Brendan Docherty - Deputy Secretary for Hospitals and Primary Care

In this episode of the One Health Podcast, Dorian Broomhall, Manager of Culture & Wellbeing, gets to know Brendan Docherty, Deputy Secretary for Hospitals and Primary Care.

During our conversation, recorded back in April, Brendan speaks about growing up alongside six siblings in Scotland and becoming one of that country’s first male midwives. 

Brendan speaks about his focus upon the PERM principles as he progressed in his nursing career – that’s practice, education, research, and management.

He also speaks about resource effectiveness as a part of clinical governance and how he considers the best use of the taxpayer’s dollar. This includes looking at new ways of using our existing infrastructure to deliver care efficiently. 

Transcript

Dorian Broomhall:

Welcome to the One Health Podcast.

This episode was recorded on the land of the palawa people. I acknowledge and pay respect to all Tasmanian Aboriginal people and to their deep history of storytelling.

My name is Dorian Broomhall, Manager of Culture & Wellbeing for the Department of Health here in lutruwita/Tasmania.

For this episode, I got to know Brendan Docherty, our Deputy Secretary for Hospitals and Primary Care.

In our conversation, recorded back in April, Brendan speaks about growing up alongside six siblings in the Vale of Leven and becoming one of the first male midwives in Scotland. He also talks about the personal reasons for his moves to London and then Australia.

Brendan speaks about his focus upon the PERM principles as he progressed in his nursing career – that’s practice, education, research, and management. 

He talks about resource effectiveness as a part of clinical governance and how he considers the best use of the taxpayer’s dollar.

He also speaks about how we need to look at new ways of using our existing infrastructure to deliver care differently.

I start every conversation with the same question, so let’s get into it:

What did you want to be when you were in kindergarten?

Brendan Docherty:

When I was in kindergarten, I always wanted to be a fireman. So I'd always been the usual kids, liking lights and sirens and liking the surge of adrenaline you used to get as a kid by chasing said lights and sirens up and down the streets. And usually, of course, in those situations, in a small town where I'm from, you would know the people whose house was in fire or where the police were going to, so it made it very personal and made it very connected to the community. So yeah, I'd always been interested in lights and sirens. I'd just thought the big red bus was kind of more my thing, but not to be. But I did follow lights and sirens to a degree.

Dorian Broomhall:

And when you were chasing the red bus with its lights and sirens in the small place where you're from, where were you?

Brendan Docherty:

In a small town near Loch Lomond, and the town's called Bonhill, otherwise known as Vale of Leven is its older name. And in fact, I stayed and trained there at the Vale of Leven hospital. It was big enough geographically, covering a lot of small villages and towns to have its own hospital.

Dorian Broomhall:

Interesting. So you've got a regional background from a very different perspective to perhaps what we're used to here, yet of course that's a key part of Tasmania, our small communities that get serviced by smaller sort of places. When did you find that you strayed from the red bus and get interested in a different sort of type of perhaps emergency work?

Brendan Docherty:

I think just having the hospital nearby made a focus for our local communities. People were very passionate about local politics, local healthcare. My dad was fervent about keeping local hospitals open and the services there, and there'd been talk for a while around closing the emergency department, or closing elective surgery, or closing the coronary care intensive care units, et cetera. And so like you see in a lot of small communities, people are absolutely wed to their emergency services more broadly and a lot of the people employed by those emergency services including the local hospital. So I'd always had it in my purview, and weirdly enough, the Vale of Leven Hospital sits on a hill in the Vale of Leven, so actually it's pitched quite high up and the villages can actually see it from most houses, so it became... You'd have your church, then you had the hospital, and then the actual ambulance station was also in the hill nearby. And so these kind of hilly views of these emergency services and support services like churches were always very visible to the community.

Dorian Broomhall:

Interesting. And looking down on 17 pubs in the small town, no doubt, if the stereotype rings true of Scotland?

Brendan Docherty:

Yes, and I don't even know this, but a lot of the Scottish public houses were actually just mainly bricks and mortar with very small square windows, because back in my day, I'm showing my age now, you were never allowed to have big windows in public houses and you weren't allowed to be able to be influencing people by allowing them to look in. And so the windows were always high in the buildings and very small square ones. And so when you went in, of course it would be dark, dingy, the carpets fairly encrusted with whatever has happened there over the years. So there were never any welcoming places. Especially in small towns and villages where there were lots of churches, et cetera, they weren't places where you'd want to be seen, and very hidden, but there's lots of them.

Dorian Broomhall:

When did you decide to make healthcare your vocation? What age were you at in your life where you went, "Okay, right. I'm going to go to the hospital on that hill and train..." Had to be a nurse, I believe, you originally trained, right? Yeah.

Brendan Docherty:

So I trained as a nurse and midwife straight after, and we had a midwifery unit at our local hospital. I have got a claim to fame. I was one of the first male midwives in Scotland. I guess there was a couple of things into connecting my absolute passion in school was English and music, and I've got a LCM diploma in music as well and play a couple of instruments and was singing in regional and national choirs. So I'd always thought I would do music, in fact. And coming from a family of seven, and my mom is also from a family of seven, we were very not financially able to support me going to university, and so that was one of the decision-making things for me then, that I definitely wasn't going to be doing a degree or PhD in music because my family just couldn't afford to keep me boarded at home and fed and watered and clothed while I went off to university. And certainly, none of my other siblings had done that either or had that afforded to them.

I did have two other cousins who were the same age as me, obviously from different aunties and uncles in the family stream, and the three of us grew up through primary and secondary school together, and so the three of us were fairly close-knit. And interestingly, the three of us were fairly academic and again, a lot of our siblings, not academic, but far more practically orientated, and I can't change a ball and I can't wire a plug and I can't paint a house, so horses for courses. My cousin Allison is a lawyer, my cousin Ralph is a doctor , I became a nurse and it's something that the three of us had kind of, not conspired, but had thought about in terms of our careers around where we wanted to be. We wanted to be helping people and that was the common thread between the three of us.

My cousin Allison, who's a lawyer, is a family lawyer, and does a lot of pro bono work and does a lot of NGO work, and she has done for the last 20, 25 years. And my cousin Ralph, who's a GP, works in GP land, but actually is absolutely wed to his local community in terms of providing those GP and emergency services there. And it just made natural sense as a three as were growing up to then think, "Oh, that hospital on the hill, I wonder what is there for me in terms of lights and sirens," and still being in awe of seeing these emergency services and being really respectful and thinking, "Gosh, that could never be me but I'd love it to be me if there was an opportunity."

Dorian Broomhall:

So six siblings then, family of seven children, and you're close with your cousins. Where in the hierarchy of kids were you? Where are you-

Brendan Docherty:

I'm the baby.

Dorian Broomhall:

You're the number seven.

Brendan Docherty:

I always had hand me downs. I never had one bike, so that I'm holding onto it after all these years, but I've never had one bike. I've always had a hand me down bike from one of my brothers. My parents had to make ends meets, so my mom would spend most of the summers doing two things. Half of the summer she'd spend on her Singer sewing machine making curtains for the whole house. She was very house-proud. She would make her own curtains, make her own bed linen, and she would spend half the summers doing that on the Singer sewing machine. The other half of the summer she would then be making us clothes on her Singer sewing machine. So we had lots of clothes made for us by our mom, because that's just what she did. And so I pitched up too many of my older siblings weddings with kind of the brother just above me, he always got blue, so he had a blue safari suit, and I always had a green, bare green safari suit for that wedding. But my mom and my sister would have kind of matching dresses.

So my mom just made a lot of our clothes, and that's just how we grew up because my mom actually worked in a factory that made materials, so she would be buying material and cheap pens and stuff, so it was a good way of making things work for a family of seven.

Dorian Broomhall:

So a lot to fit in six weeks of Scottish summer, of course, to fit all of that in such a short amount of time.

Brendan Docherty:

And catch the two days of sunshine.

Dorian Broomhall:

Yeah, that's exactly right, if you're lucky. It sounds like you maybe didn't buck the trend in the family though, but you did move in a different direction, taking on this more perhaps academic vocation as even then it is probably seen. What was your family's perception of that, especially going in as a male nurse and midwife in Scotland at that time? On one hand, it's quite amazing that you're one the first, if not the first male midwife in Scotland, but the perceptions of that would've been curious, I imagine in the small town as child number seven.

Brendan Docherty:

Yeah, it was a bit weird, I guess. Of course you always reflect back and you always kind of joke, but when I was a student nurse, my mom would go at length to tell family members and friends and et cetera that I was a male nurse. And really that thing about being a male nurse really comes from TV because there'd be shows like ER and all those other hospital emergency department stories. And of course, stereotypically, the nurse in charge was a male nurse, it was a male charge nurse in charge of all these EDs, and she thought I was training to be a male nurse who's going to be in charge of whatever I was going to be in charge of.

Dorian Broomhall:

Just straight to being the boss, right?

Brendan Docherty:

And that was just our lack of kind understanding of what it was and stuff. But I mean I was particularly lucky because clearly we had half of our workforce in Scotland in those days were enrolled nurses, and so I taught a lot of my skills and art of nursing and midwifery from enrolled nurses and absolutely delighted to have had that opportunity. Enrolled nurses trained for two years rather than three, but actually were immersed in patient care and patient-centeredness, so it was a great training. But I also had lots of male enrolled nurses through my training who trained me, and therefore had lots of positive male role models around nursing as an art and a science, as I think. And so I had lots of positive role models about both dealing with the academic side and also the outside of nursing about the CARE components.

Dorian Broomhall:

I like this art and science of nursing. My wife's a nurse, so when she was going through university, I learned a bit myself when I was proofreading all the essays and all these sorts of things a few years back. But that idea that as an enrolled nurse you actually might lean more into the art of it, that focus being on sort of patient-centred... Not less on clinical, but it's that sort of slightly different blend. I hadn't really thought about it like that. It's a really nice way to put it.

Brendan Docherty:

The main difference was in the old curriculum before degree nurses, the last year was always focused on management. So the people who became registered nurses, because in theory, anyone could be an enrolled nurse all the way through their training, and two years you could opt out and say, "I'm happy to be qualified as an enrolled nurse," but you would then... Some of us would go and do the third year, and that's where you were learning to take charge of ward, learning how to do rosters, learning how to do skill mix and patient acute allocation. All those things came the third year, and I was always really impressed with the clinical driver of enrolled nurses to say, "No, I'm fine here. This is kind of where I want to offer myself to the value of healthcare in this system." And I was always so impressed with their integrity and values around that care delivery.

Dorian Broomhall:

And so you've trained in the hospital on the hill, as we'll forever now know it. What happened next?

Brendan Docherty:

By pure timing, NHS Scotland had decided they were going to do a restructure. So when I qualified and did my midwifery right away, I also got another opportunity and I did my coronary care nursing course as well, right away after qualifying, because there was a job freeze across the whole of Scotland announced for two years. And so basically, the way of keeping people engaged in the system was to actually keep sending them in courses while keeping them employed in the hope that eventually, the jobs freeze would be lifted and the new structure would be announced. And it was supposed to be six months, but of course those things, it actually took a couple of years to restructure the whole of the Scottish NHS system. So after doing general nursing midwifery and my coronary care course, feeling, I really had not consolidated very much, because I was continually on courses, that I then moved to London and got my first position in London.

Dorian Broomhall:

How long did you spend in London?

Brendan Docherty:

Probably about 15 years. So maintaining my nursing and midwifery credentials for a long time, I had a very challenging situation as a midwife about seven years in and opted to not renew my midwifery qualifications at that time. And when you're less experienced, you do reflect back and think was that the right thing to do? But that's the decision I made at the time, and then decided to then steer my way through general nursing and general management.

I had an absolute fantastic role model who I admired and adored. She held a job that I thought would be for me. I used her as my career coach, if you like. And what she taught me was sort out your practise, be a practise expert, be a clinical excellent nurse that everyone will look up to. Then use your expertise in education and training and professional development, then make sure you apply these two things into evidence and research and audit, and then you become a better manager and leader because of it. And that's called the PERM principles. If you think of PERM here, PERM, practise, education, research, and management. And that's how she had expressed her career trajectory. I followed that, and of course being a leader and the manager and understanding what research, education, training, and practise I think has helped me as a leader move forward and has given me a bit of extra credibility having worked in all those domains of the nursing, healthcare, and midwifery sectors.

Dorian Broomhall:

Another fantastic nurse who's also a leader in our organisation, Laura Pyszkowski, when we did a webinar with her for International Women's Day, spoke about this idea of identity, and as a nurse, you have that profession and you have that professional identity that goes with it, and as a midwife is a component of that as well. You talked about PERM, right? There's quite a lot to think about between all of those different buckets of stuff. So to actually make a decision for whatever reason it might be to stop doing something and not continue with midwifery as being part of your career, that's actually quite a profound thing to do and possibly what I call something that is enabling, because you can't simply do everything can you? And at some point you have to make a choice about going, "Well, how am I going to fit it all in if I want to progress into these sorts of ways." What's your approach with that?

Brendan Docherty:

I was absolutely enabled by the absolute nursing infrastructure. Like nursing has got the highest FT of course of most healthcare workers, and so the career ladders and career trajectories were far more available to anyone. So when I applied to be a lecture practitioner, when I applied to be an associate researcher at the university, when I applied to be the deputy director of Nelson Wood midwifery for practise, development, research, and education, those roles were becoming available. And so actually, grabbing those opportunities and knowing where it fitted into that pathway of four things was fairly easy for me. I'm not saying I got absolutely every job I went for, but I'm just saying being very clear on your career direction when you go for interviews and then explaining to panel where your career is going and how this role is therefore critical in terms of you actually can do the job as well as then make the job elevated before you think about your next part of your career.

It is a really important tactic in interview skills. So I was afforded, and perhaps being in London for 15 years afforded more opportunities because far more tertiary centres, far more in subspecialization, far more clarity around the contribution of practise, education, and research and healthcare practise, and far more academic relationships and partnerships to benefit from in terms of those working arrangements. And I also worked in London in the years 1999 and 2000, again, I won't give away my age, but of course that was the emergence of clinical governance and what clinical governance actually meant to following our review of practises which were variable across NHS, or in that time NHS England. And so being immersed in part of the clinical governance agenda also heavily influenced my career trajectory as well, because of course the clinical governance framework does talk a lot about education, practise, audit, clinical effectiveness, and patient-centeredness and embodies a lot of what we talk about today as national standards in fact.

The other pillar of clinical governance, which people are often... They find it hard to remember this pillar, I'm not sure why, and maybe just because it's not as sexy, but one of the pillars of clinical governance is resource effectiveness. And so when I started taking on managerial roles, I was thinking about this thing about resource effectiveness as clinical governance, how to deploy our resources, our valuable healthcare taxpayers' dollar into the business. And that's where I built a lot of acumen around efficiency, productivity, value for money, and seeing, as our learned friend, Professor Brian Dolan says, think like a patient, but act like a taxpayer in terms of how we provide these services, because the taxpayer's dollar has to be used judicially. And I didn't learn that from being Scottish, although people might hint at that.

But I did learn it through my management roles, and I was lucky in that my management roles came around the same time as clinical governance. We were also having to talk about all those other things around practise, education, research, and best outcomes for patients, and being resource-effective at the same time. And that's where it really solidified for me why resource effectiveness or sustainability in our healthcare system is part and parcel of everything we do every day.

Dorian Broomhall:

Yeah, great. I want to talk a little bit more about that shortly, because I think it's probably of particular importance for where we're at as an organisation right now to maybe think about that a little more. There's lots of upsides about being a relatively small health service unlike where you're at in London, but of course, we've got people who end up working in similar positions for a long time and don't necessarily always get invited to think about some of these things. So I think it's a really important thing to touch on. So 15 years in London, then what happened?

Brendan Docherty:

In my last year of work, I'd already started to feel that living and working in London wasn't bringing me much joy. So when you live in Brixton or Camberwell as I did initially, and travelling to Greenwich to the Queen Elizabeth Hospital where I was based would take me an hour-and-a-half on the South Circular Road. And so I leaving at half 5:00 in the morning, getting to work for half 6:00, quarter 7:00. I'd be leaving in work at 6:00 PM and not getting home till 8:00. So I had very long days, and the day that I realised that I'd never been on top of a double-decker red bus touring around London was the day I realised that maybe I was in a kind of race that I didn't want to be part of any longer.

And so after discussing that with various colleagues, I was offered a year opportunity to be the NHS improvement director for sexual health and to work with our NGO partners to revolutionise sexual health practises across the whole NHS. And it was a year position. And so I did that, and really that was a gift because they were giving me time to look for alternative opportunities for employment, because they didn't want to lose me, but at the same time knew that my last role before that was general manager and commission of critical care services for the whole of South London consortium. And so they had been great at working with me around what a transition might look like, so I was very grateful for that.

During that transition. However, and this is a bit of a personal story, but my best friend who lived in Sydney, she was split with her partner and her two children are my godchildren, and I took that role very seriously through the years, and we'd frequently be travelling to Sydney to see them. My friend Clare and I lived together around the corner from each other in London. We worked in set similar jobs together. And in fact, she was my sister when I was an intensive care nurse at University College in London. And so we've had a friendship for years. And so I opted to then apply for jobs in Sydney to help her out. She was becoming a single parent with a part-time job, a 4-year-old and a 2-year-old kid, and I decided that actually it was time for me to step up and come here and help her in a way which I could do.

So that's when I was applying for jobs in Australia, and I became the bed manager at Prince Wales Hospital as my first career move in Australia. But what that meant was that my friend then had someone in Sydney where I could take the girls to school, I could have them overnight, I could have them for weekends when Clare had to work or be away training or doing whatever. But it just meant I always had a bedroom for my godchildren and I was always there and they always had my phone, and it just meant that my friend had a bit more support. And the other option for her was to move back to Manchester to her family, but the quality of life and the quality of schooling for our children, as I call them, and Sydney was just too great an opportunity to miss, and so I opted to come to Australia and became a bed manager.

Dorian Broomhall:

What was that change like for you professionally? I know the beautiful reasons for doing that, and you're clearly at a really good time in your career to be able to take an odd and unexpected step perhaps. What was that like for you professionally then to find yourself in Sydney, Australia as a bed manager?

Brendan Docherty:

The healthcare systems are very different between the NHS... The NHS is one and always has been. I've always been part of one system. So to come to Australia, the learning for me was really, I was in this tertiary centre, which is part of a district, where every other tertiary centre in that district was absolutely competing with each other, and that district was then competing with the other districts next door, and I came into this kind of Australian competitive environment where it wasn't one health system, although it is one Medicare system. And that was my learning, and that's where I really grappled with understanding.

Because teams work differently in Australia, the health infrastructure works differently, our health systems work differently, so I had a lot to learn is the take home message. So I may have arrived on the plane thinking I can nail this so easily because I'm so experienced, but actually I did think this was time to take a step back before I could take two steps forward because the systems were so... They weren't apples and oranges. There were definitely two different beasts. So again, it was an opportunity for me. But like everything else, opportunities cropped up, and we, strangely enough, in the organisation, I was restructured, and I was restructured upwards.

Dorian Broomhall:

That doesn't happen very often, does it? 

Brendan Docherty:

No, it doesn't happen very often, but I was structured upwards, and certainly in my early days got an opportunity to work with some great leaders in that Southeast Sydney district where I worked for many, many years in various roles and guises. One of my favourite jobs was working for Elizabeth Koff. So she is a dietitian by background, so to have a coup or a exec director of operations for whole health district who is a dietitian brought me so many learnings, because she came with a very different skillset.

It's very unique to see allied health leaders in top executive or policy roles, and of course people will know Elizabeth Koff became the secretary for New South Wales Health at a later stage soon after that role, and was also the chief exec of the Children's Network for New South Wales. So she's got a very prominent, eminent career. And so I'm just grateful to had the experience of working for Elizabeth. I was our director of operations and director of clinical streams because we were implementing clinical streams at the time after the galling review. And so that's where I got the opportunity to work for Elizabeth.

Dorian Broomhall:

So you're still here in Australia, and now you're in Tasmania. What made you stay? Why didn't you go back to NHS, if not London, somewhere else? I suspect they would've welcomed you with open arms after your time away to help your very, very close friend get some stability again. What did you stay for?

Brendan Docherty:

So my godchildren are now 24 and 22, and at university. One lives in Canberra, one lives in Melbourne. So, actually, I've always been part of their life, and so it felt as if I'd made some family roots here, but I also had other friends who were moving from London and moving to Sydney as well. And so it was weird, but I set up a second home. And I'm not sure whether I call London home, because I'd always left Glasgow with the intention of working in London for a few years, waiting for the jobs freeze to finish and go back to Scotland because it was always intended that I would always work at the Vale of Leven hospital, and I'd always be a male nurse there. And so the difference between being in Sydney and Glasgow became bigger for me and became... I felt more settled in Australia and decided to apply for citizenship because I was absolutely clear that my career and my personal life would be here.

Dorian Broomhall:

And so now, jumping ahead, I know you've worked in a few different places across Australia. And what, we've had you in down here in lutruwita for what, maybe six months?

Brendan Docherty:

Five.

Dorian Broomhall:

Five? Yeah. So what was the decision to come down here? Was it job first, or was it a pretty great opportunity with this new role that you now hold? Or had you spent any time in Tasmania before you came down? What brought you down to work with us down here?

Brendan Docherty:

I did see it jokingly as a way of saving money in the first instance, because I would come to Hobart..

Dorian Broomhall:

I bet that didn’t age well.

Brendan Docherty:

... and other places two or three times a year with friends and other people. Hobart was one of my top holiday destinations. And so I would guess that if you asked any Airbnb host if they knew my name, they would all know it because I've been here so often in holiday over the last 15 years living in Australia. So I kind of jokingly thought "Well, we're certainly saving flights and Airbnb." so yes, it is the opportunity, but remembering how beautiful these lands are, and thinking about the great offering that is a fantastic social life and literal return, Hobart specifically, it's been really great moving here and feeling like part of the community. I do reflect back on my other moves across Australia and my move to Australia, and this by far was the easiest.

I feel as if Tasmania was able to wrap themselves around me, and I felt part of Tasmania quicker than any other state that I've lived in, and I think that's special. On my very, very first working day for this organisation, Dale Winton picked me up because I had to go to Davenport on my very first day, and Dale Winton drove me through the central Highlands, and that was just one of the route together as opposed to the motorway. And it is identical to Scotland, and called the Central Highlands. Probably didn't help my mind, but I could not believe how identical it was. And from my first day of work onwards, I have always enjoyed driving up down this beautiful state to see our health services and our workforce, and that brings me so much joy.

Dorian Broomhall:

Yeah, I did wonder whether you'd made those very real connections between here and there. I think this is the place that will be most like Scotland that you'll find anywhere else.

Brendan Docherty:

Of course there's a Ben Lomond, and there was a Ben Lomond at Loch Lomond. So even some of the names, and Strahan and...

Dorian Broomhall:

Yeah, that's right.

Brendan Docherty:

... Strahan.

Dorian Broomhall:

And our whiskeys even pretty on par now too, which is interesting. So then, one thing that I've noticed since you've been here is that you've made a really visible effort to be right across our state. I think sometimes, no matter what industry you might work in, we get seen as a Hobart-centric state because it's where the bulk of the population is and often where the bulk of corporate services or leadership might sit. Very important to note that you've made a real presence or made a real effort to have presence across the state. What have you found? What have your observations been in five months of working across our organisation?

Brendan Docherty:

So I've learned about the passion Tasmanians have working in the health system, and whether that's primary care, rural care, tertiary care, whichever part of care they're delivering, social care, Tasmanians definitely have a passion for what they do, and that's been very clear from day one for me. What I've also learned though is we've got lots of services so geographically spread-out, and in fact more spread-out than other jurisdictions I've worked in. And we're so focused on sometimes the bricks and mortars of our four main hospitals that would forget about all those other services, because actually those other services are delivering the majority of care. And so that's why I'm really keen to connect up and down the state to make sure we create meaningful hubs and spoke models, meaningful models of care, meaningful connections for our workforce and for our patients.

And of course, when you go to some of our smaller regional or rural places, again, like where I grew up, people are passionate about the services they've got, be it health, ambulance, social, education. They're absolutely passionate, and absolutely holding onto it for dear life. And so that's the passion you see. And I'm actually a firm believer that I'm a very small cog in this system, and my job is to enable the bigger cogs, and that probably includes community members and patients in rural and primary care settings, to help us define what good primary care looks like for them. And I can't do that from an ivory tower or a desk in Elizabeth Street. I need to be out there hearing it and experiencing it.

And I guess the other benefit of going up and down through the state is, so for example, when I stay in Burnie, I've got a favourite coffee shop I go to, and when I go to that coffee shop, the staff and the customers are so warm and welcoming even though they don't know me from Adam. They all stop and have a conversation. They all check on how I'm going, and they're curious to know who I am and because I'm kind of new in town or whatever. But weirdly, I found that friendliness and that ability to kind of be curious and find out who you are in the community increases as you go north, and more northwest. So that's been quite nice to see. And it's not to say that people in Hobart are kind of... think they're special. It's just the level of curiosity tick goes up as you go up through the states.

So I've really enjoyed meeting the communities and hearing from them what they think about services. I don't say secret shopper, but clearly everything they tell me is usually relevant to education, emergency services, health services. So usually people's kind of conversation is geared around something like that, and they're all really good ways of us to interconnect and integrate our systems together. I've always thought the artificial divide between social and healthcare has been too broad and too breached, and I would love to work with our communities more around how we bring them a bit closer together. And you'll know in the NHS, not that NHS is platinum standard by any means, but the NHS does have a more smoother social- and health-integrated model because of the funding methodology that's used there as opposed to the Australian funding methodology, which is very separately staying commonwealth primary care and secondary care. So just a bit more hurdles for us to navigate to make that happen for patients, but absolutely passionate about making sure it does happen.

Dorian Broomhall:

I think being able to link that to the voice on the ground, not the voice that we read in the newspaper, but the actual voice on the ground, which is underrepresented in so many conversations that to make sure that that's actually what we're linking purpose, direction, all of these things that you're working towards too, yeah, I think is super important. I think it's really great, role-modelling that you're out and about doing these sorts of things.

I want to go back to something that you said earlier around this idea that people working in the Tasmanian health system are very passionate and they care deeply about the work that they do and they take it very, very seriously. Some of those words are mine, not yours. I want to link that then to this idea of, perhaps, ownership of resources. How do you think we can do that better? How can we connect that passion and that deep care we have with that business acumen, that ownership on sustainability around finances, but I think also people become really important in that as well. How do you think we can approach that idea that I do think we need to do differently?

Brendan Docherty:

Yeah. It's the 6-million-dollar question at times, isn’t it, across most health jurisdictions. The health funding, federal and state pie is not getting any bigger. It's really how you slice it that makes a difference. And whilst I'm always nervous about using the word productivity, especially post-COVID, there is a lot more we can be thinking about in terms of our healthcare delivery systems. We still have opportunities to modernise our models of care. I was delighted to see the media release from the Australian Nursing and Midwifery Federation around the scope of practise and autonomous nature for nurse practitioners and midwives. So no longer having to work under the scope of a medical practitioner to guarantee their practise, so that will absolutely liberate our nursing and midwifery roles going forward in terms of modernising models of care. We do need to think about our workforce and those instruments in terms of that kind of resource effectiveness.

So when you think about our primary care locations and some of our regional and rurality, what happens when the nurse is off sick? How does the admin staff, the GP, the aboriginal health liaison officer actually change their scope to then still deliver a service consistently even though the nurse is off sick? Because we're currently in a system where we're so union professionally defined, which isn't anyone's fault, it's just the industrial instruments that we work within, that actually sometimes it's hard to say, "How can we cover this person or this gap in service provision?" But I think that's an opportunity more than a constraint. So we need to get better at thinking about how we maximise our human resources, as well as sweating our infrastructure resources because we still have a model where we focus a lot of our service delivery in five days a week.

Now that doesn't mean we have to fund them seven days a week, but we actually could roster people seven days a week, or we could actually think about how we might deliver parts of the service to other parts of the day outside the 9:00-to-5:00 business day. So a lot of patients tell me, they would rather have their short-stay elective surgery the weekend because it means they can not take time off work. It means they don't have to give up their family responsibilities or care and responsibilities, and can quite often get cross cover for their other responsibilities at weekends.

But doing elective surgery for us at weekends is quite unusual. It's just not in our models of care yet, in a way, which would... We do it by exception more so than by standard. So again, that would absolutely be sweating our infrastructure and our assets we've got available too as rather than switching the light off on Friday at five o'clock and then flicking them back on in the Monday morning, and would better create more efficiency and productivity as I call it, around how we use our assets and how we use our human resources.

I don't want people to be working all hours, but when I look at, for example, the amount of overtime some people do or the amount of callbacks people do, surely there's a better model that we would fund to create that workforce then to deliver those services seven days a week. Because we're currently spending the money on things like overtime and agency and callbacks, and maybe rather than spending it that way, that's just spend it this other way, which gives us some hands and feet on the ground on the Saturday and Sunday as an example of where I think we could think about how to be more judicious with the public dollar that we're spending on behalf of the taxpayers.

Dorian Broomhall:

I really like your metaphor there of sweating our infrastructure, and by addition, of course, sweating the infrastructure rather than sweating our people, which sadly perhaps is what's going on a little bit more than we'd like right now. 

Brendan, thanks so much. It's been a wonderful conversation. As always, every time I speak to you, I learn something. So thanks for taking the time and yeah, enjoy the rest of your day.

Brendan Docherty:

Pleasure.

Dorian Broomhall:

Thank you to Brendan Docherty, our Deputy Secretary for Hospitals and Primary Care, for taking time to speak with us, and to you for listening. I hope you found something in our conversation that you can take away into your own work and life.

Join me again for our next episode when I speak with Sally Badcock, the Acting Deputy Secretary for Policy, Purchasing, Performance and Reform.