Govt adjusts health plans – but Repat still to close
The State Government has confirmed the closure of the Repatriation General Hospital, but given in to some demands from medical and community groups in its first raft of final decisions on health reform released today.
The 500-page “Next Steps” document confirms several of the government’s original proposals for health reform.
The most significant is the creation of three “super emergency departments” – the Royal Adelaide Hospital, Flinders Medical Centre and Lyell McEwin Hospital – which will receive “life-threatening emergency” patients from smaller metropolitan hospitals.
But it makes some concessions to medical professionals, with the idea of a “walk-in emergency department” for Noarlunga Hospital rebranded as a “Community Emergency Department” retaining 24-hour emergency care. In addition, the Flinders Medical Centre neonatal unit will not be downgraded.
But several questions remain about the plans, including how many staff will be made redundant, moved or newly employed in the health system, how much money the reforms are projected to cost and save, and the definition of a “life-threatening emergency”.
The paper commits to roll out the Transforming Health process over four years and promises: “We will not initiate any change where there is evidence that it would result in patient harm”.
The paper also warns the state currently spends nearly a third of its revenue of healthcare, and that at today’s growth rates, that could increase to half of the state budget within 15 years.
The paper claims between 180 and 200 beds will be “released” across the metropolitan hospital system by improving scheduling and efficiency of surgery theatres.
Repatriation General Hospital
The government confirmed its plan to relocate the vast majority of services from the Repat to other Adelaide metropolitan hospitals.
All of its rehabilitation services will be moved.
The acute mental health service for the elderly, currently operating at the Repat, will shift to a 30-bed unit at Flinders Medical Centre.
Decisions have yet to be made on where the palliative care services currently offered at the Repat will go, or where the Centre for Excellence in post-traumatic stress disorder to replace the Repat’s Ward 17 will be placed.
The government says it will consult with medical professionals, veterans’ groups and the broader community before those decisions are made.
There will also be more consultation before the government decides on the future use of the Repat site.
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The paper claims the “positive culture” at the Repatriation General Hospital will be “replicated” within hospitals across Adelaide.
Old RAH, New RAH
The Royal Adelaide Hospital (and later, the New Royal Adelaide Hospital) will become a 24-hour super site for the state’s most seriously ill.
Senior doctors and senior nurses, diagnostic and imaging services and on-call acute coronary syndrome services will all be provided 24 hours a day, seven days a week.
The RAH will be the hub for complex head and facial surgery and a statewide centre for complex cancers.
A hydrotherapy pool will be installed to service increased rehab services.
Queen Elizabeth Hospital
The paper confirms the Queen Elizabeth Hospital emergency department will be downgraded, and “life-threatening emergency” patients will be transferred to the RAH and other large hospitals.
The QEH will have a multi-day elective surgery centre and day surgery will be managed both at the QEH and the RAH.
It will become the “statewide centre for rehabilitation”, taking over the bulk of rehab services from the Repat, St Margaret’s Rehabilitation Hospital and Hampstead Rehabilitation Centre.
An additional level will be added to the Allied Health and Rehabilitation building to expand the scope of those services.
Flinders Medical Centre
Flinders Medical Centre will receive seriously ill patients from Noarlunga Hospital and will offer some of the rehabilitation services currently delivered at the Repat.
It will host senior doctors and senior nurses onsite 24 hours a day, seven days a week.
A new building will house 55 rehabilitation beds and new gyms and a new hydrotherapy pool facility.
A new multi-level car park will also be built.
A previously committed $17 million upgrade to the neonatal unit will go ahead.
Flinders will host a new centre for psychiatric care for the elderly, previously provided at the Repat.
Noarlunga Hospital
A Community Emergency Department – rebranded from the “Walk-In Emergency Department” initially proposed by the government – will operate 24-hours a day, but “life-threatening emergencies” will be transferred to Flinders Medical Centre.
The ongoing complaint from doctors has been that “life-threatening emergencies” are not defined, and that patients with the most serious illnesses will always have to be stabilised at the hospital where they arrive.
Renovations will begin for a dedicated elective surgery centre, ward space will get a “refit” in order to make space for the dialysis unit and “minor works” will be conducted to create a dedicated space for children’s medical care.
Lyell McEwin Hospital
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The Lyell McEwin Hospital will become the state’s third “super ED”, as originally proposed.
That will mean “life-threatening emergency” patients will be transferred there from Modbury Hospital.
The hospital will also host senior doctors and senior nurses onsite 24 hours a day, seven days a week, and contain an 8am to 8pm on-site stroke treatment service.
Modbury Hospital
Modbury Hospital will retain a 24-hour emergency service.
Paediatric emergency services will continue to be provided there.
Modbury will become a “major rehabilitation centre for the North” with an expanded gym and pool facilities.
St Margaret’s, Hampstead
St Margaret’s Rehabilitation Hospital will lose its rehabilitation services to metropolitan hospitals across Adelaide, but it will continue to have “a health focus”.
Those are the only facts mentioned about St Margaret’s in the 454-page document.
Hampstead Rehabilitiation Centre will also lose its rehab services to Adelaide hospitals.
The government has not yet decided on the future use of the Hampstead site.
Ambulance services
The government recommitted to its $15 million investment in ambulance services, including 72 new paramedics and 12 new ambulances.
Paramedics will have added responsibilities to take patients to “the right hospital, first time, every time” and “options will also be explored to maximise the skills and expertise of extended care paramedics”.
“Extended Care Paramedics can save patients the disruption of a trip to an Emergency Department so they can, where appropriate, remain in the comfort of their own home while receiving the treatment they require,” the paper says.
“The model of care provides a tailored approach to patient care.
“We will also explore options for building new ambulance stations, including in Adelaide’s North and West.
“Only once capacity is unlocked across the metropolitan system will any changes be made to ambulance services and staffing, and in full consultation with staff and their representative unions.”
Training new doctors
The government also says it will work with training colleges and universities to ensure that the changes do not harm the accreditation of trainees.
Flinders University medical students will be hit hardest by the changes, with the closure of the Repat and the downgrading of the Noarlunga Hospital ED.
Medical students told InDaily last month that they were concerned the quality of their training would suffer amid uncertainty over placements and internships held at facilities to be closed by the State Government, such as the Repat.
Mental Health
The state government is hoping to significantly improve waiting times for mental health patients.
Over the past several months, overcrowded emergency departments have held mental health patients – sometimes shackled to a bed or sedated – in emergency departments, because acute psychiatric beds have not been available for them.
Overcrowding has been blamed for the death of a mental health patient at the Royal Adelaide Hospital.
The main way the government intends to reduce this problem is by creating a new “direct admission” pathway into mental health wards, avoiding emergency departments altogether.
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