Teaching hospitals lead agenda

FAR-REACHING changes to the structure of Perth’s three major teaching hospitals are likely to be among the major reforms arising from the work of the State Government’s health reform committee.

Committee chair Mick Reid believes the duplication between Sir Charles Gairdner Hospital (SCGH) and Royal Perth Hospital (RPH) is one of the major problems he is facing.

“We are trying to deal with a fundamental bad planning decision in WA,” Mr Reid said.

“In 1983, Charlie Gairdner was rebuilt on the agreement Royal Perth would move on-site, and for whatever reasons that commitment wasn’t carried through.

“We’ve ended up with two major teaching hospitals very close to each other, a population dispersed over 190 kilometres, growth of population up the north and south which is quite dramatic, and a dramatically ageing population.

“So the picture is grim over the next 10 to 15 years, with the ageing, the turnaround in length of stay and the greater emphasis around mental health and chronic and complex conditions that communities worldwide will experience.”

A discussion paper issued by Mr Reid’s health reform committee spoke of the “uncoordinated development of major teaching hospitals within a few kilometres of each other” as well as “unhealthy sibling rivalries” between the hospitals.

“Partly as a consequence, some services have been duplicated inappropriately and/or have developed in an unplanned fashion,” the paper says.

“This is unfortunate, as the contention that every tertiary hospital must provide every speciality and sub specialty cannot be defended in the current environment.”

On this basis, the discussion paper suggested major changes at each of the teaching hospitals.

“In short, there needs to be one major trauma centre, one adult cardiac surgery centre, and an integrated cancer care centre,” it says.

“If such proposals are accepted, there will be some short-term disruption.

“The longer term gains in service quality and efficiency, professional job satisfaction, education and research are, however, unequivocal.”

The State Government has already accepted the proposal to make SCGH the hub of the cancer care network in WA.

The Government sweetened this decision by deciding to buy two additional radiation treatment machines – linear accelerators – costing $3.5 million each, almost doubling the treatment capacity now available at SCGH.

The discussion paper says that, as well as providing comprehensive cancer care, SCGH should develop more of an elective surgery focus.

RPH would become the single location for major trauma and cardiac surgery while Fremantle would be expected to assume a larger role in elective surgery.

The discussion paper says medical research also has some significant structural problems.

“As in the case of clinical services, there is a degree of fragmentation and a difficulty in many areas in achieving the critical mass essential for research.”

It suggested greater institutional coordination to maximise the benefits of medical research in WA.

The discussion papers issued by the health reform committee provide strong clues about other likely reforms.

They have identified a range of innovative models of care that could help to manage demand and improve the quality, safety and financial sustainability of the health system.

Examples include home care, freestanding surgicentres, telemedicine, electronic record keeping, nurse managed emergency departments and electronic prescribing.

At an administrative level, the committee supports the area health service structure established in 2001.

This structure involved the division of health services into four areas – north metropolitan, south metropolitan, east metropolitan and women and children’s health.

However, the committee acknowledged the system “has not yet realised its full potential”.

It said each area should focus on the health of its local population rather than concentrating on discrete hospital services.

In relation to patient care … “the committee believes that the current system of care is too fragmented and is frequently designed around a building or a service provider”.

It has proposed initiatives to better coordinate patient care and reduce unnecessary hospitalisation, for instance by providing care through GPs or community services rather than in a hospital.

The committee identified Indigenous health and population health as two areas needing a greater focus.

It said the health status of Indigenous people remained a major problem and new strategies were urgently needed.

The committee also believes continued investment in prevention programs is vital to reduce long-term demand for health services.

It found the WA health system’s “own source” revenue, such as private patient revenue, is lower than most other States and less than half that raised by NSW on a per capita basis.

The committee observed that increasing revenue would provide more funding flexibility and reduce pressure on the budget.

Finally, the committee has sought to identify measures to improve the accountability and transparency of the health system.

It said: “The current approach to resource allocation within the WA public health system lacks transparency, rigour and public accountability”.

To address this problem the committee has proposed improved performance agreements via a range of output metrics and key performance agreements.