Silver Chain has nearly 2,5000 staff, 700 volunteers, and controls around 35% of the Health and Community Services public funding in WA, giving it a unique and leading position within Western Australia’s primary care infrastructure. Because of this unique position, Silver Chain’s CEO Mr Chris McGowan was lured across from South Australia. He has been in the job just over twelve months, having had senior preventative health and nursing management experience in SA’s public health system.
The organisation he inherited was known for its top-heavy bureaucracy, a situation Chris has been steadily changing since taking power.
“When I got here, Silver Chain had managed some risks in funding through centralising, which was probably a sensible thing to do at the time. But every action has a consequence and one of the consequences of that was that it became quite a bureaucratic organisation and the bases where our frontline caregivers are became a bit disempowered. They didn’t have much ability to finesse what they do to meet local needs, be it the GPs, clients, or other partners involved in the health system.
“We are going through a process now where we are trying to re-empower the front end of the service, retune the management system so we can get rid of a bit of bureaucracy, and credit more autonomy at the front end,” Chris said.
Part of Chris’s reforms is to maximise the use of government funding, which forms a significant portion of Silver Chain’s budget.
“Governments can’t give a blank cheque to an organisation like Silver Chain, so they need to put restrictions on us. When they put restrictions on it, they create funding streams to address specific issues – and there are not many ways around that. I have found the Department pretty savvy in this sense. Realistically, I’d expect if we were going to do things outside of the parameters they have set, you’d expect us to get that clear. Is it a frustration? Yeah, from a service providers point of view, we’d love a blank cheque.”
Because of their situation, Silver Chain does have some flexibility in how they administer their grants.
“We have switched money between programs. For example, we get designated money to run hospital in the home, community nurse referrals from GPs, and for post-acute services. If one of those is slightly busier and one is slightly less busy, we meet the demand as we need and then let the Department know. But If I took that money and wanted to do a chronic disease management program which overlaps with the chronic disease management program someone else is funded to do, the Health Department would get a bit cranky.”
One of the new directions for Silver Chain is a move towards a user pays system, Chris said, where sales of independent living devices such as ‘Virtual fences’ would help finance their operations. Chris is also keen to collaborate on the impending GP Super Clinics.
“GP Super Clinics are just a term. I haven’t heard the definitive statement on what they are. If you simply want to reduce presentations to emergency departments, you have to start asking questions like ‘where is the evidence that this works?’. You have to have to be crystal clear on what you want to achieve and bring in the players around you who have to be active in delivering that, and have them involved in designing the approach. We have said we will be collaborators in WA’s Super Clinics, we don’t see ourselves as leaders.”
Not surprisingly for the CEO of a nurse-heavy organisation, Chris sees nurse practitioners as a possible value-add to Super Clinics.
“I’ve met thousands of doctors in my time and there aren’t many GPs who would say a respiratory nurse, for example, wouldn’t know much less than they do about managing respiratory patients. The GP’s enormous job is to manage the diversity within the primary care field. Primary care has a broad role in the context of the whole person. Whereas once you start getting nurse practitioners in, they can get quite specialised. We support this model, and at the end of the day, there aren’t enough GPs, particularly in the current funding model.”