Dr Stephen Conaty was appointed the director of the new South Western Sydney Public Health Unit (PHU) earlier this year. Among his duties is to establish a new PHU office in Liverpool. We asked him how he went about it.
It wasn’t my life ambition to start a new public health unit. And it still isn’t. However, I think most people in any sphere of life would recognise that starting anything from nothing is an opportunity. There is nothing extremely complicated about a public health unit – it is largely just people, office space, computers, telephones and some storage including vaccine storage. Setting up many different kinds of offices, clinics or laboratories is more troublesome and exacting. Nevertheless there are many things to think about to ensure that we are likely to function optimally.
First some background. When the large South West Sydney Area Health Service was formed in 2005 the Liverpool and Camperdown Public Health Units were amalgamated on the Camperdown site. This brought some advantages in scale. When the new South Western Sydney and Sydney Local Health Districts were formed in 2012 (splitting the old Area Health Service and reverting to old boundaries) for a period of time Population Health Services continued to be provided across both districts. Eventually a decision was made in around March 2013 that Population Health Services would be split. This had greater implications, of course, for the public health unit than most other services because it was a fully amalgamated service. After a protracted period and various financial arguments the date for division of services was set at 1 July 2014.
The start was in many ways provided for me. First step divide up the money at Population Health level. Second step allocate the money across the reconstituted units / services. Third step set up a structure that fits the budget. All these steps had essentially been completed by the time I came on board in February 2014 – a structure to fit the budget had been devised with advice from Leena Gupta and others in the still combined Camperdown PHU. I did have an opportunity to review the structure and put forward changes before the structure was agreed by the Chief Executive. So this was my first step. Is the number of positions and balance of positions right? Are there enough admin staff, public health nurses, environmental health officers and medical staff to do the job? Are they correctly graded? Is the reporting right? I made some relatively minor changes to the structure. One particular constraint was that people from the existing public health unit needed to be able to elect to go to positions in either public health unit structure. So there needed to be positions that were similar to existing positions so that no staff were inadvertently displaced. Our revised structure amounted to an effective FTE of around 19. This includes a notional 3 FTE for Public Health Nurses casually employed in the school immunisation program.
The old location of the Public Health Unit in Liverpool was on the Eastern Campus of Liverpool Hospital in the Hugh Jardine building. This was previously a paediatric ward that had been converted to offices. It was the subject of many complaints about lack of light, damp, cracks, leaks and was slated to be knocked down so the Public Health Unit had to be housed somewhere else. There was brief search for premises. Specifying the exact physical requirements is an important part of the internal process. The health service has uniform space requirements for 1 person, 2 person offices, meeting rooms, store rooms, etc. Specifying the exact requirements gave us a space of 215 m2. I personally scouted out offices and was particularly interested in space in the same building as the NSW Refugee Health Service which is located in George Street a couple of blocks from Liverpool Hospital in a salubrious area opposite the court house. I thought this at least would give us some friendly neighbours. Refugee Health also have an interesting staff profile with a number of nursing staff and I thought that this would provide us with some capacity for surge staffing in case of emergency (yet to be negotiated!). The health service also pointed us towards some other private suites that were currently occupied by Cancer Services that had some advantages in proximity to Liverpool Hospital and cable connection. We put forward a case for George Street and this was accepted. The George Street site needed a complete refurbishment and fit out for office space. A lease was signed on 8 August 2014.
There are various systems that also need to be thought through. How many phone lines and data ports do we need? Are we going to have a phone menu? Are we going to have a PO Box or rely on the hospital mail service? Do we really need to have two mail deliveries a day? How many car spaces do we need and should we pay for additional above those specified in the lease? How do we transfer our electronic files? The details of the solutions to these problems are too tedious to relate but the small problems are numerous and all need to be solved.
Building a team is like putting building blocks in place. Partly is a mechanical process, but the quality and fit of the staff is important for creating a positive workplace culture. After finalisation of a structure, staff in the combined Public Health Unit had an opportunity to choose to accept a position in either Liverpool or Camperdown. Unsurprisingly a large number chose the existing location in Camperdown reflecting particularly where staff lived. However, there was a hardy group of six people who elected to go to Liverpool either drawn by proximity to the place where they lived or the opportunity to take on a different role in the new PHU. We also inherited some skilled administration staff that had been displaced from restructuring of other units in Population Health.
This left us with quite a few vacancies to fill. There is not much you really can do except advertise positions and try to fill them with the best calibre candidates. Attracting a good field is very important and in some cases ensuring personally that people you think should be applying are applying is important. I also found that being on every interview panel was important part of quality control.
Although our PHU will not be small it will be smaller than the combined Camperdown Unit and ensuring that we have a viable on-call roster that is fair and does not over-burden staff was another consideration that headed me down the direction of ensuring that public health nurses in both our immunisation and communicable diseases team will be more multi-skilled and be able to provide mutual support and participate on the on-call roster.
South Western Sydney is a very interesting and challenging area for public health. It has the largest population in the state of any Local Health District, a highly culturally diverse population, a reasonably sized Aboriginal population, and in parts a relatively disadvantaged population compared with the rest of the state. It also has a semi-rural metropolitan fringe and is growing rapidly with much green-field housing development. There is also industry and infrastructure expansion including the second Sydney airport and a large freight intermodal. However, the priority for me in the coming year is fairly prosaic but important: to have a team and system in place so that we can operate safely and competently. In the new calendar year we will be able to lift our gaze a little and begin to plan more seriously.
Never underestimate how long it takes to recruit staff. The process is like one of those long-distance steeplechase races with a numerous hurdles and puddles of water. I had in mind a three month time period from 1 July 2014 to becoming operational on 1 October thereabouts. This would allow time for both recruitment of staff and refurbishment. Some of the positions that were advertised from early July have only received letters of offer for start dates in late September and some positions will not be filled by the time we open our doors to business.
Also, although I am an insider and have worked in the NSW Health system a long time and know how public health units run, you can never talk enough with your colleagues to get ideas about different possibilities. I could have done this more. It may have given me stronger ideas on ways to adjust the structure prior to CE approval.