Transforming Health report fails to address SA hospital problems

A STUDY of the Transforming Health reforms does not mention ambulance ramping, people stuck in emergency departments, other chronic problems or even if the overhaul was value for money.

A STUDY of the Transforming Health reforms failed to look at basics such as value for money, despite running for almost two years.

The SA Health-commissioned study also ignored building reconfigurations, impacts on primary care and shifting of services, instead focusing on “case studies” of staff and patients.

While parts are so turgid as to be barely intelligible, its recommendations are simple motherhood statements such as “actively celebrate achievements” and “ensure all staff voices are heard”.

The evaluation was done by the SA Academic Health Science and Translation Centre, whose partners include SA Health, SAHMRI, universities and Cancer Council SA.

But the task proved a bit big.

“With a time frame of 20 months and a limited budget, it was only possible to investigate a very small proportion of the complex Transforming Health program,” the report says.

Transforming Health closed hospitals, upgraded three major hospitals as flag-bearers and downgraded three others to focus on elective and rehab services.

Its stated aim was to improve health outcomes but it later emerged it aimed to save almost $1 billion.

The study does not mention many of the problems the reforms were supposed to fix, such as ambulance ramping. Picture: AAP / Keryn Stevens

The study does not mention chronic ambulance ramping, people being stuck in EDs for days on end after being treated or other problems the reforms were supposed to fix.

It does show the promised savings failed to materialise, pointing to Auditor-General reports showing the targeted saving of $52.3 million in 2016-17 was not achieved. Instead a net cost of $17.2 million was recorded. But there is no broader cost-benefit analysis.

Professor Warren Jones, a prominent critic of Transforming Health, said the report confirms there was no clinical basis for the reforms.

“We always knew the claims of 500 avoidable hospital deaths a year in SA was a fantasy based on modelling, not data, and now this report tells us our hospitalisation rates were lower than the national average,” he said.

“So, it was entirely a cost-cutting exercise … and this was a dismal failure, with no savings and with the ongoing cost of repairing damage done to the system and no significant benefits except lower stroke mortality which could have been achieved in easier ways.”

The study also failed to look at impacts of the new RAH on the health system. Its turgid prose included:

“What we can deduce from our work is that it is possible to generate a narrative around the experiences of multiple stakeholders, going through a large-scale system change, in ways that both acknowledge the limitations of the data but support the emerging themes from the data, and from other (realist) literature reviews.”