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SA children face 'enormous' wait times for allergy specialists

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South Australian children with severe allergies are waiting an average of 505 days to see a specialist at the Women’s and Children’s Hospital – with some waiting up to five years, a parliamentary committee has been told.

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The head of the hospital’s department of allergy and clinical immunology, Dr Patrick Quinn, said the rising prevalence of allergic disease, and a lack of resources, was causing “enormous waits” for children.

He told the health services select committee the wait list had been growing by roughly 30 or 40 patients a month, with 70 to 80 new referrals each month.

Quinn said figures from April showed the average wait time for priority two patients, including those with anaphylaxis, was 505 days.

“That’s the average, that’s not the longest waiting patient,” he said.

“The longest waiting patients I have wait four years, up to five years. I saw an email when I was collecting this data from one of my consultants from November last year who told me she saw a patient who had been waiting six years to see us.

“So we have enormous waits, and it’s hard to deal with that.”

But SA Health said wait lists had improved “by almost 40 per cent” in the past year and the longest wait was now two years and five months, compared to six years and five months a year ago.

Quinn was one of several doctors who gave evidence in private in April to parliament’s health services select committee, which is examining the state’s health system.

His evidence, along with that of several colleagues, has recently been made public with their permission.

Quinn said his department used to have the longest wait list in the division but there had been some improvements thanks to some “temporary” funding.

“We had up to 1,300 patients waiting in February,” he said.

“We now have 1,050. That’s now the second longest wait list by four patients.

“Another unit has four more patients than us waiting. This figure is as at 1 April. I am pretty proud of that drop, actually, but it is based in large part of temporary funding.”

 I don’t think we always deliver the equivalent care that a patient might get in another state or another centre, to be honest, and that is distressing for South Australians – these children ought to get the same care, they are all Australian.

Quinn said the waits lists and lack of resources to deal with them were “a real problem”.

“We do this work currently, including the new funding, with 2.3 FTE (full time equivalent staff), but there’s not one of us who are full time in the service,” he said.

“I have the biggest fraction and I am 0.8 in the Department, in terms of consultants.”

Quinn said more innovative treatments in future were likely to add further strain on the system.

“For a very long time we were about diagnosing food allergy and trying to keep people safe by telling them what to avoid and giving them an EpiPen, or something like that,” he said.

“These days, we are moving towards the ability to intervene with that and maybe move towards treatment.

“A lot of our research is about oral immunotherapy for food allergy. It’s not currently a mainstream treatment, but it is something that is likely to be here in the next five years.

“When that comes, I don’t know where the resources will come to deal with that case load because all those patients I would see, diagnose with peanut allergy and say, ‘I’ll see you in two years,’ I will now be bringing back every couple of weeks to every couple of months to tolerise them to peanuts, to treat them, but I don’t know where I am going to see them and see the new patients as well.”

SA Best MLC Connie Bonaros, who chairs the parliamentary committee, asked the doctors giving evidence if a lack of resources was having and would continue to have “detrimental outcomes for our kids”, despite the best efforts of clinicians and the overtime they did.

Quinn said: “I think broadly the hospital does deliver quality care, but I think we can always do better.”

“I don’t think we always deliver the equivalent care that a patient might get in another state or another centre, to be honest, and that is distressing for South Australians – these children ought to get the same care, they are all Australian.

“There are risks, and with a long waiting list like that, I have lots of kids on there with anaphylaxis.”

Quinn said his department did all it could to protect those children, taking on its own risks to do so.

“If we get in a referral that looks like anaphylaxis, we send out an authority to use an EpiPen because you need an authority from a paediatrician to get an EpiPen—a GP can’t write an initial prescription without the authority,” he said.

“So those patients would sit there for two years being at risk of anaphylaxis. That is a risk we take on.

“Clinically, we would not normally be recommending a treatment for a patient we haven’t assessed ourselves, and some of the referrals don’t contain a lot of information, but it is what we have done to keep them safe.”

Dr Drago Bratkovic, head of the hospital’s metabolic clinic, told the committee his department had also seen a huge increase in services without any significant increase in resources.

“Despite all these increases in activity… we have not had any change in our consultant FTE for over 25 years,” Bratkovic said.

“At the moment, we only have 1.1 FTE health consultant time to devote to the service, and in actual fact it dropped from 1.3 down to 1.1 in order to fund a nurse about 15 years ago, which has been a valuable addition to our team, but it came at the cost of a consultant FTE.”

Bratkovic said in order to provide a 24/7 on-call service for sick children, he was required to be on call three out of four nights and sometimes every night.

He said that had been the case since he became head of the department in 2008.

“I have shouldered that burden over that time,” he said.

“Up until now it has been relatively manageable, but I am finding that after doing this for 12 years it has become a significant burden.

“You are unable to make firm social plans, you can’t be more than 30 minutes away from the hospital and it makes it difficult to attend your kids’ sporting events and very difficult to play sport yourself.

“I have highlighted this issue with our on-call service with various executives.”

A spokesperson for the Women’s and Children’s Health Network said the longest wait for an allergy outpatient appointment was now two years and five months, compared to six years and five months in July last year.

“We are the state’s leading provider of specialist care for women and children, delivering high quality services to South Australian families,” the spokesperson said.

“The community should rest assured that anyone who requires our services will always receive the best possible care.

“Thanks to overall outpatient reforms and the appointment of an additional immunologist, allergy outpatient wait lists have reduced by almost 40 per cent compared to this time last year.”

Responding to concerns raised about a lack of resources and staff, the spokesperson said “we prioritise our workforce planning to ensure the wellbeing of our staff including the importance of succession planning”.

“We thank our dedicated doctors and nurses for their ongoing commitment to providing our patients with the highest level of care,” the spokesperson said.

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