Secret SA health masterplan proposed shutting four hospitals and 1000 beds

EXCLUSIVE: A secret health masterplan suggested shutting four Adelaide hospitals — or their EDs — and taking 1000 beds out of the public health system.

• EXCLUSIVE: Women’s and Children’s Hospital left in limbo
• What is Transforming Health, and why is it so controversial?
• Health reforms go back to the drawing board
• Transformed? The hospital nobody wants to work at
• Hospital staff ‘stuck in the past, failing to work as one’

THE closure of four major metropolitan hospitals — the Women’s and Children’s, The Queen Elizabeth, Noarlunga and Modbury — was recommended to the State Government in a secret health masterplan obtained by The Advertiser.

A report by consultants McKinsey & Co, which eventually became the Transforming Health reforms, also mooted closing country hospitals and 1000 beds, noting the 8 per cent annual growth in the health budget was unsustainable.

Another option was to close the WCH and the Repatriation General Hospital while shutting emergency departments at the QEH, Noarlunga or Modbury hospitals — or a combination of the three.

The options factored in a demand to deliver on savings targets.

McKinsey’s options estimated savings in excess of $3 billion over five years under 10 different scenarios — the most lucrative being to close the WCH, close EDs at Modbury and Noarlunga, and shut the Repat “due to the investments required to maintain its facilities”.

The options were gradually whittled down and modified after input from clinicians’ groups and consideration by government, including the political fallout.

It also considered the ripple effect of closing facilities, such as how loss of an ED would affect a hospital’s future.

Several scenarios, including closing Modbury, Noarlunga and the QEH, were rejected early in talks by SA Health executives and clinicians groups in favour of plans to close the Repat while also closing the Modbury and/or Noarlunga EDs.

The resulting Transforming Health plan closes the Repat next December while the EDs at the QEH, Modbury and Noarlunga hospitals remain open 24/7 but have been scaled down to handle less complex and non-life threatening cases.

These are now transferred to the three major hospitals — the Royal Adelaide Hospital, Flinders Medical Centre and Lyell McEwin Hospital — where equipment and expertise to handle emergencies is being consolidated.

While there will be a reduction of beds in the system as a result of the reforms, officials have declined to nominate a target, saying instead there will be sufficient beds available to meet demand.

SA Health interim chief executive Vickie Kaminski told The Advertiser the documents form a four phase project, starting with collection of health system data, the options based on that data by consultants McKinsey, input from clinicians and focus group, then the resulting Transforming Health plan.

She noted she had never seen a consultant’s report where everything had been accepted.

“This was Big Picture stuff — close 1000 beds, close some EDs, close some hospitals,” she said. “This was the art of the possible, this is consultants coming in and throwing every possible option at you and saying ‘here are your options, what do you want to do?’

“However, there are nuances integral to people-based systems that consultants don’t get when they look at numbers.”

Ms Kaminski said these options were taken to clinicians’ groups which refined them, based on their standards of care for patients, and advised where services should be consolidated.

She said the report looked at a range of speciality services offered in relatively small numbers at a lot of hospitals, and how consolidating these would help build up expertise for better patient outcomes.

While the consultants suggested closing WCH and also either Modbury, Noarlunga, QEH or the Repat, the Repat quickly became the prime candidate while also offering the best budget savings.

Ms Kaminski said orthopedics and outpatient work could be absorbed by FMC while Noarlunga could take the Repat’s endoscopy work.

“That left us with services that should not be in a stand-alone facility — could we accommodate them somewhere else?” Ms Kaminski said. “That led to us to looking at closing a hospital which was the Repat.”