Browse the frequently asked questions below or download Frequently Asked Questions (PDF 440KB).
What is Transforming Health?
Why do we need to transform our health system?
What are the Clinical Advisory Committees?
What is the purpose of the Clinical Advisory Committees?
What are principles and standards?
What are the next steps for Transforming Health?
Which hospital should I go to for the right care? Am I supposed to self-diagnose?
What happens if it is not an emergency? Can I still go to my local hospital?
I have regular treatments at my local hospital. Will this change?
I am currently on a waiting list for elective surgery. Will my operation be delayed?
Where do I go if my child breaks his/her arm?
If I need mental health treatment, where do I go?
What will happen if someone has a drug overdose? Where will they be treated?
Will these changes cause a spike at major emergency departments?
If I am transferred between hospitals by ambulance, will it cost me money?
I am pregnant and having complications, what do I do?
Does Transforming Health cover all of South Australia?
What does Transforming Health mean for country South Australia?
What is the process for Transforming Health?
What do these changes mean for staff?
How can we afford these changes?
Will we continue to need all the sites we currently have?
Is administration of the health system being addressed?
What about the work already underway in the health system?
When will the changes start?
Transforming Health is about ensuring South Australians have the best quality healthcare system into the future. It is clear that we need to change the way we manage our system so that we can meet changing community needs, advances in treatments and technology and deliver consistent, quality care.
Through the Transforming Health process – which involves engaging doctors, including surgeons, nurses and midwives and allied and scientific health professionals in re-designing the system – we realised that we need to improve the consistency of our healthcare, so that the many areas of excellence that we have in South Australia can be replicated across our system.
The Delivering Transforming Health – Summary outlines the next steps for Transforming Health and is the result of in-depth consultation with the community, our staff and the health industry that began in mid-2014.
The overarching aim is this: a more streamlined healthcare system that provides better service for patients. We want to make sure patients’ experiences are a seamless journey through all stages of care.
Best care. First time. Every time.
We have many areas of excellence – but our health system does not consistently deliver the quality of care we all expect from a modern health system.
The changes we will make through Transforming Health are all about delivering high quality care. This includes being able to respond better to our changing health needs, advances in technology, the specialised skills needed in our system and the consistent, quality care South Australians expect and deserve.
Our health needs have changed
In the past, hospitals were designed to deal with acute medical crises, like heart attacks or major accidents. Today, our hospitals also care for people who have multiple, complex conditions and chronic diseases like diabetes. Dealing well with these different health needs means redesigning how we care for people.
Our population is changing
South Australia has an ageing and very diverse population. Ours is one of the oldest populations in Australia. One in six people are older than 65 and, on average, 40 percent are aged between 65 and 85. As we age, we are more likely to develop chronic conditions, which raise new challenges for our health system.
At the same time, we know that different groups have different levels of health and wellbeing. For example, Aboriginal and Torres Strait Islander people experience the poorest health of any population group in South Australia and face different challenges in accessing appropriate healthcare.
Technology has changed
Advances in technology happen quickly. Used properly, they can help record information about our health, send it electronically to health professionals and track and monitor important information like blood sugar levels, heart rate, diet and exercise levels.
Breakthroughs in medical science have also improved clinical practice and recovery times. For example, open abdominal surgery for gall bladder removal has been replaced in most cases by laparoscopic surgery, which is less invasive and has a quicker recovery time.
We need to deliver consistent quality care
South Australia’s health care system is good but it can be great and there are things that can be done better. Our doctors, nurses and midwives and allied and scientific health professionals believe this will be enabled by delivering the 284 Clinical Standards they developed through the Transforming Health journey.
Too many deaths occur in our hospitals
On average, South Australia has 500 more deaths each year in our hospitals than other hospitals across Australia, with hospital mortality rates varying up to 50 percent overnight and on the weekend.
Senior clinicians unavailable
While senior clinicians are available on‑call overnight in cases of emergencies, generally there are no senior clinicians rostered on-site overnight in our major hospitals.
Insufficient opportunities for staff to maintain their skills
Some speciality services need to see a minimum number of patients to meet safe, quality care standards and so staff must treat enough patients to maintain their skills and expertise.
Too many cancelled elective surgeries
Approximately 25 percent of elective surgery is cancelled, with 41 percent due to theatres, doctors and beds being unavailable. We know that our patients and their families plan their lives around scheduled surgery, and that cancelling or postponing is disruptive and inconvenient.
The remainder of the cancellations are due to patients cancelling for personal reasons or decisions being made that the patient is not fit for surgery. Of the 11 000 elective surgeries postponed in 2013-14, 41 percent were due to hospital-related causes. We don’t think this is good enough and will be working hard to ensure surgery does not get cancelled because of factors that are within our control.
Low day surgery rates
The day-only elective surgery rate (as opposed to overnight surgery) for the State’s metropolitan hospitals is 52 percent of total surgery, which is too low compared with other Australian states, which average 60 to 70 percent, and the United Kingdom which averages 75 percent. What’s more, the amount of time elective theatres are used for elective surgery is as low as 40 percent in some hospitals.
Too many procedures
South Australian hospitals perform more procedures in some speciality groups for the number of people they see than anywhere else in Australia. For example, on a population basis, South Australia has some of the highest rates for procedures such as hysterectomies and knee arthroscopies.
Long waiting times for discharge or placement
Some patients stay in hospital for up to three days longer than others with the same condition, depending on which hospital they are treated at and what day of the week they are admitted. There are a number of reasons for this, like allied health staff and senior clinicians not being available to see them on the weekend so they can be discharged.
Other patients who no longer need acute care cannot be discharged when they are medically fit because they are waiting to be placed or transferred to another location. We describe these patients as requiring restorative care. They are ready to be discharged, but are waiting in hospital beds, and risk getting infections and their health deteriorating rather than improving.
Too many transfers between hospitals
More than 4700 patient transfers are made each year between hospitals in South Australia, often because patients are not in the right hospital to treat their condition. As a result, treatments are delayed, leading to longer recovery times.
Our health system is unable to meet some national standards
Although South Australia’s healthcare system is well resourced, we are unable to meet some national standards. For example, South Australia’s emergency departments struggle to meet the National Emergency Access Targets (NEAT).
Mental health consumers experience excessively long waits in the emergency department, with visit times being about 16 hours. Indeed mental health consumers wait far longer than any other patients in South Australia and we need to ensure that they can access treatment when they need it.
Risk to the financial sustainability of our healthcare
We currently spend 31.5 percent of our State budget on health, and if we keep going at the current rate South Australia’s spending on health will be nearly half of the State budget over the next 15 years. If spending in healthcare doesn’t change, it will mean there is less money to invest in other important services like education, police and emergency services.
The medical, nursing and midwifery, and allied and scientific Clinical Advisory Committee members were selected to include a diverse range of clinicians and healthcare workers from across the State.
The Clinical Advisory Committees have assessed the available data and compared the evidence to recommend quality principles and standards that should be provided in South Australia. View the Clinical Advisory Committee gallery walks (PDF 4031KB) which include information reviewed by the Committees.
The recommended principles and standards feature in the Discussion Paper and guide the changes outlined in Delivering Transforming Health – Our Next Steps.
Principles provide guidance for decision making and express our collective expectations of our health system.
Six principles of quality will guide how we transform the South Australia healthcare system:
- Patient centred
Standards provide guidance on achieving consistent quality care. They state what the community and staff should expect from our health system.
The Standards in the Proposals Paper do not cover every aspect of public healthcare, but detail overarching standards for the whole system and then focus on four aspects of care:
- General Unscheduled Care (or emergency care)
- Routine Elective Care (elective medicine and surgery)
- Women’s and Children’s Care
- Selected Specialties
The Standards will be regularly reviewed, monitored and assessed to ensure they are effective in driving quality.
The next steps for Transforming Health are based on extensive input, feedback and ideas provided by the community, our staff and the industry.
Transforming Health is a systematic approach to ensuring all South Australians can access and receive the right care, first time, every time, while making sure our health care system is sustainable for future generations.
Transforming Health is the beginning of the conversation. We commit to engaging with our consumers and community to ensure that their needs, values and preferences are sought and considered as we transform our health system.
As part of our next steps towards Transforming Health:
- We will focus on improving how the community accesses hospitals and health services, as well as how they use the system. Everybody should receive the right care, in the right place, at the right time. Nobody should have to stay longer in hospital than they need to.
- We will focus on improving patient access and flow, which will create capacity in our system. This is necessary before we can safely make some of the required service changes.
- The engagement strategy for our consumers and community will be developed in partnership with and through the Health Consumers’ Alliance of South Australia, and the many communities of interest whom they partner with to provide a voice about our public health care.
- Three major Emergency Departments, located at the Royal Adelaide Hospital, Lyell McEwin and Flinders Medical Centre, will operate 24/7 with appropriate support and senior medical staff on-site.
- Emergency Departments at The Queen Elizabeth Hospital and Modbury Hospital will operate 24/7 with only life-threatening emergencies going directly to major Emergency Departments.
- Noarlunga Emergency Department will become a 24/7 Community Emergency Department. It will be staffed by doctors and nurses, and protocols will be developed so that Ambulances can be taken to Noarlunga Hospital for patients who are unlikely to be admitted to hospital.
- The Women’s and Children’s Hospital will continue to provide 24/7 major emergency and trauma care for children.
- There will be a major increase in the number of ambulance officers and support staff, 12 new ambulances and proposed new ambulance stations to make sure patients are taken to the right hospital for treatment.
- Three dedicated elective surgery centres will be created, with multi-day surgery provided at The Queen Elizabeth Hospital, day surgery at Noarlunga Hospital and eye surgery at Modbury Hospital. Having specialist streams will mean fewer cancellations, shorter waiting times and teams that see enough patients each year to maintain and improve their skills. Elective surgery will continue at other hospitals.
- More than $275 million will be invested in capital works and refurbishments to prepare our hospitals for Transforming Health.
- A new $15 million Centre for Excellence, planned in consultation with Veterans, will provide first-class care for Post-Traumatic Stress Disorder.
- A 24/7 stroke service will be established at the Royal Adelaide Hospital and dedicated stroke units at Lyell McEwin Hospital and Flinders Medical Centre will provide care 8am to 8pm, 7 days a week. These units will be able to treat stroke patients fast to make sure they have the best possible health outcomes and have a reduced risk of death and long-term disability.
- Rehabilitation services will be moved from Hampstead Rehabilitation Centre and be integrated into our major hospitals so rehabilitation can start sooner and patients can have better health outcomes. Discussions will take place with the community and users of the centre to determine the most appropriate future use of the site.
- Services from the Repatriation General Hospital will be integrated into other hospitals, with Orthotics and Prosthetics SA, the Chapel, Museum and Remembrance Garden remaining on the site. The site will be earmarked for healthcare, ageing and community-related purposes. The Government will explore opportunities with community groups for the future use of the site, including the pool.
- Palliative care services provided at the Daw Park Hospice will transfer to a new location, following consultation with the community, clinicians and the industry.
- People who are ready to be discharged but who can’t be accommodated in an aged-care facility or other suitable setting will be cared for in nurse-led restorative care. This will free up beds for people who are unwell.
- The treatment and accommodation of mental health consumers will be improved with new models of care that will be developed in consultation with clinicians. In addition, there will be a focus on improving services and pathways within emergency departments and ensuring that clinicians lead mental health services, in line with other medical specialties.
- We will plan for the earlier relocation of the Women’s and Children’s Hospital to the South Australian Health and Biomedical Precinct with the new Royal Adelaide Hospital.
- We will create statewide governance for a number of specialty services, including for neonatal care and paediatric surgery, so that care is consistent.
- We will create capacity to enable us to configure our health system for a sustainable future, and reinvest in continuous improvement and new infrastructure.
Read Delivering Transforming Health – Our Next Steps to find out more.
No, you don’t have to self-diagnose. If you are seriously ill or unsure, you should call 000 for an ambulance. Ambulances are like Intensive Care Units on wheels, so they are the best place to be when you are very ill. The ambulance team will make a decision about the best hospital to take you to for the best care, first time.
Under Transforming health, the Royal Adelaide Hospital will be retained as the State’s major complex multi-trauma emergency department and the Lyell McEwin Hospital and Flinders Medical Centre will each operate Major Emergency Departments.
Emergency Departments at The Queen Elizabeth Hospital and Modbury Hospital will operate 24/7 with only life-threatening emergencies going directly to Major Emergency Departments.
Noarlunga Emergency Department will become a 24/7 Community Emergency Department. It will be staffed by doctors and nurses, and protocols will be developed so that ambulances can be taken to Noarlunga Hospital for patients who are unlikely to be admitted to hospital.
The Women’s and Children’s Hospital will continue to provide 24/7 major emergency and trauma care for children.
If you are not suffering a medical emergency, but you still require medical treatment, and you can’t access your General Practitioner, you can attend your closest hospital for urgent, non-life threatening care. If it is determined by your clinician, that you require a higher level treatment, you will be transported by ambulance to the appropriate Major Emergency Department or a specialist centre.
Treatments that require regular visits to the hospital, such as chemotherapy and dialysis, will continue to be available at sites as close to your home as possible.
Elective surgery is often postponed in our hospitals. That is why we are planning to establish three dedicated elective surgery centres. By establishing separate, dedicated centres for elective surgery, there will be fewer postponement, shorter waiting lists and better planned and managed care for you. This will also reduce emergency surgical team members being distracted by elective surgery, improving their ability to focus on emergency work.
You will still be able to take your child to your closest hospital for medical treatment.
If you have an emergency, you should call 000. Alternatively, specialist mental health clinicians will be available at all Emergency and Major Emergency Departments, and can provide appropriate treatment.
Where appropriate, acute mental health consumers will be directly admitted to a mental health bed, avoiding the Emergency Department, ensuring they get access to timely and appropriate care, also reducing the distress for mental health patients.
An ambulance team will make a decision about the best hospital to take the patient for the best care. This is likely to be one of the Major Emergency Departments, at Flinders, The Royal Adelaide or the Lyell McEwin, which is where most cases are currently treated.
At our new Major Emergency Departments, people with complex, life-threatening conditions will have the medical attention they need, including access to specialist clinicians, the equipment needed for diagnostic tests, quick test results and the support services needed for a speedy recovery.
This will reduce delays to decisions and treatments, resulting in lower mortality rates, better recovery and less time in hospital.
People with urgent but less-serious conditions will be able to be seen more quickly than now in most cases, closer to home, because staff will be skilled and experienced with the urgent treatments needed, and not called away to the more complex, life-threatening situations that are better treated at the Major Emergency Department sites.
No. If you present at a hospital, and it is determined that you need to be transferred to receive more appropriate care, the costs associated with the ambulance travel will be covered by our public health system.
If you have an emergency, you should call 000. Alternatively, you can present at any of our Emergency Departments for initial treatment.
If it is determined that you require a higher-level of maternal treatment, you may be transferred to the Flinders Hospital, or the Women’s and Children’s Hospital. Low risk, non-complex maternity will continue to be available at sites as close to home as possible.
Transforming Health must be a whole-of-system transformation but we have to start where the impact is greatest – our metropolitan hospitals. The metropolitan area is where most services are delivered, specialty services are located, and our most complex and often vulnerable patients are treated.
We want to get our metropolitan hospitals delivering consistent quality care before we tackle the full spectrum of the health and community sector.
We will then know how to best apply the agreed standards to our country hospitals.
Improving metropolitan hospital services as part of Transforming Health will improve services for all South Australians, including those who live in the regional, rural and remote parts of our State.
Right now, country patients account for 16 percent of overnight admissions in metropolitan hospitals. This means that they, and their families, are significantly impacted when their surgery is cancelled or postponed. Similarly, many country people have to travel to Adelaide for a 10-15 minute follow up appointment. Improving our elective surgery performance and better use of technology such as telehealth to link city specialists with country doctors and patients will improve the access and quality of care for country South Australians.
Delivering the full suite of Clinical Standards and consistent quality care at these sites will lay the foundations and help determine how best to implement Transforming Health across the State.
Clinical Engagement Committees
June 2014 – Present
The Minister for Health, the Hon. Jack Snelling M.P., appointed three Clinical Advisory Committees comprising of doctors, nurses and midwives and allied and scientific health professionals, to look at our current health system and understand what we do well and where we can improve. View the Clinical Advisory Committee gallery walks (PDF 4031KB) for data that was reviewed during this process.
The Clinical Advisory Committees worked together to develop quality principles and standards for healthcare, which will guide how we transform the system.
Transforming Health Discussion Paper and Consultation
17 October – 21 November 2014
South Australians were asked to help shape the future of the State’s health system with the release of the Transforming Health Discussion Paper (PDF 1140KB) on 17 October 2014. Staff, community and industry feedback was collected during a five week consultation period, which ended on 21 November 2014. View feedback and written submissions received during the consultation period.
More than 35 community consultation listening posts were set up across the State to explain the Discussion Paper and understand community feedback. During the consultation process over 5000 community members, staff and industry partners were involved in an event or submitted feedback to the State Government for review and consideration.
More than 90 percent of people who provided feedback endorsed the need to improve the health system, particularly supporting the six quality principles.
Transforming Health Summit
28 November 2014
At an unprecedented gathering, more than 600 South Australians agreed that a transformation is required to ensure the State’s health system delivers the best quality healthcare first time, every time.
Health experts including doctors, nurses and midwives, scientific and allied health and other professionals – joined consumers, representatives from the community, local government, unions, the public service and the non-government sector at the Transforming Health Summit and endorsed the Summit Communiqué.
View more information about the Transforming Health Summit, including presentations, videos and the Communiqué.
Delivering Transforming Health Proposals Paper
3 February – 27 February 2015
The Delivering Transforming Health Proposals Paper (PDF 1506KB) outlined a range of proposals for transforming our healthcare system to deliver consistent quality care for all South Australians.
The proposals were developed with doctors, nurses and midwives and scientific and allied health professionals to achieve the principles and standards they consider essential. The responses to the Transforming Health Discussion Paper and Summit were also considered.
Feedback on the Proposals Paper closed on 27 February 2015. More than 2,300 people provided their feedback on the proposals.
Our Next Steps
Following feedback on the proposals, Delivering Transforming Health – Our Next Steps (PDF 1352KB) and the Delivering Transforming Health – Summary (PDF 997KB) were released on 17 March 2015.
These papers outline the next steps to implement Transforming Health to provide the best care, first time, every time. System and service changes will only occur once enough capacity has been created for them in the health system. To find out how Transforming Health will be implemented, view the Indicative Implementation Timeline.
Transforming Health is about working closely with our staff so we can collectively ensure all South Australians have access to the best care, first time, every time.
To ensure the consistency and quality of care across South Australia’s health system, Transforming Health:
- requires some of the State’s services to work differently in partnership
- focuses on evidence-based, statewide models of care
- introduces multiple initiatives to unlock capacity and improve patient access and flow across the system of care.
The next steps for Transforming Health are explained in Delivering Transforming Health – Our Next Steps (PDF 1352KB) and are based on extensive input, feedback and ideas provided by our staff, consumers and community, clinicians, unions, professional associations, universities, and our research and industry partners.
For some staff, Transforming Health may result in changes to how and where you work. These changes will not happen immediately and you will be kept up to date about changes before they happen.
The Capital Reconfiguration Fund, which was announced as part of the 2014 State Budget will support Transforming Health initiatives including upgrades and construction of new facilities. The fund consists of money that was allocated for hospital developments and quarantined when Transforming Health began.
Other funding requirements will be met by running our metropolitan hospital services better. Services that have been spread too thinly to offer maximum effectiveness will now be co-located, providing better services for patients at reduced cost. Better quality healthcare is always less expensive because it means fewer complications and fewer repeat admissions.
The Repatriation General Hospital, St Margaret’s Rehabilitation Hospital and Hampstead Rehabilitation Centre currently provide services that will integrate to other major hospitals. Rehabilitation will be better integrated and a new Centre for Excellence will be developed for PTSD services currently provided at the Repatriation General Hospital’s Ward 17. Palliative care services, elective surgery and outpatient services currently provided at the Repatriation General Hospital will also integrate to other locations.
The Chapel, Museum and the Remembrance Garden will be retained at the Repat site for their considerable significance, particularly to Second World War Veterans and their families. The existing Orthotics and Prosthetics SA will continue on the site. The Government will earmark the site for healthcare, ageing and community-related purposes. We will explore opportunities with community groups for the future use of the site, including the pool.
St Margaret’s Rehabilitation Hospital is a dedicated community asset and will continue to have a health focus.
Discussions will take place with the community and users of the Hampstead Rehabilitation Centre to determine the most appropriate future use of the site, including the pool.
Every part of South Australia’s health system needs to support the delivery of Transforming Health and, as a result, consistent, safe and high‑quality care. Our entire system needs flexible and adaptable supporting systems and structures, a transparent, accountable and collaborative culture, and connected leadership.
The Department for Health and Ageing has a responsibility to provide comprehensive leadership and governance to support the transformational change that is currently taking place in our hospitals and health sites.
As part of this, a two staged review of the Department for Health and Ageing is being undertaken. Stage one was completed in February 2015 and saw a new streamlined structure implemented, with the number of divisions reducing from the previous structure of five, to a total of three.
Stage two of the Departmental review is currently underway. This will focus on identifying further reforms to realign and integrate functions, reprioritise activities to underpin and support clinical practice and deliver frontline services more effectively.
The State Government’s dedication to quality health care continues in this process – we are simply building on the valuable and innovative work across the State’s health system.
For more than a decade, we re-built and re-invested in the facilities of our health system after years of neglect and now it’s time to transform the way we deliver high-quality health services to all South Australians.
We’re thinking creatively as medical technology continues to astound us and our population ages.
The reform and efficiency activities currently happening across our health system and in the day-to-day management of our hospitals and health services will complement the Transforming Health process.
These changes will not happen immediately and you will be kept up to date with any changes at your local hospital before they happen.
Implementing Transforming Health’s main changes will happen between 2014/15 and 2018/2019. Beyond 2019, Transforming Health will be a journey of continuous improvement applied across the healthcare system.
Delivering Transforming Health is an enormous task, given the sheer scale of the changes required, and the input of our communities, our staff, unions and industry partners will be essential to ensure the changes reflect views of those affected by them and meet the Clinical Standards.
System and service changes will only occur once enough capacity has been created in our hospitals by introducing new ways of working and improving things like emergency and surgical pathways, so patients are better able to access and use the services they need.
For more information, view the Indicative Implementation Timeline.