Publication Date 24/02/2011         Volume. 3 No. 2   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the March 2011 edition of i2P.
The month of February has seen free enterprise in the pharmaceutical industry breaking out of the mould that is regulated health and upsetting any semblance of balance within community pharmacy.
Government negotiated price reductions with Big Pharma collided head-on with the new business model from Pfizer Direct and its potential to destabilise the entire supply chain process and the supply of medicines under the PBS.
This process has been described in eloquent detail by Neil Retallick, in his article “New landscape, new directions, new Government role in community pharmacy?”

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A Can of Worms- The Story Continues

Neil Johnston

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Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

The NSW state elections began in earnest 16 days ago on the 20th February, 2011, when Barry O'Farrell launched the NSW Liberal and Nationals Election Campaign.
The following is an excerpt from his speech titled “Time to Start Real Change for NSW”.

“I was first elected in 1995 – the year Labor went into government.
It’s been a sixteen year lesson in how not to run government.Never before has Australia witnessed such a scandal-plagued government, a parade of MPs hauled before ICAC Ministers sacked for corrupt, disgraceful and embarrassing behaviour.
A record number of MPs quitting because they lack the courage to front up and answer for their role in the sorry mess that is NSW Labor.
And that’s why the next 34 days are about starting real change.”

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The 26th March 2011 is election day and Labor is tipped to retain only 13 seats and that will prove a massive loss for Kristina Keneally, the first female premier of NSW.

Against this election backdrop there are still real people trying to survive in business and make a difference in their chosen vocation. They are also trying to come to grips with a government in NSW and elements of the bureaucracy, who have forgotten what ethical boundaries are.

They seemingly exhibit behaviour and an absence of standards that make it impossible to sustain a progressive business relationship.

In the home page edition of i2P published on March 1st 2011, the feature article described a small business involved in health information technology systems, that was caught up in a NSW governemnt quagmire, where sevices had been provided for NSW Health but remained unpaid in excess of 45 days.

Many invoices in fact, alleged to have not been paid for up to six years.

Phil Clare, the owner of the business, was not only deprived of his cash flow, but also had to stand by and watch his current contract cancelled with no hope of a renewal.

Effectively, he had been blacklisted for simply asking for his money, and in desperation threatened to resort to legal action for recovery.

During the preparation for, and in the implementation of various contracts undertaken for NSW Health, it was found that that in a number of instances, NSW Health was in breach of an alleged range of regulatory and legislative issues that could prove extremely embarassing for the entire government.

When the contract with Phil Clare was cancelled, these issues still remained.

While the original contract called only for surplus asset management, what Phil was able to demonstrate was that if they did not manage all assets of value less than $10,000, (they were only trying to manage assets above that value), they would simply need a better system than the on they had.

Phil described this as a “turning on the lights” experience for the decision-makers of NSW Health because of their low level of experience, and he even had to brief and educate their consultants, Ernst & Young, so that they could better advise their client on the process.

These numerous reports and information papers prepared have now been used as a base by Health Support, the agency involved in the preparation of tenders for governement, to prepare the current tender (number HT10005) for “Integrated Asset and Facilities Management Software Support and Implementation Services”. It has been prepared with uncharacteristic speed given the time between cancelling Phil's contract and the preparation of a new tender.

Applicants are to lodge their tender by March 29 2011, just a few days past election day but well within a time frame to officially lock in the winner of this tender.

Of course, the above tender replicates the exact work that Phil Clare had successfully tendered for at an earlier date, most of which still remains unpaid.

It will be intriguing to find out who the winners of this tender will be.

I2P is betting that it will be IBM in conjunction with Thiess as part of the Infrashore Consortium, or an alliance partner with a different name.

Scott Gartrell, an original employee of Thiess and the short-term adviser to Carmel Tebutt (Minister for Health) has now recently emerged as CEO for Infrashore, the consortium with the contract to develop the Royal North Shore Hospital in Sydney.

He is a person who would have had access to a range of confidential government-held information, including the “know how” of Phil Clare's organisation.

It is a requirement for all government tenders that full information be disclosed so that government can evaluate whether the various systems are practical and will actually work.

He has been reported to ICAC by the Opposition health spokesperson, and he appeared last November During his appearance at the commission in November, Jeremy Gormly, SC, asked a final question.

''You'll appreciate the issue concerning cooling-off periods for people who have come out of government positions and then move into private positions where relationships or knowledge can appear to be sold.

''The only question I have about that is whether you consider that there is a material difference between the departmental officer on the one hand and the ex-minister on the other in terms of the length of the cooling-off period.''

Gartrell: ''I don't see any reason for any difference.''

It is also a fundamental condition of a government tender that the tenderer has no knowledge of any other tender, including prices.

While Phil Clare's original tender and his numerous reports are regarded as obsolete by NSW Health, it does give a basic blueprint for price and method that would be invaluable for a new applicant.

But where are the boundaries?

There is supposed to be a twelve-month cooling-off period for ministers and senior advisers when they move into private enterprise and begin dealings with their old department.
Here we have Scott Gartrell with a long history of moving in and out of Thiess (or associated entities) seemingly at will, and not missing a recent beat when he took up his position at Infrashore.

How can this be?

i2P has a proposition for Barry O'Farrell, the likely premier after the election.

If he wants to bring the state health budget back into line, he needs to move towards encouraging (even funding) consortiums of Australian-controlled vendors.
Only then will he stop the haemorrhage of taxpayer funds that eventually benefits other countries to Australia's detriment.

It is a given that it might take a little while to come up to speed and development mistakes would be made.
But Australia has the potential to provide a first class health system using its own local brains – it only needs the chance and a different government culture to rise from the current mess.

Global vendors are renowned for transplanting systems into Australia that have been developed in countries like the US or in Europe and finding, quite cynically, that they do not work under Australian conditions. Nor will these vendors rewrite their code to properly adapt these systems for Australian conditions.

The IBM system called “Maximo” for use in asset management and tracking has been utilised a number of times by NSW Health with problematic results and wasted dollars. It is possible that it may resurface again under Tender HT10005.

Only recently, another debacle occurred through the use of Cerner's FirstNet System that runs the Emergency Departments of NSW public hospitals.

“Difficulties retrieving patient records could delay treatment, and the system - on which $115 million has been spent - automatically cancelled pathology and radiology requests if the person was transferred from the emergency department without checking whether these were still needed”, according to the study by Jon Patrick, the director of the University of Sydney's health information technology research laboratory.

The Cerner system is so compromised that it has been recommended that it be scrapped.

''When do we stop throwing good money after bad?" said Dr McCarthy, who heads the emergency department at Prince of Wales Hospital. "Anything that takes staff off the floor to spend their working time on an inefficient IT system is a detriment to patients."

The project, part of a 10-year electronic medical records plan intended to make patient histories, X-rays and test results accessible from any hospital in the state, had proceeded too fast - apparently because of contractual obligations - for clinicians' feedback to influence it, Dr McCarthy said.

The potential for records to be linked to the wrong patient raised a serious risk they would be given incorrect treatment, she said, and the inability to compile multiple patient records into reports meant doctors could no longer evaluate new treatments or disease epidemics. "Simple audits and research projects are just impossible now," she said.

Phil Clare stated, “I also reported to NSW Health that that the Cerner/EMR First net was flawed, and I wasn’t picking on the software, ( it had enough of its own problems). My interest with the “blowout “of revenue was to do with the hardware.”

Meanwhile, i2P will be keeping a watching brief on the activities surrounding Phil Clare's difficulties and we hope that at some early date this injustice will be reversed.

Look out for the winners of tender number HT10005.

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