Balancing the Books

West Gippsland Healthcare Group

The shire is made up of the former shires of Buln Buln and Narracan, City of Warragul and part of the Shire of Yarra Ranges, and is experiencing a dramatic influx of people keen on a semi-rural existence within reach of the big city.

All of which means they need to be looked after and for Dan Weeks, Chief Executive Officer of the West Gippsland Healthcare Group, it is a constant challenge to balance the usual pressures to cut costs against the need to increase service levels and scope to deal with the expanding population.

The number of births in 2011 was the highest ever and when we spoke in late 2012, another record year was assured. Figures include a substantial number of women based in outlying areas who come to West Gippsland for their births, for a variety of reasons including its reputation for high levels of care.

The West Gippsland Healthcare Group comprises of a number of sites. They are Baw Baw Health and Community Care Centre, Community Services Centres in Warragul and Trafalgar, Cooinda Lodge Aged Care Residence, Rawson Community Health Centre, Andrews House Aged Care Residence, Warragul Linen Service and West Gippsland Hospital. The group’s history dates back to 1888 when the community established a hospital to service the area between Melbourne and Sale. A member of an early settler family, Mary Sargeant, donated the land on which West Gippsland Hospital, the main campus of the group, now stands.

In some ways, West Gippsland could be seen as a sort of bridge between metro Melbourne and real rural Victoria. Many of the relative newcomers are choosing to live here and commute by rail into the state capital; “moving out to enjoy the benefits of the country living while still being able to maintain employment in Melbourne,” Dan explains. “We have lots of demand and it is growing at a rapid rate.” The group is funded for a fixed amount of activity but, “if the activity exceeds the limit by more than two percent then extra work is not funded.”

The planning part is quite tricky and there are a lot of reasons why it is such a complicated issue. Dan agrees though that in principle if there is significant population growth in the area, funding ought to keep pace with it to maintain the ability to do the work required.

This funding is not a simple matter of a per-capita sum; it is rather a complex and historic mix of calculations and as government and planning rarely if ever get to work in a holistic manner. “I am not sure that the growth in population versus the growth in health funding is on the same page.” Dan says that a big effort was being made in 2012 to get on that same page with the Department about “what role West Gippsland Healthcare Group ought to be playing” with a view to establishing agreement on more activity, given the number of people, the growth of demand and the fact that the area has the capacity for more. “It is difficult to be optimistic in a climate where it is well understood that the health dollar is under incredible pressure.” From his perspective, Dan is realistically hopeful of no more than a “re-carving of the existing pie”. If there is no increase in the overall amount available, “it might be useful if some of the assumptions underlying the current allocation were reviewed”.

In 2012, the group formally commenced an approved Low Level 2 Special Care nursery, “to support the very busy obstetric unit and care for newborns that have more complex needs.” But it’s not only the birth rate that is rising. In four years the number of presentations at emergency departments in the region has rocketed by a third – to 20,000 in 2011. So as Dan points out, the only area of health care that can be controlled in these austere economic times is elective surgery, which has been severely curtailed in the last two years and “if we don’t get funding growth then the brakes will have to be put on even harder, which would be a real shame”.

Not all is bad news though. Agreement was reached in 2012 with one of the branches of Bendigo Bank’s Community Enterprise Foundation (aiming to provide employment opportunities for local people, keep local capital in the community, be a local investment option for shareholders and provide a source of revenue for important community projects determined by the local community) on a long-term arrangement to allow the group to fund new equipment – specifically the lease of new laproscopic towers which will enable the group to “greatly increase the range” of minimally invasive or ‘keyhole’ surgery carried out in the region. Dan points to the advantages of this technique in faster recovery times and also the fact that patients no longer have to travel to Melbourne for such treatment. “The support of the Drouin & District Community Bank has been fantastic. Indeed we get tremendous support from the community and from businesses – donation after donation, although this is an intrinsically precarious method of funding health care, impossible to predict year by year. We never take it for granted. The board certainly recognises and appreciates the support of the community and that in turn creates a commitment to look after the community, so we always try to ensure the community is involved and informed about what we are trying to do.”

Work continued throughout last year to double the capacity of the emergency department at West Gippsland Hospital, grafting on a 3-3.5 million-dollar extension to the existing building to accommodate a total of 16 cubicles. “It has been extremely overcrowded in recent years and we have had the unfortunate situation of having to treat people in chairs in corridors. The redevelopment is funded jointly from the Commonwealth, the state and a $500,000 donation from the Andrews Foundation.” It should be ready for business at about the same time as you read this feature. The board recently appointed a director for the emergency department who is a Fellow of the Australian College of Emergency Medicine. “This reflects the growing importance of the department and aims to provide strong clinical leadership.”

The group also recently concluded a feasibility study with the Department of Health, examining two alternatives for expansion of the hospital – either rebuilding on the existing site or building a new campus on 50 acres of land near the old Prince’s Highway owned by the group which nestles beautifully between Drouin and Warragul, the two main population areas. Either option appears viable, says Dan, “but the preferred option is to build on the greenfield site. The board is very keen to explore that option,” although it recognises that at both state and federal level, funding for new hospitals, with budgets around the 250-300 million dollar mark, “is a big ask.” He is resigned to the probability that such a project – desirable as it would be with a clean start and no disturbance of current facilities during the build phase – would be longer- rather than shorter-term. “Securing commitment for funding would be a major challenge.”

Dan says the private patient initiative in West Gippsland is not dissimilar to schemes working elsewhere – at least in Victoria – but it is proving highly effective. Patients who have private health insurance are encouraged to use it to help the hospital. “We make sure there are no out-of-pocket expenses or gap payments and we take care of all of the dreaded paperwork that is often associated with being a private patient.” Access to services and quality of care are not affected and there is no sense that ‘private’ patients might be occupying ‘public’ beds or rooms, but Dan says many patients have been discouraged from claiming on their insurance by the daunting paperwork. “We try to remove that disincentive by taking care of it.” Generally, patients are only too willing to help; doctors generally support the initiative but there are still a few issues to overcome, notably where a doctor may not have insurance to work with private patients.

Dan stresses though that not all the West Gippsland initiatives are aimed at saving cash. His, his board’s and their entire team’s efforts are mainly concentrated on improving the level of care for all patients. An electronic medication prescribing system, with all its attendant training requirements, is an example where the primary aim is better care. West Gippsland strives for good care rather than innovation for its own sake; “I guess we are not the Lone Ranger. I think the issues are pretty much the same for everyone in the public health system.”

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October 20, 2018, 10:48 AM AEDT

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