Health shake-up: The questions that need answers
On Monday, Health Minister Jack Snelling held a press conference in which he told a group of adults to wait just one more day for his confirmation of what he had already hinted at so pointedly – that the Repat was to close.
The next day, he confirmed the closure as expected, and released his government’s ‘Proposals Paper’, containing, as the Premier put it, “our plans, unless we can be persuaded that there is another way”.
The South Australian community has been given a 59-page brochure full of hints – but we’re still looking for detailed answers.
Here are the key questions.
Job losses
Snelling gave a wink and a nudge to thousands of nurses, doctors and allied health professionals yesterday that “obviously we’ll have to work on the workforce issues”.
He said he wanted fewer acute beds in the state’s hospitals, and committed to abiding by the relevant Enterprise Bargain, which ties nurse numbers to bed numbers.
“But there’ll also be new opportunities for nurses … new opportunities for nurse practitioners.”
And he gave this tantilising nugget: “While we have more doctors and nurses per head of population than any other state we have lower numbers of allied health, so we need to change our mix.”
We know, that he knows, that we think we know, that nurses are going to lose their jobs.
But how many, or from where?
SA Health told InDaily they’ll have to wait to find out.
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“The Transforming Health proposals are currently out for feedback,” a spokesperson said.
“A detailed implementation plan will be developed at the end of this process, which will also include staffing changes if required. These details will depend on which proposals are adopted.”
Snelling is responsible for the largest employer in South Australia – SA Health – and he’s leaving thousands of people extremely nervous about their future.
Bed closures
“At the moment, we have more acute beds per population than any other state in the country,” Snelling said.
“I would like to see that acute bed number get down to where we’re more middle-ranking and more consistent with other states, rather than being right at the top.”
According to the Australian Hospital Statistics Report, South Australia has three hospital beds per 1,000 head of population.
The Australian average is 2.6 beds per 1,000.
The OECD average is five beds per 1,000.
How many beds will actually go? How will the system cope with less beds when mental health patients are still waiting for days in EDs because wards are full?
Snelling’s greatest asset in selling these reforms, his Clinical Ambassador for Transforming Health Dorothy O’Keefe told reporters: “What we need to do is make sure that the beds in the hospitals are free and available when the patients in the emergency department need them.”
“We need more beds available and unoccupied. That doesn’t mean we need more beds in number, it means we need to make the beds available more efficiently.”
Aside from improving day surgery rates, there is very little detail on how the government plans to make this happen.
Emergency departments
With the severe overcrowding of emergency departments well-documented, how will the three “Super” emergency departments cope when patients are diverted from the Queen Elizabeth, Modbury and Noarlunga hospitals?
Snelling said yesterday that “our emergency department reform, particularly ambulances taking people directly to either the Lyell McEwin, Flinders or the Royal Adelaide Hospital will happen in the next couple of months”.
The next couple of months.
That leaves very little time for the government to transform processes and build extra capacity.
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As the SA chair of the Australasian College of Emergency Medicine Tom Soulsby told InDaily last month, “all of the EDs are struggling”.
“As it currently works, we could not take an increased number of patients.”
“The major issue affecting all of the EDs … is access block – being unable to move patients to the wards.
“What needs to happen is not fixing the ED but fixing the hospital behind the ED.”
If the minister is serious about his blistering timetable, he better produce some detailed plans on how to move patients through the hospitals behind EDs quicker – and fast.
The patients
The key principle of the proposed health reforms is consolidation.
The argument is that if you consolidate the best services and the best expertise in fewer facilities, you will get better health outcomes.
But the reforms ask much more of the patient and their family – who will now have to travel further for care, and know the health system fairly intimately, in order to get the treatment they need.
Snelling said one of the biggest problems with the state’s health system is a lack of consistency in health outcomes.
“I won’t rest as health minister until I’m satisfied that we don’t just have pockets of excellence in our system but we have consistency of excellence,” he thundered, “and that South Australians can be assured that when they present to one of our public hospitals, regardless of the site that they present to … they’re going to get the best possible care that we can provide.”
The problem, of course, is that in moving towards one type of consistency – excellent 24-hour emergency care at three of our major hospitals – another type of consistency goes out the window.
Where previously all hospitals tried – and struggled – to be all things to all people, now patients will have to know that it would be very bad to arrive at what will be the Noarlunga Walk-In Emergency Clinic with severe stroke, because that emergency room may not even try to treat you. According to Snelling, an ambulance will instead be commissioned to take you to one of the three hospitals with the skills and resources necessary to save your life.
“Sometimes it is better to spend a little bit extra time in an ambulance, rather than spending a lot of time in an emergency department that’s not able to effectively look after you,” said Snelling.
SA Health told InDaily: “If a patient has a life threatening condition they should call Triple zero (000). The ambulance team will make the decision about the best hospital to take patients for the best care, first time.”
“If a patient self-presents to any emergency department they will be treated and receive the care they need. Depending on their condition, this may require a transfer to another hospital more suited to their needs.”
As the Opposition Health spokesperson Stephen Wade has pointed out, almost half of those who arrive at a South Australian hospital do so in their cars, not in an ambulance.
To some degree, the State Government will ask patients to ‘self-triage’ – at least to a greater degree than they are at the moment. According to the ABS, just 41% of Australian adults are considered to be health literate.
The question is: will you know which hospital to choose and for what health issue?
Your capacity to answer may well save your life.
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