Things were not going well in the NSW public hospital system around the turn of the millennium. In late 2003, prompted by a run of front-page exposés, the Health Care Complaints Commission investigated and released a report into the “Cam affair” regarding 47 serious clinical quality and safety breaches at Camden and Campbelltown hospitals in Sydney’s south west over the preceding five years. A follow-up editorial and related responses in the Medical Journal of Australia reflected on the legitimacy of the HCCC investigation, and on the cultural and governance challenges afflicting the Macarthur Health Service.
As front-page exclusives continued and new government inquiries were called, an informal group of publicly-minded clinicians, academics and community leaders began meeting regularly over dinner in the private dining room of a Chinese restaurant on Sydney’s lower north shore. Trust and camaraderie developed, and the group agreed to start advocating for just and sustainable reforms that would lead to safer and more efficient public hospitals in NSW. The participants were independent, committed to the public interest, and not aligned with any profession, institution or political party. They would in time call themselves the Hospital Reform Group.
These were dangerous ideas to advance at the time, particularly for NSW Health employees. Moral courage became a prerequisite for attending HRG dinners, which were held in private and under a strictly observed Chatham House Rule. Health ministers, past and present, state and federal, serving and shadow, were invited into these discussions, both to learn from and to contribute.
The Garling Inquiry
On 25 January 2008, sparked by a tragic clinical failure at Royal North Shore Hospital but kindled by HRG’s lobbying in preceding years, the then NSW Premier Morris Iemma commissioned the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals, the Garling Inquiry. Members of HRG made a written submission, gave verbal evidence and participated in expert panels. The final report and its 139 recommendations were released ten months later, on 27 November 2008.
Among the most concrete of the ensuing reforms was the establishment of four pillars providing the NSW public hospital system with arms-length scrutiny and impetus for improvement: the Agency for Clinical Innovation, the Clinical Excellence Commission, the Health Education and Training Institute, and the Bureau of Health Information. Other reforms included the shift from Area Health Services to Local Health Districts, the establishment of Clinical Councils, and the appointment of Executive Clinical Directors.
Where things stand
Two decades on, the pillars remain, but their independence has eroded. Pillar chief executives now report to the Secretary and Minister, and negotiate budgets the way hospitals do. The result has been a return to centralised decision-making, reduced transparency, and a diminished capacity to give frank and fearless advice. The recent Beasley Special Commission into healthcare funding found itself largely limited to describing the system’s ills. The NSW hospital system continues to produce front-page failures, most of which were preceded by warnings from frontline staff.
In 2018, HRG changed what its initials stood for, from Hospital Reform Group to Health Reform Group, recognising the rise of chronic diseases not amenable to acute treatment and the need to shift effort towards prevention and community-based care. The dinners continue in the same restaurant.
Founding convenor
Professor Kerry Goulston AO is a retired physician and gastroenterologist who previously served as Associate Dean at the Northern Clinical School of the University of Sydney and Royal North Shore Hospital. He held the inaugural position of Chair of the Postgraduate Medical Council of Australia and New Zealand.