A long-awaited review of Fiona Stanley Hospital (FSH) clinical services has detailed a failure to properly prioritise urgent surgery, excessive emergency department demand and problems with the contract with private operator Serco.
The problems are outlined in an independent review released this afternoon, which was commissioned in April this year after a string of problems with patient care at the facility came to light.
At the time it was billed as a “15-day review” by Health Minister Kim Hames, but the report was not completed until June.
The report makes 32 recommendations including calling for changes to numerous clinical procedures, greater transparency in executive decision-making and ongoing reviews of procedures to ensure compliance with the hospital’s aims.
But acting Health Department director-general Bryant Stokes said the report confirmed problems with the hospital were “basically teething problems”.
“[Most of the problems] are basically communication, and as I have said to the staff themselves there was perhaps a loss of tenderness of care in the frustration of learning new system and new processes,” he said.
“A significant number of [the issues] have already been dealt with and we are hoping that by the end of August many of the issues will be attended to.”
He said the recommendations had his support and would be implemented, but admitted one relating to the reporting structure at the hospital would pose some difficulties.
Serco contract under scrutiny
The report also described a “them and us” mindset between contractor Serco’s staff and other health employees.
“The contract with Serco has proved challenging at a number of levels,” the report stated.
But Professor Stokes said the way Serco staff had handled recent flooding incidents was evidence problems with the service provider were easing.
“I think those issues have improved significantly and will continue to improve,” he said.
One problem detailed was that the contract failed to allow porters to physically touch patients.
“Given that a significant part of a porter’s role is transferring patients to and from beds, chairs, wheelchairs, operating theatre tables and so on, this created a major difficulty for the hospital to overcome,” the review stated.
The emergency department is still subject to a ‘honeypot’ effect.
Report into Fiona Stanley Hospital clinical services
It also detailed problems with the prioritising of surgery for those deemed either semi-urgent or urgent.
“It was reported that patients who were considered semi-urgent had been left waiting for surgery for several days and some patients chose to have their care transferred to St John of God Hospital, Murdoch,” it stated.
“Surgeons stated that urgent cases were not appropriately escalated over routine cases.”
Furthermore, the report detailed how initial demand at the emergency department had been greater than anticipated and staff were stretched as a result.
“Demand has reduced with time, although the emergency department is still subject to a ‘honeypot’ effect (i.e. popular local attraction),” it said.
According to the report, there has also been “numerous patient complaints and unnecessary tension between patients and their clinical carers” over failure to change bed linen, which is only done when requested by clinical staff.
We certainly believe there are a lot of corners being cut to deliver on the [Serco] contract.
Pat O’Donnell from United Voice
There were also problems with excessive wait times, of up to seven hours, for patients to receive medication upon discharge and ward cleaning taking place late at night, therefore disturbing patients.
The report said physicians had found the operating structure “cumbersome” and that senior clinical managers had reported insufficient contact with the FSH executive.
It stated 105 complaints had been referred to Dr Hames since the opening of the hospital.
Twenty-two per cent related to clinical issues, 21 per cent were about clinical communication and a further 18 per cent were about waiting times.
The report only addressed clinical problems and not structural issues, such as the two flooding incidents that caused substantial disruption at the facility.
‘Chaos and dysfunction’: Opposition
State Opposition health spokesman Roger Cook said the report painted a picture of chaos and dysfunction at the hospital.
United Voice, which represents some Serco workers at the hospital, said a re-working of the WA Government’s contract with the service provider was necessary.
“It’s a failed experiment so far, it has failed overseas,” said the union’s WA Assistant Secretary Pat O’Donnell.
“There’s other failures that are yet to be talked about … we certainly believe there are a lot of corners being cut to deliver on the contract.
“We’re going to see more of the same until they bring the contracts back under the control of the Government.”
Mr Cook said he believed the privatisation of services at the hospital was the catalyst for the most of the problems.
“I don’t blame Serco, I don’t blame the clinicians, I blame this Government that saw fit to try and clip the bill of running this hospital, and as a result of that, patient services and patient care has been severely compromised.”