ALBURY-Wodonga’s public health revolution is a bit like the never-ending house renovation.

Stuart Spring doubts it will ever be finished, no matter how much hard work and innovation goes into the job.

He reckons though that what has been done in the past few years in making Albury Wodonga Health a genuine major regional health service is quite remarkable.

Five years ago, at 62, he started out as its first chief executive.

When he applied for the job he had already been CEO of some of the nation’s biggest health services in the public and private sectors for more than 30 years.

“But I was at that stage of my life where I was looking for something genuinely different, that hadn’t been done before,” he says.

“It was just blindingly obvious that here was a wonderful opportunity to live in one of the most incredibly beautiful and interesting places in Australia, and to do something interesting in such a place.”

Albury Wodonga Health clearly fitted his personal job description of an organisation with “no rule books, was clearly a challenge and had a lot of potential”.

Yesterday he bowed out of the top job satisfied the organisation is here to stay.

But a job well done?

“I didn’t really know what I was coming to five years ago, so to judge whether you’ve done a good job or not is quite hard.”

It might have all started out as a great unknown, the NSW and Victorian governments initially not sure it would even work — the first inter-government agreement for the service was only given until 2017.

Negotiations now under way show a lot more faith as the next agreement is likely to run until 2035.

NO project probably stands out as more symbolic of where public health on the Border is heading than the $60 million cancer centre.

Add a cardiac centre, $10 million in new clinical equipment and Wodonga hospital’s new emergency unit, plus other projects, and the spend hits $90 million.

It’s a long way from the system Dr Spring knew of when he was working for a national group that operated health services in Queensland, NSW, Victoria and Tasmania — that brought home the problems caused by cross-border anomalies.

“From my time in the NSW public health service I was very aware of some of the problems over the past two decades or longer in Albury,” he says.

“It was not as if I was blind to it, but I only saw that as history and that we’d create a new future.”

Public health on the Border was simply off the state and federal government radar.

“What I hadn’t appreciated is that what we had down here was two unsophisticated, under-resourced hospitals that really had not been on the planning map of either state for over a decade,” he says.

“They were always in the too-hard basket. The last innovative thing that had been done here really was the combination of all the maternity services on one campus at Wodonga.

“That was a bold move at the time but they didn’t go on from there. It was almost like ‘we’ve done this, that’s it — we’ve sorted it out’.”

It was an attitude from government that Border residents had lived with for decade. Each state government only looked at the river “and saw nothing south or north”.

“They missed 100,000 people, 20th biggest city in the country,” Dr Spring says.

“They failed to plan adequately, but I think that’s changed. Albury Wodonga Health and Albury-Wodonga are certainly on the map in Sydney, Melbourne and Canberra and I think that’s very much a positive for the future.”

IT’S inevitable though that not everyone can be happy, all of the time.

When there are about 2000 people under your charge that means the potential for a lot of people wanting to chew off someone’s ear about their concerns — usually close colleagues, maybe an immediate manager, often the boss with his “always open door”.

Albury Wodonga Health got whacked with that reality last October when its “people matter survey” revealed 60 per cent of staff had witnessed and 40 per cent experienced bullying in the workplace.

Dr Spring feels it more likely that the service’s work brought a lot of that to the surface, rather than was the cause — though it still took it as a strong reminder that staff needed to feel their concerns were being listened to and taken seriously.

“Some of the issues have been around for many years,” he says.

“Part of it is an inherent tension in a community that’s living together. You don’t have a lot of other alternatives where you can go for your workplace.

“And you don’t always get on with everybody in your workplace, but you’ve got to find a way of living together.”

IT’S the community connections that most surprised and often influenced Dr Spring’s time at the top.

That is something, he says, that just doesn’t exist in the capital cities.

“It’s taken me five years and I’ve still only touched the top of it. Something will happen in the health system and it ripples throughout the community,” he says.

“We’ve seen it with the death of a staff member or a family member. You suddenly realise how many of the staff are impacted because they’re friends or family.”

Add 10 family members or friends to each of its 2000 staff and that’s a direct reach to 20,000 people. The 60,000 who go through the two emergency department is equivalent to half of Albury-Wodonga’s population.

“But it’s a plus because everybody is mindful that they can’t hide,” he says.

“That’s something I didn’t appreciate was going to be the case and you have to take that and try to build it into support at some stage.”

Albury Wodonga Health’ success, he says, shows cross-border anomalies can be nullified.

“That is, this community can do far more than two smaller cities.”

Those problems had not been as disabling as may have been first thought.

“Yes we have two industrial environments but we’ve been able to do what we’ve done even with that constraint.

“A lot of is mindset. It’s amazing what you can do when you not ignore the constraints, but work within them to still get the best result you can.”

NEXT stop is a return to Sydney with his wife, Ginny, though he has not ruled out a return to the Border after they work out where they want to end up.

“We’ve just had a ball. But this is a genuine retirement,” he says.

“This is about the family and the golf course and friends, travel and making sure that however long I’ve got to go that I don’t waste it working.”

Getting back to Sydney for now will also leave mean he can give new Albury Wodonga Health boss Sue O’Neill the space to get on with the job.

“We’ve made a lot friends down here, or I might say it’s my wife who has made all the friends. I’ve just been the handbag.”

The wins:

 1. Major recognition in Sydney , Melbourne and Canberra that Albury Wodonga Health is a major regional health service delivering care to more than 200,000 people, not two small hospitals serving two small communities

2. A mutually supporting health system with each component combining to make up the whole - despite working from 17 locations

3. A combined workforce of more than 2000 across a range of fields. Fifteen interns for the whole of this year and going around again next year is “a major stepping stone for the future”.

4. The establishment of the North East and Border Mental Health Service

5. More than $90 million in capital works and new equipment acquired from 2009 to 2016. This includes the cancer centre and new endoscopy and renal dialysis units

6. Established an accurate waiting list for elective surgery that through targeted strategies has fallen by more than 800 in 2013-14 with all available beds opened

7. Increasing community support and involvement in areas such as the Community Advisory Committee, the Concierge Volunteer Service and in the near future a new opportunity shop in Albury.

What’s next:

1. Developing the cancer centre as a service that meets all our hopes of achieving better treatment outcomes

2. Developing the cardiac centre so patients going to Melbourne becomes the exception rather than the rule

3. Managing the two major campuses as one

4. Development of supporting relationships with other North East and southern NSW health services in order to support those centres in what they do well

5. Bringing new IT solutions to the work of AWH and especially clinical staff to makes decision-making faster and more accurate and to avoid duplication

6. Redevelopment of the Albury emergency department as stage one of other acute service developments. Giving recognition to the fact AWH is the second largest emergency service in regional Australia yet consistently struggles to meet national emergency targets

8. Improving performance --both clinical and management in an environment of increasing competition for the shrinking health dollar ( in real terms) and a growing, ageing population