Disarray in Bay’s sex abuse service

An article from New Zealand Doctor magazine by Lucy Ratcliffe

Seven months of negotiations have failed to bring agreement on who will deliver a new model of sexual abuse assessment and treatment in the Bay of Plenty.
Western Bay of Plenty PHO has pulled out of contract negotiations for the ACC-funded Sexual Abuse Assessment and Treatment Services, or SAATS, because concerns couldn't be allayed. Bay of Plenty DHB isn't impressed. "The PHO's decision has resulted in seven months of lost time and is very disappointing," DHB chief executive Phil Cammish writes in a report to his board.
What's more, other PHOs are unlikely to step up because of capacity and capability issues, Mr Cammish says.
Western Bay of Plenty PHO chief executive Roger Taylor says contract negotiations ceased mainly because of the DHB's reluctance to provide an appropriate facility to undertake the assessments in Whakatane, and contract terms relating to management fees and fee-for-service.
The contract's draft terms included an "exceedingly poor" management fee, and in response to that, Mr Taylor says, it was stated clearly in the fee-for-service component that any savings made during delivery of the programme could be thought of as a management fee top-up and retained by the PHO.
Mr Taylor says the PHO wanted absolute clarity about what the money could be used for.
There were also clinician concerns about a different ACC issue - the new clinical pathway for sensitive claims.
The new pathway, begun last October, was designed to tighten controls over sexual abuse claims. Changes included a new requirement for a DSM-IV diagnosis in order to access ACC-funded therapy.
The organisation Doctors for Sexual Abuse Care says this has removed the ability of many individuals to access timely psychological support.
The PHO agrees.
Mr Taylor says: "At a time when we are endeavouring to grow the number of doctors and nurses involved [in this service], the uncertainty and concern make them think twice."
ACC's programme manager for SAATS, Kendra Sanders, says she was not told of concerns about the new clinical pathway.
The pathway and SAATS are two separate matters; the pathway deals with mental injury and SAATS deals with physical assessment.
The SAATS contract replaces what was previously known as the DSAC contract held and delivered by doctors trained by the DSAC organisation.
It is intended SAATS will continue to be delivered by DSAC-trained doctors or clinicians with appropriate training as the contracts are finalised and rolled out nationwide. Fourteen DHBs have finalised their contracts so far.
Ms Sanders says the new SAATS model was developed by ACC, the Ministry of Health and police after the DSAC workforce came near crisis point in 2006.
ACC's manager of treatment and rehabilitation services, Phil Wysocki, says SAATS is designed to be a more comprehensive model of care allowing consistent coverage across the country.
The SAATS contract is now held by DHBs, which contract providers to run the service.
DSAC national manager Hayley Samuel says this is the first the organisation has heard of clinician concerns about the clinical pathway interfering with the SAATS contract negotiations.
Bay of Plenty GP and DSAC coordinator Jillian Caisley was not aware of the concerns either, but Mr Taylor maintains there are clinicians not yet involved in delivering a service, for whom such concerns preclude involvement.
"The DHB is aware of our position and dialogue continues to occur," he says.
The DHB declined a request for an interview on the matter.
In a written statement, Grant Pollard, acting general manager of planning and funding, says the DHB is in discussions with another provider.
Meanwhile, as New Zealand Doctor went to print, ACC minister Nick Smith announced the new pathway would undergo an independent clinical review, with a report due back in July.

http://www.nzdoctor.co.nz/in-print/2010/may-2010/05-may-2010/disarray-in-bay%E2%80%99s-sex-abuse-service.aspx