The mistake that is contracting out of vital pathology services in regional and rural Victoria is coming home to roost for the Victorian government as private pathology providers are downgrading and closing laboratories in public hospitals across regional and rural Victoria putting patient safety at risk.
Across regional and rural Victoria public hospitals are experiencing shrinking capacity to deliver their full range of clinical services as private pathology providers downgrade and close pathology laboratories. Over 80 per cent of diagnoses in public hospitals come from a pathology test of one kind or another which makes turn-around times for the results crucial to ensuring treatments can start as soon as possible. A fully functioning pathology laboratory is as important to maintaining a hospital’s key clinical services as an ambulance is to maintaining accident and emergency department services.
In some health services we are currently witnessing a rapid decline in quality and patient safety standards as private pathology providers make very significant cuts to services based on commercial interests.
We’re getting a grim picture of how much private pathology providers are dictating public health standards by moving work out of regional and rural areas and centralising it in Melbourne. We’re witnessing this happening across regional and rural Victoria in places like Kyneton, Latrobe Valley, Geelong, Mildura, Alexandra, Warrnambool, Bendigo, Cohuna, Kerang and Kyabram.
The very worrying trend is that health service Executives and Boards are not lifting a finger to stop private providers implementing changes that are contrary to patient safety and clinical standards. Instead of better healthcare, we get in pathology services closures of microbiology and other specialist services, redundancies of senior scientists, escalating workloads and widespread dysfunction in laboratories.
And with the ongoing job losses it means there are fewer scientists working in our healthcare system. It also has very real impacts on local communities as more jobs are lost in regional and rural Victoria, taking away the ability for highly trained and qualified scientists to remain in local communities.
As the scientific workforce is made smaller and the amount of work grows, there comes a point at which either quality standards suffer or the workforce suffers, or more likely both.
There is also a flow impact of diminishing economic activity as people who were employed in good, well-paid positions either seek to cut their household expenditure or leave the local area to pursue employment opportunities in other parts of the state, or leave to go interstate or overseas. Once these roles are lost, it is highly unlikely they will be reinstated and makes retaining high paying, quality jobs in regional and rural Victoria much more difficult, leading to a further brain drain.
Cutting pathology services and laboratories in regional and rural Victoria also impacts on other local care services like aged care facilities and local GP services which rely on local pathology services to deliver quick and timely turn-around times for tests.
The Medical Scientists Association of Victoria has long been reporting that quality standards in pathology have been declining. Unfortunately, we are now witnessing a more rapid decline in turn-around times, to the point that in health services like Bendigo Health, doctors have publicly expressed concerns that patient safety is being seriously compromised.
Safer Care Victoria is currently investigating the actual impact of the closure of the microbiology laboratory on Bendigo Health’s full range of clinical services.
The dangers of making scientists work longer hours, across disciplines without adequate competencies and undertaking more work are obvious. As the scientific workforce is made smaller and the amount of work grows, there comes a point at which either quality standards suffer or the workforce suffers, or more likely both.
This is serious business; without medical scientists there is no clinical diagnosis and no treatment. Likewise, delayed turn-around times means delayed diagnosis and delayed treatment. Each scenario has dire consequences for patient safety. But many public health services seem to be willingly ignorant to the consequences of delays in getting test results as the business decisions of private pathology providers are excused and patients are told that services won’t be affected. Yet it’s a complete furphy to tell patients that services won’t be affected when it is clear that closing and downgrading laboratories and shifting work to Melbourne increases in turn-around times, which has a direct impact on the quality of healthcare given.
Worryingly, the MSAV has recently discovered that a two major regional public hospitals have failed to monitor clinical quality standards in contracted pathology services, despite the fact that the respective contracts have prescribed standards and contract monitoring and enforcement provisions. In both cases this significant governance failure has been occurring for many years, and in one case the hospital’s pathology service was critically reviewed by the Victorian Coroner after an avoidable death.
There is no place in public health for private equity firms to effectively determine levels of clinical quality and patient safety by cutting scientific staff and downgrading services. If a pathology laboratory is essential to being able to deliver safe, high quality clinical services to patients this week, how can the same services be delivered safely the next week with no or reduced pathology? The government needs to resolve this critical question.
Unfortunately the business decisions of private pathology providers are dictating the safety of patients and the quality and range of care delivered at public hospitals. There is every chance that, without a pathology laboratory, local patients will now have to travel large distances to receive medical treatment currently delivered in their local public hospital.
These sorts of decisions by private pathology providers means that local public hospitals in regional and rural Victoria may not be able to safely perform many clical services, for example obstetrics and general surgery, without medical scientists in a fully functioning pathology laboratory in the hospital. It also means that local public hospitals could be left without an onsite blood bank meaning the hospital’s full range of acute care services are unlikely to continue or at the very least will be severely impacted.
If a pathology laboratory is essential to being able to deliver safe, high quality clinical services to patients this week, how can the same services be delivered safely the next week with no or reduced pathology?
Decisions to cut and downgrade pathology services will lead to patients being required to travel long distances in order to access the basic healthcare services they need. It doesn’t bode well for the prospects of large regional centres like Bendigo, Traralgon and Geelong when local patients may be forced to travel to Melbourne on a regular basis to for treatment that can no longer be delivered in their local hospital because of cuts to pathology.,
The Medical Scientists Association of Victoria has strongly advocated for the end to contracting out of crucial clinical services like pathology laboratories. For the health system to be world class there needs to be access to a full range of pathology laboratories on-site which means there has be an end to contracting out of pathology services. Unless health services in Victoria start enforcing contractual obligations required of private pathology services, the only reasonable course of action for the government to take is to stop the now obviously broken model of contracting out the services.
It’s also becoming evident that the state establish an independent body to be responsible for pathology clinical and quality standards oversight to ensure that public hospitals have consistent minimum standard for pathology services. Such a body would complement the work done by the National Association of Testing Authorities (NATA) and safeguard against cuts or closure of other clinical services because a private provider has decided to close or downgrade a lab.
It should go without saying, but it’s well past time that governments at state and federal levels and of all persuasions need to stop cutting funding from healthcare and truly invest in the system to ensure that every public hospital has the full range of pathology laboratories operating on-site.
Victorians should be able to expect access to world-class healthcare when they need it regardless of where they live. We should not have delays in test results being returned or delays in or compromised treatments because entrepreneurial pathology companies close pathology to turn a larger profit.
