Big plans for Local Health Networks

The Lamp September10 cover

NSW Health reveals plans for Local Health Networks.

NSW Health has released a discussion paper on the Federal Government’s health reforms, which will transform the State health system into a National Health and Hospitals Network.

The discussion paper includes proposed boundaries for the new Local Hospital Network. The full discussion paper with an outline of the proposed new boundaries can be accessed online at www.health.nsw.gov.au

Earlier this year the Federal Labor Government announced wide-ranging reform of the national health and hospitals system. Central to this reform was the creation of Local Health Networks to replace the current Area Health Services and a greater emphasis on primary care.

The reform has been agreed to by seven states and territories and the Commonwealth. West Australia was the only state that did not sign up to the agreement.

Seventeen Local Health Networks in NSW will replace the existing eight Area Health Services. The LHNs will comprise a single hospital or group of hospitals and other health services that are geographically linked.

They will work closely with the primary health care organisations (to be called Medicare Locals), which are to be established by the Commonwealth.

There will also be two specialist networks: the Sydney Children’s Hospitals Network (Randwick and Westmead) and the Forensic Mental Health Network.

The Federal Government will take full responsibility for funding and policy for all general practice and primary care. It will also become the dominant funder of the public hospital system, increasing its share from 40% to 60%.

The discussion paper proposes that each Local Health Network should include a principal referral hospital, a clinical school and high-level EDs. It is proposed that each LHN would be self-sufficient in high-level complex services such as cancer services, maternity services, cardiac services, stroke services, paediatric services, and mental health services.

NSW Health has conducted numerous consultations across the State. It says a key feedback point was the importance of preserving clinical networks and clinical councils and the need for local clinicians to have a role on local governing bodies.

The NSW Government says it wants to implement the national reforms without delay to provide certainty and to reap the benefits of the changes.

Under the agreement NSW will receive around $1.2 billion for recurrent and capital funding over a four-year period. The funding will be linked to performance targets based on improved access for patients.

The nuts and bolts of the Local Health Networks

  • Each LHN will have a Chief Executive and a governing council.
  • The LHN will negotiate a service agreement with the NSW Government. It would manage its own budget and develop a strategic plan to deliver improved health outcomes to its local community.
  • It is expected that metropolitan LHNs would cover a population of at least 500,000 with regional and rural LHNs less than 500,000.
  • Responsibility for industrial relations functions including pay and conditions resides with the state government.

Medicare Locals

Medicare Locals is the name given to the primary health-care organisations that will be set up by the Federal Government.

According to Federal Health Minister Nicola Roxon, ‘They will be responsible for improving and coordinating GP and primary care services in local communities. Their first task will be to improve access to after-hours GP services.’

The first centres are due to commence operation in mid 2011.

Nurses need to be represented in the new LHNs

There are positive elements in the move to Local Health Networks but restructure fatigue is a danger, says NSWNA General Secretary Brett Holmes.

‘I know many of you will be concerned that once again wholesale restructuring of our health services is on the cards. I think most experienced NSW nurses and midwives would have some level of restructure fatigue and I think it is important this is acknowledged as we contemplate another major rearrangement of services into Local Health Networks,’ said Brett.

In broad terms, and along with most health stakeholders, the NSWNA welcomes the move to restructure in order to enhance local decision making and to strengthen clinician involvement.

‘It is clear the existing arrangements have created problems due to the excessive size of some of the AHSs and the remoteness of decision making processes from the reality at the coalface.

‘The challenge for the NSWNA is to ensure that the nursing and midwifery perspectives and insights are effectively represented in the new structures. There is also the very important issue of how the nurses and midwives currently in area level nursing and midwifery positions will be absorbed into the new structures.

‘I encourage nurses and midwives at every level to engage in the consultation processes that are underway to maximise nursing and midwifery inputs to the process,’ said Brett Holmes.

Nursing education and workforce support need to be maintained

By Coral Levett, Nurse Manager, Education SESIAHS

‘The new structure effectively goes back to what we had five years ago. I have no problem with that; it worked before. Nurses on the floor won’t notice much difference.

‘The problem with the discussion paper is there is no detail about the nursing structures that operate across the area health services like nurse education and workforce support services.

‘We did get some efficiencies with getting bigger. Previously, the Illawarra had poor nurse education services while South East Sydney had good ones, and with the amalgamation the Illawarra gained. We wouldn’t want a gap to open up again when the AHS is split.

‘I would like to see that we learn from experience so we get the best of both worlds. That is, we have Local Health Networks of an appropriate size but we also have network DONs and good nursing education and workforce support services across the network.

‘I also want to see equity in clinical representation on the governing council.’