Dr Chris McGowan replaced Vickie Kaminski – one of the architects of the controversial Transforming Health program – as CEO of SA Health in May.
McGowan argues that the state’s health system is overinvested in acute services and underinvested in relatively cheaper and safer home care alternatives for patients who are too sick to be cared for by general practitioners, but not sick enough to justify hospital admission.
Investing in home care and community health services was a key to reducing the overcrowding and ramping crises in SA’s hospitals, he argued.
“If you’re too ill for your GP to (be treated) in a normal, you know, 10-minute business model of general practice you’ll end up in our public hospital system, and that’s just crazy,” McGowan told ABC Radio Adelaide this morning..
“Over the last couple of decades, we’ve just continually divested off a lot of the care outside of the hospital.
“There’s lots of work to do inside the hospitals but the big piece that’s obviously structurally missing in South Australia is the alternatives outside the hospitals.”
McGowan is a former CEO the Silver Chain Group, which manages in-home not-for-profit health service RDNS.
He argued that “some poor decision-making around budget management” meant SA Health had spent too much money on the proverbial ambulance at the bottom of the cliff.
He said he intended to “rebalance” the South Australian health system to invest more in the metaphorical fence at the top of the cliff.
“Nothing that I saw in Transforming Health … was about the out of hospital domain – that’s why I think the system has been out of balance,” he said.
“As you get older, towards the end of your life (and) you need (acute) care, we should deliver a lot more of it in the community where it’s more convenient, it’s safer and it’s cheaper and people much prefer it and use our hospital systems for those who are most acutely ill.
“My objective is to free up capacity.”
He gave the example of a 85-year-old patient with a lung infection.
In South Australia, that person would be admitted to hospital, he said.
“In other states, that patient would have a nurse come around with a doctor, possibly coming around within a few hours – they have IV antibiotics at home,” he said.
“The patients’ experience of these sort of services is ‘this is Rolls Royce care at home’.”
Citing research from Sydney hospitals, McGowan said 30 or 40 per cent of SA’s hospital patients – or perhaps more – would be better off being treated outside of hospital.
“Sydney has a lot of these out of hospital services so, for us, it’s likely to be higher,” he said.
“We know statistically we have a lot longer length of stay in our hospitals than other states and that’s why we are the most expensive (health system in Australia).
“If you’ve got people in hospital longer than they need to be, or who are even in hospital unnecessarily, it means that the ambulances … have got nowhere to take anybody, they’ll be ramping.”
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