Unsafe staffing levels, unsafe working hours, unreliable technology. Good luck getting safe, quality public care at NBH, says the doctors’ union.
Northern Beaches Hospital is failing to meet acceptable staffing, safety and resources standards, according to a damning submission to the NSW Audit Office’s inquiry into the troubled hospital.
The Australian Salaried Medical Officers’ Federation NSW branch’s submission to the inquiry reported feedback from its members around chronic understaffing, unsafe working hours, bed block, unreliable technology, inadequate overtime compensation, unsafe staffing levels, and “significant challenges” in accessing leave entitlements.
“It was dangerous—last year, there was one registrar and an intern sometimes covering upwards of 50 patients on one team,” said one ASMOF member’s feedback to the submission.
“There were two weeks when my registrar was on nights or sick leave, and no relieving registrar was provided.
“This left a single intern managing high patient loads, often without proper supervision.
“Inconsistent consultant supervision and a lack of registrar cover go against HETI’s standards for intern teaching and supervision.”
Consultants at NBH frequently work on weekends with insufficient support, said the submission.
“The hospital’s operational stability is increasingly reliant on the goodwill of consultants, who regularly exceed their contractual obligations to cover staffing gaps.”
One member reported that one doctor was often responsible for up to 30 patients.
“My days are frequently between 12 and 14 hours long; I routinely work 14 consecutive days straight,” reported an unaccredited registrar.
“There are times when I have stayed at work till 11:30pm just to return at 6:30am because I have to complete JMO jobs that could’ve been done earlier with a JMO in our team (which we don’t have),” said another registrar.
The ASMOF NSW has made 12 recommendations to the NSW Audit Office, some of which are:
- Staffing and WHS: implement MSC staffing recommendations and improve recruitment and retention efforts with union input;
- Overtime monitoring: enforce compliance with NSW Health’s “14/10” rule which limits shifts to 14 consecutive hours and provides at least 10 hours of break between shifts;
- Fatigue management: conduct a WHS audit of doctors’ hours;
- Better pay and conditions: begin enterprise bargaining to address recruitment and retention challenges;
- Resources and oversight: enhance IT systems, address bed block and increase oversight of NBH to meet public hospital standards.
Healthscope, the operator of Northern Beaches Hospital, told HSD that it was cooperating with the Audit Office’s inquiry into public funded hospital services at the facility.
“It is not appropriate for Healthscope to comment on individual submissions to the Audit Office,” said a spokesperson.
“NBH employs more than 180 JMOs, with 121 JMOs on rotation from NSLHD, and 68 employed directly by NBH.
“NBH rosters to NSW Health safe working guidelines and actively works to minimise overtime and ensure leave provisions for doctors.
“In the event of unexpected leave, NBH has a pool of relief JMOs to provide additional cover and where necessary employs short term locums to cover rostering deficits.
“NBH has a doctor wellbeing program which includes managing fatigue. This includes ensuring adequate breaks and providing rest/sleep rooms.
“NBH continues to perform strongly across key clinical measures compared to its peer hospitals.”
NBH is run via a public private partnership between Healthscope and Northern Sydney LHD (NSW Health). Since 2018 it has provided free public patient services as well as a range of private services.
The audit will examine whether the Northern Beaches Hospital PPP is efficiently and effectively delivering public hospital services. It will focus on two areas of clinical activity: emergency department activity and general surgery between July 2022 to June 2024.
HSD has previously reported that Healthscope received $183.7 million in revenue in 2023 for treating public patients.
The PPP ends in October 2038, meaning NSW Health will fork out another $2.62 billion – or $749,200 per bed, per year.
Northern Sydney LHD issued the following statement to HSD:
“Northern Sydney Local Health District is assisting the NSW Audit Office in their completion of the Performance Audit of Northern Beaches Hospital. This audit is not yet completed.
“NSLHD will allow the audit process to be finalised before commenting on submissions or any subsequent findings.”