About one-third of positions in the NSW Health Department head office will disappear under sweeping changes predicted to make it the country’s smallest state health authority when adjusted for the size of the system it regulates.

A report released by the Director-General, Dr Mary Foley, Future Arrangements for Governance of NSW Health, says the Department, to be renamed a Ministry, is to step back from day-to-day operations, with greater authority devolved to the local health districts (LHDs) and clinician-led Pillar agencies.

The Ministry of Health will focus on advising the Minister, planning for future needs, securing resources and distributing them fairly to promote “equity, quality and efficiency”.

The recommendations are the result of a review announced in May, conducted by the DG working with Shane Solomon, former Under Secretary for Health and Executive Director of Metropolitan Health Services in Victoria, and former CEO of the Hong Kong Hospital Authority; Nigel Lyons, Chief Operating Officer (Northern) and Chief Executive Health Reform Transition Organisation (Northern); Karen Crawshaw, Deputy Director-General, Health System Support. Denis King, Chairman of Illawarra Health District and member of the Transition Task Force and Joanna Holt, Director of Policy and Co-ordination, Office of the Director-General, also helped the team.

The changes represent a huge shake-up; for example the redeployment of clinical and support services staff in the Health Reform Transition Organisations alone will affect almost 12,000 people.

Principles for what the document calls “restructuring of staff” (talk about obscuring language) include that they will be redeployed where possible and afforded priority consideration for positions in the new structures.

Hopefully someone, somewhere will be measuring the impact of yet more upheaval on systems and people who are already suffering restructuring burnout.

The report cites Lord Ara Darzi, former UK Parliamentary Under-Secretary of State at the Department of Health, “localise where possible, centralise where necessary”. Does this mean, I wonder, that the centralised media control of the department will loosen the strings?

Meanwhile, this is the message from the DG to staff

The Minister for Health and Medical Research, the Hon. Jillian Skinner MP has announced the outcomes of the Governance Review of NSW Health. The proposed changes are outlined in detail in the report titled “Future Arrangements for Governance of NSW Health – Report of the Director-General“.

I am confident that the new governance arrangements will provide us with a strong framework, which clearly delineates roles and responsibilities for each of the entities that together form NSW Health. This framework will provide us with the adaptability and flexibility to respond to local health needs and to provide strategic capacity at the statewide level. A vital objective of the new arrangements is to allow each individual part of the system to focus on its core strengths while at the same time building in relationships which systematically encourage cooperation and joint ownership of the excellent health outcomes we expect for our patients and the broader community of NSW.

The Review was predicated on implementation of the Government’s policy commitments to devolution, transparency and accountability as the basis for supporting an effective, patient-centred public health care system.

Local Health Districts and Specialty Health Networks

Under the new governance arrangements, Local Health Districts and Specialty Health Networks will have clear responsibility and accountability for governing hospital and health service delivery for their local district or specialty network. These responsibilities and the funding required to deliver a specified volume of activity will be articulated in a Service Agreement negotiated between the Department of Health, as purchaser and system manager/regulator, and the Local Health District or Specialty Network Board, as providers of health services. These arrangements will be consistent with recently agreed COAG Health reforms.

The Ministry of Health

The Department of Health will become the Ministry of Health, providing Westminster functions supporting the Minister and the Government, regulatory functions, public health functions (disease surveillance, control and prevention) and system manager functions in state-wide planning, purchasing and performance monitoring of hospitals and health services.  A number of functions will be transferred from the Ministry to other health entities such as the four “Pillar” agencies.

The four “Pillar” agencies

The Agency for Clinical Innovation and the Health Education and Training Institute (previously the Clinical Education and Training Institute) will have an enhanced range of responsibilities and accountabilities. Both these entities will therefore require major changes to their organisational structures.  The Clinical Excellence Commission and the Bureau of Health Information will also take on an expanded portfolio of responsibilities but largely within their current roles.

The “Clusters”

The Northern, Southern and Western ‘Clusters’ will be abolished and the services managed by the Health Reform Transition Organisations will be devolved to other health entities, principally to Local Health Districts either directly or via hosted or jointly managed arrangements.  It is anticipated the transfer of staff from the transition organisations will be finalised by the end of October 2011.

In relation to the other key components of this restructure, we aim to have finalised the transfer of functions and be bedding down the new structures across NSW Health by the end of 2011.

In embarking on this journey of organisational change I am committed to fostering a culture of cooperation and mutual respect as we transition functions and accountabilities from one area of responsibility to another.  While I will be seeking some external assistance with this governance transformation, I will be asking many of you to participate and contribute to the final outcomes as we build a new way of working together.

Dr Mary Foley



Meanwhile, here are the reports in the SMH and The Australian.

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