Emergency doctors warn SA Government’s hospital reforms will put patients at risk
PATIENT safety may be at risk when moves to divert all urgent medical cases to three major hospitals start in about two months — because the hospitals are already at the edge of their capacity, emergency department doctors fear.
The ambulance union also worries the changes may lead to further ramping — as occurred at Flinders Medical Centre during the week — if the three major hospitals are overwhelmed by the sudden increase in workload.
Health Minister Jack Snelling has confirmed the moves to have ambulances with urgent cases bypass Noarlunga, Modbury and the Queen Elizabeth hospitals will begin “in the next couple of months” as part of the wideranging Transforming Health reforms.
Instead, they’ll head straight for the so-called super EDs at the RAH, Flinders and Lyell McEwin Hospital, with services to deal with urgent cases consolidated at these sites to give patients the best available care.
The secondary hospitals’ EDs will continue to treat non-urgent cases such as ear infections and broken bones, while Noarlunga will become a walk-in ED by the end of the year with no ambulances stopping there at all.
The changes — which will commence in the lead-up to the start of the winter flu season — have triggered concern among frontline ED doctors.
The Australasian College for Emergency Medicine welcomed some of the planned reforms but warned of the risks with the ED changes.
“Chief among these is the inevitable increase in patient numbers presenting to the emergency departments at the (three hospitals),” the College said in a statement.
“These EDs are already functioning at the absolute edge of their capacity. The processes outlined in the Transforming Health paper will significantly increase the number of attendances at these sites and without a commensurate increase in clinical resources, the safety of patients could be put at risk.
“Further concern is raised by the move to downgrade one ED (Noarlunga) to a walk-in emergency clinic.”
While acknowledging resources should be focused on the areas of greatest need, ACEM said it believed the best emergency care was provided by properly trained emergency medicine physicians working in EDs that were adequately resourced.
Selling hospitals to developers could reap a fortune for the Government
THE Repatriation General Hospital and Hampstead Rehabilitation Centre could be redeveloped into apartments and townhouses after they are closed by the State Government.
Health Minister Jack Snelling announced the closure of both facilities last week, as part of a major overhaul of South Australia’s healthcare system.
The Hampstead is expected to close in late 2016, while the Repat is scheduled for closure at the end of 2017.
Property experts say redevelopments of the Hampstead and Repat were likely to include new residential components and the sale of each site could fetch the State Government between $7 million and $12 million.
Professionals Real Estate Group chief executive Ted Piteo said the 13.7-hectare Hampstead site, in Northfield, would provide the best financial return for the State Government if it was sold off for residential redevelopment.
“The Hampstead really is perfect for some kind of residential development as it’s in an inner suburb of Adelaide and close to transport options,” he said.
“It’s just next to the Lightsview infill development at Northgate and that has been extremely successful.”
Connekt Urban Projects director Brett Williams said the 14-hectare Repat site, in Daw Park, was suitable for residential redevelopment and an aged-care facility.
“At the Repat you could have medium-rise apartments on the Goodwood Road interface,” Mr Williams said.
“But there’s also the potential for some kind of aged-care development on the site or maybe another community facility.”
Mr Williams said both sites were likely to attract attention from major developers.
“Without question, there will be a lot of interest in them,” he said.
Mr Snelling said no decision had been made on the future of either site but certain facilities may be kept in public ownership.
“There are community assets at Hampstead, such as the pool, that would involve discussions with the wider community as what happens with those facilities,” Mr Snelling said.
“The State Government will also explore opportunities for future use of the 25-metre hydrotherapy pool at the Repatriation General Hospital for use by community groups.”
Mr Snelling said the Repat site could be used to build new mental health facilities for veterans.
“There has been no decision made about where a new $15 million Post-Traumatic Stress Centre of Excellence will be built, that will be discussed with veterans groups, but building that at the Daw Park site is an option,” he said.
“It is also proposed that the chapel and the remembrance garden will be preserved for their considerable significance, particularly to Second World War veterans and their families.”
Opposition Health spokesman Stephen Wade said the State Government’s plan to close both facilities was wrong and amounted to a cash grab.
“I think their plan for the Repat and the Hampstead is more to do with financial considerations rather than improving the quality of the state’s health system,” he said.
Q&A WITH HEALTH MINISTER JACK SNELLING
Why is the State Government pursuing these reforms — is it to save money or is it to improve outcomes?
Quality healthcare is always more affordable than bad healthcare. If people get the right care, the first time, it will reduce the likelihood of them being readmitted because of complications or staying in hospital for longer than they need to.
There are delays and duplication of services that affect patients and waste resources. If these proposals are adopted and we make improvements to the system to ensure patients get the best care possible it will naturally make our system more efficient.
If we did nothing and the State Health Budget kept on growing at high rates, it is conceivable that health could take up half of the State Budget within 12 years. That is simply not a realistic option.
Some of the proposed changes challenge our thinking. For example, we would not assume that going further to a hospital will be safer in some circumstances.
Yet that is what the evidence has shown and what our medical professionals have found.
We now need to commit to implementing the changes that are necessary to bring better care to South Australians.
We can improve care for patients if we reduce the wide variation in effectiveness of services across our system. This is how we will deliver a more sustainable health system for all South Australians.
Why has it taken Labor 13 years in government to get on with this sort of reform?
There is never a wrong time to try and make improvements to our health system.
When the Federal Government cut $655 million out of the state health system at the last Federal Budget, it made us rethink what we were doing in our health system and what we needed to do in the wake of these savage cuts.
Since that Federal Budget, we have put in place a process in place and have listened to our healthcare professionals about ways to make the system work better.
Our doctors, nurses and midwives and scientific and allied health professionals do an amazing job and as part of the Transforming Health process, they’ve been poring over the data on our health system in a way never seen before.
They’ve identified areas of excellence and also areas where we can do much better; some of their findings shocked me.
For example, we now know that if you have a stroke, whether you live or die can depend on which emergency department you go to and what time you go there.
I want a system where people do not die unnecessarily. We have the best doctors, nurses and allied health professionals in the country, we need to give them a system to work in that they deserve.
Will centralising services save money and improve services or will it just create levels of bureaucracy and less personalised services?
Currently, people will often go to one hospital, be assessed at the emergency department, only to be transferred by ambulance to another hospital that has the appropriate senior staff and equipment to deal with their condition.
This needs to change. We need a system where people are taken to the right hospital, the first time.
Across our metropolitan hospitals, one in four planned operations is postponed, leading to a lot of delays and inconvenience for patients and their families.
We need a system where patients can rely on the set date for their elective surgery, knowing it won’t be cancelled at the last minute.
That is why we are proposing to have elective surgery centres of excellence at three of our metropolitan hospitals.
Experiences interstate have shown that specialist elective surgery services can result in shorter waiting times, shorter stays in hospital and better health outcomes for patients.
Patients are better off travelling a bit further to get to the right hospital for their condition.
Lots of people think that every emergency department currently provides the same level of care. This is not the case.
South Australians need to get major emergency care from a senior doctor at any time of the day or night and we will have senior medical staff on site 24/7 at the proposed major EDs. Currently we don’t have that 24/7 cover that we need.
How do you explain to people who would be treated at the Repat or Hampstead that closing these hospitals will result in better outcomes for them?
Rehabilitation is most successful when it starts as soon as a patient is ready but stand-alone rehabilitation services mean that patients must be transferred from hospital to another site before their rehabilitation can start.
The people who work at our rehabilitation hospitals do an amazing job and we want them to continue doing so but we think those services will be better provided as part of an integrated hospital network.
For instance, take for example someone who has a hip replacement and can’t be transferred to an off-site rehabilitation facility until they are medically stable.
Say for instance, this takes 12 days and, because they are transferred on a Friday afternoon, no rehabilitation is available until Monday so that person can’t start any intense rehabilitation until two weeks after her operation.
And say for instance that this person de-conditions — reducing their ability to use their legs — resulting in their total recovery time being much longer.
This is not saying the results that come out of the Repat and Hampstead are not first class, but we want to invest money building brand new rehabilitation facilities at our major hospitals so that rehabilitation can start straight away.
Will these reforms be the silver bullet that fixes the state’s health care system or is it just the beginning?
Health reform is incredibly difficult. About 70 per cent of attempts by Governments around the world fail.
Where I think this one will succeed is it is not something that has been dreamt up by politicians but one that has been driven by people who know our system better than anyone else — our doctors, nurses and allied health professionals.
The cost of providing healthcare, particularly the acute healthcare citizens have come to expect, threatens to overwhelm budgets around the world.
A Federal Government that is hellbent on doing anything it can to discourage people from managing their health conditions is not helping.
In South Australia each year we spend almost $300 million on avoidable admissions — people with a chronic illness whose admission, if effectively managed, could have been averted.
On any day they occupy more than 400 of our hospital beds — the equivalent of one of our larger metropolitan hospitals.
Anything that reduces the accessibility of primary healthcare and discourages people from going to their doctor, for instance the introduction of GP co-payments, is going to make this much worse.