Senior Queen Elizabeth Hospital doctors revolt over plans to close Hampstead, shift services

SENIOR doctors at the QEH and Hampstead Rehab Centre have demanded plans to close the centre be dumped and the “dysfunctional management ... be held to account”. HEALTH REFORMS EXPLAINED

QEH

• Transforming Health — for and against
• Senior Modbury doctor quits over Transforming Health
• 32 beds moved from Modbury to Lyell McEwin
• Outrageous price we’re paying for Transforming Health focus groups
• Fewer hospital beds in the future because we won’t need them

SENIOR doctors at The Queen Elizabeth Hospital and Hampstead Rehabilitation Centre have demanded plans to close the centre be abandoned and the “dysfunctional management that led to this debacle ... be held to account”.

Their concerns are some of the strongest criticism yet from doctors over the Transforming Health plan.

The doctors say shifting Hampstead’s services to the QEH is “unachievable” and is being driven by an “incompetent planning and consultation process.

They join others from major Adelaide hospitals who have signed letters condemning aspects of Transforming Health with warnings that the cutbacks will potentially cost lives.

Doctors at Lyell McEwin, Modbury and Noarlunga hospitals have in the past sent strongly worded letters protesting against aspects of the plans. The clinical director of Modbury’s emergency department quit last week citing frustration with the reforms.

Parts of the plan have also been criticised by the Australian Medical Association, SA Salaried Medical Officers Association and the Colleges of Surgeons, Physicians and Emergency Medicine.

There have also been public petitions against the closure of the Repatriation General Hospital, protests over downgrading the QEH, and complaints by consumer groups such as Paraquad SA.

The Transforming Health blueprint was announced a year ago this month, after the State Government seized on federal cuts as the reason to freeze major hospital upgrades, overhaul the health system and address its ballooning budget.

Writing in The Advertiser’s Monday edition, Health Minister Jack Snelling says 500 South Australians die unnecessarily in our public health system and he “will not continue to let this happen”.

“This isn’t a reflection on our doctors, nurses or allied health professionals, rather it shows the failures of the structure to support their vital work,” he writes.

As details of Transforming Health have emerged, clinicians have revolted against aspects. This has included closing the Repatriation General Hospital, downgrading the Noarlunga, Modbury and Queen Elizabeth hospitals and adding workload to Flinders Medical Centre, Lyell McEwin Hospital and the Royal Adelaide Hospital which will be the major hospitals with “super EDs”.

It also includes closing Hampstead and shifting most spinal and brain rehabilitation services to the QEH, which will get a $20 million upgrade, down from the $124 million upgrade promised before the last election.

However, senior staff and the heads of 10 clinical units at the hospitals have taken a vote of no confidence in the plan and forwarded it to SA Health, calling the plan “unachievable”. It says “the planning and consultation process that has led to the current situation has been incompetent”.

“The current flawed plans for the relocation of HRC to QEH must be cancelled, with HRC remaining on its current site until the new Royal Adelaide Hospital is fully functional and all options for accommodating HRC and the QEH have been properly evaluated with comprehensive costings and genuine clinician engagement,” the letter sent in late January states.

“The clinicians believe the dysfunctional management structure that led to this debacle prior to the current Central Adelaide Local Health Network’s chief executive’s intervention must be urgently revised and the individuals who have failed in the appointed roles be held to account.”

Paraquad SA also has called for Hampstead to be retained, as it is not convinced planned services at the QEH would equal those now available.

Health Minister Jack Snelling responded to the letter by saying Transforming Health aims for high-quality and patient-centred healthcare, and that the concerns would be addressed by SA Health officials.

Opposition health spokesman Stephen Wade wants the plan dropped. “It is reckless and dangerous for the Health Minister to ignore the deeply held concerns of the doctors, nurses and ambulance workers,” Mr Wade said.

EXPLAINING TRANSFORMING HEALTH

WHAT

The Transforming Health overhaul of the health system was unveiled a year go with the slogan Best Care. First Time. Every Time.

WHY

The ballooning health bill threatens to eat the State budget, heading towards a projected 50 per cent of spending in about 15 years. In the 2014 budget the State Government seized on federal cuts as the reason to freeze major hospital upgrades and overhaul the health system, although federal funding is actually rising — just not by as much as promised by former Labor governments.

WHY ELSE

Despite plenty of beds and staff, SA’s system has poorer outcomes and longer inpatient stays than some other jurisdictions, and patient outcome — including survival — varies from hospital to hospital and time of arrival. Health care has also changed dramatically — there is more day surgery, fewer long term stays, better equipment, drugs and techniques such as keyhole surgery, which have changes the nature of hospital care.

WHO

The State Government recruited members of three clinical groups to draw up standards for the changes, allowing it to say the reforms were driven by clinicians rather than politicians. Little mention was made of consultants such as McKinsey and Co who have been paid millions of dollars. The resultant plan was criticised for its lack of detail.

WHAT

TH aims to create a two tier, streamlined metropolitan hospital system. Lyell McEwin Hospital, Royal Adelaide Hospital and Flinders Medical Centre will form the north-south spine of flagship hospitals with the best people, equipment and allied services available 24/7 for major trauma and life threatening cases. Faster treatment and streamlined discharge, especially on weekends, also aims to unclog gridlocked EDs. Scare resources will go to these ‘super EDs’ rather than be thinly spread among more hospitals. Second tier hospitals Modbury, Noarlunga and Queen Elizabeth hospitals will have 24/7 EDs handling only non-life threatening cases while ambulances with urgent cases will bypass them. Their medical wards and capacity for complex surgery and cardiac care is being wound back, and they will be focused on elective surgery, routine day surgery and rehabilitation care. The Repatriation General Hospital will close, despite former Premier Mike Rann’s pledge it would ‘never, ever be closed by a Labor government.’

CONCERNS

The Government claims ‘95 per cent of clinicians’ back the plan, but as details emerge metropolitan clinicians from the deep south to the far north — Noarlunga to Lyell McEwin — have rebelled with robust letters of complaint bluntly stating patients are at risk from some changes. A protest letter from emergency department specialists at Lyell McEwin Hospital sums up the difference between spin doctors and genuine doctors.

“We note there is rhetoric being delivered (by SA Health) to promote these changes to staff and to the public, yet this rhetoric conflicts with the judgement of medical practitioners who are in a position to know the true likely outcomes,” it states.

Coalface clinicians in hospitals including Lyell McEwin, Modbury and Noarlunga have warned ED changes will put patients at risk as the already often overloaded major hospitals are ‘overwhelmed’ as the second tier hospitals’ EDs are scaled back. Modbury’s director of ED quit over the changes last week.

MORE CONCERNS

Groups including the Australian Medical Association, SA Salaried Medical Officers Association, the Colleges of Surgeons, Physicians, and Emergency Medicine, and consumer groups such as Paraquad SA are hostile to aspects of TH. A letter from senior clinicians at the Queen Elizabeth Hospital blames ‘dysfunctional management’ for the TH ‘debacle’.

ON THE OUTER

A question mark remains over outpatient services, with Transforming Health documents stating for most hospitals: ‘Outpatient clinics will continue. The final location will be agreed through consultation.’

THE OUTLOOK

The State Government says Transforming Health will create a more efficient system with better outcomes for patients; the Opposition says it is a cost cutting exercise; and Premier Jay Weatherill last month threatened to close more hospitals unless more federal funding is available.

WHAT’S HAPPENING WHERE

NORTH

LYELL MCEWIN HOSPITAL

Flagship hospital in the north, will handle all major trauma and life-threatening emergency cases from the region in its ‘super ED’, gets 24/7 orthopedic trauma service cutting waiting time for surgery from around 150 hours to under 24 hours, a new cardiac catheter lab, new CAT scanner, gets an emergency stroke service operating 8am-8pm seven days.

Lyell McEwin will become the major northern hospital for elective multi-day surgery, allied health services for rehabilitation will be available seven days a week, and it will get a new gym facility. The move to direct urgent ED cases from Modbury and QEH resulted in 19 of 23 ED doctors signing an open letter saying they fear they will be overwhelmed, resulting in ‘potentially avoidable deaths. They want their warning on the record in the event of any coronial inquiry as their objection is ‘based on clearly foreseeable poorer patient outcomes and adverse events.’ Last week 32 medical ward beds were transferred from Modbury.

MODBURY HOSPITAL

Thirty senior staff signed an open letter warning changes will put patients at increased risk. Clinical director of ED resigned last week citing the changes. ED to be downgraded, will remain open 24/7 for non-life threatening cases, ambulances with urgent cases will bypass it in favour of Lyell McEwin. Plan to have major eye clinic there abandoned after protests from consumer and clinician groups about difficulty with access.

Lost 32 of its 50 medical ward beds last week which were shifted to Lyell McEwin to make room for rehabilitation services. Loses Gynaecology, Orthopaedics, General Surgery, E.N.T., Cardiology and non-acute Medicine. Estimated to get 3000 more patients a year for same day elective surgery.

A $32 million upgrade includes a new hydrotherapy pool and rehabilitation centre for expanded rehabilitation services, and expanding rehabilitation services to 52 beds by the end of the year. Also gets a comprehensive new breast health service. A dedicated ambulance shuttle with paramedics dubbed the ‘MoHo Express’ now stationed at Modbury to take urgent cases who arrive by their own transport to Lyell McEwin once they are stabilised, at a cost estimated by Modbury clinicians to be up to $15 million a year. Junior surgeons seeking a career path already refusing job offers at Modbury as it is downgraded to only handle less complex day surgery cases.

WEST

THE QUEEN ELIZABETH HOSPITAL

A $124 million upgrade promised prior to the State election wound back to $20 million. ED to be downgraded but remain open 24/7 for non-life threatening cases, loses its two cardiac catheter labs. Will have a focus on multi-day elective surgery and rehabilitation services with a new hydrotherapy pool, extra floor added for rehab services and existing wards refitted for rehab services.

Will take over long-term, post-acute brain and spinal rehab services when Hampstead Rehabilitation Centre is closed. Senior clinicians from both sites say the plan is a ‘debacle’ and ‘impossible’ to achieve under the $20 million budget, have called for it to be abandoned and for the ‘dysfunctional management’ behind the plan to be held to account.

Paraquad SA wants Hampstead retained as it is not convinced services at QEH will be equal to existing services. Doctors told a public meeting — which no Labor MP attended — the loss of the cardio catheter labs, and longer ambulance transfer time for urgent cases, would put lives at risk for western suburbs residents.

Dialysis services at Hampstead will relocate to the neighbouring GP Super Clinic, and officials say: “programs like wheelchair basketball and services like the hydrotherapy pool will continue to be provided at Hampstead Rehabilitation Centre, and the future use of the site will be determined in consultation the Centre’s other users.”

CENTRE/EAST/AMBOS

NEW ROYAL ADELAIDE HOSPITAL

The $2.1 billion flagship is over budget and behind schedule. The 800 bed hospital is now due to take patients from November. Major centre for trauma, 24/7 centre for stroke victims, centre for complex elective surgery. Will provide statewide acute rehabilitation services for brain injury, including stroke, and spinal injury patients. New models of care include single rooms with en suites, use of natural light and views. NRAH is designed to run on the new electronic patient records system EPAS but doctors who have used it say it is a lemon creating risks for patients, its cost has blown out to $422 million, and it is years behind schedule. EPAS will be introduced to the QEH in June.

WOMEN’S AND CHILDREN’S HOSPITAL

Continues as is, largely unaffected by Transforming Health. There are plans to relocate the WCH to the South Australian Health and Biomedical Precinct, adjacent the new Royal Adelaide Hospital, so women’s and children’s services are alongside an adult intensive care unit and a wide range of adult speciality services are available for mothers. This will allow mothers and babies to stay together even if there is a medical emergency.

SA AMBULANCE SERVICE

Twelve ambulances to be added to the fleet, more officers employed and ambulance stations built, as paramedics in some cases face travelling longer distances to the three major hospitals when carrying life threatening cases.

SOUTH

FLINDERS MEDICAL CENTRE

Flagship centre for the south. Gets a new 55 bed rehabilitation centre with gyms and pool, the top level of the five storey building will be for palliative care now at the Repatriation General Hospital. $170 million in planned upgrades also include a 1240 space car park and an older persons mental health unit. Its 24/7 ‘super ED’ will take all urgent ambulance cases including those which will bypass Noarlunga, despite its ED often operating near or above capacity resulting in occasional cases of ambulances ramping in the carpark. Emergency stroke service available 8am-8pm, seven days and will become regional centre for complex surgery taking over cases previously dealt with at Noarlunga and Repat. Has taken beds from Noarlunga’s 29 bed medical ward which is closing.

NOARLUNGA HOSPITAL

ED downgraded, but not just a walk in clinic as originally planned after ED doctors publicly rebelled. Will be open 24/7 for non-life threatening cases, ambulances with urgent cases will bypass it for Flinders Medical Centre, patients with urgent conditions arriving by own transport will be stabilised then sent to FMC. Is now in the process of losing its 29 bed medical ward. Will focus on same day elective surgery, and ambulatory care treating outpatients who previously would have been admitted. Gets two new operating theatres, total of six, and a new renal dialysis unit replacing the one now on the site of the planning operating theatres.

REPATRIATION GENERAL HOSPITAL

Despite Labor promises it would never close, it will close. Public protests and tens of thousands of signatures on petitions made no impression on the State Government. A $15 million Centre for Excellence of Post-Traumatic Stress Disorder — smaller than originally envisaged — will be built on the grounds of the Glenside Health Precinct, without access to medical care for veterans who have physical problems in addition to PTSD. Palliative care will be shifted to the top floor of a new five storey building planned for FMC. Repat’s 140,000 outpatients per year will be sent to other sites still to be defined. In 2013-14 the Repat handled 1341 orthopedic procedures, 1353 urological procedures, 604 general surgeries, 665 plastic procedures, and it takes low level ambulance diversions when FMC is full — who will handle these remains to be seen.