A landmark review of the South Australian hospital system says no new beds are needed to improve it.

Health Minister Jack Snelling released a discussion paper this morning which recommends the consolidation of specialist services at fewer hospital sites in order to reduce waiting times and delays.

It remains unclear which services are in line for the chop.

The paper also outlines several failures of the health system, including that people with similar conditions often receive different levels of care depending when they present at hospital, and which hospital they present to.

Included in the proposed new services would be a dedicated emergency service for patients with conditions which are urgent but not life-threatening.

The paper, written in consultation with three clinical advisory committees, also recommends that South Australia’s surgeons either practice elective surgery or emergency surgery – not both.

“In specialties with a high emergency workload the surgical team should be free of elective commitments when covering emergency and consultants should not cover more than one site,” it reads.

The paper also reveals shocking disparities in the delivery of care by South Australian hospitals on particular days of the week, including differing death rates amongst stroke patients, depending on which day they arrive in hospital.

“…there are unacceptable variations in death rates from stroke depending on the time or day or admission,” the paper says.

The clinical advisory committees agreed on around 300 standards of care which should exist in South Australia’s hospital system.

The review found that the current system fails to meet 52 of them.

It says the state’s hospital system:

• Fails to deliver consistent care on each day of the week; a patient’s length of stay is up to three days longer depending on which day they are admitted to hospital.
• Fails to ensure all acute admissions are seem by a consultant within 12 hours.
• Fails to ensure all wight-loss surgeons perform enough procedures every year to maintain a safe skill level.
• Fails to provide a 24-hour stroke unit.
• Fails to provide the minimum number of anaesthetists for any stand-alone surgical sites.
• Fails to provide a semi-elective pathway for patients that need urgent surgery.
• Fails to provide a emergency operating theatres close enough to emergency departments to transfer patients quickly and safely.

Following  a period of consultation on the discussion paper, Snelling will convene a summit on how to improve the state’s hospital system, which has been in crisis over the past several months because of overcrowding in emergency departments.

Notably absent from the paper is any mention of overcrowding in emergency departments.

Overcrowding has been blamed for the need for mental health patients to be confined for several days in emergency departments and to be “chemically restrained” while waiting for acute psychiatric beds to become available.

It has also been cited as the reason physical examinations have been carried out on some patients in public waiting rooms and why medical staff have suffered  hundreds of violent threats against them.

A significant factor in the overcrowding, according to health professionals, is a lack of aged care places in the community, which forces elderly patients who are ready for discharge from hospital to wait in hospital beds.

None of these issues is canvassed in the paper, other than to say that a comprehensive multidisciplinary psychiatric liaison service is not being provided in hospitals.