July 2021

COMMUNITY PRESSURE TEST SURVEY

Wimmera Health Care Group, Edenhope and District Memorial Hospital, Stawell Health and
Ballarat Health Services Amalgamation.

INTRODUCTION

Regional Partnerships engage with community and local stakeholders around issues of concern in
local communities, to identify local priorities and place-based solutions for issues. Partnerships also
have a role in providing information and advice to the State Government about local and regional
issues.
Partnerships work across all government portfolios and with the three levels of government to
explore and address issues facing rural and regional communities. They build on and complement
existing regional leadership and working groups and strategic planning processes, providing a
community perspective into government policy and projects.
Issues of quality and availability of public health services in the Wimmera Southern Mallee have
been identified as a priority of the Wimmera Southern Mallee Regional Partnership. The response
provided by the Boards and CEOs of some local health services to support an amalgamation of
services with Ballarat Health Services, may address this concern, but a lack of available data and
information relevant to the provision of health services and the benefits of change has made it
difficult for the Wimmera Southern Mallee Regional Partnership to provide advice to Government
about the support (or otherwise) of these proposed changes.
The knowledge that the Wimmera Base Hospital is the largest employer in Horsham and provides a
“base” for other hospital services in the region adds a further level of interest in the broader social
and economic outcomes which may result from changes in this space. This is an important
consideration from a regional development perspective, as the flow on effects from changes within
large employers to the region, can be significant, and have unintended consequences.
The level of support within the community for the proposed changes that had been communicated
by Health services was also identified as an area requiring more independent investigation.
To this end, the Wimmera Southern Mallee Regional Partnership asked Wimmera Development
Association to support a short regional survey to test community awareness of the proposed
changes, and the level of information that has been communicated to see what appetite for change
exists, and what some of the concerns around the proposed changes might be for community. This
will help ensure these concerns will be appropriately considered by the Minister for Health, and the
Health services themselves in their own engagement activities.

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THE SURVEY

Over 400 people completed the survey. The survey was conducted online using WDA licensed
product SurveySparrow between July 14 and July 31, 2021.

The survey was communicated via local media, (newspapers and radio) in collaboration between the
Wimmera Development Association and Wimmera Southern Mallee Regional Partnership.
The Survey asked seven questions to test for community awareness about the proposed inter-
regional hospital amalgamations. These were:

1. How aware are you of the proposed amalgamation between Wimmera Healthcare Group,
Stawell Health, Edenhope Hospital and Ballarat Health Services?
2. Did you participate in community consultation sessions about the proposed changes?

I participated in consultations by - Survey

I participated in consultations by - Workshop

I participated in consultations by - Social media

I participated in consultations by - Consultation session held in a Main shopping area

in your town

I participated in consultations by - Via Letter writing/email

I participated in consultations by - None of the above

I participated in consultations by - Other - Other

3. Do you feel like you have enough information about the proposed changes and the likely
impacts on your community?

4. From what I have heard about the changes proposed changes to the health services I think
things are on the right track?

5. Do you feel like you have enough information about how the delivery of health services in
your region may change as a result of the amalgamation?

6. I feel I have a good understanding of the changes and how it will affect my access to local
health services

7. Do you feel like you have the necessary information to understand the impacts of proposed
changes on jobs and career opportunities in the region?

Summary data (graphed) from each question is provided below:

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5
Scale – 0 = No Information & not comfortable things are on the right track; 5 = I have all the
information I need to feel comfortable.

 Response is for those who participated in consultion (85% did not feel they had enough
information)

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Scale – 0 = I have no understanding; 5 = I have all the information I need to feel comfortable.

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Scale – 0 = I have no understanding; 5 = I have all the information I need to feel comfortable.

The survey concluded with an opportunity for additional comments and questions, which have
informed the key thematic areas identified for framing current questions and concerns about the
proposed amalgamations in the next section of the report. This provided an opportunity to collect
qualitative data about people’s individual views about the communication of changes to health
services in the region, and what concerns they have (if any) about the proposed changes.

The survey also collected basic data identifying age and location by postcode, and contact details for
verification purposes only.

In terms of respondents, the largest population to respond were the 40-60 year old age group,
followed by the 60 – 80 year old age group, and then the 20-40 year old age group. The under 20
age group only had one respondent.

Postcode responses identified a strong contingent replied to the survey from Horsham and
surrounds, there was also a strong response from Stawell, and in rural areas with limited health
services that feed into Wimmera Base Hospital, including Goroke and Rainbow. There was a low
number of submissions from the south including Edenhope and surrounds, as well as from the
Warracknabeal area, which reflects that the survey does not provide a comprehensive snapshot of
the perspectives of these communities.

While the level of comfort with the level of information provided was consistently low across the
majority of survey respondents, Horsham residents consistently rated information provision
particularly low with most scoring this at a zero or one on the performance scale.

Horsham and Stawell residents also consistently posted lowest in terms of believing the current
approach of amalgamation was on the “right track.” For respondents across the region who posted
positively about the proposed changes, the comments that were provided alongside this high rating
were often about a strong need to improve services:

 “From all reports the current local hospital structure/system, lack of local health
professionals and staff shortages is a disaster. As a professional with a young family I
have often thought about relocating from this area due to poor/severe lack of
healthcare options, lack of quality medical services and subsequent poor health
outcomes. It is a genuine worry. To our family, an amalgamation can only improve a
current disastrous broken system or structure.”
 “It’s got to be a good thing had to go to Ballarat for a couple of operations that could of
happened in Horsham”
 “I think something that could bring about benefits should be supported- something has
to change to allow rural people get better health services”
 “Services in the Wimmera could not be any worse, so just do it already”

With regard to positive comments regarding the proposed amalgamation and information provided
about the changes, comments highlighted motivated personal engagement as key to accessing
information about the proposal, and a need for wider communication of the positives of the
proposal:

 At first I felt caught up by the hearsay, but I realised a lot of community members say
things without any factual reasoning behind their statements. Things like “they

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 obviously decided this a long time ago,” “they didn’t listen to any consultation,” “all our
staff will be sent away” which is based on nothing but assumption and rumours. When I
took the time to read all the information that had been presented, my opinion changed
completely. Not a lot of people are taking the time to think about what’s going to
happen to our hospital (EDMH) if the board had chosen not to join the amalgamation.
 I hope that in the coming months we see a more equal representation of reporting of
the partnership process and the potential benefits such as most importantly improved
health access and outcomes for the region, further career opportunities for employees
and workforce development in the region and no net job losses or loss of current
services.
 Yes, I thank the boards for all the work that they have done in exploring partnerships, I
know that it was not an easy decision and was made using their heads not their hearts.
We really need to be a relevant health service for our communities. I would be
concerned that if we remained in our current state for example Edenhope, decline of
acute patients and aged care residents would not remain viable. The hospital is one of
the biggest employers in Edenhope and I worry what would happen to the town if we
lost the service. Long term I believe that working together is the right way to go.
 Without amalgamation some of these smaller town health services will fold.

COMMUNITY THEMES & EXPECTATIONS (QUALITATIVE DATA)

From the request for additional comments which was provided at the end of the survey, we were
able to identify six clear themes. This highlights areas where additional information is required:

1. Cultural Issues/transfer of power

2. Lack of Clarity of Information
3. Lack of Information about how attraction of skilled professionals will improve
4. Lack of information about impact on ancillary services (local jobs)
5. Impacts on other health services in the region
6. Impacts on aged care delivery

Indicative qualitative responses within each of these six key themes are identified below.

Cultural Issues & transfer of power

There were a range of concerns highlighted about the likely transfer of power and control away from
the region, with an amalgamation, highlighting strong concerns about the gradual erosion of control
over service provision with time. Elements of history also came through in understandings around
the long-term outcomes of amalgamations and mergers in the region.

 In the 1990s Horsham Technical School and Horsham High school merged. What was
promised never happened and it was a mess for students and staff for ten years. The
University came under the wing of Ballarat – another mess. If the current hospital
board does not have the ability to expand and develop health services for our town, get
off the board and don’t give our hospital, services and jobs to another hospital 200km
away.

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  I don’t believe that shifting power to Ballarat will give better services to the Wimmera
Mallee region. My belief is hat Wimmera Mallee people will be forced to travel to
Ballarat to receive treatment. Specialists will no longer feel the need to travel two hours
each way to see patients.
 If there is a merger with Ballarat, I am afraid our region will end up with less
representation in the decision-making process. I am afraid of losing critical jobs and
services for our region.
 past experiences show merges such as these only ever result in loss of services and jobs
 Terrible decision. There will be no amalgamation as eventually everything will be
managed from Ballarat even though they say it wont. The big organisations keep getting
bigger and the smaller ones will loose their identity and as a result loose services and
jobs. Of course all the media statements will say otherwise, believe me in 10/15 years
time this is exactly what will happen.

Also identified was a sense of inevitability, coupled with concerns about whether the wider
expectations of regional Health services as a service for the broader community, and the community
sense of ‘ownership’ were understood and acknowledged:

 I feel the public was never listened to and I believe that it was a done deal. I do not
believe that WHCG had any intention of listening to the concerns of Horsham citizens
 I feel this more about management rather than delivery of services. With the best will
in the world this will lead to a gradual centralisation of decision making to the detriment
of service delivery, especially in the smaller Healthcare campuses. With the centralising
of management will inevitably come the centralisation of services. I severely doubt
whether in the future the CEO or management team of the newly amalgamated Health
Care Group whatever it will be called will have a clue where Goroke or Beulah are much
less have any idea how much these services mean to their communities.
 Local people have contributed time, resources and funds to the WHCG and we are
entitled to securing all current services and support as well as directing improved
services to the Wimmera region. A centralised health agency does not provide the
needed local empathies and resources that a regional community-based health service
can provide. Many of us locals are against ANY merger but would welcome changes
which provide improved medical services to the region including regular specialist visits
for consultations as a premium cost if necessary. And remove community board
members who says they commit to local issues when they take the opposite voting
stance.
 Instead of merging, lift Horsham’s status as a regional hospital. Now this is one option
the health services should have explored! If state is not providing incentive for
Wimmera to take the lead showing the rest of state how regional and sub regionals
merge, why should the health boards here blindly give away the turf they are tasked to
manage?"

Lack of Clarity/Information

A further strong theme in the qualitative data collected was around the provision of information
about the proposal, identifying a lack of clarity around the problems the hospital was seeking to
address, as well as how the strategy of amalgamation would prove effective in improving services:

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  I need to know more about people’s agendas and why this shift is being done to help
make an informed decision. Just because a system is bigger does not mean the service
is better
 I am aware of the merger via media, but there is no clear communication on how the
level of service will improve
 I am proactively reading all information I can get regarding this amalgamation and still
feel very uninformed. I feel like the community is not being told everything. There’s a
feeling of an elephant in the room and no one is addressing it. Hidden agenda is what it
feels like.
 The survey asked if we wanted more services with no implication that the yes answer
was yes to the amalgamation. I felt that was misleading and loaded to yes being Yes to
amalgamation. Should have been a separate question.
 Not enough information has actually be shared with the community about what the
changes will actually mean. Stating that we won't lose services or etc. is not enough
information to be able to understand what exactly the changes are going to be and the
impact that it is going to have. I also think communication around the proposal, and
now the confirmation that it is going to amalgamate, has been very poor with the
community and has therefore caused a great deal of stress and anxiety for the
community that was not needed.
 What problems does the hospital now face? and how does amalgamation solve them?
 From my observation the general public feel as if they have been left in the dark
regarding the amalgamation. The board have continually said that the public
consultation has been very positive, what public consultation?
 Its difficult to have a strong position given the limited knowledge ie what's the problem,
is this an outcome a proxy of poor management or a systemic funding problem?

Lack of Information about how attraction of skilled professionals will improve

The qualitative data identified issues with communication around how amalgamation will improve
the opportunities to attract skilled professionals to the region:

 I do not understand when Horsham struggles to get skilled doctors to the area, how it
would make a difference being merged with Ballarat. Skilled medical professionals can
share their time now between their ‘home’ practice and Horsham, a merger cannot
force more of these people to commit to such an arrangement.
 If doctors are not coming here now, why would they if there is an amalgamation. It may
be in their 2 year contract but what will happen after. If they indicate they don’t want to
come to the Wimmera will they get the sack?

Lack of information about impact on ancillary services (local jobs)

A further consideration was around the issue of jobs, recognising Hospital services as the largest
employer in Horsham and significant employers in Stawell and Edenhope. Concerns about the
ancillary supports provided by hospitals, such as laundry services as well as the links of hospital
services to local contractors was highlighted as a concern:

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  I have major concerns regarding the impact the amalgamation will have to our existing
health services, and I am also concerned about the impact on employment
opportunities in this sector and the flow on effects for the region
 Dollars lost to our community and local businesses will be significant. Job losses to
Ballarat and centralized systems will be negative to Horsham. So many services will be
contracted out, cleaning, kitchen, laundry. When Board members make decisions and
do NOT live in the region, what do they care about the on-going effects to our
community. I wish they would explain how better services will be available when this
has been an age old problem, they have no idea !!! The article in last week's Weekly
Advertiser was spot on, everything about the amalgamation for Horsham is negative.
 What happens to local jobs? Shifting normal Hospital job centres such as Laundry,
payroll, accounts etc - where does that leave young people looking for work?

Impacts on other health services in the region

There were a range of views around the impacts of the proposed merger on the smaller hospitals of
Edenhope and Stawell, with some of the positive comments listed above. However, the qualitative
data also showed a lack of clarity around how these services will be supported, and other comments
demonstrated concerns about the services not included in the new amalgamated model:

 Minimal Communication to Community, I believe decisions are made and notification to

community is a mere formality. Travel and wait times will increase and the far reaching
campuses will become a “ dumping ground “ for our elderly and aged services. Big
Mistake.
 WHCG only services Horsham properly, not their Dimboola campus, hard to imagine
they will treat Edenhope any differently, Edenhope will be much worse off.
 The Wimmera Base hospital is just that - a base for the Wimmera medical fraternity.
There is a tremendous opportunity to gain efficiencies from other Wimmera facilities
(Warracknabeal, Edenhope, Nhill etc.) by running an effective hub and spoke. Making
the Wimmera Base hospital 'a hub of a hub' makes not sense at all."

Impacts on aged care delivery

The other major area to be identified as an area of concern was around the provision of aged care
services, with a particular focus here on the services provided by Wimmera Base Hospital. The
community utilising these facilities expressed concerns about a lack of communication with residents
and families regarding proposed changes:

 To date, the nursing home, CEO or the Board have not communicated with family or
residents of the nursing home regarding this proposed merger at all.
 I have real concerns that the nursing home will continue to decline as we have no
information on how the merger may/will effect the nursing home.
 My concerns are mainly regarding Wimmera Nursing Home...where communication re
proposed changes has been zero to residents and families ...that I am aware of. I feel
somewhat remiss in that I have not actively enough sought information- though I did
ask the question of the CEO a few weeks ago...with ambiguous and non clarifying
response.

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CONCLUSIONS

The data collected by the Wimmera Southern Mallee Partnership Pressure test survey conducted in
July 2021 identified that communication about the proposed changes remains a concern, and that
there are a number of key areas where information needs to improve for the community to be
effectively engaged.

It is recommended that action to improve communication include the release of the Business Case
developed by participating Hospital Boards to justify decision making around the decision to
amalgamate, which will provide a stronger evidence base to support broad public communications
by PR firms engaged by the Hospitals involved to communicate key messages.

The survey acknowledges that a range of views around the proposal exist in the region, but that
communication around the key benefits and costs of the proposal, and promotion of both costs and
benefits needs to be clear. Specific concerns identified through this survey also need to be
responded to, and the Wimmera Southern Mallee Partnership would encourage the development
and monitoring of performance indicators for impacts around jobs and services as this is a significant
regional issue given the role of health services as employers and contractors of services in the
region.

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