Transforming Health Submission - Noarlunga Hospital

Read the submission I have made on behalf of the community as part of the Transforming Health reform process, with recommendations to improve the draft plan for Noarlunga Hospital.

Download the submission here (PDF 475kb)

Transforming Health consultation submission

The best care for hospital patients in the South - February 2015

Joint submission by Chris Picton MP, Katrine Hildyard MP and Nat Cook MP
State Members of Parliament for Kaurna, Reynell and Fisher

Summary of our recommendations

Following extensive discussions with and feedback from community members in our electorates, we support –

  • the need to reform our health care system to ensure best care, first time, every time, for every South Australian;
  • emergency services at Noarlunga Hospital continuing to be located at their current site with the current range of facilities including resuscitation rooms;
  • clinical guidelines be established for which patients should go to Noarlunga Hospital’s emergency department via ambulance depending upon the clinical needs of the patient
  • emergency services at Noarlunga Hospital being classified as a ‘Community’ or ‘Local’ Emergency Department rather than a ‘Clinic’;
  • a dedicated paediatric treatment area be considered as an element of the upgrade of Noarlunga Hospital
  • the creation of a central governance for Neonatal Services to ensure all pre-term infants are offered the same care pathways across the state;
  • the involvement of clinicians and consumers in the southern suburbs in the detailed implementation of health reforms.                  

Health needs of the South

The southern suburbs of Adelaide comprise a diverse and strong community and one of the fastest growing areas of our state.  Residents deserve top quality health services inside and outside of hospitals.

For many years our community has been well served by two public hospitals, Flinders Medical Centre and Noarlunga Hospital, working in partnership to manage the caseload of emergency patients from the local area and country areas.  It is recognised that Flinders Medical Centre provides the major tertiary services and Noarlunga Hospital as a ‘general hospital’, provides local services for the nearby community.

The health needs of the south involve the full spectrum of care – from primary health care to aged care, elective surgery, rehabilitation, palliative care, maternal care, paediatric, neonatal and emergency care.  The growing population of the region includes many young families in their first home, many ageing South Australians moving to the area for their retirement and long term residents in a diverse range of housing.  The area is wide and the distances to definitive care are therefore an important consideration, particularly for those living in the outer southern suburbs and the Fleurieu Peninsula.

Staff at both Flinders Medical Centre and Noarlunga Hospital do a fantastic job and are highly respected by the community. They are supported in the community by hard working General Practitioners, Paramedics, Allied Health Professionals and community workers who ensure continuity of care.

Consultation we have undertaken

Since the release of the Transforming Health paper we have been active in our community, having discussions with local residents, clinicians and other workers about health needs and their views about the Transforming Health plan.

Each of us have held or are holding a public forum with the community  in our electorates that has seen a strong response from local residents. This has been an opportunity for the Minister and his team to outline the plan and for the community, local residents, clinicians and other workers to ask questions and provide their feedback. Many people were able to outline their personal interactions with the health system and connect that to their issues or questions about the proposals.  After the forums we collected more information and questions from the forum attendees and these were submitted to the Minister.

We have also been consulting with the southern community through a number of other methods – holding meetings, receiving correspondence and promoting the plan on our social media pages.  That feedback has informed this joint submission.  We have also met regularly with the Health Minister and SA Health staff to both be briefed on the plan and to raise issues and questions with the proposals directly on behalf of our community.

Positive aspects of the Transforming Health proposal

There is broad agreement that our health system needs reform and improvements to take us into the future. There are important elements of the Transforming Health proposals that have wide support.

These include:

-       improving the emergency department capability of Flinders Medical Centre – especially ensuring that senior specialists and dedicated on site stroke teams are available at more times;

-       reducing the bed block at Flinders Medical Centre that results in delays in the emergency department;

-       investing to upgrade the physical facilities at Flinders Medical Centre and Noarlunga Hospital;

-       conducting more elective surgery at Noarlunga Hospital;

-       maintaining strong mental health services at Noarlunga Hospital;

-       increasing paramedic numbers and building new ambulance stations at Noarlunga and Seaford;

-       ensuring no staff lose their jobs as a direct result of implementation;

-       basing rehabilitation services at major hospitals including Flinders Medical Centre;

-       creating a central governance for Neonatal Services to ensure all pre-term infants are offered the same care pathways across the state;

All these elements have wide support and we advocate for them to form part of the Transforming Health implementation.

Patient Flow at Flinders Medical Centre

The bed block at Flinders Medical Centre has been a recurrent theme of many discussions during our consultations.  With discussion that a number of inpatient clinics will be moved from the Repatriation Hospital many are concerned about the capacity at Flinders Medical Centre.  It is our understanding that there is a need for improved processes that support a criteria-lead discharge approach at Flinders Medical Centre. We understand that this would assist earlier discharge and eliminate the need for patients to await a definitive medical review on the day of discharge.

We have been informed by staff that there is a very large number of patients that still present at the Flinders Medical Centre for treatment of minor complaints which are unnecessarily blocking the cubicles in this very busy Emergency Department.  It is vital that there is a clear plan mapped out to improve discharge processes and reduce the pressure on emergency departments. 

Emergency at Noarlunga Hospital

Our main recommendations for improvement of the Transforming Health document refer to the proposals for Noarlunga Hospital emergency services.  By Australian standards Noarlunga Hospital has quite a busy emergency department, seeing some 44,000 patients a year from its local catchment.  The department is networked with Flinders Medical Centre so that major ambulance cases go direct to the tertiary centre, with 87 per cent of Noarlunga’s patients therefore being seen, treated and discharged without the need for admission to a hospital ward.  This – together with the skills of the clinical team – has meant that Noarlunga Hospital has the state’s best performing emergency department on measures such as the National Emergency Access Target.

We do believe that the proposals in Transforming Health were designed with the intention of building upon the success of Noarlunga Hospital’s current emergency services to its local catchment but we also believe that significant improvements to this section of the proposal are required in the finalised Transforming Health plan. These recommendations are outlined below.

Location of emergency at Noarlunga Hospital

Moving emergency treatment away from the current location at Noarlunga Hospital across the road to the Noarlunga GP Plus Super Clinic has been a source of serious concern in the community and from clinicians.

The concerns include -

-       This location not enabling clinicians to provide care in line with the agreed quality standards.

-       Currently emergency clinicians provide services for inpatients within the Noarlunga Emergency Department that are having a serious incident. It would be very difficult for emergency staff to cover this role from a separate building.

-       Staff have raised safety concerns about being in a separate building and needing to travel back-and-forth to the hospital at all hours.

-       The space required at the GP Plus Super Clinic for ambulances to pick up patients would be too limited.

We recommend that the emergency department at Noarlunga Hospital be kept in its current location and not moved to the GP Plus Super Clinic. The flow on effect of this could be that the Hospice is able to stay on the current Repatriation General Hospital site and not move to Noarlunga Hospital.

Facilities at Noarlunga Emergency

We appreciate that the Minister has clarified that emergency care at Noarlunga Hospital will still be able to provide care for the 87 per cent of patients who are currently seen, treated and discharged from emergency without needing hospital admission. As the Minister has said, keeping these patients treated at Noarlunga Hospital is important in order to manage our system as a whole and the pressure on Flinders Medical Centre.

Clinicians have informed us that for these emergency services to be provided safely a very similar set of facilities need to be provided for in emergency at Noarlunga Hospital to what is currently the case. These include resuscitation rooms and high acuity mental health facilities.

We recommend that important parts of the emergency department such as the resuscitation rooms and high acuity mental health facilities be maintained.

We appreciate that the Minister has confirmed that the emergency department will still have doctors present 24 hours a day, which we have also been told is necessary for this number of patients to be safely treated.

One issue that has been raised with us is the need to ensure that there is a dedicated treatment area for paediatric and adult emergency services which is currently not the case.

We recommend that a dedicated paediatric treatment area be considered as an element of the $15 million upgrade of Noarlunga Hospital to enhance the treatment and safety of children as well as improve outcomes.

Clinic vs Department

Part of the proposal for Noarlunga Hospital’s emergency services is that it be rebadged as an ‘emergency clinic’. This name has caused concern in the community and with clinicians and has led to some people to believe wrongly that the Emergency Department at Noarlunga Hospital was planned to close.  Clearly that is not the case.  There has also been concern that referring to the emergency services as a ‘walk in clinic’ would lead some to think that the care would be more akin to a GP surgery than the current hospital. Some have expressed a concern that this would not help the Minister’s objective of keeping 87 percent of current patients at Noarlunga Hospital and not overwhelming Flinders Medical Centre.

To provide greater certainty for the hospital and a more accurate description of the care that Noarlunga Hospital provides for the community, we recommend that emergency be known as a ‘Local’ or ‘Community’ Emergency ‘Department’. This would be a better reflection of the skills and abilities of the staff, as well as the services that will continue to be available at the hospital.

Ambulance patient access

We support the principle in Transforming Health that the closest hospital is not always the best hospital to attend.  Sometimes it is best to spend 15 minutes longer in an ambulance if you are going to be delivered to the best-trained specialists with the latest equipment, rather than spend hours being transferred between hospitals. This principle is already the case in the South to some extent with many ambulance paramedics making decisions to get patients to Flinders Medical Centre or sometimes the Royal Adelaide Hospital depending upon what expertise is required for treatment.

However not every patient in an ambulance needs a senior specialist or a dedicated team. Many ambulance patients are being transported to hospital in an ambulance because they are arriving from an aged care centre, a school or a shopping centre. Many people with more minor conditions arrive in an ambulance because they take the precaution of not driving themselves to the hospital. For these lower-acuity patients in the outer south going to the busy Flinders Medical Centre is not necessary as they can be very capably managed at the Noarlunga Hospital emergency department.

We recommend that the Local Health Network and the SA Ambulance Service have the flexibility to determine clinical guidelines for which patients should go to Noarlunga Hospital’s emergency department via ambulance depending upon the clinical needs of the patient – rather than a hard-and-fast rule stopping ambulances arriving at Noarlunga.

 Implementation and clinical/consumer input

Following this consultation and government decision making will come the all-important implementation of reforms to our system. The doctors, nurses and all staff in the South are experienced, well-trained and passionate about improving health outcomes and would welcome the opportunity to be further involved as the reforms proceed.

We recommend that there be strong input about how the detailed implementation occurs from clinicians and consumers in the Southern Adelaide Local Health Network.

Flinders Medical Centre Neonatal Services

The Neonatal Unit, incorporating Special Care and Neonatal Intensive Care, is world class and provides an essential service to the families of Southern Adelaide and Regional South Australia.  It is our understanding that there are some fundamental differences regarding the scope of care offered to the very premature (<24 weeks) infants. 

We believe issues regarding the NICU can be addressed in the initial stages by working on an agreement with all NICU services to come under a model of Central Governance.  This model would ensure that all pre-term infants are offered the same scope of care at all units in the state.  The eventual model of services could then be agreed on by this Statewide Service and positioned to suit all needs.

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