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Tuesday, 26 November 1985
Page: 2243

Senator GEORGES —I present report No. 238 of the Joint Parliamentary Committee of Public Accounts-Review of the Auditor-General's Efficiency Audit Report on the Administration of Public Hospitals by the Capital Territory Health Commission.

Ordered that the report be printed.

Senator GEORGES —I seek leave to have a short statement incorporated in Hansard.

Leave granted.

The statement read as follows-

This report outlines the findings of the Committee's Inquiry into the `Report of the Auditor-General on an Efficiency Audit-Administration of Public Hospitals by the Capital Territory Health Commission'. Coincident with the Committee's inquiry and coincident with the tabling of this report, there has been widespread industrial activity in the public hospital system of the Australian Capital Territory. Industrial relations issues do not, however, fall within the scope of either the audit report or the Committee's inquiry. The audit report concentrates primarily on the managerial issue of how the former Commission balanced the need to contain hospital costs whilst ensuring an acceptable standard of service. The Committee's report focuses on the audit report's findings and recommendations on this issue.

During the inquiry, the top structure of the Commission was significantly altered. The Committee reviewed these changes and considered that they were largely irrelevant to the Committee's inquiry. Coincident with the changes to its top structure, the name of the Commission was changed to the Australian Capital Territory Health Authority. The Minister announced the new structure for the Australian Capital Territory Health Authority on 1 October 1985 and included a patient advocacy and complaints unit to increase the Authority's responsiveness to the community. The Committee was told that the new structure was expected to be operating early next year. There are three public hospitals-Royal Canberra, Woden Valley, and Calvary-and one private hospital, John James Memorial Hospital, in the Australian Capital Territory. The Authority administers the Royal Canberra and Woden Valley hospitals and provides grants towards the operational and capital costs of the Calvary Hospital which is administered by the Roman Catholic Order of the Little Company of Mary. The Authority exercises some administrative control over Calvary Hospital, for example, through determination of bed numbers, services provided, budgets and conditions of service for staff. The private hospital is independent of the Authority.

Parliamentary appropriations to the Authority for 1985-86 were $107.4m for operational items and $4.0m for capital works and services. The sum of $77m was allocated to the Royal Canberra and Woden Valley hospitals. The grant to Calvary Hospital in 1985-86 was $9,066,000m. The details of the staffing of the Australian Capital Territory Health Authority as at 30 June 1985 is set out in Table B of the report and totalled 3,784 full time staff and 957 part-time.

The Committee was informed that Canberra's public hospitals have excess bed capacity. The three public hospitals were designed to provide 1,448 beds. The number of beds that were staffed as at 30 June 1985 was 913. In addition, there were 81 beds staffed and 10 day-stay beds available at the private John James Memorial Hospital at 30 June 1985. In addition to submissions detailing the former Commission's and the Authority's responses to the main audit findings and recommendations, submissions were also sought from the Australian Audit Office and two expert witnesses, Dr R. B. Holland, Director, Department of Anaesthetics and Resuscitation, Westmead Hospital and formerly Chairman, Australian Council on Hospital Standards, and Dr A. W. Ireland, formerly consultant on clinical review to the Auditor-General and to the Jamison Inquiry. The transcripts of evidence and other evidence authorised for publication have been published separately.

In its inquiry the Committee found that whilst the former Commission generally expressed support for the recommendations of the efficiency audit report and developments were in progress in some areas, for example, automatic data processing, there have been only limited substantive changes in administration. The efficiency audit examined the administration of hospitals by the Commission in three areas: Planning of hospital services; use made of hospital services by clinicians; and management of hospital resources, in particular, finances and staffing. The Australian Audit Office reported that: In terms of broad indicators of financial performance, the Royal Canberra and Woden Valley Hospitals were comparable to similar hospitals in Victoria and New South Wales; and the hospitals had achieved a desirable reduction in length of patient stay and compared favourably in terms of low patient length of stay with a group of Sydney metropolitan hospitals.

The audit also identified a number of areas in which the administration of the hospitals could be improved. Particular criticisms were: The lack of developed processes for peer review of clinical use of hospital facilities; processes for planning the number of public hospital beds appeared to allow an excess supply of staffed hospital beds relative to efficient bed usage; despite improvement, patient length of stay at both Royal Canberra and Woden Valley hospitals was still excessive with resultant inefficiency of bed utilisation; there were weaknesses in systems for identifying financial and staffing requirements and monitoring staff use within the Commission's hospitals-management information systems were inadequate; and there was under-use of physical facilities, especially accommodation.

In its report, the Committee addressed these and other related issues and made a number of detailed recommendations. In regard to resource management issues, the Committee considered that audit findings concerning the excessive cost of staff cleaning and the magnitude of debts outstanding to the Authority were accurate and cause for concern. Further, the recommendations for upgraded management information systems and associated administration changes were sound. On the question of the quality of medical services in the Authority hospitals, the recommendations for enhanced peer review activities were considered to be the major practical means of improving the service.

This aspect is closely linked with the accreditation of hospitals which in Australia, is undertaken by an independent body, the Australian Council on Hospital Standards. Council surveyors review the performance of the hospital and report to the Council, which grants full or 3-year status, provisional-one year-or consultative, that is, non-accreditation status. Woden Valley Hospital applied for accreditation in 1979 but was unsuccessful largely because of the hospital's unsatisfactory medical structure. It lacked hospital-based departments and a developed process of clinical review. The medical staff structure at the Woden Valley has not changed since 1979 and the hospital has not re-applied for accreditation status. The Royal Canberra Hospital has not applied for accreditation.

Other hospitals in the Australian Capital Territory have been accredited. Honourable senators may be interested to know that the majority of public hospitals in New South Wales and Victoria and increasing numbers of private hospitals in these States have been surveyed for accreditation. During the period 1974-1983, 68 per cent of hospital beds in New South Wales and 81 per cent in Victoria had been surveyed. The Committee is of the view that the process was valuable because of the process of self-examination in the preparation for assessment and consequently recommended that: The Authority require the Royal Canberra and Woden Valley hospitals to begin immediately to prepare for assessment leading to accreditation by the Australian Council on Hospital Standards.

Senator GEORGES —by leave-The Committee is grateful to the former Commission and the Australian Capital Territory Health Authority for the co-operation provided throughout the Committee's inquiry. The Committee thanks its adviser, Ms Robyn McClelland, and members of its secretariat for the support given to this reference. I commend the report to honourable senators.