Supporting a voluntary amalgamation of three Victorian rural health services
Together for good – the client challenge
Cobram District Health (CDH), Numurkah District Health Services (NDHS) and Nathalia District Hospital (NDH) served the townships of Cobram, Numurkah and Nathalia and their surrounding communities. Given their geographic proximity to each other, they had a long tradition of working co-operatively. It was not surprising that in 2016 the Boards and the Executive of all three health services started examining how they could work together more closely and potentially combine their resources to build better and more sustainable health services for their communities. Significant work was undertaken over a three-year period (2016-2019) to build the case and the support needed for the amalgamation of the three health services.
Cube Group was brought in to support the three health services navigate the challenges and key steps along the journey to a possible amalgamation. Throughout the journey there were many and varied conversations with the Numurkah, Cobram and Nathalia communities.
Cube Group partnered with the three health services to help them explore options to better meet the health needs of their communities. Outcomes sought included enhancing the range of services available, reducing the need for consumers to travel long distances to access care, and providing clear pathways to care where services cannot be provided locally.
Bringing the right thinking and people to the table
How the three health services currently worked together was an important starting point. It gave an understanding of how the three health services were already working together to meet the health needs of their communities. Building on this we looked at and assessed options to formalise the arrangements, referral pathways and collaboration to deliver strengthened clinical governance, operational efficiencies and improved financial sustainability of the health services.
We worked with all the health services to understand the challenges and articulate the benefits of various different ways the health services could be configured and the criterion that should be considered when determining the most feasible option. A voluntary amalgamation was considered the best option moving forward.
Cube Group along with other financial and legal advisers undertook a formal independent due diligence to see if there were any potential barriers to a successful voluntary amalgamation of the three entities. No significant barriers were identified as part of the due diligence process.
The final step was the preparation of a voluntary amalgamation proposal to seek approval from the Minister for Health for the voluntary amalgamation of CDH, NDHS and NDH into a unified new health service – NCN Health. It was also unanimously supported by the three Boards following extensive community and staff consultation, due diligence assessment, and careful consideration of the benefits and issues – with focus on improving access to care for local communities.
The positive change we delivered
The voluntary amalgamation was approved by the Minister for Health and on 1 July 2019, NCN Health came into existence. The establishment of NCN Health will, over time, deliver better health services for Numurkah, Cobram and Nathalia and surrounding communities, providing effective governance of the quality and safety of those services. This will ultimately contribute to better health outcomes for these communities. Health services are a key employer in small regional centres. The retention of all three campuses as part of the amalgamated entity will continue to support local economies through sustained employment and the purchase of goods and services from local businesses.
Insights for inquisitive minds
Start with ‘why?’ – having clear objectives is an important early step and forms the basis of a ‘contract with the community’
The benefits needs to be clear and informed by evidence
Rural health services are often the largest employer in small rural towns. The employees of the health services are also community members. They are a crucial voice when having the conversation about how to improve the configuration of health services.
Contemplating joining up organisations can’t be rushed – the support of the community is vital for success.
Exploring options to deliver better outcomes does not necessarily mean organisations have to amalgamate
Good governance, strong leadership and information sharing are key success factors
“It has been a privilege to work with individuals whose sole objective was to deliver improved health services for their local communities. It could not have happened without the foresight, dedication and leadership of the three Boards.”