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Transforming Health: the questions that need answers


It is now eight months since the release of the Transforming Health (TH) proposals for a massive overhaul of our health system. Since then, we have been given little information about how these proposed changes, particularly, the closure of the Repat, will be accomplished and accommodated within the existing hospital system.

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Transforming Health questions

The impression gained from this prolonged silence is that many of the Transforming Health proposals have been poorly reasoned and constructed, or are proving to be unworkable, or will involve significant unbudgeted expenditure.

This, presumably, is proving to be an embarrassment for the Government, since the primary aim of Transforming Health was to be cost-cutting.

We now need to hear some long overdue answers from Health Minister Jack Snelling to the following questions:

WHAT was the reasoning behind the decision to purchase a pre-bundled ‘Franchise Package’ from McKinsey and Company as a template for Transforming Health ?

WHY was a decision taken to close the Repat when no plans had been formulated to accommodate 80% of the facilities and patient services on the site?

WHAT will happen to the inpatients who occupy the 140 beds at the Repat not yet accounted for in Transforming Health planning?

GIVEN that the outpatient departments in all metropolitan public hospitals are overloaded, where will the 170,000 outpatient and ambulant visits to the Repat each year be accommodated?

WHAT is the meaning, of the statement, relating to each public hospital, in the ‘Delivering Transforming Health’ document, that “Outpatient Clinics will continue, with final locations agreed through consultation”? Does this mean that outpatient departments will be downgraded?

WHAT will happen to the busy procedural services at the Repat such as general surgery, ophthalmology, orthopaedics, plastics and urology, given that they cannot be absorbed into Flinders Medical Centre?

WHERE will the 2,000 patients per year who are transferred from FMC to the Repat be accommodated in the new system?

GIVEN that there will be no room at FMC, will patients in the outer southern suburbs have to travel to the Queen Elizabeth Hospital for major surgery?

Health Minister Jack Snelling

Health Minister Jack Snelling

HOW accurate, and relevant to SA, is the claim by Transforming Health that efficiency gains of 30% can be achieved in our public hospitals?

SHORT of attempting to cost shift to the Commonwealth, how will the earlier discharge of old, frail and disabled patients from our public hospitals be accomplished?

HOW will ophthalmology services in Adelaide be re-organised, given that the busy Repat service will close, and there are minimal services in the other local health networks?

ARE you concerned that services at the three “downgraded” emergency departments will progressively deteriorate to the point where they will serve no useful purpose?

GIVEN that this will lead to a progressively escalated load on the three ‘super’ EDs, how will this overload and consequent ‘ramping’ be managed?

DO you have concerns about the ability and appropriateness of ambulance officers making complicated diagnoses, so that they can take patients to the ‘correct’ hospital?

WILL the Ambulance Service be given the appropriate resources to cope with the massive increase in inter- hospital transfers occasioned by the fragmentation of services between our public hospitals?

WHAT plans will be made to facilitate the re-deployment and re-training of the 1,600 members of staff at the Repat?

WHY did you not recognise or respond to the concerns of SA Health staff about workplace gagging and intimidation in relation to their right to speak out about the Transforming Health proposals?

WHAT contingency plans are in place to maintain staffing levels in public hospitals, if the mooted (and expected) exodus of senior medical staff into the private sector occurs under Transforming Health?

SURGICAL training posts are already being lost because of the anticipated distortion of surgical services; more will follow. How will this problem be addressed?

HOW will the Government and SA Health support and compensate the universities for the loss of teaching and research funding, facilities and infrastructure from the re-structured hospitals and the closed Repat?

These and many other questions about Transforming Health and its proposals, are of great importance to patients, health workers, trainees, students and the general public.

They deserve answers as a matter of urgency.

Warren Jones AO is an Emeritus Professor at Flinders University and a former head of obstetrics at the Flinders Medical Centre.

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