%)
- Grafton Base Hospital - $63.6 million (+2.3%)
- Kyogle Hospital - $8.4 million (+2.3%)
- Urbenville Hospital - $3.5 million (+2.3%)
- Mullumbimby Hospital - $7.9 million (+2.2%)
- Nimbin Hospital - $3.6 million (+1.9%)
- Bonalbo Hospital - $2.2 million (+1.6%)
- Byron Bay Hospital - $9.2 million (+0.6%)
- Coraki Hospital - $506,000 (-6.3%)
- NSW Health overall - $19.9 billion (+5.2%)
GRAFTON: Things are improving - slowly
DR ALLAN Tyson wears several hats - on one hand he is the head of the Grafton Base Hospital medical staff council, on the other he is a member of the board which falls under Mr Crawford's jurisdiction as CEO.
He suggested calls for Mr Crawford's scalp were hasty and said changes were on the way, albeit slowly.
NSW Health is moving towards an "activity-based" funding model, where districts are funded on the basis of the work they actually do, but it has been a drawn-out transition.
Dr Tyson said the Northern NSW health district had seen a 6% increase in services provided last year, but the budget remained locked into "a historical funding model".
"There is a big difference between the increase in demand and the actual funding increase," he said.
"As a result, there have been some really tight budgetary controls which have led to delays in recruiting staff.
Dr Tyson said efforts had been made to remedy the strained relationship between administrators and medical staff.
NORTHERN NSW HEALTH STATS
- Current smokers (aged 16+) - 19.5%
- Risk drinking - 33.8%
- Overweight or obese (16+) - 48.7%
- Adequate physical activity (16+) - 57.6%
- Recommended vegetable consumption - 14.5%
- Recommended fruit consumption - 52.8%
TWEED: We're the forgotten cousins
STAFF at Tweed Hospital feel like "forgotten cousins" shackled by bureaucracy, medical staff council spokesman Dr Michael Ghusn said.
Dr Ghusn stopped short of calling for Mr Crawford's resignation, but said his tendency towards micro-management had done a disservice to patients.
"Basically, none of the managers at Tweed can sign-off on anything until it has gone across his desk," he said.
"It means things function slowly and ineffectively.
"We have a hospital bursting at the seams, and we're not getting our fair slice of the pie."
Mr Crawford said patients within the health district were happy with the service they received, with 93% of Northern NSW patients rating their hospital care as good or very good.
Dr Ghusn echoed the complaint about staff vacancies going unfilled. "The cynics would say that's all part of keeping the budget down - that's three months' wages he doesn't have to pay," he said.
"It's a bit hard to call for him to be sacked - I just always thought of him as an immoveable object you have to work around or work with."
BYRON: Planned Ewingsdale hospital is a major win
THE start of construction on the Byron District Hospital has been heralded as a major win for the health district under Mr Crawford's guidance.
Byron Bay medical staff council's Dr Greg Gover acknowledged the issues other areas were having but said Byron had fared well under the current system.
He hoped that relationship would continue once the new hospital opened.
"The ground is being turned for our new shire hospital, and that is going to be a very hot issue - whether it's adequately staffed," he said.
"It's about resourcing not only the hospital services, but the community-based services."
Byron is part of the Tweed health network but is somewhat removed from operations at Tweed Hospital.
Dr Gover recognised the facilities in Tweed left much to be desired.
"In the not-too-distant future, they will need to overhaul that hospital because of the burgeoning population."
CRAWFORD'S RESPONSE: Local health service's strong performance speaks for itself
A BARRAGE of criticism has come his way, but Northern NSW Local Health District chief executive Chris Crawford says the service he runs is meeting all its obligations to patients.
He said emergency department waiting times and elective surgery targets were up to standard and every health facility in the district was accredited.
"At the same time the quality and patient safety indicators are being met," he said.
"The rate of infections in (the district's) hospitals is below benchmark and the proportion of staff complying with the hand hygiene protocol is above the benchmark."
Mr Crawford said the most recent staff survey showed staff engagement had improved 10% and was above the state average.
"Should medical staff or other staff have concerns, I am happy to sit down with them to discuss their concerns," he said.
Do you have confidence in the Northern Rivers' health service?
This poll ended on 01 December 2014.
Absolutely, our health service is well run and staffed by good people - 10%
Kind-of - I have confidence in the staff, but not the system they work within - 19%
No. Health service staff are doing their best but are completely overwhelmed by the flaws in the system - 70%
This is not a scientific poll. The results reflect only the opinions of those who chose to participate.