Former PDH board backed Hillis report, despite Health Department claims

LETTERS exchanged between the former Portland District Health board and the Health Department have cast serious doubts on the government agency’s claims that the board opposed the implementation of a report that would revolutionise the way the health service would recruit doctors.

Documents released under Freedom of Information laws clearly show the former PDH board supported the implementation of the “Towards a sustainable medical healthcare workforce in Portland” report by Associate Professor David Hillis, and in fact suggested it should be given credit for moving the way the report called for several years earlier.

And the government’s most senior health bureaucrat wrote back to the-then board chairman Andrew Levings thanking the board and chief executive Christine Giles, as well as doctors and others for their contribution to the report.

Yet the Department told the Observer last week that among other things “the board and leadership of Portland District Health were restructured following the lack of progress and opposition to implementing the recommendations of the Hillis Report”.

That was strongly refuted by Dr Levings and Ms Giles in the same story, with Dr Levings telling the Observer “the idea that we resisted implementation of the Hillis report is a just complete nonsense and it’s a fabrication of what happened”.

A letter written in June 2020 by Dr Levings to Terry Symonds, a deputy secretary in the former Department of Health and Human Services, is one of those released under FoI and it says “we are excited by the challenge of becoming a champion for the training of rural generalist doctors (the key recommendation of the report was that these doctors be recruited over the next 5-10 years as a new more sustainable way of staffing PDH)”.

“As proposed the PDH board and management welcome further conversations with you to develop an agreed path forward to achieve the desired outcomes for the community,” the letter says.

The board also accepted there would be challenges along the way.

“We expect the adoption and implementation will be complex and take some time,” the letter says.

“The report notes ‘this change of workforce model is not a decision for Portland District Health alone, Indeed Portland District Health could not achieve this change by itself.’

“We agree with this and look forward to the Department’s active role in bringing all necessary stakeholders to the table.

“Our commitment is to work with you to identify and implement a better and more sustainable staff structure that will enable PDH to continue to provide a high quality of service at an acceptable and agreed cost.”

The letter also calls on the Department to credit PDH “for our continuing efforts over a number of years to move in the directions suggested in the report”.

It also shares the report’s concerns that little progress had been made regarding developing meaningful partnerships with other local health services.

“(PDH is) equally disappointed in this limited progress as the board and executive have invested

much time and resources to this end,” the letter says.

“We are currently working constructively with Western District Health Service in this regard and PDH wishes to continue to work with the Department and other partners in overcoming barriers to progress at a regional level.”

The letter also touches on existing staff recruitment.

“The board for many years has recognised the potential risk inherent in being a small outer regional hospital including having to rely on an unstable workforce; but having worked hard at risk mitigation strategies our reported outcomes show we perform well against all quality of care measures,” the letter says.

“In collaboration with Active Health Portland, we are excited by the challenge of becoming a champion for the training of rural generalist doctors in consultation with universities and medical colleges and an evolving commensurate in the education of our workforce.”

Another letter released under FoI was from then-secretary of the Department, Kym Peake, to Dr Levings thanking the board for its co-operation in beginning the review as well as the input to it from Ms Giles, the board, clinicians and others.

It says an audit of all specialist medical contracts would be conducted, to be submitted 10 days from the date of the letter and PDH had been directed not to enter into any new specialist medical contracts without the Department’s prior written approval.

Ms Peake wrote that “key positions within the Victorian Rural Generalist Program have been funded and are being recruited to”.

“All trainees across the Barwon South West region, including PDH, will be supported by the Victorian Rural Generalist Program region co-ordinator at South West healthcare (Warrnambool),” she wrote.

“The renewed focus of the Victorian Rural Generalist Program provides a good opportunity to develop medical trainees and build sustainable models for medical services in rural Victoria.”

The Observer asked the Health Department questions about the two letters – where the former board, in writing, expressed its opposition to the Hillis report, how Ms Peake’s statement thanking PDH for its co-operation sat with the supposed opposition and whether the audit of specialist contracts had been conducted.

In response the Department said issues previously identified at PDH were communicated to the board and Dr Levings at the time of his “removal” (the Department previously said he had simply resigned), including ineffective financial management and budget deficits, quality and safety and clinical governance concerns and poor governance and compliance and code of conduct.

“Significant but necessary changes were made to the Portland District Health Board in 2021 following systemic management issues which have been outlined to the relevant parties on multiple occasions,” a Department spokeswoman said.

In a previous response to the Observer the Department also said “unresolved safety concerns at Harbourside Lodge” were another issue which led to the changing of the board – when asked what these issues were and if they had been resolved, the Department said “Harbourside Lodge is compliant with the Aged Care Quality and Safety Standards and Portland District Health and the current board has confirmed its commitment to continuous improvement to ensure high quality and safe care is provided to the residents”.

Regional Health Services Partnerships had been established to support collaboration (as previously reported this is chaired by former Health Minister Rob Knowles) – which was a step towards the federated model recommended by the Hillis report. PDH was “a key partner of the state-wide rural generalist program in the South West region”, the Department said.