Transforming Health

Adjourned debate on motion of Hon. K.L. Vincent:

That this council notes that the Delivering Transforming Health document—

1. Plans to shut down the Repatriation General Hospital and Hampstead Rehabilitation Service thus disenfranchising the clientele who are both familiar with and confident in the services these facilities provide;

2. Ignores the additional positive rehabilitation benefits of the community outreach programs offered by the Hampstead Centre which facilitates reintegration into family, community and work;

3. Fails to recognise the ongoing rehabilitation value of access to attractive outdoor environments in contrast to an acute clinical environment;

4. Fails to address the shortage of adequately equipped hydrotherapy pools in metropolitan Adelaide;

5. Ignores that mental health services in South Australia are already overstretched;

6. Fails to address the issue of people with mental illness presenting to emergency departments due to a lack of support services;

7. Completely ignores the June 2014 SA Health report on borderline personality disorder which recommends establishing a statewide borderline personality disorder service;

8. Fails to address the critical shortage of primary healthcare services available in the community following the minister’s cuts to these services in light of the McCann review; and

9. Remains silent on the poor communication between SA Health, Disability Services, Housing SA and other commonwealth social services and that this miscommunication prevents people returning home once they have been declared fit for discharge, and in doing so continues to waste taxpayers' money.

(Continued from 11 February 2015.)

The Hon. T.A. FRANKS ( 17:49 :57 ): I rise on behalf of the Greens to put on the record some of our concerns about Transforming Health. In doing so I echo the Hon. Stephen Wade's words. I have grave reservations about the time frame that has been given for people to make submissions with regard to the Transforming Health document, the end of this week being the deadline. I called for that time frame to be extended. I have heard many in the sector express concern that they do not have the detail they need to make an appropriate response. Certainly with a conversation this important, I really think we need to take the time to get it right.However, I do in many ways commend the government for taking on health reform, because it is essential. On a Channel 2 program (I am not sure what the program was) that covers state politics there was a joke where one of the characters, who was a member of parliament, was threatened with punishment by his colleagues by being given the health portfolio if he did not pull his head in. I think it is a bit of a poisoned chalice to be given the health portfolio, but it is also a privilege. It is also vital, which is why it is important that we get it right.

I have been disappointed with the lack of attention to the Hon. Kelly Vincent's and my previous work on raising awareness about a specialised service for borderline personality disorders. I urge the government to keep that on the agenda. It is a great way forward and it ensures that people are not needlessly in an emergency department, which is the worst possible environment for them. It is an area of mental health that is quite rightly defined as the Cinderella of mental health, although in this case I think 'Cinderella' is possibly too kind a description for the way borderline personality disorder and people with borderline personality disorder and their carers are treated. Some people find themselves leading quite desperate lives in those situations. There is a great deal more that we could do in this area. There is more we could do that would actually save the health budget. It would be good health economics and it would be a better, kinder, more compassionate way of handling the situation for those people.

I have been contacted by a registered nurse who has worked at the Repat for a significant amount of time. His name is Daryl Bullen. He has been campaigning online, raising awareness about the role of the Repat. I note that many members are aware that the Repat is more than just a building, and I think that is one of the things that has been borne out in the ongoing rallies and protests that we have seen and the real passion that the proposals in Transforming Health have held for the Repat. Mr Bullen writes:

So here we are Adelaide. We're going to close the Repat. I have worked at the Repat for 19 years. In that time I have worked on all of the wards and services that will be closed. What I think is special about the Repat is that all of the areas are linked to each other and nurses go relieving to each of them, so the culture becomes blended, creating a post World War II country/state hospital. It's a Repat thing.

So what does this mean? Hospice. Many South Australians have had their loved ones die at Daws R oad. Everyone would agree that the compassion they received was excellent, and the care and ease of suffering their loved ones received was of the highest standard. Many people have been so moved by the care that their loved ones receive d that they came back to volunteer, staying on long after their family member's death. The nurses that I have worked with are both skilful and compassionate and have taught me a lot about pain relief and caring for the dying. I have taken these learnings into other aspects of my role in the hospital and into my home and community.

Many Vietnam vets have made the Repat their second home. I even heard the words 'sacred site' used to describe it. Many of these men suffer PTSD (post traumatic stress disorder) from their time served in Vietnam. When I have listened to their stories I have learnt what horrific experiences they've had and understand the importance of a place to feel safe and to share with a 'family' that understands them. This family is made up of the Vietnam vets, volunteers, nurses, doctors, physios and occupational therapists, ward clerks, social workers, the ward 17 support community, church groups, and many more. This is the Repat family that has taken years to develop. It is not just a specialised unit that can be uprooted and placed anywhere.

The surgical and medical wards at the Repat have evolved out of the original nightingale wards, which were established in 1950 when Repatriation hospitals were modelled and built in cities around Australia. The post WWII years were the busiest and most exciting for the Repat, and helped establish the relaxed but compassionate approach employed to care for the Aussie Larrikins, who were the WWI and WWII vets.

Most of the acute wards at the Repat now are only equipped to look after the post-operative, semi-acute patients, or medical step down acute patients. The wards take a large stress off the Flinders Medical Centre, and in the winter they help to reduce ambulance ramping. Wards such as 1 and 2 deal a lot with newly diagnosed dementia patients, who are predominantly elderly patients. When I go relieving there I am in awe of the skill and compassion the nursing, medical and multi-disciplinary teams (all of the rest) show the confused patients. These patients require a special unit and cannot be mixed in with the general population. The Repat suffers the same budget restraints as other hospitals, but those teams keep delivering the goods, and I believe maintain that relaxed compassionate feel that has been passed down since WWII.

The Intensive Care Unit is the ward which has been increasingly under-resourced each year, the unit proves specialised nursing care to our more critically ill patients and is also the medical emergency team for the rest of the hospital.

I work in the rehabilitation section. Around the year 2001 an $18 million rehabilitation health unit was built to cater for 40 patients. This is a fully functioning State of the Art rehab service. It has an Olympic size pool, a massive gym, a large physiotherapy area, great facilities for amputees and, of course, an excellent rehabilitation ward. Last year a new Vita ward was built to cater for 20 extra CVA patients who require rehab. I work in this facility. Southern Health only funds 55 beds, so the rehabilitation service at the Repat is a 55 bed service. The Vita ward is a beautiful unit; the prettiest health facility I have ever worked in. It has a patient lifting gantry system and a beautiful physio gym. The patients have private rooms with ensuites. It would have cost SA Health a lot of money to build it. Many patients come back and visit the rehabilitation service and give back in some way, either through motivating other patients or volunteering in some way.

I believe that closing the Repat is a ridiculous money wasting venture, when a simple retrofit upgrade would be more effective. A lot of unfunded resources will be lost if the Repat is closed due to the amount of volunteer work given to the hospital because of the special connection people have with it.

I understand that the Repat is not going in its entirety, and that is some of the detail we have in this document, but there is great uncertainty, and certainly when you have a Minister for Veterans' Affairs and the Minister for Health on the radio with two different answers about what will happen with Ward 17, those who work in this sector, those who have a connection to the Repat, have every right to be reassured and to have real answers and meaningful dialogue.

The business case must be released. Those documents must be provided to ensure we get this right. Dignity for Disability is quite a right to raise concern. While I acknowledge that much work and a lot of consultation has gone into preparing the documents that we have to inform the present debate, a three and a half week time frame for public submissions to be made is inadequate, and is a sign that I think shows a disdain for people's concerns, along with the lack of detail that the sector is complaining about, not having the Salaried Medical Officers Association, and so on. These are not people who engage in this without great expertise themselves, but we need to get the health sector right. If Transforming Health is truly to work, I think the government should be taking heed of the words in this motion, ensuring that we have an informed debate and not just talking about getting the right medical treatment right the first time but getting the debate right the first time.

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