NSW government asks private sector to take public hospital patients as hundreds of psychiatrists set to resign | Health

The New South Wales government is considering moving public psychiatry patients into private hospitals in preparation for the mass resignation of the state’s psychiatrists next week but doctors warn the panicked response will not help the “droves of people with significant illness and crises”.

At least 205 psychiatrists will resign on Tuesday after 16 months of negotiations over the workforce crisis, with the government not agreeing to the psychiatrist’s proposed solution – a special levy increasing their pay by 25%, similar to that which emergency doctors received in 2015.

The resignations will represent closer to two-thirds of the workforce, as there was already a pre-existing vacancy rate of 30% to 40% within the 443 psychiatrist positions in the NSW public system, the minister for mental health, Rose Jackson, said on Wednesday.

At a meeting on Thursday, no agreement was reached between the minister and the doctor’s union, the Australian Salaried Medical Officers’ Federation, as well as the NSW branch of the peak body for psychiatrists, the Royal Australian and New Zealand College of Psychiatrists.

As a result the NSW government is continuing its efforts to put contingency plans in place, which the state health minister, Ryan Park, said were likely to include “engaging with the private sector around additional workforce capacity they have”.

Guardian Australia has seen an email from Anne Mortimer, the director of the country’s largest private mental health provider, Ramsay Mental Health Australia, seeking to “organise public/private contracts to assist with patient care” due to “the current situation in the public sector”.

The email was sent to NSW visiting medical officers – experienced senior doctors appointed to provide services on a contractual basis – asking for their agreement to care for the patients.

“I am writing today to inform you that your hospital may have one of these contracts put into place over the coming few days and I would like an understanding through an EOI if you are happy to care for these patients,” Mortimer wrote.

“We are negotiating an all inclusive daily fee for care which will include appropriate remuneration for our doctors.

“Our admission criteria remains the same and we mostly take patients suffering affective disorders or who are towards the end of their stay in a public hospital and have their care transferred to us.”

Mortimer said all previous public contracts in Ramsay’s mental health facilities nationally, including several in NSW, “have proven successful and easy to manage”.

Dr Tanya Ahmed, a psychiatrist who has worked in both private and public hospitals in inpatient and outpatient settings, said she believed the NSW government was “flapping around, panicking and looking for any sort of potential capacity to have somewhere to send what will be droves of people with significant illness and crises”.

“To me, it smells of ignorance and reactive measures that aren’t really thought through,” Ahmed said. “I just feel like there’s a complete lack of understanding of the system.”

It was not possible for private hospitals to accommodate involuntary high-risk patients – who make up more than half the admissions to NSW public hospitals – because they were not legally allowed to do so under the NSW Mental Health Act, she said.

There were also practical reasons private hospitals could not provide care for those high-risk patients, she said. Their facilities could not physically contain them if necessary and they were not adequately staffed as there were no doctors present 24 hours a day as there would be in a public hospital.

“Private hospitals’ model of care is based around patients who are stable, who voluntarily want to be there and who are choosing to engage in what is predominantly a psychologically based model of care,” Ahmed said.

She said while the movement of a patient from a public hospital to a private hospital was possible, “in reality, it’s often very difficult to make that happen” because the shortage of psychiatrists and nurses extended to the private system as well. As a result there were often long wait times and uncertainty surrounding high-risk patients.

Dr Pramudie Gunaratne, the NSW chair of RANZCP, said: “The reality is the private psychiatric hospital sector is also contending with a workforce crisis. There are increasing reports of private hospitals unable to take patients with empty beds, because there simply isn’t enough workforce to staff them.

“These shortfalls would need to be filled by a temporary workforce at a premium rate, which further perpetuates the driving issues behind the current crisis we’re in.”

Because private hospitals are not equipped to manage individuals requiring involuntary treatment under the Mental Health Act, it “risks leaving some of the most vulnerable people in our community without access to appropriate care”, Gunaratne said.

Ahmed said: “A lot of the people presenting to public services, and particularly through ED, are high-risk and they’re often there because no one else can manage them.”

In a statement, Jackson told Guardian Australia: “[The contingency plan] is one very small part of this planning, which has already included the establishment of a Mental Health Emergency Operations Centre.

“We are pulling every single lever available to ensure continuity of care for mental health patients across New South Wales.”

A NSW Health spokesperson said: “NSW Health has plans in place to manage impacts of any disruption to the psychiatrist workforce, and to continue to provide care to those people most in need.

“However, we acknowledge this action will cause extensive disruption to mental health services and the broader public health system.”

A Ramsay Health Care spokesperson said private hospitals in NSW had historically provided more than 65% of all mental health admissions.

They said Ramsay Health Care had delivered mental health services to public and private patients for decades and had the capacity to treat mental health patients.

“Wherever possible we will increase support for vulnerable mental health patients if called on by [the] NSW government and our local communities,” the spokesperson said.

“With a shared workforce and scarce resources, it is important that public and private operators work together to meet the needs of their communities.”