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medicSA September 2018 | President's Report | A/Prof William Tam  

With the new Liberal government’s first budget delivered on 4 September, we now have a clearer view of what lies ahead. The Government has dutifully funded the things it said it would preelection, but also flagged a range of savings strategies as it seeks to rein in costs.

While savings targets for health have been ‘re-set’ to levels it considers more realistic, the measures proposed provide some troubling reading, in particular for pathology and radiology. That said, we commend the government for sticking to its promises – although with the caveat that the Modbury HDU model needs revisiting.

One of the most crucial promises, in my view, is that of a co-located Women’s and Children’s Hospital (WCH) at the new Royal Adelaide Hospital site. The Liberal Party was the first to commit to this, long before the previous government got on board (and then partly disembarked). Now they get a chance to deliver.

At the moment, we await the findings of the WCH Taskforce, which is set to report to Government by the end of this year. In the meantime, we can probably expect to hear more about costs and logistical issues, that being par for the course on any major development – as we know from the RAH.

But while the RAH relocation was a matter of hot debate at the time, and can still activate a pretty frank barbecue conversation, there has long been a strong confederacy of agreement on the WCH move, and especially among WCH doctors. It has been a matter of AMA(SA) advocacy since at least 2009 and will remain so. And our strong position remains that the move should include both the women’s and children’s services.

A full move would be better for women and children, and also avoid duplications that would otherwise be necessary – such as having two neonatal intensive care units; two sets of radiology, pathology and other support services; and duplicated surgical theatres. Also, duplicated staff, or staff travelling between hospitals, wasting time. There would also be increased costs from interhospital transfers. That’s before you get to the clinical benefits, of course,
which include a better transition – and access – to specialised and adult services for children, and safer care for women.

In fact, there is now a national push across Australia to have co-location of women’s, children’s and adult hospitals. Look at Perth, Randwick, Westmead and Monash, just to name a few. No one is building standalone hospitals, or wanting to maintain them, where they have the opportunity to bring them into a precinct.

Of course, the Government will need to learn from the new RAH experiment. When The Advertiser got in touch a little while ago to ask for my assessment of the new RAH one year in, I called up the notes filed on my phone which read: ‘Lost Services’; Fragmented Services’; ‘Stranded Services’.

Then I started on a list of good news … the largest automated microbiology system (Kiestra) in the Southern Hemisphere. Generally, a good patient experience. A 5-star facility. A brand new shiny building. Apparently, food that is improving. But there is still much unfinished business. EPAS is under review. EPLIS is still slow and not fully interfaced with EPAS. Length of stay has increased. Uncertainty remains about Outpatients. The hybrid theatre or ‘RAPTOR’ suite strongly advocated by RACS is still at business plan stage.

KordaMentha are interviewing staff in the RAH on strategies to improve efficiency, reduce duplication, and save money. An understandable object, but surely the most important goal must be to bring the new RAH up to its promise.

Hopefully when the WCH planning is underway, a better consultation process will mean less teething troubles for this next new endeavour. How the new Government handles this project will be telling.

Since the election, we have seen action on the ‘first 100 days’ deadlines the Liberal Party outlined pre-election, and pledges funded. What we don’t yet see is a longer-term vision for health beyond these margins. The AMA(SA) has highlighted some of the areas we see as crucial both in the election lead-up, and since, in our AMA(SA) Key Priorities for Health: Beyond the First 100 Days.

These include a clinician-led governance model, including a clinical data analytics entity to support evidence-based health policy; integrated hospital and GP services; and a commitment to training and research. Also, key measures for younger South Australians; for older South Australians whom Oakden failed; for improved rural and remote health; palliative care; and caring for the carers with support for doctors’ wellbeing.

The first 100 days are now well and truly over; the budget has delivered what was pledged but with little new to discuss beyond the savings mechanisms. But the future is ahead of us, so the next step is working to ensure it is a better one for our health services, and patients. In other words, a vision for what’s next.