Red News Readers,

Despite the plaintive cries by the parties in the RNS cleaning and portering dispute , it is more likely the poor old patients, who everyone seemed to have forgotten about in the Industrial Commission , who are the meat in the sandwich!

Nice to see that the Labor Party has recognised, at last, its mistake in contracting out the cleaning and portering services at RNS. It was indeed a mistake that has cost patients and staff dearly,  but the problem now is we have a government that is committed to PPPs and they are not going to pay out this contractor just when they are trying to prove that PPPs are the way forward in NSW. Gillian Skinner and Treasury I say this to you, this PPP is not appropriate to the hospital system.  Pay it out now before any more patients are harmed. Employ skilled porters and cleaners who have knowledge and experience of the health system. A new building at RNS is going to be wonderful, but the problems with quality and safety of care are going to persist unless you deal with the portering and cleaning contract forcefully.

Jenny Haines

Patients are at risk in the Royal North Shore blame game,

write Amy Corderoy and Anna Patty. SMH 5.5.12.

Hugh Richardson was freezing. The 78-year-old, who had just suffered a minor stroke and was having a series of tests in Royal North Shore Hospital, had been waiting for more than half an hour to be moved back to his room.

His thin hospital gown provided barely any warmth against the draughty hospital corridor. A nurse had covered him with towels, but they made little difference.

''They were trying to get someone in to wheel me back to my ward, but they couldn't get anyone because there was no one available,'' he says.
Mr Richardson was one of the lucky ones. This week the Herald obtained a letter written by the Royal North Shore Hospital Branch of the NSW Nurses' Association outlining the impacts of a shortage of cleaning and portering staff.

It told of incontinent patients waiting up to two hours to be cleaned; of a patient with the highly infectious superbug MRSA being left in a hospital corridor because no clean single room was available.

The dispute stems from a $1.1 billion public private partnership to redevelop Royal North Shore Hospital and provide so-called ''hotel services'': cleaning, the portering of patients, and food.

Since the contract was signed in 2007 by the Labor government and the consortium InfraShore, backed by the Royal Bank of Scotland, the hospital has expanded and bed numbers have risen.

But the company subcontracted by InfraShore to run the hotel services, ISS Health Services, says it cannot meet the increased costs.

ISS Health Services says it has been trying to resolve the problem for more than a year, going through a dispute resolution process after first formally complaining to the government last May.

But the department says the consortium ''has not used the dispute resolution process available in the current contract''. The health department has consistently refused to answer questions about how many beds are operating at the hospital.

In the end, it was the union representing the cleaning workers, the Health Services Union, that brought the issue to a head 12 weeks ago after ISS Health Services slashed its casual workforce.

While its state office was dealing with allegations of corruption and police raids, local Royal North Shore Hospital members of the union were forcing the government to the negotiating table through the Industrial Relations Commission.

In the IRC court this week the NSW government's Health Infrastructure, ISS and InfraShore agreed to provide 20 extra staff for an additional two months, in excess of the month ordered by the judge.

However, hospital staff say the problems run deeper than job cuts, and aside from the agreement to provide extra staff there was little consensus elsewhere.

The situation descended into farce with the government, InfraShore, ISS Health Services and the union each telling the court they were the ''meat in the sandwich'', stuck between other warring groups.

The president of the HSU East Royal North Shore branch, Colin Lee, says since the job cuts 15 staff have been injured keeping up with the increased workload. More have been disciplined when tempers flared and fights erupted between cleaners and other hospital staff frustrated at delays.

Lee says staff are also upset by having to implement savings measures, ignoring unclean areas or not providing extra items such as food when patients request them.

''It affects them greatly … it becomes embarrassing to staff when they have to say no to patients.''
At the heart of the issue is the question of whether services such as meals, cleaning and patient movements should be privatised.

The opposition health spokesman, Andrew McDonald, a paediatrician who still works in public hospitals, speaks fondly of the cleaners who have worked alongside him. He says he worked as a cleaner for three months while studying medicine in the mid-1970s.

''Cleaners and porters are clinicians just like nurses and allied health staff,'' he says.

It was a ''mistake'' for Labor to outsource the cleaning and portering services at the hospital, he says, and the Health Minister, Jillian Skinner, must intervene.

''To allow this mistake to be compounded is unconscionable and a dereliction of duty,'' he says.
McDonald says if the minister was working in a hospital and refused to respond to an issue putting patients at risk, she would be subject to disciplinary action.

''You just can't say that it's not your job,'' he says.

Senior health bureaucrats have told the Herald they are becoming increasingly frustrated that Skinner is not taking responsibility for the crisis and is instead ''trotting out'' health bureaucrats including Cliff Hughes from the Clinical Excellence Commission and the chief executive of Health Infrastructure, Robert Rust, to comment on her behalf.

A health administrator says ''it is pretty unusual for something to get to this point where the minister doesn't get involved''.

When the Port Macquarie Hospital public private partnership failed, the former government bought it out.

Bureaucrats say it is unlikely the O'Farrell government could afford to buy out the Royal North Shore partnership, the biggest of its kind for a hospital in NSW. ''And even if they could they wouldn't want to because the government wants to do more PPPs,'' the administrator says.

Skinner stands by her hands-off approach, however.

''A politician intervening is not going to fix this problem … The ministry has been engaged in this since the beginning of April,'' she says.

She says private public partnerships are fundamental to the future of infrastructure development in NSW.

''There will be PPPs provided there is interest from the private sector in building hospitals and in providing some non-core clinical services,'' she says.

''The question is about the quality of the contractual arrangements.

''The big lesson is make sure all parties are clear about their obligations and the contract is clear and fair and the cost and prices are clearly agreed and accepted.''

Dr Tony Joseph, the chairman of the hospital's medical staff council, says the issue is bigger than catering and cleaning. He says the public private partnership was doomed from the beginning.

''The contract was signed for a hospital without enough beds, and by the time doctors secured more beds, the development plans couldn't be appropriately modified,'' he says.

''[The public private partnership] affected the infrastructure as well as the delivery of services.''
Joseph says he can see why the public private partnership model is attractive, as it delays government expenditure.

''But in the end the government still has to pay,'' he says, adding that it is locked into a long-term contract with a private company, even if things go sour.

The Royal North Shore InfraShore contract is for 28 years.

Joseph says public private partnerships are incompatible with the goal of local clinicians being given control of their own hospitals.

''Previously, individual wards had their own cleaners and their own orderlies and the nurses controlled them … as soon as a patient left the nurse manager would order cleaning to start''.

Now, they must request cleaners and wait for someone to have time to do the job, creating inefficiencies.

Clinical staff say poor or delayed cleaning can lead to deadly hospital-acquired infections, which are estimated to cost the Australian healthcare system about $40 million annually.

When Craig Gaudion was a patient at Royal North Shore last year he developed an infection with the dangerous Klebsiella bacteria that was resistant to treatment.

He was in hospital for complicated spinal surgery, an attempt to fix chronic hand pain from nerve damage he developed after surgery at another hospital.

He says he was put into a room that was essentially a ''filing cabinet'', not set up for patients. All night people came in and out of his room, and at one point he was told he would have to urinate in a sink because there was no toilet.

''All the nurses and doctors were really helpful, but these are world-class people working in Third World conditions,'' he says.

The infection he developed eventually meant he could not work for nine months, and meant the spinal implant he had entered hospital for in the first place had to be removed.

The assistant secretary of the NSW Nurses' Association, Judith Kiejda, says ''bean counters'' think they can cut corners on services such as cleaning, without realising the risks.

She says the association is often called in to put out ''spot fires'' in the hospital system when corners are cut, and she is fundamentally against public private partnerships in healthcare.

Asked to respond to the treatment of patients Hugh Richardson and Craig Gaudion, a spokeswoman for Royal North Shore said patients were placed in ''clinical treatment rooms'' as a ''capacity management strategy'', and because they were close to nurses.

She said at times patients are required to wait on trolleys in corridors between procedures, and it was ''common practice'' to cover them with towels.