28^th February 2008 

ROYAL NORTH SHORE HOSPITAL REPORT

The Rev Hon Fred Nile MLC, Leader of the Christian Democratic Party, has reported the findings of the ‘Joint Select Committee On The Royal North Shore Hospital’ to State Parliament.

 “I move that the House take note of the report.

I am pleased to report to the House that the Government has issued its response to this report in the past day or so. It has announced that it accepts and supports in principle 43 of the 45 recommendations. The remaining two recommendations deal with matters that are in hand. One called for a follow-up inquiry, if necessary, into the Vanessa Anderson case. That has now been overtaken by the Government's decision to establish a special commission of inquiry into the delivery of patient care within the New South Wales public health system. Therefore, the recommendation has been adopted in principle on a larger scale than intended by the committee.

The other recommendation that was not accepted as presented by the committee has also been taken up in another form. It raised the operation of the Australian triage system and whether it would be appropriate to review the terminology used in emergency departments. The term "triage nurse" could be replaced by something more meaningful, such as "priority nurse". The Minister has referred that recommendation to the Australasian College for Emergency Medicine for further expert consideration. I am pleased that the committee's 45 recommendations have been dealt with.

 

I made some introductory remarks when I tabled the report of the Joint Select Committee on the Royal North Shore Hospital. I referred to the Government's acceptance of 43 of the 45 recommendations. I express my personal appreciation as Chairman of that committee and I am sure the other committee members, who worked diligently on the inquiry, share my appreciation of the Government's prompt response to the recommendations. The Government did not accept recommendation No. 1, which was that if any recommendations from the coroner's report into the death of Vanessa Anderson fell within the terms of reference the Parliament should consider re-establishing the committee of inquiry to report on those matters. All members of the committee supported that recommendation and I was anxious that that should occur. There had been debate in the community, and amongst some members of the House, that the Joint Select Committee on the Royal North Shore Hospital should have remained active until the coroner's report was presented. I was not in favour of that procedure because I believed our inquiry discovered a number of areas where matters needed to be rectified at the hospital and our report should be tabled as rapidly as possible to enable the Government to deal with our recommendations. If our inquiry had been extended until later in 2008 any implementation of our recommendations to correct some of the glaring problems at the Royal North Shore Hospital would have been delayed”, Rev Fred Nile said.

“I am pleased with the approach adopted by the committee: to table the report and recommend that the Parliament consider re-establishing the joint select committee to examine the Coroner's report into the death of Vanessa Anderson. As members know, the Coroner's report was a damning one. The Coroner strongly stated that a further inquiry into the hospital system should be undertaken. As I recall, he did not use the precise words of recommending a special inquiry or a royal commission as we do in Parliament, but the Government responded by establishing a special inquiry to investigate New South Wales hospitals, particularly acute services, with the report due in the middle of this year. Although the Government did not adopt recommendation No. 1, it took action by establishing a special inquiry. So there was no need to re-establish our joint select committee. The Government also did not implement recommendation No. 11, which sought a national review of the Australian triage system categories relating to women who present at emergency departments with signs of miscarriage. That recommendation related to recommendation No. 10, which the Government did adopt. Recommendation No. 10 is:

That NSW Health change the terminology in use in Emergency Departments' signage, by using
the term "patient priority" in place of "triage".

"Triage" is a French word meaning "priority". The committee heard evidence from former patients about their experience in the emergency department. People arrive at the emergency department with serious problems, perhaps a miscarriage or injury, in distress and without the advantage of calm, cool thinking on arrival see the sign "Triage" and a nurse says to them, "I am the triage nurse". They wonder what it is all about. The word "triage" unnecessarily confuses people who are in distress. The committee recommended that English terminology be used so that it is black and white and absolutely clear. Signs should be marked "Patient Priority" and nurses should say, "I am the patient priority nurse. I will make an assessment as to the seriousness of your situation and whether you are category 1, 2, 3, 4 or 5". Patients would then understand why they are being interrogated. The Committee followed this up in recommendation No. 11, which is:

That the NSW Government seek to initiate a national review of the Australian Triage System
categories in relation to women presenting to Emergency Departments with signs of miscarriage,
to ensure they are appropriate.

That recommendation, although not adopted by the Government, has been implemented in that the Government forwarded the matter to an expert medical body to give a considered response. The Committee heard evidence from a number of women who had presented with miscarriages at the Royal North Shore Hospital. They believed they were facing an imminent miscarriage, with signs of blood and other distressing symptoms, and felt that they should have been treated as priority category 1. They were treated as priority category 4, which means they could wait up to two hours before receiving attention from a qualified doctor. The Committee asked the Government to review the categories. Although a miscarriage may not be life threatening to the mother, it is life threatening to the baby. Women presenting with signs of miscarriage should be allocated a high priority even though experts say that at point it is difficult to save the baby's life.

In the case of Jana Horska, the baby was alive when Ms Horska went to the toilet in distress. Her husband, after hearing her screams, found the baby in Ms Horska's hands still connected to the umbilical cord. Only doctors would be able to assess whether the baby could have been saved at that point. But, as a layman, I believe the baby may have been saved if expert medical care had been provided earlier. In many hospitals babies born preterm survive, even at seven months gestation. They are placed in a humidicrib and receive special treatment. Those babies, which sometimes are only as big as the palm of my hand, receive expert care and are given the opportunity to live and grow into childhood and become adults. Woman experiencing miscarriage symptoms should receive high priority. I accept that the Government has adopted procedures whereby those women will bypass the emergency department and go to an area where they will receive expert assessment and assistance.

I am very pleased that the Government has responded to all 45 of our recommendations. I believe that is unique and no other committee would receive such a positive response to all of its recommendations. I have referred to the Government's response to the report of the Joint Select Committee on the Royal North Shore Hospital. The committee raised the need for additional nurses to be employed at Royal North Shore Hospital. Experienced nurses on staff at Royal North Shore Hospital told the committee they estimated a minimum shortage of 100 nurses at the hospital. This shortage placed tremendous pressure on the existing medical staff, both nurses and doctors, and patients. I am very pleased with the response from New South Wales Health through the Minister. The Government's response to recommendation No. 3 of the Committee states:

Most recent reports indicate that 97 nurses have been successfully recruited to vacancies at RNSH in the past four months. And to further boost nursing workforce numbers, a record 128 nursing graduates commenced work at RNSH on 14 January this year. These professionals will play an important part in easing the pressure which has been recently reported.

That obviously refers to evidence presented to our committee by nurses, doctors and patients. During the recent Federal election the nurses union ran a number of television advertisements to make the point about the shortage of nurses. As Chairman of the Joint Select Committee on the Royal North Shore Hospital I am very pleased with the inquiry. I thank the Committee members, the Committee staff, and all the doctors and nurses who gave evidence before the inquiry, and I thank the Government for its positive response”, said Rev Nile.