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An Open Letter by Dr Michael Holland

24th September 2021

An Open Letter to the Eurobodalla Community, the Southern NSW Local Health District and our local State and Federal political representatives.

I write this letter on my 64th birthday.

I am fortunate to have good physical and mental health.

Nevertheless, I have required medical, surgical and mental health services.

My family has experience of cancer, early death from preventable disease, mental health disorders as well as obstetric, neonatal and paediatric emergencies

We are fortunate to live in a society where health services have a high standard of care.

However, despite the Medicare principles & commitments shared by State and Federal Governments of choice, universality and equity for healthcare, we live in a community that is, and will continue to be, deprived of these services relative to our neighbouring hospitals and the rest of the State in general.

The New Eurobodalla Health Service Development Fact Sheet August 2021 was released this week following 2 community information sessions.

The information requires anatomical dissection and bureaucratic translation.

1 - “The new hospital will be larger than both Moruya and Batemans Bay hospitals combined.”

The combined area of Moruya and Batemans Bay Hospitals is 11,753 square metres.

The Eurobodalla Health Service Clinical Services Plan 2020 requires a 20,481 square metre building which is an increase of 74%.

The current funding of $200 million delivers a building of approximately 15,000 square metres which equates to a 27% increase.

Therefore, what is said is true, but it is false. A paradox.

The total footprint is larger but not as large as recommended.

How many beds will there be in the new hospital?

2 – “What will the new Eurobodalla Health Service deliver?”

An emergency department, surgical and operating theatres, dedicated medical, surgical and rehab beds, medical imaging services, chemotherapy and renal dialysis, paediatric and maternity services.

Thank you but we have these already.

What about some things that we don’t have like paediatrics, orthopaedics, comprehensive surgical cancer services, inpatient mental health services and radiation oncology services?

The mention of paediatrics is an exercise in equivocation of the highest degree as you will see.

3 - “The CSP outlines the current and projected health service needs of the Eurobodalla population up to 2031 and describes key infrastructure and future clinical services recommendations to best meet those needs.

This means that, with their hand on their hearts, NSW Health and the SNSWLHD can promise you some of these services by 2031 according to their discretion.

“Is the CSP a blueprint? The CSP is not a blueprint, it is a plan that reflects the current and projected health service needs of a community at a point in time. It is one of the many sources of information that informs the future direction of a new hospital.”

If it is not a blueprint, what is it? A document that can be metamorphosed or ignored at will?

It is a document that will be superseded by the forthcoming Coastal Network Clinical Services Plan 2022 which will inform the Eurobodalla community of the inevitable provision of services in the proposed resource hub of the South East Regional Hospital, Bega.

4 - “Close observation unit and Intensive care unit. The hospital will open with a close observation unit (COU) with a view to progressing to an intensive care unit (ICU). This will be justified by demand and supported by staffing capability and networked agreements with higher level facilities.”

The closest thing to the truth so far.

Along with the confirmation that the bipartisan Federal commitment to radiation oncology services for Bega and the Eurobodalla will be rejected by the NSW Ministry for Health, we now know that the new regional hospital will not open with Intensive Care services.

It is too difficult for a Health Department which has been given 4 years’ notice since their appointed Agency for Clinical Innovation Review 2017 to open a Close Observation Unit, recruit medical and nursing specialists now who will transition to the Intensive Care staff of 2025.

5 – “Operating theatres. The new hospital will include two state-of-the operating theatres and one surgical procedure room.”

How many theatres are there in the Eurobodalla now? Three. Net gain. Zero.

The number of theatres as with the number of beds generally is not the major concern.

The major concern is the provision of services and the staffing that is required to fulfil these services.

6 – “The new hospital will open with paediatric and maternity services equal to what is currently available at Batemans Bay and Moruya hospitals combined. Maternity will gradually increase to support high-risk pregnancies (level 4) which currently are diverted to Bega or Queanbeyan. Neonatal services provide immediate care for newborns and short-term and ongoing care for simple neonatal concerns. This service will increase to support more complex cases. Both of these units will be developed alongside the proposed expansion of paediatrics.”

This statement causes me more despair than anything else in this document.

Zero plus zero equals zero. There is no paediatric service in Batemans Bay or Moruya hospitals combined.

I have just completed a week of obstetrics where there were 10 births including 3 caesareans, 3 instrumental births, 2 newborn transfers and 1 complex maternal transfer.

Fortunately, our community had a specialist paediatrician on call for 4 nights.

Four nights out of the 19 years that I have practiced obstetrics in the Eurobodalla!

The statement ignores the fact that neonatal resuscitation services in the Eurobodalla are critically deficient.

It is a perennial deficiency which has reached the point of threatened closure of the Maternity service if this parlous state persists. It is relying on the goodwill of already overworked and extended clinicians to provide some semblance of safety.

The solution to the problem is specialist paediatric cover backed up by well trained and credentialled procedural GPs.

The response from NSW Health is that to establish a paediatric service in the Eurobodalla would be unsafe at this time without appropriate governance.

The paradox?

You can still have the largest rural maternity service in the SNSWLHD and deliver babies without comprehensive neonatal services.

You can have a maternity unit which has beds reduced from 7 to 3.

You can expect a reduction of the proposed paediatric beds to 2 beds which effectively eliminates the potential to recruit paediatric specialists, paediatric nurses and qualified GPs and therefore goodbye paediatric unit.

We are faced with a Catch 22 worthy of Captain John Yossarian.

It is a problem for which the only solution is denied by a circumstance inherent in the problem or by the rule

We have reached the end of the infinite loop of health care.

A sequence of instructions that, as written, will continue endlessly, unless an external intervention occurs.

Having negotiated for years with the SNSWLHD and NSW Ministry for Health, I have realised that the external intervention that is required is community advocacy and action.

I call on our State and Federal political representatives to act on behalf of the Eurobodalla and the Far South Coast of NSW to provide adequate capital funding for the necessary infrastructure and the recurrent staffing expenses (estimated to be one third of the construction cost annually).

There needs to be immediate recruitment and staffing of specialists, procedural GPs, nurses, midwives and allied health workers to provide safe clinical care now and to establish and transition to higher levels of clinical services in the new hospital.

The current plan closes a level 2 and a level 3 hospital and opens a level 3 hospital.

The current clinical service particularly for neonatal and paediatric care is inequitable and unsafe.

For this reason, in July, the combined Eurobodalla Medical Staff Council unanimously voted to not endorse the current Functional Design Brief for Maternity, Neonatal, Paediatric and Emergency Services and to suspend any further planning for the new hospital until future bed and service provision is resolved.

Needless to say, Health Infrastructure NSW continues to work towards delivering an inadequate service plan by their November deadline.

The Eurobodalla will be represented at the NSW Parliament Inquiry into Health outcomes and access to health and hospital services in rural, regional and remote New South Wales on Wednesday 6th October.

Above: Margaret Bennett-Chief Executive NSW Southern Local Health District, Dr Michael Holland and Lisa Kennedy-GM Eurobodalla and Queanbeyan Health Services. Photo: Annie Clarke