The head of John Hunter Hospital's Medical Staff Council has defended health service chief executive Michael DiRienzo from claims he has overseen deteriorating standards of clinical care at the hospital.
The Newcastle Herald reported on Friday that a group of specialists at the hospital had penned a letter threatening to call for a vote of no confidence in the Hunter New England Health boss.
The letter is signed by 45 staff specialists and visiting medical officers in a broad range of disciplines and will be distributed to the nearly 500 doctors on the Medical Staff Council.
The letter raises a host of concerns about "compromised" care, including "continuing and worsening inadequate resourcing of our health service".
"As a matter of public interest, coming from medical professionals, this has reached a crisis point, and we now are obliged to act," the letter says.
"In our opinion, there is inadequate bed capacity, inadequate critical care capacity and inadequate urgent theatre access. This was experienced before the current COVID crisis.
"Every day, because of these shortages, we are forced to make decisions that seriously compromise both immediate clinical care and longer health outcomes."
The letter also alleges staff morale is "worsening" and a "growing culture of fear" exists at the hospital.
The doctors say they have lost confidence in Mr DiRienzo's ability to lead the hospital and suggest he is "in the economic paddock".
"We see no evidence of his leadership in the clinical sphere," their letter says.
"If no action is taken, we will have no choice but to ask the Medical Staff Council to arrange an extraordinary general meeting to take a vote of no confidence in the chief executive and/or the board.
"We are committed to dialogue to avoid this outcome."
Mr DiRienzo said in a statement that he engaged regularly with senior clinicians at the hospital, including the department clinical directors, and had not been made aware of the concerns outlined in the letter.
"While this feedback is important, it is not an accurate representation of the 479 doctors who make up our medical workforce at John Hunter Hospital," he said.
"I acknowledge the last two years have been incredibly challenging for all health staff across the state, and I am very grateful for the efforts of our clinical and support staff who worked extremely hard against a backdrop of workforce and resource challenges.
"Despite this, Hunter New England Health staff have continued to deliver safe, quality patient centred care, which is validated by our quality and safety data.
"This has also been confirmed through a recent routine assessment by the Australian Commission on Safety and Quality in Healthcare.
"The chair of the Hunter New England Health board and I will be offering a meeting to these clinicians to further discuss the concerns raised in their letter."
The government is about to start an $835 million upgrade of the hospital, due to be completed by 2026, but the letter warns a lack of ongoing funding could lead to a "forced devolution of services with most complex, and even less complex, services being transferred to Sydney".
Medical Staff Council chair Rob Pickles disputed some of the claims raised in the letter.
He said the council had discussed the letter at its annual general meeting in August but the group's executive had decided "this was not the way to deal with the issues that were raised".
"Most are not in favour of this approach," he said.
Dr Pickles said the council acknowledged health funding was an issue for HNEH, NSW Health and across Australia, but this was a broad political problem rather than Mr DiRienzo's fault.
"We're not unique. This is across the whole footprint of health.
"Hunter New England clinicians have always felt somewhat aggrieved, and Wollongong are in the same boat, that we're not treated equally with regards to fair, reasonable distribution by state health compared to metro Sydney, but that's not a local hospital management problem.
"That's actually a state health problem. The local hospital and district board and Michael DiRienzo are well and truly aware of this and have been advocating on this for a long time.
"This is a political problem more than a local management problem."
Dr Pickles, who has worked in the Hunter New England Health system for 18 years, said it was "hard to know" if resourcing issues had affected clinical care.
"John Hunter has been under the pump for a long time in regard to bed capacity, and again that's something that we were working with our local administration to try to advocate for.
"The resourcing issues for Hunter New England are not a secret, are not new, and are things we need to work at at a smart political level, not blaming the local people who I know are doing the best they can in advocating within the constraints of how NSW Health works.
"I'd include Michael DiRienzo and the board in that. He has a budget that NSW Health gives him, and he has to do his best to come in on that."
Opposition leader Chris Minns raised the doctors' letter in Parliament on Thursday, asking Premier Dominic Perrottet when he would "start listening to doctors and specialists on the front line and address the crisis in our state's hospitals".
Mr Perrottet replied that the government was listening to doctors and "there is no question that, when doctors have concerns, they should be raised".
"It is important that is done through the proper process, as always takes place," he said.
"I understand from advice I have received from the Health Minister that the process is going through the Medical Council."
The government would spend $30 billion this year in recurrent health funding and the budget had promised an extra 10,000 front-line staff over four years.
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