The local health districts say there will be no health-related decisions made, but senior psychiatrists are not convinced.
Executives with no medical training may be making health-related decisions in Sydney emergency departments thanks to the continuing psychiatry workforce crisis, according to internal Local Health District documents.
An explosive report in the Guardian today shows that contingency plans to cope with the loss of up to 200 state-employed psychiatrists over the next several weeks include limiting the times and circumstances under which a psychiatrist will be called by emergency department staff.
At Royal Prince Alfred Hospitals emergency department, managers have been told by the CEO of Sydney Local Health District Deb Willcox that in order to reduce the burden on remaining psychiatrists, the ED is required to contact the executive on-call “to ensure other options are exhausted prior to contacting the psychiatry registrar on-call”, alleges the Guardian.
The executive on-call is not usually a doctor.
According to a senior psychiatrist, quoted by the Guardian, that means “people who often have no experience in clinical medicine will now be making health-related decisions. And people who present outside normal working hours mostly do so because it is urgent.”
A Sydney LHD spokesperson denied this, telling HSD that “the executive on call will act as an escalation point of contact for emergency department staff and will not be involved in clinical decisions about any patient”.
“Sydney LHD acknowledges the disruption the current industrial action involving psychiatrists will cause to our health system,” said the spokesperson.
“SLHD has contingencies in place to ensure any mental health patient who presents to one of our emergency departments will be provided the care they need.
“Plans are in place across NSW Health to ensure the best quality mental health care continues including the establishment of the Mental Health Emergency Operations Centre to co-ordinate efforts through the public health system.”
In Western Sydney LHD, internal emails allegedly show temporary reductions in the number of beds in Westmead hospital’s medical psychiatry and older person’s mental health unit, and the closure of the hospital’s mother and baby unit.
“Proposed additional beds will be secured through a private provider contract for this specialist model,” said one email from WSLHD CEO Graeme Loy.
According to the Guardian, Mr Loy’s letter says other wards at Westmead hospital will operate under a “psychiatry consultant liaison model” – meaning psychiatrists will be called in for consultation by other teams but will not be responsible for the patient’s care. A psychiatry consultant liaison model will also be used at Blacktown hospital under the governance of the drug and alcohol unit.
Western Sydney LHD’s only response to a request for comment by HSD was:
“The latest information was made available to the media at yesterday’s press conference with Minister Jackson.”
Northern NSW LHD has confirmed to HSD that it will extend the staffing arrangements put in place to cover the Christmas and New Year holiday period, including maintaining a reduction of bed numbers from 24 to 18 at Tallowwood adult acute mental health unit at Lismore, and from 25 to 23 beds at Kurrajong adult acute mental health unit.
At St George Hospital in South Eastern Sydney LHD “face-to-face reviews by psychiatrists will be less frequent”, according to documents seen by the Guardian, and six paediatric emergency care centre beds will be “redeployed”, meaning those beds will be closed to mental health patients.
HSD has reached out to SESLHD for further comment. This article will be updated with any response as soon as we receive it.