Modbury Hospital and the north-eastern community were dealt a critical blow under the previous State Government’s Transforming Health agenda. High dependency services, acute medical and surgical beds, emergency surgery and major elective surgery were all closed.
This left an Emergency Department (ED) seeing 40,000 patients each year without back-up emergency services, and meant that acutely ill patients are transferred to the Lyell McEwin Hospital (LMH) and beyond, sometimes after long and life-threatening delays. The incidence of ambulance transfers from Modbury Hospital is 10 per cent – the highest in the country.
Over the past three years there have been many instances where lives have been put at risk by the lack of acute services at Modbury. Patients with emergency conditions requiring surgery or intensive care, or with heart attacks, have faced delays in inter-hospital-transfer of up to 12 hours or more.
The National Emergency Access Target (NEAT) expresses the percentage of patients admitted, transferred or discharged within four hours of presentation to a hospital ED. Australia-wide this ranges from 65 -90 per cent. At Modbury it has been as low as 6 per cent. This is a national disgrace.
SA Health is adept at re-arranging statistics, particularly in relation to EDs, to avoid public scrutiny of the extent of overcrowding. This has been going on for years at Modbury. The strategy reached its most imaginative in 2017 when it was revealed that patients were re-assigned ‘on paper’ as hospital admissions under two consultants who no longer had admitting rights at the hospital. This created the illusion that these patients had been admitted, whereas they were still waiting in the ED.
The fact remains that there is a pressing need for the return of acute care and emergency support services to Modbury Hospital. The new Liberal Government made a core election promise to restore to Modbury an acute care facility (High Dependency Unit – HDU, or Level 1 Intensive Care Unit – ICU), along with upgraded emergency services and increased surgical capabilities.
This would allow emergency surgery and more complex elective surgery to be performed and acutely ill patients to be admitted rather than being transferred elsewhere. This would go a long way to restoring self-sufficiency to this important general hospital.
Unfortunately, at present, there is little evidence of planning for the implementation of these commitments. Indeed in September, SA Health told a State Budget Estimates Committee that the Modbury HDU/ICU would not open until “early 2021”.
The need to return an ICU and other acute services, to Modbury has been questioned and resisted by a small group of administrators and senior doctors at the LMH and by the Labor Party. Their argument that an ICU cannot be safely restored at Modbury is seriously flawed. This facility previously ran safely and efficiently at the hospital. And an authoritative review in 2012 concluded that it could be safely returned if properly resourced and staffed.
The busy ED and the requirement to care for very sick patients in rehabilitation, geriatric and palliative care wards, dictates a clear and urgent need for an ICU at Modbury. Health Minister Stephen Wade and his Government must expedite this key election pledge and synchronise the establishment of the ICU with associated acute care and surgical facilities.
This important upgrade of Modbury Hospital must be given priority in the state capital works schedule, with a completion date of no later than early 2020.
Patients and their relatives in the north-east deserve nothing less of this Government.
Warren Jones AO is an Emeritus Professor at Flinders University and a former head of obstetrics at the Flinders Medical Centre. He was a prominent critic of Transforming Health.
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