How does Healthscope defend its review of a 2020 parliamentary inquiry into the embattled Northern Beaches Hospital?
Healthscope’s top dogs faced an uncomfortable interrogation at the NSW budget estimates hearing this week, as fresh headlines emerged about the death of another child at its embattled Northern Beaches Hospital.
As the only privately operator to run a public hospital in the state, Healthscope has been under enormous pressure since the damning results of a review into the tragic death of two-year-old Joe Massa at the hospital were made public last week.
The toddler died from a cardiac arrest in September last year after spending about two hours in the emergency department. His mother pleaded a number of times for urgent care including intravenous fluids, but she was dismissed by staff.
A Serious Adverse Event Review Findings Report into the death identified “systems, issues that impacted and delayed the child receiving a thorough assessment and comprehensive care during his time in the emergency department”.
“The SAER team acknowledge they cannot say definitively that the child’s death was preventable, however they do acknowledge that there was a delay/failure to recognise deterioration,” the report says.
“The SAER team accept that an earlier recognition of the deteriorating child may have provided an opportunity for early escalation and resuscitation with potential prevention of the cardiac arrest event.”
Outgoing Healthscope CEO Greg Horan, who appeared at the estimates hearing with NBH’s CMO and COO Associate Professor Peter Thomas and incoming Healthscope CEO former Qantas and Boral executive Tino La Spina, took accountability for Joe’s death.
Addressing Joe’s parents Elouise and Danny Massa, who were present at the hearing, Mr Horan said:
“I just wanted to pass on my deepest condolences to the Massa family for the loss of your baby boy, Joe, and for the care that Joe did not receive at our hospital at Northern Beaches.
“I cannot imagine the grief that you’re feeling right now. I’m also sitting here accountable for what happened at Northern Beaches and accountable for making sure the actions going forward prevent this type of incident from ever happening again.”
The Healthscope executives faced a fresh barrage of questions from the estimates committee, as news broke during the lunch break that a newborn had reportedly died at the hospital on Saturday.
Professor Thomas said an early investigation had not uncovered any misconduct.
“I’m limited in what I can say due to confidentiality, but there was an emergency caesarean section for the mother of the child who was transferred to North Shore Hospital,” he said.
“The provisional risk assessment, or preliminary risk assessment has been done and hasn’t highlighted any key deficiencies as far as I’m aware.”
Professor Thomas later clarified that while an emergency caesarean section was called for, it was not performed as the baby had already been delivered.
Health Minister Ryan Park said in a statement that Healthscope, had informed him it was reviewing the circumstances leading to the baby’s death, and the state’s chief obstetrician would also conduct a review.
During the afternoon session of the hearing, Mr Horan and Professor Thomas faced repeated and at times relentless questioning about the circumstances around this latest death and the circumstances leading up to Joe Massa’s death.
There was a focus on staffing, on activity levels at the ED at the time, the presence of CCTV footage, what happened during Joe’s final minutes and the REACH (Recognise, Engage, Act, Call, Help) program, which was introduced in 2013 after the tragic death of a six-month-old who had been misdiagnosed at Shoalhaven Hospital on the NSW south coast.
The program allows parents to request a clinical review if they feel something is wrong with their loved one’s treatment, which should take place within 30 minutes. If concerns persist, they can request a rapid “independent review.”
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NSW premier Chris Minns met with the Massas this week and promised to strengthen this program across the state.
However, Professor Thomas acknowledged that the program had been too “passive” at NBH. Since the review into Joe’s death, staff have been proactively providing parents with QR codes and a contact number to escalate any issues.
During the hearing, Professor Thomas conceded that Joe should have received the intravenous fluids requested by his mother on three separate occasions.
Committee member and Legislative Council deputy opposition whip Wes Fang spent most of his question time asking about staffing, the REACH program, CCTV footage of the NBH hospital’s ED and staff training. But it was his question to Professor Thomas “12 seconds” out from the end of his allocated time that is likely to raise even more questions in the coming days and apply even more heat to Healthscope.
“I just want to double check on a couple of things. Have you read the Northern Beaches inquiry report that was released in 2020?” asked Mr Fang. He was referring to a state parliamentary inquiry into the NBH that recommended “that the NSW government not enter into any public private partnerships for future public hospitals” among the total of 23 recommendations.
The 219-page report was released in February 2020.
“I have read parts of it. I’ve not read the complete report,” said Professor Thomas.
Mr Fang was unimpressed.
“You’re the medical officer for Northern Beaches hospital, we released a parliamentary inquiry into the hospital outlining a number of issues, including IT issues, including the accreditation, issues of staff training, which it sounds like there might be some, still a few,” he said.
“We talk about a number of cultural issues in the hospital. You’re in charge of the clinical services at hospital, and you haven’t read the complete report.”
“I’ve read all the recommendations. I’ve read the majority of the report, but … I haven’t read every single page.”
Mr Fang then aimed the same question at Mr Horan.
“I’m aware of the report, I have read the recommendations, and I have read parts of the report. I have not read the full report,” said Mr Horan.
Mr Fang – clearly now past his final 12 seconds – turned to Mr La Spina, who takes over from Mr Horan at Healthscope from next month.
“Mr La Spina, before you start, are you going to commit to me you’re going to read that report,” he asked.
“Given that prompting, I’ll commit to you that I’ll read the report,” replied Mr La Spina.
“Thank you, I’m out of time, unfortunately,” replied Mr Fang.
NSW health secretary Susan Pearce was also drawn into the NBH controversy, when she was asked – and refused – to put a price on what it would cost to end the public-private partnership with Healthscope and have the ministry assume control.
She was however more forthcoming when asked whether NSW health minster Ryan Park had asked the ministry to “look at any options for NSW Health to take over the running of Northern Beaches Hospital”.
“We have, over a period of time, had a look at what that would mean in the event that there was a an issue … with respect to the Healthscope team here, noting the private equity component and media reporting with respect to some issues associated with the financial viability of the organisation, we have done some work to understand what that would mean for us,” said Ms Pearce.
The NBH hospital was destined to be steeped in controversy even before it opened thanks to the local outcry over the closure of Mona Vale Hospital (which has now been bulldozed and is home to a range of community health services including an urgent care centre, rehabilitation service and palliative care centre) and Manly Hospital (which is now a palliative care centre for young people).
Federal Mackellar MP, teal independent and GP Dr Sophie Scamps last weekend launched a petition calling for the hospital to be handed back to the government, describing it as a “failed experiment”.
The petition has more than 3600 signatures.
“The Northern Beaches Hospital public-private partnership is a failed experiment. Public health and private profit-making are fundamentally incompatible,” said Dr Scamps.
“Northern Beaches Hospital must now be returned to public hands.”
The hospital is already under investigation by the NSW auditor-general, which is looking at whether the controversial public-private partnership delivers public hospital services and quality care effectively and efficiently.
That report is due in June. One can only hope the Healthscope and NBH bosses decided to read every single page. Exposing themselves to questions like those asked by Mr Fay and having to answer the way they did does them no favours when it comes to rebuilding community confidence in their ability to provide public health services.