SA’s hospital system no longer ‘fit for purpose’, Advertiser/Flinders University’s Fearless Conversations series hears

Health experts have called for changes to our hospital system that go far beyond more hospital beds, arguing early intervention, care at home and more nurses are needed.

South Australia is well placed to cautiously open its borders without overwhelming the health system, thanks to its record of good hygiene, social distancing and rising vaccination rates, experts say.

But they say today’s hospital system is no longer “fit for purpose” and an overhaul is needed, including a bigger focus on measures to keep people healthy, care in the home when needed, and more support for nurses.

Health was the topic of the latest Fearless Conversations roundtable, a collaboration between The Advertiser and Flinders University.

The panellists were vice president and executive dean of the College of Nursing and Health Sciences at Flinders University, Professor Alison Kitson, the uni’s health economics and Matthew Flinders Fellow at the college, Professor Julie Ratcliffe, Wellbeing SA chief executive Lyn Dean and COTA SA chief executive Jane Mussared.

Ambulances entering the Royal Adelaide Hospital. Picture: NCA NewsWire/Brenton Edwards

Prof Kitson said hospitals were busy with older people with chronic conditions but stressed there was no point in blaming them for “a whole of system problem”.

“Let’s get a bit fearless in acknowledging our systems are not fit for purpose,” she said.

“The systems were built for an individual acute episode, so you’re going to go in and get sorted out and get out.”

Prof Kitson said chronic diseases now represented a “tsunami of challenges” so “we need to think differently.”

Prof Kitson said hospital staff were under pressure particularly from the pandemic but that personal care in hospitals and aged care was crucial to wellbeing.

“It is almost as if care is a dirty word,” she said, stressing oral care, being able to eat properly and even help with glasses and hearing aids was vital to the vulnerable, a point Ms Mussared supported.

Flinders University/The Advertiser Fearless conversations panellists: Back row – Moderator, Brad Crouch with Lyn Dean CEO of Wellbeing SA. Front now L-R – Professor Julie Ratcliffe, Health Economics and Matthew Flinders Fellow, College of Nursing and Health Sciences, Professor Alison Kitson, Vice President and Executive Dean, College of Nursing and Health Sciences, Flinders University, and Jane Mussared, CEO of COTA SA. Picture: Dean Martin

Other panellists agreed, calling for more early intervention steps to avoid hospital admissions if possible, and also better pathways out into community care.

Ms Dean said issues around chronic conditions had been growing for some 40 years and it would take time for agencies such as Wellbeing SA to make significant inroads by encouraging healthy diets and exercise, particularly without making people feel bad about themselves.

The issue of the impact of mental health on hospital emergency departments raised a strong response from panellists, with calls for alternative care and ways to build community resilience and support.

Ms Dean said “psychological distress” was a broader issue than just hospital care and ways to address it could range from support for families to more local parks for exercise and community gardens where people can socialise while growing nutritious food.

Ms Mussared said mental health issues affecting older South Australians ranged from housing stress, with some 10,000 people at risk as a result, to climate change affecting regional areas due to worries about bushfires and floods.

Panellists also raised the notion of the state adopting a measurable “happiness index” so political success would be measured beyond just economic performance.

Balance of costs must be healthy

Balancing the benefits of new but expensive medical technology against the constraints of the state’s budget will be one of the key ongoing challenges for the health system, experts say.

It’s a key focus for Flinders University health economist Professor Julie Ratcliffe, who works closely with clinicians looking into the cost effectiveness of new products.

“We know there’s a lot of wonderful new technology being introduced into our health system but we also have to be very mindful of how we spend our limited funding available for the health system,” she said.

“It’s fantastic for clinicians to have the greatest new piece of technology but we also have to make sure that when we introduce those new technologies that they’re cost effective.

“(That’s) so we’re not spending a lot of money that might only result in a very small increase, if any, in the health and quality of life of the population that the technology has been designed to serve.

“We do need to focus on evidence as well. We need to have much more of a focus on measuring health and quality of life from the perspective of the patients.”

The uni’s Professor Alison Kitson said it was not just “shiny new technologies” that need to be embedded in healthcare systems.

Prof Kitson cited US studies showing a rise in hospital patients contracting pneumonia simply because their teeth had not been cleaned while in hospital, adding to hospitals’ costs and length of stay. Wellbeing SA’s Lyn Dean noted technology now included mobile phone apps such as one an out-of-town friend of hers used when in Adelaide to contact a GP, who sent a script to a pharmacist.

“Half an hour later she had a medication,” Ms Dean said.

“When we talk about cost- benefit analysis, it’s also about driving technology to (deliver) better care, but not necessarily (in) hospitals.

“So this idea that all roads lead to an emergency department needs to shift.

“People in residential aged care don’t want to leave residential aged care.

“So why don’t we bring the technology to those services, rather than always being a cost-benefit analysis for hospitals rather than for services across the board.”

COTA SA chief executive Jane Mussared, centre, with residents of the Kalyra Belair Village (left to right) Doone Winnall, Pamela Roberts, Rae-Marie Roberts, Lydia Anderson, Anne Dixon and Peter Mussared in their communal garden. Picture: NCA NewsWire/Brenton Edwards

Covid brings community closer

A benefit of the pandemic has been a reassessment of community connections, which in turn feeds into a focus on physical and mental health, the Fearless Conversations forum heard.

COTA’s Jane Mussared said in tough times, neighbours cared for each other more.

“Neighbours reached out to each other – casseroles over the fence became an important part of caring,” she said.

“It is a gesture of belonging and it was neighbourhood connections as much as anything that kept people safe.”

Ms Mussared said the importance of things ranging from communal gardens and cooking, particularly for older people living alone who may otherwise skimp on meals, to opportunities for exercise were vital for physical and mental wellbeing.

Flinders University’s Professor Julie Ratcliffe said that surveys since the pandemic hit had shown people’s political priorities were shifting from the traditional focus on measures such as economic growth and employment towards wellbeing.

Wellbeing SA’s Lyn Dean said the agency had taken regular surveys checking the level of psychological distress among the public since the pandemic hit.

Ms Dean said while some were still showing levels of distress, people could now see a trajectory out of the pandemic more clearly “but it won’t be a return to the old ways” in every aspect of life.