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Answers about Dingee nursing service amalgamation

Dingee residents might find the Q and A session about the amalgamation of the Dingee Bush Nursing Centre and Rochester and Elmore District Health Service insightful.

January 8, 2013 4:34am

Members of the Dingee community are still concerned about the amalgamation of the Dingee Bush Nursing Centre and Rochester and Elmore District Health Service.

The Dingee Concerned Citizens group provided the Campaspe News with a list of their concerns about the amalgamation, which REDHS chief executive Matt Sharp and DBNC board chair John Twigg responded to.

Here are the 20 questions and answers:

1. The REDHS Draft Terms of Reference for the Transition Advisory Committee (the group set up to help with the amalgamation) states that it must:

“Review the current service mix at DBNC and make recommendations regarding the optimal service mix into the future (subject to available budget and Department of Health guidelines).”

What is wrong with our current level of service from the Bush Nursing Centre? The new centre opened in 2009 was steadily growing in ancillary services and delivery of health and well being programs, until the last few months when services have reduced.

Matt Sharp: There may be opportunities to enhance the services that are currently provided which is why a review of the services would take place. An annual process exists where health services are able to negotiate with the Department of Health the service mix within its designated Home and Community Care funding and targets. This is normal practice and enables each health service that receives Home and Community Care funding to determine the best service mix regarding its Home and Community Care programs for the community. The need for physiotherapy or another allied health service may exist and this will be explored by the

Transition Advisory Committee to ensure the best possible services are provided to meet community needs.REDHS has secured a new visiting GP service through its relationship with Elmore Medical Practice. It is anticipated this will commence in early 2013 and will begin at a half day per week. This approach was also taken by the same medical practice at Lockington and District Bush Nursing Centre.

The medical practice now provides doctors to Lockington and District Bush Nursing Centre for two days per week following a steady increase in demand over the last 12-18 months.

2. What happens to the land and buildings? According to Victorian Incorporations Act, amalgamation entails “any property belonging to the individual associations becomes the property of the amalgamated association.”

MS: A model to ensure the community retains control of the land and buildings at the centre in the event REDHS ceases to exist has been explored. This is based on the scenario where the land and buildings assets at the centre will be transferred to REDHS as part of the amalgamation. It would see a legal agreement put in place between REDHS and another organisation that will exist in perpetuity, which in the unlikely event that REDHS ceased to exist, would ensure the land and buildings are transferred to this organisation that would hold these assets in trust on behalf of the Dingee community. This will ensure the community retains ultimate control of the land and buildings should something unforseen happen to REDHS.

It would be rather complicated and time consuming if there was to be another party involved that owned the land and buildings as it raises a range of other issues such as rental agreements, repairs/maintenance and it would greatly limit the ability REDHS would have to apply for any grants the Department of Health offer regarding building and other projects.

3. Is the above statement from the Terms of Reference meant to imply that they can only deliver services to Dingee if funding is available? Does this mean that health services will diminish over time?

MS: The only reason services will diminish is if the activity targets are not met which means the community is not using the services. As long as funding is provided by government for the HACC program or other services in the Dingee community and district, REDHS will continue to provide these services from the centre as it is contractually obliged to. This is the same set of circumstances for every health service in Victoria that receives government funding from the Department of Health.

4. What pressures would any reduced Dingee services and hours place on Bendigo primary care and emergency department?

John Twigg: From December 1 2012, palliative care, post acute care and domiciliary post natal care will continue to be available from DBNC on weekends, by appointment. Planned visits for district nursing and palliative care on weekends are currently being provided and will continue under REDHS. Unplanned visits, where someone attends the Centre on a weekend have been constant at one to two patients per day. It is unlikely this will have an impact on Bendigo primary care and the emergency department.

5. Will Dingee be able to retain its Remote Area Nurses? From the records of the November 6 public meeting, this is unsure. REDHS do not have any Remote Area Nurses and there is no guarantee that Dingee will retain a remote area status, which is the service Remote Area Nurses are trained to provide, i.e. they have the ability to take charge of an emergency situation and stabilize the patient prior to the arrival of the ambulance.

MS: Yes - this has been confirmed in writing by the Department of Health to me on 20

December 2012. The situation regarding the Remote Area Nurses was unclear at the public meeting held on November 6 2012 as I was waiting for further advice from the Department of Health.

However, REDHS has since had discussions with the Department of Health and the Remote Area Nurses classification for nurses who are employed by REDHS working from the centre at Dingee following the amalgamation will be retained.

6. If Remote Area Nurses are lost, Ambulance Victoria would lose a vital link to first on scene emergencies. (RANs being available to respond to 000 at the request of the Ambulance Vic Operations Centre with fifty Remote Area Nurses callouts from Dingee in 2011/2012). The possible development of an alternative volunteer Critical Emergency Response Team would be a difficult service to establish within the Dingee district. Volunteers are already spread thin with community commitments. Dingee’s town population is very small with its main demographic, geographically focused in outlying areas.

MS: Please refer to question five regarding the Remote Area Nurses status. Discussions with Ambulance Victoria shows that the Remote Area Nurses based at DBNC have not been able to respond to all 000 calls received when an ambulance has been despatched. This is consistent with other Remote Area Nurses responses in Victoria. Ambulance Victoria is aware that RANs across the state may sometimes be unable to respond to all 000 calls for a variety reasons and it is at the RANs discretion if they attend an emergency. An ambulance will always be despatched for all 000 emergency calls.

REDHS has held preliminary discussions with Ambulance Victoria regarding the establishment of a Critical Emergency Response Team. Critical Emergency Response Team is a community initiative that would need to be driven by the community not something that REDHS or DBNC Board would necessarily drive. However, REDHS would be able to assist if requested.

7. The vehicle attached to the Bush Nurse service could be lost. The vehicle is funded via remote area status and fitted out with first on scene emergency equipment.

MS: The vehicle and equipment within it will be retained.

8. REDHS need to elaborate on how the Remote Area Nurses Occupational Health Safety issue of two nurses being required to attend emergencies will be overcome.

JT: REDHS has confirmed with DBNC staff, that it is, and has been for a number of years, current practice for only one Remote Area Nurses to respond to emergencies. Further, the RANs at DBNC receive annual training regarding solo practice and are well aware of adopting a danger first approach regarding health and safety when working alone.

9. Public have a right to participation within their community and are entitled to an opinion and to provide an alternative view. Concerned citizens have been advised to have; “any public correspondence preapproved by DBNC board or their solicitor and CEO REDHS…..this includes letters to members and any article forwarded to the media including the East Loddon Community News.A request for a copy of the DBNC AGM minutes from September 2012 has met with a response that legal advice is being sought prior to releasing the AGM minutes to members. Why?

MS: The request to have information approved by the DBNC board or their solicitor and me related specifically and only to the due diligence review following a meeting held with representatives of the Concerned Citizens Group on November 22 2012. Confidential and private information was discussed at this meeting and the request to pre-approve public information was based on advice provided by the auditor who carried out the due diligence review who is also a qualified legal practitioner. No other such requests have been made by REDHS or the DBNC board.

JT: A request for the DBNC AGM minutes was made to the DBNC Secretary on December 3 2012. The request was minuted at the DBNC Board meeting held on 18 December 2012. The AGM minutes will be provided.

10. Is it correct DBNC met accreditation requirements at the October 2010 review but since then, the compliance provider has been changed to another provider, if so why?

JT: The change to another party for accreditation was an industry wide decision made by the bush nursing centres across Victoria. This change was due to the previous accreditation provider increasing their fee which many centres could not accommodate. The bush nursing centre managers across Victoria took the issue to the peak body and the majority of bush nursing centres agreed to change providers, DBNC being one of them. The DBNC Board became aware at the Board meeting on December 18 2012 that this provider also does the accreditation at REDHS.

11. Was a shared “non-clinical health sector administration officer” considered? Smaller hospitals form clusters or share skilled labour where there could be a shortfall i.e. governance administration.

JT: A non-clinical health sector administration officer is a very specific role and would set a model which would be difficult to recruit to the position. As suggested in the question, DBNC is amalgamating with REDHS to share their skilled labour as there have been shortfalls identified at the centre.

12. Dingee’s main health alliance is based with the Bendigo Loddon Primary Care Partnership formed in 2000 as a network of health and community service organisations to improve the health and wellbeing of people in the area by working in a partnership. This health sector catchment includes: Inglewood, Serpentine, Boort, and Wedderburn; whereas Rochester is aligned with the Campaspe Goulburn Valley Primary Care Partnership. Bendigo Loddon Primary Care Partnership encompasses Greater Bendigo and the Loddon Shire. Removing Dingee Bush Nursing Centre from this Primary Care Partnership could have unknown consequences.

MS: There are no plans to remove the centre from the Bendigo Loddon Primary Care Partnership. There are a number of other primary care partnerships such as Southern Mallee Primary Care Partnership, covering the local government areas of Buloke Shire, Gannawarra Shire and Swan Hill Rural City Council, as well as the the Bendigo Loddon Primary Care Partnership which operate across multiple local government areas. REDHS is not aligned with the Campaspe Goulburn Valley Primary Care Partnership no such organisation exists. REDHS is a member of the Campaspe Primary Care Partnership.

13. What other options are available to remain autonomous and retain Bush Nurse remote area status?

JT: The remote area nurse status will remain as previously outlined in question five. The DBNC board have endeavoured to remain autonomous over the past 18 months however there are a number of matters of concern which have subsequently been confirmed the due diligence review undertaken in October 2012.

These issues include:

-The ongoing demands for accreditation to be kept up-to-date (funding being tied to accreditation);

-The currency and veracity of policies, procedures and practices having regard to best practice.

-The financial viability of the centre is under duress due to staff leave liability, meeting obligations as they fall due and a fringe benefit tax issue.

-Potential occupational health and safety and essential safety management issues.

To get the centre up to an expected best practice standard it would involve considerable executive time and skills. DBNC currently does not have adequate resources and capacity to meet required standards and required laws to provide these resources in the future as a stand-alone service. The current stand-alone model for the centre is not sustainable and amalgamation is the only way to ensure the long term future for a health service in the Dingee community.

14. Will the Position of centre manager be lost along with the services of a resident nurse living at the centre? This raises another issue, site security and access to meeting room after hours.

MS: The management model is being reviewed and the staffing structure has not been developed or agreed to. Further, it would be inappropriate and disrespectful to the people concerned for any public statements regarding the employment of staff at DBNC to be made at this time.

Alternate arrangements will be put in place to ensure security of the site is maintained as well as access to meeting rooms should it be required.

15. Could control of the food share program be lost as the Centre coordinates the ordering on behalf of the East Loddon Food Share/Community Centre.

MS: No there are no plans to change the arrangements regarding the food share program auspiced by DBNC.

16. The DBNC has always been an independent community facility/private not for profit, and would become part of the public health system if it amalgamates.

MS: Even though REDHS is part of the public health system, it is also not for profit. The same government requirements and regulations that apply to DBNC apply to REDHS in regard to not for profit status.

17. The loss of function by the DBNC could have far reaching impacts on the local community. The Bush Nursing service along with the railway line and P-12 College is extremely attractive to tree changers, retirees and young families. Some people have either remained or bought into the district solely because of the health service availability.

There is room for growth, extending the Dingee retirement units that would increase demand for the services of the bush nursing centre.

MS and JT: Loss of function or reduction in services has not been proposed by the DBNC board or REDHS and services will continue as previously advised and outlined in the FAQs and these questions. The DBNC board and REDHS support any developments to enhance Dingee community and the communities that DBNC services.

18. What services may be lost? Services in place now are:

Loddon Chronic Disease (Diabetes) Group

Pathology Collection Service

Skin check/sun spot clinic

Pharmacy

Mens Health Information/Screening & Referral Services

Womens Health Information/Screening & Referral Services

Blood Pressure checks

Health Screen and First Aid at most community events

East Loddon Food Share

East Loddon P-12 College - support of staff and students

Raywood Outreach Clinic

Mitiamo Clinic

Remote Area Nurse 000 service

Hospital in the Home

MS: Subject to requirements of funding and service agreements with health authorities, all current services provided will be retained as per contractual requirements with the Department of Health and providing the local community supports them by utilising the services. The pharmacy service requires further review because of the relevant legislation regarding this service. Further information will be provided in due course.

19. If all options are not thoroughly investigated prior to this proposed amalgamation and concerned citizens do nothing, our grand children will ask: “Why didn’t the community stand up against the amalgamation in 2012?”

JT: The DBNC Board and REDHS have engaged with staff and the community and will continue to do so in the future. If the amalgamation does not proceed, then it is more than likely that the centre would be closed sooner rather than later as currently there is not the funding and resources to meet the ongoing demands required to keep the centre operating.

The DBNC board are amalgamating with REDHS to ensure that the service remains open for future generations.

20. The community of Dingee and district requires being involved in decisions that substantially impact on its future. The indications are - we have not.

JT: Membership of the DBNC Transition Advisory Committee was finalised on December 20 2012.

The committee will be responsible for:

- Identifying and discussing issues regarding the amalgamation of the DBNC services with Rochester and Elmore District Health Service (REDHS).

-Providing advice to the DBNC board as well as REDHS board and matt Sharp regarding the amalgamation.

-Supporting activities needed to transition DBNC to REDHS.

The members of this committee consist of:

DBNC Board representatives: John Twigg (DBNC President) and Rebecca Cullen (DBNC board member).

REDHS representatives: Matt Sharp (chief executive) and Anne McEvoy (director of clinical nursing)

Loddon Shire representative: Cr Cheryl McKinnon (Terrick Ward)

Four DBNC members as voted for by DBNC members.

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