Northern Territory Second Reading Speeches

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HOSPITAL BOARDS BILL 2009

Mr VATSKALIS (Heath): Madam Speaker, I move that the bill now be read a second time.

The purpose of this bill is to establish a new
Hospital Boards Act, replacing the now dated Hospital Management Boards Act 1980. The original act has had minor amendments over the past 29 years. In contrast, approaches to hospital management over this period have seen significant changes nationally. Previous reviews of the act, around 2000, were in regard to national competition policy, and in relation to other health legislation. However, a comprehensive review and updating of the purpose, operation, function, governance and powers of the board was warranted, and long overdue.

The Department of Health and Families commissioned the formal review of the
Hospital Management Boards Act 1980 by an independent consultant, Health Consult, in 2007. Extensive consultation occurred across the Territory with existing board members, management of the five Northern Territory public hospitals, Department of Health and Families management, and other key stakeholders. The review found Northern Territory hospital boards were operating effectively at the Royal Darwin and Alice Springs Hospitals, with strong representation from the local community.

The operation of boards in Nhulunbuy, Katherine and Tennant Creek were struggling with maintaining adequate community representation, and with their sense of purpose and function. Even though the Royal Darwin and Alice Springs boards were highly functional, they operated with a different understanding of their role. Board members made a presentation to the minister, and senior departmental officers, for amendments to the legislation to clarify the role and function of the boards Territory wide.


It is important to understand this point. Legislation governing hospital boards has to be workable for all our hospitals, and relevant to the communities they serve. The review addressed this challenge by acknowledging our towns and communities may be small and widely dispersed, but they all contain people who are passionate about the Territory and our lifestyle. These are the people we want to attract to the boards, who will be committed to making our hospitals the best they can be for all Territorians, regardless of the location and size of the hospital.


The review considered the existing legislation, and how boards have been able to meet these requirements. Where it was apparent boards had difficulty in complying with the legislation, an analysis was undertaken to explore the reasons for that. Options were developed to make the legislation more contemporary and workable. Under the existing legislation hospital management boards were required to meet at least monthly. They were responsible for providing the Minister for Health with regular communication about the hospital, and a formal annual report for tabling in this House.


Over the years, the ability of the board to fulfil these two requirements has proven to be problematic. Boards have not recorded consistent data on hospitals and the operation of the board. The review reported boards required more clarity and guidance about what is expected for their reporting obligations. Since 1982, when annual reports had been provided by Northern Territory hospital boards collectively, the boards have only met the expectation to meet monthly 44% of the time. This issue has been most apparent in the smaller regional hospitals.


Gove District Hospital has not had a functional board since 2000-01. This is despite repeated and expensive attempts to recruit community membership over this period and support for the operation of the board through the hospital management.


Katherine Hospital Board has held a maximum of only seven meetings per year from 2001-02 to 2005-06, and no board has been in operation since then. A similar situation has evolved with the Tennant Creek Hospital Board. In light of these difficulties, significant reform was indicated for the act to provide conditions where the hospital boards can operate and provide an effective governance role to their local hospital.


During the consultation process for the 2007 review, it became apparent there were diverse views about the best way forward for hospital boards. When considering the trend around Australia the consultants strongly recommended the need to maintain active community participation in the operation of public hospitals, and the need for government to retain control of the management and expenditure of public hospitals.


The chairs of the Alice Springs and Royal Darwin Hospitals Boards provided significant input during the period of the review, and I commend them for their patience and dedication to seeing the quality of boards across the Territory improve. Chair of the Royal Darwin Hospital Board, Mr Colin McDonald QC has made an enormous contribution to the development of this new legislation, bringing his legal expertise and extensive knowledge of the board’s role and function to the fore. He has provided sensible and informed advice about workable solutions for all Northern Territory hospital boards.


The new act provides for each public hospital in the Northern Territory to have a board with membership solely constituted from persons living within the community served by these hospitals. Local community representatives will be sought to provide clear input in the way their hospital delivers services and ensures it is meeting the needs of the community. The previous act required the senior management group from the hospital to be members of the board. The new act now requires that the only people independent of the administration of the hospital are to be members.


Senior management of the hospital, such as the general manager, the director of medical services, the director of nursing services, for example, will be required to attend board meetings and provide information. However, the new board will be completely independent of the hospital. The number of persons required to constitute a hospital board has been reduced from the previously required eight to a more viable and more flexible range, consisting of three to six members. The difficulties experienced by boards over the years attracting and retaining adequate membership, especially in some of the smaller Territory communities, will be reduced considerably by these changes.


The primary focus for boards in the new legislation has been directed away from management-related roles to concentrate on community liaison, consultation and the improvement of service quality. Realistically, this means we are not expecting community board members to have the skills of hospital managers with advanced expectation of clinical services or complex budget management. We are, however, expecting board members to know their community, know how to interact with the community and provide advice about improving the quality of services patients receive. Hospitals are an integral part of the local community; through this new legislation, we aim to strengthen their position by allowing the communities to have a real voice in their hospital.


As mentioned earlier, hospital management personnel are no longer described as members of boards, although they still have responsibility to support and assist board members in carrying out the function of the board. Existing board members have recommended adequate administrative support needs to be provided to assist with the operation of the board by explicitly stating hospital management is responsible to support and assist the board - this administrative role is assured.


The management of public hospitals in the Northern Territory falls under the organisation of the Department of Health and Families acting, on behalf of the Northern Territory government. Staff who work in the hospitals operate under the relevant legislation such as the
Public Sector Employment and Management Act, the Financial Management Act, and the Medical Services Act, to name a few. The new Hospital Boards Act makes it clear there must be consistency between the board’s direction and advice and the current acts governing the public service.

Considering the function to be carried by hospital boards, an increased emphasis in the new act has been placed on board members’ understanding and monitoring the health care standards adopted by Territory hospitals. Board members will not, however, be expected to have technical or expert understanding of health care standards, nor will they be expected to engage professional health surveyors to assist with their monitoring function.


As constituted of members of the local community, boards will have capacity to assess the day-to-day experiences local people have with their hospital services. To learn perspectives as sophisticated consumers, board members will be able to monitor the implementation of health care standards and inspect how these standards are met across the hospital. The new legislation explicitly states that boards will have assistance and support to inspect the hospital. They will be able to compare experience and expectations with the accepted standards, and provide advice to hospital management and government about ways to improve the quality and appropriateness of hospital services.


Boards will also provide the mechanism for health professionals to consult with experts in the field of ethics about the increasingly contentious and, often litigious, range of ethical matters that come up in the day-to-day operation of hospitals. Through their membership of a board subcommittee, these experts will be able to consult frankly and confidently, with the understanding that this legislation provides them protection from the threat of civil or criminal liability.


Another feature of this legislation is its reinforcement of the local community’s role in contributing to the direction and strategic planning of the hospitals which serve the community. The new act clearly provides for the strategic planning as one of the functions prescribed for hospital boards. It also reinforces the capacity of boards to engage with government through their increased contact with the Health Minister, and the provision of annual reports to the Legislative Assembly.


Further reinforcing the role of these community boards and their important contribution to the governance of our hospitals, the new act clearly identifies government’s interest in having the boards involved in the selection of key hospital personnel. This will be accomplished through the participation of the board members on the selection committee for members of the hospital’s management group, such as the general manager of the hospital, the director of medical services, and the director of nursing services. These are all very important positions which have considerable profile within the community, which should be filled with persons who are compatible with the community and its special needs and priorities. Similarly, these are positions that will also benefit from the support and assistance of the board in advancing the quality initiatives across the hospital and within the community.


Considering the almost 30 years experience with hospital boards under the current act, and acknowledging the difficulties experienced by boards in trying to sustain adequate membership, a number of changes can be incorporated into the new act. In addition to the previously mentioned changes to the mandated number of members required to constitute a board, additional administrative flexibility has been provided in the new act to allow for membership to be temporarily suspended until sufficiently members can be recruited from the local community. This enables the minister to undertake the board’s function and powers as considered necessary during the period of suspended membership. It is important to understand in this situation the board continues to exist, only membership is suspended, and this is only until an adequate number – three - of members have been obtained. Notices will be advertised in the local community, seeking expression of interest to recruit new members for the board. Every effort will be made to maintain adequate membership of the boards, and every effort will be made to assist the boards in conducting their function.


Another provision in the new Hospital Boards Act, designed to enable communities to cope with fluctuations in their capacity to provide the membership for a hospital board is the power to amalgamate the boards of two or more community hospitals into one board, should it be necessary. This should result in a greater critical mass of population and greater potential for the combined communities to sustain enough membership for a hospital board.


Since the commencement of the current act in 1980, both hospitals and the communities they serve have experienced extensive, wide-ranging change. These changes, and the knowledge and experience gained from hospital boards across the Territory, have contributed substantially to the development of this new act. In addition, recognising the contribution of the experience and knowledge gained through the administration of the act, it is most important that we acknowledge the hard work and overall contributions made by the many Territorians who volunteered to serve on the boards of their community hospitals. The hours of involvement in fundraising activities, long and arduous meetings, contentious agenda matters, and the advice provide to ministers over the years, has been most appreciated.


Government sees this type of involvement by local communities as essential to achieving the best outcomes for the health and wellbeing of Territorians. We acknowledge the time and effort required of those volunteers is precious, and there is intense competition out there for the attention of individuals who are able and willing to make this type of contribution.


Let me say again - and I am sure members will agree – the Territory owes a considerable debt of gratitude to those Territorians who have given their time and effort so selflessly to support their local hospitals.


This bill for a new Hospital Boards Act incorporates the contributions of those who volunteer their time and effort over 30 years to the hospital boards that have been in operation under the previous act. It also incorporates the knowledge and experience gained by the Department of Health and Families through its administration of the act.


Earlier this year, I released a number of major reviews into the operation of the Royal Darwin Hospital. The governance review, conduction by the Australian Council on Health Care Standards, made a number of recommendations on the function and role of the board. The review recommended the board’s role in the governance of the hospital be clarified and communicated widely. Introducing this new legislation is a major step in this process.


The implementation of recommendations from the governance review has commenced, with the appointment of the new Head of Hospitals, Mr Alan Wilson. Mr Wilson is overseeing the expert task force guiding the improvements at Royal Darwin Hospital. Organisations such as the Australian Medical Association are represented on the task force.


The task force, with the Executive Management and Clinical team at Royal Darwin Hospital and the Royal Darwin Hospital Board will steer the RDH in a strategic manner to position it well for the future. Notwithstanding that improvements can be made, Royal Darwin Hospital is a first rate hospital, with a very experienced and dynamic team of staff that provide excellent care.


The new bill is important legislation for all our public hospitals across the Territory, encouraging and enabling local communities to become involved with their hospitals to support improvements in the quality and the appropriateness of the services they are providing. I commend the bill to honourable members.


Debate adjourned.

 


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