The advent of the Transforming Health process has necessitated a reappraisal of the adequacy and accessibility of eye health services in our public hospitals.
The result is disturbing and raises issues that must be addressed by Transforming Health, or, failing that, by firm and wide-ranging action by SA Health, to rectify the inequities and geographic maldistribution of ophthalmology services in metropolitan Adelaide.
The imperative for action is underlined by predictions of eye disease trends in Australia. Blindness and visual impairment will increase by 20% in the next five years. This figure is likely to be higher in SA where the main cause, age-related macular degeneration, will be reflected in our ageing population.
There are current deficiencies and future problems in each local health network (LHN), which need to be addressed in the Transforming Health process, or by comprehensive urgent planning by SA Health.
Southern Adelaide LHN
Ophthalmology services at Flinders Medical Centre are stretched to the limit. There were 22,000 outpatient visits and 1,500 day surgery procedures last year. There are 2,000 people on the waiting list for outpatient appointments and 500 waiting for surgery.
The waiting times for appointments and surgery are up to a year. There is no space or capacity for further growth. The situation could become critical should problems arise in re-leasing the Flinders Eye Clinic premises from Healthscope/Flinders Private Hospital.
At the Repat, the ophthalmology service sees 5,500 outpatients and performs 350 day procedures a year. The waiting times are 12 months for an outpatient appointment and six months for surgery.
If the Repat closes this will impose an extra 20% workload on FMC, unless some of the activity is taken up at Noarlunga. This may not be feasible, given that Transforming Health will require the total day surgery workload in all disciplines from a closed Repat to be absorbed into Noarlunga.
The upshot is that there will be a 10-20% shortfall in eye health services in the south if the Repat closes.
Central Adelaide LHN
The RAH and Queen Elizabeth Hospital eye clinics between them see about 40,000 routine outpatients and 6,000 emergency cases a year. The waiting times are 12 months at the RAH and 2 years at the QEH. There are 600 day surgery procedures per annum at the QEH, and 1,200 at the RAH.
Given that these figures reflect some overflow from the inadequate facilities in the north, eye health in the central area is under-serviced, and the transition to the new RAH will exacerbate the problem in both the short and long term. Present planning reduces the public eye health service in the central area.
Northern Adelaide LHN
An eye clinic is run out of the Lyell McEwen Hospital at the GP Plus Centre at Elizabeth. The waiting time is three years or more and the books are closed to new referrals. There are 150 day surgery procedures per annum at the Lyell McEwen. There is currently no ophthalmology service at Modbury, but it is likely that, at least, a rudimentary service will be established under Transforming Health.
It is clear that public eye health services in the north are in a parlous state. Patients have a choice of long waiting times, travelling to the RAH or accessing private care.
With the abandonment of the proposed Eye Health Centre of Excellence proposed for Modbury, ophthalmology services seem to have dropped off the Transforming Health radar. Urgent solutions are required to address the many problems in our eye health services, not least of which is the key component for vision impaired patients, that is , ease of access, without resort to difficult public transport options.
There are three public/private proposals extant, or mooted, to provide much needed eye health services, two in the Central Adelaide LHN , and one in the Southern Adelaide LHN. The Government must either support these initiatives, or generate and implement realistic plans to establish public facilities to solve the pressing problems in eye health in SA.
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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