Minister not listening on Repat hospital restructure

THE Minister must seriously consider a proposal developed by senior Repat health professionals that would see elective orthopedic (and urology) services retained at Daw Park as part of a restructured Repat.

FOR many years the orthopedic service at the Repatriation General Hospital has efficiently and effectively met the needs of veterans and the broader community across southern Adelaide.

Ten years ago, all public elective orthopedic services in southern Adelaide were consolidated at the Repat.

This met the ‘world’s best practice’ requirement of separating trauma and elective surgery to achieve efficiency, reduce cross-infection and speed recovery. This standard still applies today.

Orthopedics is one of the Repat’s busiest services. In 2015, there were 4500 outpatient attendances and 1800 elective operations — 25 per cent of all orthopedic surgery across the metropolitan public health network. The 500 hip and knee replacements done at the Repat was the highest number undertaken in any Centre in SA.

The joint replacement service, pioneered and refined at the Repat, now ensures that over 30 per cent of patients are safely discharged within three days. Overall, more than 90 per cent of patients are discharged direct to their homes.

Time is of the essence in providing hip and knee replacement surgery. Quality of Life (QOL) studies have shown that, if a patient presents with a QOL score of, say, 50 points, surgery can return them to an ideal score of 100 points, and to a productive community life. On the other hand, if delayed surgery results in their QAL score decreasing to, say, 10, they may only return to a score of 60, leaving them socially dependent, and a potential long term financial burden on the community and the Government.

What is the Government’s plan for elective orthopedic surgery in the south if the Repat closes? How will these established and proven pathways to joint replacement and other elective surgery be protected, and high quality patient care maintained? To date, there has been minimal communication with hospital staff and the broader community about the future. ‘Forums’ have been held, allowing staff to voice their frustrations, but have not been informative or constructive.

The Minister for Health, and his Government, appear not be in touch with staff at the ‘coal face’, and seem determined to ignore the concerns of an angry community and their frustrated General Practitioners, searching for timely treatment and quality outcomes.

The Minister must seriously consider a proposal developed by senior Repat health professionals that would see elective orthopedic (and urology) services retained at Daw Park as part of a restructured Repat. The preservation of these important high volume services at RGH would avoid the fragmentation and expense involved in rebuilding them in other locations, where facilities, access, and parking may already be challenged. It would also avert the downgrading of standards and patient access, which will result if these services are moved to less suitable sites.

There is limited capacity to absorb the Repat’s current orthopedic and urology workload into other facilities in the south. Pushing ahead with the current plan will inevitably lead to longer waiting times for outpatient and surgical services, reduced efficiency and throughput, and unnecessary patient deterioration, particularly of those waiting for joint replacements.

Change could improve our State’s health services — but only if the proposed changes are needed and well planned. The Government has not made the case for dismantling of one of South Australia’s most important and efficient health services.

It’s time to re-evaluate the Transforming Health proposals for the Repat in the light of the essential, efficient and cost-effective services it provides to Veterans and the community alike.

Associate Professor Graham Mercer, Past President of the Australian Orthopaedic Association was Head of Orthopaedics at the Repatriation General Hospital from 2004 to 2015.