Chief Executive Officer's Foreword image: "DHCS Annual Report 2005-2006 cover image"
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"This Foreword is an opportunity to reflect, at the end of a big year for the Department of Health and Community Services, at the mid point of the Government's Building Healthier Communities framework and toward the endpoint of my own tenure as CEO.
Nearly four years ago Alan Bansemer submitted his comprehensive Review of the Department. It was a difficult report for the Department, hard on us in many ways. It acknowledged the quality of our professional staff and many of our services but criticised the organisation's structure, its decision-making, its corporate management and its financial systems. It also pointed to major holes in our core services, including in quality and safety systems.
We spent the next six months in a major redesign of the Department, while also continuing to deliver our wide range of services and responding to a new Government's ambitious agenda for service expansion. Management and staff responded magnificently. A new structure was in place by July 2003. Corporate systems were comprehensively reviewed, financial controls revised and management jobs re-scoped and filled.
The Government responded with strong support and has maintained a record funding expansion for health and community services. Funding has now grown by 64% since the Government came to power. Nurse, doctor and welfare staff numbers have all grown substantially and a range of new services have been put on the ground. Despite some commentary to the contrary, a much smaller proportion of staff growth has gone into corporate support roles than existed before this expansion. It has been a period of growth, concentrated on service delivery to Territorians.
The Government's promises have been met by adding extra hospital beds, increasing nursing and medical staff, opening the new Emergency Department and hospice at Royal Darwin Hospital, overhauling Intensive Care at Alice Springs Hospital, and launching major initiatives in child and maternal health.
All of our five hospitals and several other services, including mental health,
community health centres, Breastscreen NT and oral health, have been fully accredited for the first time, and there has been significant growth and reform to Child Protection and Mental Health services and to our renal, rehabilitation and palliative care services. The first Australian legislative response to petrol sniffing is another example.
These are just some of the achievements. They are, in fact, too numerous to mention in full here. The BHC Report Card tabled in Parliament in August 2006 provides the list in full.
When I reflect on the achievements listed in the Report Card there are two other points to make. First I sincerely believe we would not have delivered the service expansion agenda without the reform process that Bansemer's Report set us on. This in fact set us up with the organisational strength and focus to drive such an ambitious agenda.
Second it needs to be understood how important was the release, at the beginning of 2004, of Building Healthier Communities. Toward the end of 2003 we had put in place the new structure and improved our corporate management. New projects and service expansion was continuing to roll out. Staff feedback was consistent, however, that we needed an overarching policy direction, to articulate clearly our priorities, our values and our direction. We worked with the Government and together fashioned Building Healthier Communities.
Building Healthier Communities unified a statement of vision and direction with a myriad of specific Government commitments. The vision articulated was based on the clear evidence that achieving an integrated and focussed response to the needs of children and families had to be the cornerstone of health development in a jurisdiction with the health and community service challenges of the Northern Territory. These priorities will remain crucial for the future, as Building Healthier Communities is refined by Government to set new goals and guide further development of our services.
Through all of the restructure, the service growth and Building Healthier Communities we have been blessed with an enormously talented staff. Professionals who work in the Territory are the peers of any in Australia but work in the most demanding environment and bring a high level of commitment to their clients and communities. Building Healthier Communities worked because it related to the knowledge and priorities of professionals, and to their values.
These are the strengths we took into 2005-06. It was a challenging and productive year.
One of the consequences of improving service reach in health and community services is that we uncover needs not previously seen. Demand growth for all our services has been substantial. This has put huge pressure on our hospital emergency departments, on medical and surgical units, on our community services (especially Family and Children's Services) and across our other services. This is good for the community and is producing health gains but it puts pressure on our systems and our staff.
During 2005-06 demand pressure threatened to overwhelm our budget and managers had to exercise an enormous level of discipline to manage within their budget allocations. This involved difficult decisions by managers at all levels, who responded and produced a budget outcome exactly in line with budgeted expenditure.
All the while new services continued to roll out, service levels increased and our work on quality systems saw an unprecedented number of Territory services accredited. And Building Healthier Communities continued to guide this development.
In his Chief Health Officer's report, Tarun Weeramanthri cites exciting evidence that we are starting to achieve results in the Territory's greatest health challenge, the appalling cost of premature Aboriginal mortality. The July 2006 issue of the Medical Journal of Australia reported that NT programs are starting to show evidence of making inroads into the mortality rates from the main adult diseases among Aboriginal people. Our Health Gains Unit reports that life expectancy of Aboriginal women is increasing and infant mortality rates are falling.
This is a great tribute to NT health professionals and to the developmental work over years, going well back before my time and to the commitment of management and staff to follow through on that work.
The department's focus on disaster planning and response was also a feature of the year and two major events - the Katherine floods and Cyclone Monica - impacted on resources.
Both events stretched environmental health, welfare staff and local service providers such as the Katherine Hospital and health clinics over a sustained period. However, as usual, staff and management worked above and beyond.
Also, 2005/06 saw the department lead whole-of-government preparations and planning for the possibility of a pandemic influenza outbreak and I am happy to say these plans prepare the Territory as well as is possible.
However, all of that said, 2005/06 also saw some points of real tension and challenge for some of our services. Like any health and welfare organisation, we do occasionally get it wrong. And when we do, there can be dire human consequences. This year we have had a small number of incidents where this has been very evident.
The most recent was the death of a 78-year-old man in Kalkaringi, following his discharge from one of our hospitals and transport back to his community. This man's death will be examined both by an Inquiry jointly established by me and the CEO of the Katherine West Health Board and by the Coroner, so I will not comment further, other than to acknowledge the appalling grief felt by his family and the distress of all health staff involved.
This department is comprised of people who care deeply about and are highly motivated by client outcomes. It is the greatest challenge faced by any health and community services organisation to deal with the human consequence when things go wrong. We need to deal with people's feelings, to sincerely apologise to those affected and then to be able to step back, be analytical and learn the system lessons to make sure these incidents do not happen again.
Again, I think the work done since the Bansemer Report in 2003 sets us up to be able to deal better with these issues. These are outcomes that we all wish would never happen and are never OK but in health and welfare systems do arise. When they do they confront us with a test of our professionalism and responsibility.
Media coverage and comment on child protection issues has also increased during 2005-06. As with other areas of the Department, the staff who work in Child Protection are very skilled and committed individuals who have seen both their program improve and client demand increase year on year. It is opportune for me to reject any notion that our Territory Family and Community Services (FACS) staff are morally or professionally timid in the work that they do, as has been implied in some media commentary over the last several months.
Child Protection work is difficult in any jurisdiction, in any community. It involves some of the most difficult judgements professionals have to make. In the Territory FACS staff, together with their Police colleagues, have long been confronting issues in child protection that are now receiving wide public discussion.
It is my hope that this public coverage will lead to a stronger sense across the community and all government programs that we all have a roll to play in protecting children. It also gives us a chance to re-examine Child Protection reform in the Northern Territory, including the substantial Caring for our Children reform program begun in 2003. One process that should help in this is the Inquiry into Sexual Abuse of Aboriginal Children called by the Government, which will report early next year.
In short, the work of this organisation is challenging. We must do difficult work, make difficult decisions and think strategically in the knowledge that problems will continue to emerge. However, I know the Department is well placed with strong managers and capable, effective and professional staff to meet these challenges and continue to respond to the community's needs.
Former Health Minister Peter Toyne, who retired from Parliament just after the close of 2005-06, said in his final speech in Parliament that, "In public life, to serve is to lead and to lead is to serve." I will have led this organisation for four years when I leave at the end of 2006. It has been a huge privilege both to lead and serve such an extraordinary organisation, staffed by such outstanding people. "
Rober Griew
Chief Executive Officer
September 2006