Why did we need to change?
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 have made through Transforming Health were all about delivering high quality care. This included 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.
Our Next Steps
On 17 March 2015, the Minister for Health released Delivering Transforming Health – Our Next Steps (PDF 1352KB), which outlined our next steps for transforming South Australia’s healthcare system.
The next steps were based on extensive input, feedback and ideas provided by the community, our staff and the industry.
Find out about the projects that have been implemented or are currently underway as part of Transforming Health.
For more information about Transforming Health in your area, visit the relevant page:
- Country South Australia
- Flinders Medical Centre
- Lyell McEwin Hospital
- Modbury Hospital
- Noarlunga Hospital
- Repatriation General Hospital
- Royal Adelaide Hospital
- SA Ambulance Service
- St Margaret’s Rehabilitation Hospital and Hampstead Rehabilitation Centre
- The Queen Elizabeth Hospital
- Veterans’ Health Services
- Women’s and Children’s Hospital