John Horowitz: Health Minister Jack Snelling, perhaps you also should concern yourself with patient care

PLEASE leave The Queen Elizabeth Cardiology Unit alone, Health Minister Jack Snelling.

This indeed is Transforming Health. The problem is the direction of “transformation” is downwards. Cartoon: JOS VALDMAN

• Reform plan may lead to heart deaths at QE Hospital: Cardiologist

RECENT events in medical politics in South Australia have the potential to seriously damage or even destroy Queen Elizabeth Hospital Cardiology.

The enforced amalgamation with RAH, despite its theoretical advantages, has thus far been a major disappointment, with no actual clinical progress resulting thus far, despite endless bureaucratic exercises.

The building of the new RAH (nRAH) is also problematic, given the resultant depletion of available funding for hospitals elsewhere and increasing pressure on budgets.

For the last 50 years, the QEH Cardiology Unit has provided good clinical care, primarily for the residents of the northwestern suburbs of Adelaide, where the prevalence of heart disease is the highest in the state. Increasingly, for the past 25 years, QEH Cardiology has also been world-renowned for its research.

A number of treatment strategies developed by QEH Cardiology are now in worldwide use, for example, the treatment of heart disease in women and for heart failure.

Recently, the results of the NACIAM (N-AcetylCysteine In Acute Myocardial Infarction) trial, an investigation initiated by Prof John Beltrame from QEH, evaluating a new treatment for heart attacks that had been developed from previous QEH research, was accepted for presentation as a late-breaking clinical trial at the forthcoming European Society of Cardiology meeting in Rome, which is the world’s leading forum for new developments in this field. This is a singular honour, emphasising the pivotal importance of the NACIAM trial.

However, about 18 months ago, a proposal arose that QEH Cardiology lose its two cardiac catheterization laboratories (“cath labs”) when nRAH opens. I oppose this strongly: cath labs are pivotal to the management of most forms of heart disease, including cardiac emergencies, electrical abnormalities and severe heart failure.

It would become impossible to continue the types of research we currently practise at QEH, in association with the adjacent Basil Hetzel Institute. Training at QEH would become severely compromised.

In recent weeks, things have become much worse. Health Minister Jack Snelling and some senior health bureaucrats (SA Health Chief Transformation Officer Vicki Kaminski and Central Adelaide Local Health Network CEO Julia Squire) have suggested that QEH Cardiology be moved, first to (old) RAH, and then to nRAH.

This had not been discussed with clinicians at either RAH or QEH, and is a proposal without any obvious merits: it is a “lose-lose” strategy. Minister Snelling’s statement that the idea relates to management of patients at LMH is a complete furphy. The idea is right up there with a recent bureaucratic proposal that RAH halve its admissions with heart attacks! Is this a government edict that people have fewer heart attacks?

Minister Snelling has never discussed any of these issues with me, despite my longstanding invitation to him to do so. He clearly has been badly advised, and is currently acting from an economic, rather than medical, imperative.

For example, he would like to move Hampstead Hospital to QEH, in order to sell the land at Hampstead. The problem is that he wishes to enforce this transfer “on the cheap”, displacing existing acute medical services at QEH.

This indeed is Transforming Health. The problem is the direction of “transformation” is downwards. Hospital beds will shrink, bureaucrats will prosper. The care of patients in the western suburbs, perhaps one quarter of Adelaide’s public hospital population, will suffer greatly unless this is remedied.

About six months ago, Minister Snelling urged me (in the media) to look after my patients rather than make public comments on medical treatment.

Minister, my message is clear: I am looking after my patients. Perhaps you also should concern yourself with patient care?

John Horowitz is the Professor of Cardiology at University of Adelaide and the Director of Cardiology/Clinical Pharmacology at The Queen Elizabeth Hospital.