Staffing and funding shortages in our hospitals must be remedied or the tragic events at the Camden and Campbelltown hospitals over the past two years will be repeated elsewhere, according to an editorial published in the current issue of The Medical Journal of Australia.

MJA Editor, Dr Martin Van Der Weyden, said public confidence in NSW hospitals was severely shaken by the recent release of the Health Care Complaints Commission (HCCC) report on the two hospitals in the Macarthur Health Service in Sydney's Southwest, which Dr Van Der Weyden has dubbed the 'Cam affair'.

The report detailed a raft of symptoms of a sick hospital administration system, and outlined a blueprint to rid the health service of this sickness.

"Health minister Morris Iemma's initial response, which included referring nine doctors to the NSW Medical Board and initiating disciplinary proceedings against four administrators, had the right political resonance and was ostensibly defensible," Dr Van Der Weyden said.

"But then the minister sacked the Complaints Commissioner and announced a second inquiry hoping to identify more individuals to hold accountable for the failures.

"It is hoped that something more substantial than yet another list of blameworthy individuals will emerge from the inquiry," Dr Van Der Weyden said.

The HCCC's recommendations have much in common with the recommendations of the Macarthur Expert Clinical Review Team, which examined the embattled hospitals in August 2003 at the behest of the minister.

The recommendations included the need for significant leadership in the clinical and administrative spheres; increased clinical service capacities in workforce and resources; involvement of academic institutions and clinical colleges to enhance the professional attractiveness of the hospital for postgraduate training and senior staff; and an ethos that encourages open reporting, review and remediation of problems - an ethos that is patient and safety centred.

While acknowledging the value of these conventional measures, Dr Van Der Weyden outlined opportunities to explore innovative approaches that might be transferable to troubled hospitals in other jurisdictions.

These include confronting the 'silo' mentality of our hospitals by appointing staff, not to specific hospitals, but to health areas; developing clinical services on the basis of area-wide need rather than political or academic opportunism; establishing a tertiary care teaching hospital at the hub of the health area, with real and transparent service or training links with the area's other hospitals; and developing indicators, or clinical 'Plimsoll lines', which signal higher risks to proper patient care and required quality and safety.

Dr Van Der Weyden said politicians should be made more aware of, and accountable for health services, suggesting this could be achieved by dismantling the highly centralised and adversarial HCCC and replacing it with local-area health ombudsmen; and increasing the proportion of bipartisan local, state or federal politicians serving on area health boards, along with limited-tenure members selected for professional prowess rather than political patronage he said.

"But change and innovation alone will not allay a real anxiety about whether the Cam affair was an isolated incident," Dr Van Der Weyden said.

"The community, through its politicians, has a confronting choice:  either reinvigorate our hospital services by increasing the number of doctors and nurses and attend to our hospitals' waning capacity and infrastructure through adequate funding, or await the next 'Cam affair'," Dr Van Der Weyden said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT:     Dr Martin Van Der Weyden, 02 9562 6666 (w) 02 9569 1208 (h)
                   Judith Tokley, AMA, 02 6270 5471, 0408 824 306