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Public health system still on waiting list for further treatment

Opinion

A year after the Liberal Government inherited an ailing public health system, it still needs ongoing, expensive therapy, argues Warren Jones.

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In March 2018 the new State Government inherited a health and hospital system in disarray.

Transforming Health had left our public hospitals with insufficient beds, overcrowding, disrupted specialist services, ambulance ramping and reduced patient access.

The problematic EPAS electronic record and data system is currently under review. If it cannot be salvaged, around $700 million of taxpayers’ money will have been wasted, and a new system found.

The poorly designed, dysfunctional and inadequate new RAH, with a final capital cost of $11.9 billion, and a recurrent maintenance bill of $1 million per day, will be a financial millstone around the neck of the health system for decades to come.

In the context of these substantial problems, how does the score card  read for the repair of our hospitals?

At Modbury Hospital, the return of the High Dependency Unit and acute surgical and medical services is in train, despite resistance from some senior staff in the Northern Health Network.

A major redevelopment of the Palliative Care Unit is also planned, however a decision is still awaited on the refurbishment or rebuilding of the Woodleigh House mental health facility, as recommended recently by the Chief Psychiatrist.

Acute care services have been expanded and mental health beds reinstated at the Lyell McEwin Hospital, but emergency services and in-patient beds are still under stress in the north.

The relentless transfer of seriously ill patients from the overloaded Modbury emergency department continues to stretch the facilities at Lyell McEwin, where ambulance ramping is minimised only by squeezing patients into inappropriate wards and other temporary locations.

At Queen Elizabeth Hospital, the full restoration of cardiology services is proceeding slowly in the wake of the untimely sacking of the Department Head, Professor John Horowitz.

Other specialist services in cancer care and respiratory medicine remain under threat, and the sleep health service is still without a home. The timeline and function of the $280 million new build foreshadowed by the previous Government is still uncertain.

The function and capacity of the new Royal Adelaide Hospital is problematic. The operating theatres and emergency department have needed major structural alterations. Outpatient services, thoracic medicine and clinical trials have been squeezed into ward areas and other reconstructed locations.

Important acute mental health beds have been opened, but their function has been impeded by ongoing problems with duress alarm systems. However, some beds remain closed and overall clinical efficiency is compromised by structural and functional problems involving medical records and patient flows.

Ophthalmology services including surgery are inadequate, and the long-promised Eye Health Centre in the CBD has failed to materialise.

The most visible problems at the RAH – ambulance ramping, emergency department overloading and  waiting times, particularly for mental health patients – still await definitive solutions.

Hospital care in the south is still chaotic and the opening of twenty ‘step down’ beds at the Repat has had little effect on Flinders Medical Centre which is chronically ramped and overloaded.

Despite the outsourcing of public patients to private hospitals, elective surgery waiting lists are blowing out. Some of the 800 patients needing joint replacements will wait for more than two years for their operations.

After an overly lengthy and complex public consultation process, a ‘Master Plan’ has been released for the re-activation of the Repat.  This foreshadows substantial accommodation for dementia care and statewide brain and spinal injury rehabilitation services.

The re-opening of the excellent hydrotherapy pool has been welcomed. Other proposals for step-down and transitional care are sensible and timely. However, at present, there are no clear plans for the return of elective surgery aimed at reducing the ever-expanding waiting lists, particularly in the south.

A twelve bed short-stay medical unit is to be opened at Noarlunga Hospital, but may only serve to participate in the current overloading of the hospital with geriatric patients, who would be more appropriately accommodated at the Repat.

Noarlunga needs to revert to providing essential surgical and other acute services to the predominantly non-geriatric population in the southern suburbs. Only then will the overloading crisis at FMC be alleviated.

On a general note, the decentralisation of the massive administrative and bureaucratic machinery of SA Health, with the establishment of Health Network Boards can only improve the governance and efficiency of the health system. The logistics and utility of six regional rural Boards replacing the current Country Health Network remains to be seen.

There is still much to be done, and substantial problems remain. The expensive new RAH, the Korda Mentha audit of the Central Network and the uncertain future of the EPAS electronic record and data system will pose financial challenges for the Government.

In the meantime, reform and repair must proceed apace to arrest further decline in health care services, and the erosion of morale in overworked and stressed, but dedicated, hospital and ambulance staff.

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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