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Health reform business case under wraps

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The State Government is refusing to reveal the contents of a 300-page business case for its health reform plans.

Medical groups have been complaining about a lack of detail in the government’s health reform proposals since they were presented by Health Minister Jack Snelling earlier this month.

Doctors’ union representatives told a community meeting of around 150 Western Suburbs residents last night that specific details of sweeping changes to the hospital system were missing, and were needed for the consultation process to be legitimate.

However, oncologist and Transforming Health clinical ambassador Professor Dorothy Keefe told the audience that the business case for Transforming Health had to be kept under wraps.

“The 300-page, detailed business case is Cabinet in confidence and we can’t publish that currently,” Keefe said.

“But all of the evidence on which we’ve based proposals is on the (Transforming Health) website.”

South Australian Salaried Medical Officers’ Association (SASMOA) senior industrial officer Bernadette Mulholland said the detail provided by SA Health had been profoundly inadequate.

“The Transforming Health (proposals paper) does not have the detail to be able to (judge) whether this is going to be a good health system,” she said.

“A better health system can only be achieved through consultation with the community, with the staff, and with the clinicians.

“We have three days left, three days before we have to provide our submission as to why we think the proposals within here will be the health system of the future.

“From SASMOA’s point of view, we are now unable to do that.”

She acknowledged that the health system needed to change, but said that the Transforming Health process had been a lost opportunity.

“The Transforming Health consultation period should be extended,” she said. The consultation period has lasted just under four weeks and closes this Friday.

The Australian Medical Association this morning released a statement agreeing the consultation period should be extended.

Immediate Past President of SASMOA and senior emergency doctor at the Lyell McEwin Hospital Dr David Pope told last night’s meeting doctors had been “silenced” by the government.

“You might have noticed that we’ve had to use a lot of people who are retired or are about to retire to come out and explain things to the public because unfortunately the way SA Health can work is that anyone that speaks out can become a target,” he said.

He also claimed doctors on the Government’s clinical advisory panel for Transforming Health had told him their views were being dismissed and ignored.

“Most of the clinicians have been ignored,” he said.

“There just hasn’t been the proper discussions that there should have been.

“That was the sort of feedback we got from people who were actually heavily involved with that.”

However, SA Health told InDaily no member its clinical advisory panel had expressed concern about the reception given to their expertise.

“No member of any clinical advisory panel has informed us that their views have not been given due consideration in this process and we’re extremely grateful for the expertise, dedication and time each of the 60 doctors, nurses, midwives, scientists and allied health workers has given to develop the proposals,” a spokesperson for SA Health said in a statement.

The spokesperson said hundreds of pages of statistical data on the Transforming Health website had been used to inform the business case, which he said remained Cabinet-in-confidence.

“The Transforming Health proposals document, currently out for feedback, is a summary of the data displayed on the website and the business case,” the spokesperson said.

Pope also expressed concern about the proposals which had been made public, saying they contained “magical assumptions” about the ability of patients to self-diagnose and attend the correct hospital.

Under the plan, emergency services for life-threatening conditions will be “consolidated” in the state’s three largest hospitals – The Royal Adelaide Hospital, Flinders Medical Centre and the Lyell McEwin Hospital.

But he said even paramedics did not have the specialist diagnostic expertise required to choose the appropriate hospital under the plan.

“In this Transforming Health document … somehow magically either you, the public, will just know where to (go),” he said.

“You don’t come into a waiting room saying ‘excuse me doctor but I’m having one of these really rare and difficult strokes, and I need that machine that’s down at north Adelaide’.

“Sometimes (medical conditions) are obvious … but most of the time that is not the case.”

He said the plan to divert ambulances away from smaller hospitals – Modbury Hospital, Noarlunga Hospital and the Queen Elizabeth Hospital – to the larger ones was “extremely dangerous” because it would exacerbate already overcrowded emergency departments.

“To the three super sites, you’re talking about over 100,000 patients per year needing to attend those sites,” he said.

“Those sites are struggling to deal with that demand now.

“You can’t impose a huge extra workload onto overloaded emergency departments until you can unblock them.”

Keefe acknowledged the overcrowding, and said that there would be no diversion of ambulances to larger hospitals until bed blockages were fixed.

“We’re not going to change where the ambulances go until we have unblocked the beds, because, as you know, the Emergency Departments are full,” she said.

Pope welcomed the commitment, but said “we haven’t seen any detail as to how that unblock is going to occur”.

But Keefe expressed confidence hospitals could be made to work more efficiently.

“We can make it so that when you turn up to the ED needing to be admitted, there will be a bed for you,” she said.

“If people don’t have immediately obvious signs and symptoms of a particular condition, they’d still go to their nearest Emergency Department (and) if it was then discovered that the care that they needed was unable to be provided at the (smaller hospital) then they would be moved.”

Health Minister Jack Snelling said earlier this month that “our emergency department reform, particularly ambulances taking people directly to either the Lyell McEwin, Flinders or the Royal Adelaide Hospital will happen in the next couple of months”.

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