Fundamentals of Organising, Organisational Design, and Culture in Health Care Services

The New South Wales (NSW) government via the NSW ministry of health has for some time provided health services to the people using the local health districts in the region. The NSW ministry of health facilitates the delivery of healthcare through sixteen local health districts. The districts offer services over a wide range of settings which include primary care stations located in the remote regions and the metropolitan health centers. The system involves a network of specialists who deal with children and pediatric services. Also, there are specialists in forensic mental health and custodial fitness. However, the Australian government in 2015, introduced Primary Health Networks (PHNs) to improve patient care and to ensure that the health care system in the nation is efficient and effective (“Primary health networks (PHNs),” 2018). The introduction of the health networks calls for comparison and critique relative to the local health districts. The report will compare and contrast the two health systems looking at different aspects to determine which is better.also; the report will offer recommendations on how to improve the two systems to ensure effective and efficient healthcare delivery.

There are 31 PHNs established across Australia. The aim of the health networks is to improve medical care for patients especially those vulnerable to unfavorable health outcomes, to ensure that government money is allocated where it is most needed and on health programs that are more efficient, to enhance the connections between hospitals and local health services to ensure that the patients receive health services at the right time and in the right place (Rørtveit, 2014). The primary health networks work hand in hand with local hospital networks and operate under the same boundaries as the local hospital networks.

New South Wales has the PHNs covering the entire region, from the central and eastern Sydney to the western Sydney to the south-western Sydney and the north coast. The PHNs have replaced the Medicare locals in the region, and there is likely hood of healthcare improvement. However, there is a need to evaluate the differences between the primary health networks and the local health district. Comparing and contrasting the two systems will show the potential benefits and possible consequences of the primary health networks on the NSW government and the people.

1. The budget

Like all government projects, the primary health networks and the local health districts require money allocations to ensure that health care services are efficiently delivered to the patients. The Australian government released the 2017-2018 health budget in which it provided for the PHNs. The PHNs were allocated $80 M throughout four years to be utilized for community mental health services. The service (psychosocial support) is aimed at assisting people with various mental illnesses who do not qualify for insurance coverage. Furthermore, the PHNs will receive over $145 M to facilitate after-hours primary health care. Also, about $8M is allocated to the PHNs to be administered for about three years to cater for home-based palliative care (“Summary of 2017-18 budget health announcements”, 2017).

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On the other hand, the NSW ministry records a $1.9B to cater for mental health in the 2017-2018 financial year. Also, an extra $20M was allocated to the local health districts to aid in the implementation of the NSW reforms on mental health. Other budget additions for the local district hospital included $23M to facilitate an increase in services for the admitted and non-admitted psychiatric patients, $10.6M to ensure the continuity of Port Macquarie Hospital of Mental Health. Furthermore, there is approximately $1B to enhance paramedics services who provide relief in NSW. The budget also caters for ambulance and helicopter retrieval services that will incorporate doctors and paramedics in all flights (“Record $1.9 billion budget for mental health – News”, 2017).

Functions

The primary health networks focus on the needs of the local community as well as on issues deemed by the government as important. They focus on cancer control, dementia, arthritis, asthma, and diabetes. The PHNs conduct research on the health needs in a particular region. The findings of the research help point out the vulnerable groups of people who require more resources and services thereby aiding the PHNs to customize health services in line with the people’s needs. Also, the PHNs implores the external health providers to offer extra services such as; after-hours services, health promotion programs, collecting information regarding children immunization, and mental health services (Booth & Boxall, 2016).

The Local health districts, on the other hand, have their share of responsibilities.  They are tasked with clinical governance which involves patient safety management, patients’ complaints management, and clinical risk management. Also, they provide nursing services and ensure that nurses are deployed to all stations. The local health district also engages with the community to find out more on the community health needs that require an immediate response. They are also responsible for the transfer of patients to higher level care facilities, managing the trauma centers as well as facilitating ICU retrieval(“Key functions of each NSW Local Health District – LHD Boards,” 2017).

A board of medical professionals manages the PHNs. The board is advised and guided by a clinical council together with the community-based advisory committee. The council of clinicians is composed of nurses, general practitioners, indigenous health workers, and specialists. The community committee is made up of patients, caregivers, and interested health consumers. However, the board of medical professionals is accountable for the allocation of funds and ensuring prompt and effective service delivery. On the other hand, the local health districts are under the ministry of health. The NSW ministry of health manages all the 230 hospitals in the region (“Our structure – NSW Health,” 2018). Therefore, the health minister is accountable for the management, budgeting, and allocating funds in the local health districts.

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The primary health networks cover a broader scope of health care that the local health districts. The PHNs provide essential services such as after-hours services which the local health districts failed to consider. New Wales State (NSW) stands a better chance at improving health services through the PHNs. The local health districts were more institutional oriented and thus focused more on the development of the hospitals. Such orientation denies the health providers the chance to engage the community and establish the groups that need more medical care. Also, the PHNs focus on the health of the population in their regions thereby establishing the needs of the regional level to decrease the poor health outcomes (Booth et al., 2016).

 However, despite the community involvement in the PHNs, the system lacks proper management. While the local health districts are managed by the ministry of health which is composed of different personnel with management skills, the PHNs are governed by a board of health professionals. Such individuals lack management training and thus could lead to misappropriation of funds. Furthermore, local health districts deal with a variety of ailments compared to the primary health networks. The local hospitals in new wales state are equipped with facilities to treat a broad range of diseases. PHNs on the other hand deal with limited disorders and focus mainly on researching the needs of the community.

The implementation of the PHNs is likely to have a few obstacles in the New Wales State. For instance, the introduction of private firms into the primary health sector is bound to bring transparency, governance, and policy issues which may impede positive changes for the people. Problems relating to accountability and tender are likely to arise due to the involvement of the private sector (“Primary Health Networks: key questions and challenges – Croakey,” 2015).
The new arrangements also difficulties in ensuring that the new organizations deliver efficiency and improved healthcare especially to the remote part of NSW where the people are more vulnerable to disease (Perkins, 2015). Social inequality is a possible challenge for the new regime. The PHNs involve working with a vast population characterized by poor people with different needs. Such a condition may force the organizations involved to favor one group over the other due to the varying needs.

Conclusion. 

 Overall, the PHNs promise efficiency and improved healthcare to the community. Unlike the local health districts, the PHNs are independent and are funded directly by the national government. The New Wales State is likely to benefit from the new regime since the primary networks engage the community and offer services to the remote areas of the region why the local health districts failed to rich. However, the PHNs is likely to face accountability issues since the personnel charged with overseeing the new arrangements lack managerial skills. The inclusion of the private sector offers an opportunity for improved service delivery but also introduces the threat of corruption in tender allocations.

The following recommendations could be applied to improve the efficiency of the PHNs

• Formation of a management board that oversees the distribution of funds.
• Invent strategies that link the PHNs to the local health districts to ensure collaboration which would ensure efficiency in health care efficiency
• Collaboration efforts with the NSW ministry of health should be encouraged to aid in research and medical facilities.
• There PHNs should expand on the range of diseases covered to ensure that the networks cover all the community’s needs.

References

Booth, M., & Boxall, A. (2016). Commissioning services and Primary Health Networks. Australian Journal Of Primary Health, 22(1), 3. doi: 10.1071/py15167

Booth, M., Hill, G., Moore, M., Dalla, D., Moore, M., & Messenger, A. (2016). The new Australian Primary Health Networks: how will they integrate public health and primary care?. Retrieved from https://www.phrp.com.au/issues/january-2016-volume-26-issue-1/the-new-australian-primary-health-networks-how-will-they-integrate-public-health-and-primary-care/

Perkins, D. (2015). Primary Health Networks: Towards commissioning for outcomes. Australian Journal Of Rural Health, 23(4), 193-194. doi: 10.1111/ajr.12226/

Primary health networks (PHNs). (2018). Retrieved from https://www.healthdirect.gov.au/primary-health-networks-phns

Summary of 2017-18 budget health announcements. (2017). Retrieved from https://www.ntphn.org.au/news/summary-of-2017-18-budget-health-announcements

Record $1.9 billion budget for mental health – News. (2017). Retrieved from https://www.health.nsw.gov.au/news/Pages/20170620_04.aspx

Key functions of each NSW Local Health District – LHD Boards. (2017). Retrieved from https://www.health.nsw.gov.au/lhd/boards/Pages/key_functions_of_lhdboards.aspx

Our structure – NSW Health. (2018). Retrieved from https://www.health.nsw.gov.au/about/nswhealth/pages/structure.aspx

Primary Health Networks: key questions and challenges – Croakey. (2015). Retrieved from https://blogs.crikey.com.au/croakey/2015/03/02/primary-health-networks-key-questions-and-challenges/

Rørtveit, G. (2014). Research networks in primary care: An answer to the call for better clinical research. Scandinavian Journal Of Primary Health Care, 32(3), 107-109. doi: 10.3109/02813432.2014.943981