Secret plan to slash jobs in public mental health were drawn up even as services collapsed

NSW public health districts were pursuing a secret policy of swingeing cutbacks to the state’s public psychiatry workforce even as a recruitment crisis was crippling critically underfunded services.

Mass resignations of psychiatrists have rocked the NSW mental health system. Picture: Getty Images

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NSW public health districts were pursuing a secret policy of swingeing cutbacks to the state’s public mental health workforce even as a recruitment and retention crisis was crippling the speciality and amid a crisis of critically underfunded services.

Internal Financial Recovery Plans for health districts have been drawn up by the NSW Ministry for Health setting targets for reducing the number of full-time equivalent staff in an attempt to address and prevent budget overruns.

The Sydney Local Health District’s Financial Recovery Plan last year set a target saving of 110 FTE positions in public mental health services over three years – 35 of them last year, exactly at the time the workforce staffing and retention crisis was reaching a critical flashpoint.

The revelation is contained in the minutes of a Medical Staff Council meeting of the Sydney Local Health District, in which senior NSW health executives told doctors they believed that mass resignations of psychiatrists from the public system were not about money, contradicting the narrative propagated by the Minns government. The minutes record SLHD chief executive Deb Wilcox saying she doesn’t believe it is all about money and that there are other issues too, including that NSW staff specialists’ rates of remuneration are the lowest in the country.

Deborah Wilcox is the CEO of the Sydney Local Health District

The Industrial Relations Commission in NSW is due to arbitrate the psychiatry dispute in a five-day hearing beginning Monday, with about 100 psychiatrists having left public hospital jobs so far.

Across NSW, community mental health services were only currently staffed and resourced at 40 to 50 per cent level that they should be before the mass resignations, according to the state’s Health Service Planning Framework. The statewide shortfall of staffing and resourcing in acute care mental health services was 20 per cent.

Despite that, Financial Recovery Plans for health districts across the state set targets to slash many hundreds of FTE hours and positions in psychiatry, mental health nursing and support and administration roles. Cutbacks also applied to other medical specialties.

It has been estimated that even before the mass resignation of psychiatrists in NSW, 30 per cent of staff specialist positions were unfilled. About 205 psychiatrists tendered their resignations late last year, and around 100 of them have so far carried through to leave their public hospital positions, plunging the state into crisis arrangements in which frontline care has at times been replaced with virtual services, executive plans to cope with threadbare staffing are in effect, and some services such as perinatal mental health mother and baby units and mental health rehabilitation services have had to suspend their operations.

Psychiatrists at the SLHD MSC meeting spoke of the intensely devastating decision to resign and some alleged they have been subject to reprisals, which management denies. One psychiatrist who said she was hoping there would be a resolution to the crisis requested to have her resignation processing suspended for eight weeks as was allowed under NSW health policy, but instead she was immediately terminated.

Dr McDonald said at the MSC meeting that target reductions in FTE staffing levels in mental health across Royal Prince Alfred and Concord hospitals and other district services and contained within the Financial Recovery Plan were not focused on as the workforce exodus escalated.

Administrators were granted approval in the wake of the crisis to increase the medical budget very significantly, but also temporarily increase nursing and allied health budget, to provide increased support in the areas where they have particular vacancies.

According to a summary of the minutes of the MSC meeting Dr McDonald said the focus of the district was to provide the staff they needed to safely run their services through this period of extreme stress and crisis.

More than a quarter of the state’s staff specialist psychiatrists worked in the SLHD, and half of them lodged resignation letters of intent late last year. About half of that number – that is a quarter of the health district’s staff specialists – have progressed to resignation. That accounts for about one-fifth of the resignations statewide.

In the wake of the mass resignations, the NSW health ministry set up two virtual psychiatry services to help cope with patient load amid a diminished workforce. Dr McDonald indicated those hubs run by the Western NSW LHD and Hunter New England LHD, have had significant teething problems and that SLHD clinician managers have had to provide significant feedback both to the ministry and Hunter New England, who are providing the service.

He said managers recognise that at the moment the advice (is) from an external person who in most cases won’t understand the particular nature of the population, the business processes, and the services of a hospital far away is not commensurate with face-to-face care.

Dr McDonald also said he recognised that the mass psychiatry resignations haven’t come out of nowhere.

Obviously there has been an increasing breakdown in engagement between the Ministry, the Government, and the senior medical workforce over the last six months or so, he said. This led to the specialist movement to resign. It has put our medical workforce, and all our workforces, in an extraordinarily difficult position, because this been going for months now. Obviously the movement to resign has created an extraordinarily high stress environment, and there has been an erosion of trust. There is a huge amount of uncertainty still, which makes forward planning and how the operational implications are managed, a challenge.

He also said that the enormous underresourcing of community care teams who were highly stretched and very reactive … constantly chasing their tails meant that proactive prevention and treatment, at times, takes a back seat to managing acuity and managing the most unwell and challenging people.

If they were able to increase capacity to provide care in the community, that would ultimately reduce the pressure on the EDs and their inpatient services, Dr McDonald said.