Garling after 10: Forum Highlights



Do clinicians have enough input into health policy and resource allocation?

Are doctors expected to do too much with too little?

How much has hospital culture changed in the past 10 years?

Has ‘the Great Schism’ between clinicians and managers been rectified?

On Tuesday evening The NSW Nurses and Midwives’ Association hosted a panel discussion to reflect on state of the public health system, exactly ten years after the Garling Report was published. Health Minister Brad Hazzard was in attendance as well as NSW Health Secretary Elizabeth Koff and a number of Chief Executives.

Forum panellists were quick to praise the NSW health system, and drew attention to significant achievements of the Report, including the establishment of the ACI and BHI , the development of world leading models of care and the Between the Flags program.

However panellists also drew attention to a range of ongoing challenges and further opportunities for change. Panellists referred to the persistent issue of bullying, and pockets of negative and adversarial culture within hospitals which have significant impacts on the medical workforce, with some burning out and leaving the system altogether. Panellists were unanimous in agreeing that improving culture is critical not just to maintain the health workforce, but to improve outcomes for patients.

Professor John Buchanan emphasised that health culture is related to material conditions, and argued that the Report missed the opportunity genuinely reorganise the system and redefine relations between clinicians and the Department.

ASMOF President Dr Tony Sara spoke about the importance of continuing to measure clinician engagement with managers across NSW, and holding Chief Executives accountable for improving culture. He noted that the ASMOF/AMA Senior doctor engagement survey will be underway again soon.

Dr Clare Skinner drew attention to the challenges of having a more fragmented senior medical workforce, the increasing administrative burden on junior doctors, and the need to ensure that doctors are able to work within a system that consistently supports them instead of forcing competition.

The Panel articulated their hopes for the future, which included addressing the social determinants of health, improving links between community health and acute care and promoting more meaningful collaboration between consumers, clinicians and the Ministry to ensure the best allocation of resources.

If you are interested in further reflections you can listen to a series of podcasts with the panellists including Dr Sara here: