Drs Marc Heyning and Peter Bowles
Chair and vice-chair, Mullumbimby Hospital Medical Staff Council
The medical staff of Mullumbimby and District Hospital would like to clarify some of the misinformation being spread about the staffing of the hospital’s emergency department.
There is no problem with attracting sufficient medical staff to maintain a 24-hour seven day per week coverage of the Mullumbimby Hospital’s emergency department. Admittedly, the cost of providing this coverage has risen with time. In its defence, the hospital has been able to achieve that coverage with minimal budget over-run thanks to efficiencies in other areas and, overall, the hospital has been able to achieve a level of financial efficiency only second to Murwillumbah Hospital in the Tweed Byron network.
Presumably the Area Health Service is looking to cover budget blowouts in other parts of the health service network and has targeted Mullumbimby Hospital’s emergency department’s medical coverage during the antisocial hours as a source of savings. Their justification is that there is a low number of patient presentations after midnight and the Byron Hospital is close enough to be considered an alternative.
The problem is that when these low number presentations are looked at, half are high-priority type presentations requiring, by definition, attention in timeframes of within minutes to a maximum of half an hour. Also, most self-present – that is, they arrive at the hospital via private transport and are not brought in by ambulance. Thus, even if ambulances bypass Mullumbimby Hospital, most of these high-priority patients would still arrive and require treatment. It is these patients that are of concern to both the nurses and the doctors. They require urgent care and the alternative being offered by the Area Health Service is for a nurse to confer via video conferencing with a registrar at Tweed Hospital, obtaining some immediate treatment advice prior to transferring most of these patients by ambulance to Tweed Hospital.
The problems are:
1) the nurses, although well trained, may be asked to function outside their skill base;
2) the registrars, although fully registered doctors, have not yet completed their vocational training in emergency medicine; and
3) financially, the cost of transferring these patients by ambulance at $1200/transfer consumes as much money as it would have cost to have staffed Mullumbimby Hospital’s emergency department for these antisocial hours. The result would be less-optimal care for the local community with no real financial savings to the local health service.
The Mullumbimby Hospital Medical Staff Council have proposed:
1) negotiating a revised reimbursement agreement for the local doctors to make staffing the hospital more attractive for local doctors and decreasing the reliance on locums to fill voids in the coverage; and
2) to use the agreed long-term impracticality and expense of the current duplication of Byron Shire hospital services to lobby for the Byron Central Hospital to be built.
This latter proposal has been in the pipeline for more than 20 years, has had a large amount of money squandered on consultative processes and yet, although there is land purchased and zoned for its construction, has not even been placed on the NSW’s government’s capital works program. Forty million dollars recently was granted to the Lismore Base Hospital that is in a zero-population-growth area while the Tweed Byron area with its five per cent growth rate received nothing.
There is no sense in closing services that disadvantage a community when there will not be any financial savings. Better, the Area Health Service and the politicians servicing this growth area should look for savings by consolidating services into a new hospital that will offer the communities concerned an improved range of services while being more efficient to run. That just makes more sense. Plug the hole by building a better service!