Hands up: John Carey says buck stops with him on hospital maintenance overhaul

A blistering report has revealed how Perth’s hospitals have been shackled by a maintenance system that is under-developed, too reactive and has “limited” oversight. The embarrassing findings of the health maintenance audit were made public, five months after The West Australian’s Hospital Of Horrors investigation revealed the scale of disrepair at Sir Charles Gairdner Hospital including leaks in intensive care and mould in the ceiling. But the full report won’t be released because, the Government said, it is cabinet-in-confidence and will inform future Budget decisions. Health Infrastructure Minister John Carey fronted the media on Thursday, insisting the “frank and fearless” advice has been accepted and vowed that it will trigger a major shake-up. “It’s a blue-print for reform,” he said. “The buck stops with me. I’m the Minister for Health Infrastructure. I’ve got to deliver it.” The report by former Health Department boss Neale Fong and former under-treasurer Michael Barnes — that cost taxpayers more than $400,000 — found that maintenance planning is “predominantly reactive” with limited oversight, has no dedicated funding for ageing assets and confirmed that has resulted in a growing backlog. “Supporting governance and policy instruments are underdeveloped, constraining consistency, accountability, and assurance across the WA Health system,” the report concluded. Long procurement processes contributed to delays, even for minor repairs. Extended approval timeframes were partly blamed on “resourcing constraints”. It found there is no dedicated asset renewal program, no key performance indicators or benchmark, no risk data, and that WA is spending less than other States. “Other jurisdictions, such as Queensland and NSW, set themselves targets regarding overall maintenance spend as a percentage of asset replacement value or the proportion of expenditure on planned versus reactive maintenance,” the report said. “WA has no target benchmark and current maintenance spend is below target benchmarks in comparable jurisdictions.” Funding is provided to health service providers as a lump sum, forcing any repairs less than $4.4 million to compete with clinical service demands for priority. The report found there was pressure to prioritise “readily deliverable, lower complexity projects” ahead of higher-risk renewals, and that there were no “master plans” for Royal Perth Hospital or the QEII campus that includes Sir Charles Gairdner and Perth Children’s hospitals. It was estimated that 75 per cent of all maintenance work in the North and East Metropolitan Health Services was “reactive”, compared to a target of 65 per cent “pre-emptive” that is set in Queensland. Mr Carey said the Government has endorsed all eight recommendations and has started acting on them. “There is a big job ahead,” he said. But he wouldn’t concede the Premier got it wrong, when he accused the Opposition of “scaring” patients and insisted the hospital system is “world class” in August. “What I can say is I’ve acknowledged that we — and even (acknowledged) at the time — we have an ageing health infrastructure system. I accept the findings of the report, I take them seriously,” he said. “We are doing a huge investment, so $4.9 billion in new hospital builds and major upgrades, so this idea that work currently isn’t underway is false. “There have been systems in place, but clearly we need to improve, and that’s what I’m focused on”. The action plan released by Mr Carey aims to complete a $50m maintenance blitz by September, but there were caveats. The audit warned that workforce shortages are making it harder, and estimated an overall “trade coverage” shortage of 14 per cent. Mr Carey also vowed to cut red tape, that he called an “over correction” after the State’s corruption watchdog uncovered fraud and bribery inside the North Metropolitan Health Service in 2019. “It is a fine balance, but we have to get money out the door to respond to maintenance issues,” he said. “The independent review has found that often it is too much burden, too much red tape, and actually, systems that were created to create efficiency are not working today.” Doctors welcomed the commitment to change but warned it must be followed through and said it was overdue. “It’s a bit of a ‘told you so moment’,” Australian Medical Association WA President Kyle Hoath said. “It’s not a world class health system . . . our facilities are languishing. They need this upkeep. They need this maintenance program. So to see the Government at least own up to that and to see the report demonstrate that fairly clearly is a good thing. “Owning up to it is a start . . . but the accountability to make sure this happens is the important part, because it won’t happen tomorrow, it’s going to take some time. “We have to give them that time, but not, you know, there’s a limit to our patience.” The Opposition said the Government has been shamed into action. “It is the Premier, ultimately, who bears all of this responsibility, both as a former failed health minister and now as the Premier of Western Australia,” Opposition Leader Basil Zempilas said. “The buck stops with the man at the top.” The woman in charge of WA’s overwhelmed health system said she wasn’t surprised by the findings. “It identified the issues that I expected and have been working on,” WA Health director-general Shirley Bowen said. Dr Bowen said the Government has been listening, and called the maintenance review an “excellent” outcome. She said she had not “personally” warned the Government that there was no dedicated asset renewal program, but said she has “actively” raised that there is work that needs to be done. Dr Hoath said a cure will take “years, not months or weeks” but warned the Government that the “clock is ticking”.