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AM: Congratulations on being elected as the Minister for Health.

RC: Thank you very much.

AM: Health accounts for almost a third of government spending. You have proposed projects that will require further investment. Are there early indications of a black hole and that things are worse than expected?

RC: There is a black hole but we were aware of it. We’re cognizant of the fact that the State’s capacity to fund growth and recurrent expenditure while concurrently meeting debt requirements is significantly curtailed. These are constrained fiscal times but that doesn’t inhibit our passion for ensuring we meet our election commitments, all of which were costed prior to the State Election. It’s about maintaining the discipline to ensure we can deliver a budget that also delivers on our election promises.

AM: During the election campaign, do you think there was doubt in the public’s mind about the Liberal Government’s performance in Health due to the problems, for example, at the new children’s hospital (PCH)?

RC: There was certainly recognition of the problems at PCH. But to give the previous government its due, it also got public acknowledgement for undertaking those big hospital projects. That said, you have to be able to deliver health services and that’s where the previous government had been challenged. The problems experienced with commissioning Fiona Stanley Hospital (FSH) and the continuing problems at PCH are testament to what happens if you don’t do these things properly.

AM: In three and a half years’ time, what would you regard as your successes?

RC: I would want to have a significant reduction in ambulance ramping. I’d want the public to be satisfied that median waiting times for elective surgery had stabilised or reduced. In broader terms, I want to be able to say to the public that we approached the Health portfolio with an agenda of innovation, integration and culture change. We will embrace innovation by delivering healthcare in a manner that is more responsive to the needs of the patient, e.g. medihotels. We will pursue a greater integration of primary care and secondary care services, rather than the current siloed approach. And finally, we will drive culture change by embracing the data and technology that we now have at our disposal to facilitate a more nimble system. That is why we discussed patient opinion during the campaign – it’s about making sure that good hospital leaders are plugged into the needs of the people they serve.

AM: Labor said it wanted to reduce the number of public servants. The AMA believes WA Heath is bureaucracy heavy at the expense of clinician culture. Can the new health boards assist in redressing this?

RC: The health boards present a great opportunity to invest in the leadership of our hospital system rather than the leadership of our government departments. What I really want to see our health boards do is focus on the way we deliver services in their areas and work with clinicians at the front line to ensure that we are constantly reforming to deliver more efficient, high quality and safer services.

AM: When can we expect to see the first medihotels in Perth?

RC: By the next election, we will have medihotels fully operational at FSH and Royal Perth Hospital (RPH). We have had early discussions with the Department of Health about how we might bring services on sooner rather than later at RPH. For instance, in Victoria they rent whole floors of a hotel. My preference is that we have a facility that is actually run by the health service; by people committed to operating a medihotel rather than a hotel. Of course, FSH will have to be a standalone facility given there is no hotel within 8km.

AM: What size would you consider?

RC: All our costings were based on 100 rooms. However the health department is developing business cases to help us consider the optimum number of beds needed and the best way to engage in the procurement, construction and operation of the medihotels.

AM: Will they be used by patients only, or to house regional families too?

RC: We want regional families to be considered within the scope of the medihotel but not to the point where we displace patients or undermine efficiencies gained. Medihotels can boost hospital efficiencies significantly by achieving better bed flow and improved services to patients, particularly those travelling from country areas.

AM: Are Urgent Care Clinics (UCC) part of the solution to ramping?

RC: Urgent Care Clinics represent a partnership with the Primary Care sector and we are considering a range of models. While we must manage demand at the front end of hospitals, we also have to manage the supply of beds at the back end. In that sense, medihotels can play a more significant role in improving patient flow. Urgent Care Clinics are about the front end – ensuring lower acuity patients have alternatives besides presenting to emergency departments especially on weekends and after hours.

AM: Will Urgent Care Clinics incorporate access to After-Hours facilities?

RC: Yes. It is also about getting patients on a Primary Care pathway rather than a hospital care pathway. This is particularly pertinent when we have to manage frequent fliers in emergency departments and patients with chronic diseases.

AM: The Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025, released 16 months ago, remains funder neutral. What is your plan for the Plan? How will you tackle the Mental Health space?

RC: We will continue the purchaser model, with the Mental Health Commission (MHC) securing services though the Health Department and the NGO sector. I don’t think we will see significant change in the strategic approach to Mental Health. What we need is increased capacity, particularly in relation to adolescent mental health. We have too many kids spending far too long in EDs and we have to find ways to get them care sooner – be it acute or step-down. I’ve had early discussions with the MHC and they are more than aware of the challenges that confront our mental health system.

AM: What are your plans for the long-running issue of Graylands Hospital?

RC: This has been one of the great lost opportunities of the Barnett Government. When they came to power in 2008, there was money set aside in the forward estimates to expand mental health services at Osborne Park Hospital. What that would have done is provide us with capacity in the system to close down wards at Graylands much earlier on. The Barnett Government pushed that funding out year after year, ultimately axing it altogether. So now we are back to square one, where we were prior to 2008.

AM: Except that we have had eight more years of deterioration at the facility…

RC: Exactly! I’ve been to Graylands and it is very confronting, particularly the Murchison and Smith wards. I want to ensure that this is a priority for the McGowan Government. I have already had discussions both with the DG of Health and the Mental Health Commissioner about how we can move forward here. I understand there are some plans and we have to work out, through the budget process, how quickly we can bring them to bear.

AM: We can’t talk about Graylands without mentioning other ageing infrastructure such as RPH and King Edward Memorial Hospital. How are you going to prioritise these dinosaurs?

RC: Unfortunately, we have these very expensive but beautiful hospitals in PCH and FSH standing in stark contrast to the neglect at RPH and King Edward Memorial Hospital. That’s one of the reasons why we have initiated a Sustainable Health Review. We want to take a fresh look at how we can best address the needs of the hospital system given the lack of resources we have been gifted by the previous government.

AM: You got out of the blocks pretty early with voluntary euthanasia. Why do think the time is now?

RC: Polling has consistently showed that the Western Australian public strongly supports the principle of euthanasia and want their politicians to take a lead on the issue. Ultimately it will come down to a private member’s bill introduced to Parliament with MPs making a conscience vote.

AM: Who is likely to introduce the bill?

RC: I understand there are a number of interested members. Minister Alannah MacTiernan has made her views on the issue clear as has the Premier. I was adding my voice to it. It would be of great credit to this particular generation of State MPs if we can actually get down and crack this difficult policy nut. Having said that, talking about these things is easy, legislating for them is notoriously hard.

AM: Do you have a view on how we protect the vulnerable — the disabled, the mentally ill and the people with no or limited access to palliative care — so that euthanasia would only be an option of last resort?

RC: It’s something we have to proceed with very carefully. What has changed in the debate is that there have been huge advances in palliative care. It will be up to the law crafters to ensure that those safeguards are built into the legislation.

AM: At this time, don’t we have a responsibility to really focus on improving palliative care and access to it as part of this process?

RC: There are two important observations here. One is that clinicians everywhere are going to play a very important role not only in terms of sharing their real life experiences with patients who are facing death but also by continuing to provide a moral authority in relation to people who are confronting this daily. The second observation is that people have a right to a good death and we need to consider the full range of policy issues that impact on this. I am very much guided by Dr Scott Blackwell in terms of this issue and the advice he has given me about how we need to continue to make palliative services an important part of healthcare delivery.

AM: Where are we going to find the solution for the disaffected youth of the meth generation?

RC: This is a huge challenge for us. During the election campaign, Mark McGowan discussed our Meth Action Plan. If nothing else, that will hopefully give us a mandate to get all the relevant government services working closer together to produce a more meaningful response. The impact of drug abuse and addiction on our community is enormous. It is now part of our collective existence and as a society we have to respond to it.

AM: Would the Labor Government look at the Portuguese approach of decriminalising drug possession for personal use and making addiction a health issue rather than a law and order issue?

RC: I think the WA Electorate is ready for the debate, an actual open discussion to make sure that as a community we are aware of all the different approaches to drug abuse and addiction.

AM: There is a perception that the previous government was naïve in contracting and overly ambitious in scope. There are the examples of the Serco contract at FSH, and the empty carpark in the children’s hospital, along with IT debacles aplenty. Is it time for us to be doing simpler things rather than trying to reinvent the way hospitals are built and run around the world?

RC: I think people expect that we will provide affordable, safe health services. But the focus should be on getting it right rather than on cutting ribbons and glamorising hospital developments. At the end of the day FSH and PCH will be huge successes for WA. But we have done an awful lot in a short period of time with a department that is change fatigued. Consequently, our capacity to meet the challenges of all these new projects is limited. It’s time we actually focused on delivering good safe health services in a way that doesn’t destroy the State’s finances.

This article first appeared in the April 2017 edition of Medicus.