ALI Cupper had just toppled long-serving incumbent Nationals MP Peter Crisp – who did not take a position for or against private hospital management – to win the seat of Mildura by a mere 253 votes at the 2018 Victorian election.
The state’s 59th parliament had just been sworn in before Christmas that year and Ms Cupper’s biggest priority was organising a meeting with Health Minister Jenny Mikakos to push the case for returning Mildura Base Hospital back to public hands.
“It was the No.1 issue for me,” Ms Cupper said. “It was the centrepiece of my maiden speech and we were able to secure a meeting with Jenny straightaway.”
Both Ms Cupper and her chief of staff, Stephen Parr, went to that meeting in the first sitting week “anxious, but full of hope” for a positive outcome.
However, the pair were soon disappointed by what Ms Mikakos told them in her Spring Street office.
“We hadn’t met Jenny before, and the first thing she said to us was that ‘according to Safer Care Victoria, there are no safety issues with your hospital’,” Ms Cupper said.
“Stephen and I just thought how this goes against testimony from nurses, doctors and patients in Mildura. I said to her that ‘there is something wrong with the mechanisms you’re using to assess whether this place is safe’.
“One of the reasons (local surgeon) Kevin Chambers blew the whistle in the first place was because he was seeing first-hand the safety issues.
“So we thought that if she’s just going by the boxes ticked, and she hasn’t been to Mildura, she doesn’t understand Mildura, she doesn’t have a personal stake in this, how the hell are we going to convince her a change was needed at the hospital?”
Ms Cupper said both she and Mr Parr “walked back to our office feeling totally defeated and deflated” after the meeting.
“That was the lowest point in the journey for us, and it didn’t seem right. I’d just been elected on this issue and we’d knocked off a National Party dynasty in Mildura,” she said.
“But yet the minister was essentially saying, ‘Nothing to see here’. It didn’t make sense.”
The turning point
August 7, 2019. Mark this day as the pivotal moment in the local campaign’s fight to “reclaim the Base”.
It was the day Ms Mikakos visited Mildura on a whistle-stop listening tour of the state of Mildura Base Hospital.
Due to Ramsay’s strict protocols, Ms Cupper had to organise a secret off-site meeting place for a number of local doctors and surgeons to express their concerns to Ms Mikakos.
Ms Cupper, who attended, says this was “the telling meeting, which was kind of like the final climactic scene in a movie”.
“We were sitting at a secret location, because one of the problems of this ongoing fight was that, as the hospital was privately managed, none of their workers had whistle-blower protection, which is what you get in a publicly run system,” she said.
“The doctors had to be very, very careful – and we had to be careful too because we can’t afford to lose doctors in Mildura (if they were sacked for breaking ranks). We knew that Ramsay had form for those sort of punitive moves in keeping things under control.
“So each of the doctors spoke and gave the minister numerous examples of the systemic problems. It just spoke to the entrenched problems linked to a structural deficit in the way the Ramsay model works, where you can’t serve two masters – shareholders and patients – together.
“Something’s got to give, and it’s always the patients that suffer.”
Then, unlike at their first meeting, Ms Mikakos’s message to Ms Cupper was one of hope for the hundreds of reclaim-the-Base crusaders.
“As we walked out of that meeting, the minister thanked me for making sure she met with the doctors and how compelling it was to hear from them. She told me how there are safety issues in hospitals around Victoria, but ‘nothing like this’,” Ms Cupper recalled.
“This meeting made all the difference.”
When asked by the Daily this week, Ms Mikakos did not dispute Ms Cupper’s account of both this meeting and the first one in late 2018.
Why did it take so long for change?
Mr Parr claims the Health Department’s key measurements of Mildura Base Hospital’s performance were “missing critical problems”.
Mr Parr previously worked for non-government health service providers in primary care and was part of the pro-public lobby group Reclaim the Base Hospital team.
“What we found out along the journey, particularly through conversations with places like Safer Care Victoria, was the way the Health Department looks at hospitals makes a lot of assumptions about the day-to-day things hospitals do that don’t tell the full story,” he said.
“With that comes a whole heap of cultural issues and other things that aren’t quantifiable and can’t be captured in contracts. Ramsay was, for example, ignoring or shooting down patient feedback.”
Ms Cupper claimed that Ramsay would “often put people’s complaints down to ‘having a bad day’.”
“So the insiders (doctors) blowing the whistle confidentially was so important, because you couldn’t dismiss what they said. They weren’t just there on a bad day; they were there every day to see all the systemic care problems,” she said.
‘It’s like fixing a broken-down house’
So, what improvements will the average patient see in the hospital returning to public hands?
Ms Cupper says that cultural change and service improvements “will be key things”; the complaints process will be more open and transparent, and “you’ll have a hospital that doesn’t have to prioritise profits”.
Ramsay made net profit of $2.3 million out of the hospital in 2019, down from $2.7 million the previous year.
“There are going to be bumps and teething problems along the road to improving the hospital,” Ms Cupper said. “But I would liken it to this: it’s like fixing a broken-down house
“If you’ve got a house that keeps cracking in the wrong spots, you can keep patching it up, but if the problem is the foundations, you’re never going to properly fix it.
“So we need to get the foundations right first and then we can build it up again.”
Ms Cupper said “there’ll be the little things can that improve a patient experience, like a hospital dog”.
“And we want to see return to community fundraising and the hospital become a hub again for social cohesion,” she said.
“Significantly, salary packaging will be available for staff so they will be able to have several thousand more dollars in their disposable income each year, which they can spend on their families.
“There’ll also be a board of directors that are part of the community. People who live here and are more accountable for their decisions.
“There should also be better connections with Robinvale Hospital and Mallee Track Health Service. Previously, Ramsay has been getting $300,000 a year specifically to develop those relationships – but nothing’s been done with that money in any meaningful way to improve services.”
Ramsay’s defence
Ramsay Health Care has hit back at Ms Cupper, saying her claims of poor patient care under its management at Mildura Base Hospital were “not only misleading, they are also an affront to the hard-working staff”.
“We are very proud that during Ramsay’s management of Mildura Base Hospital,” the private health care provider said in a statement this week. “There have not been any major quality, safety or performance issues.
“Ramsay has managed the operations of Mildura Base Hospital within budget, never having to ask the government for additional funding.
“Ramsay Health Care is proud of its staff and doctors at Mildura Base Hospital and the high-quality health care we have provided to the community together during the past 20 years.”
Asked what its biggest achievements for the hospital were over the past two decades, Ramsay said: “In the past eight years alone … a $4 million, eight-bed paediatric unit; $4 million expansion of the intensive care unit; and a $2.3 million redesign of the mental health high-dependency unit; the inpatient ward emergency department expansion from 13 to 21 treatment spaces; and expansion of the short-stay unit.”
It also listed an expansion of the special care nursery; doubling in size of hospital chemotherapy services; the “recruitment and retention” of a permanent oncology specialist; and the expansion of Ramsay Specialist Clinic.
“Ramsay is very grateful to the Mildura Base Hospital team for continuing to focus on what is important: caring for one another and their patients,” it says.
