HOSPITAL DEMAND

Mr RAU (Enfield) (14:35): My question is to the Minister for Health. What is the government doing to reduce demand on our hospital system?

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (14:35): I thank the member for Enfield for this probing question. He should be a proctologist; he is very good. South Australia is faced, as we all know, with an increasing burden of providing health care to our ageing population. As the proportion of the population aged over 65 increases, they will require more services and there are relatively fewer working age people to support the system. This is occurring right across the developed world. In broad terms, SA Health projections show that, if we were to continue on a business as usual approach to health care, the entirety of the state's budget would be need to be spent on health by 2032 in order to simply maintain services. Clearly, this is untenable; it is unsustainable; and the government is undertaking the major task of reforming our health service to ensure that it is sustainable for the future.

We started in 2003 with the Generational Health Review, and last year we released South Australia's Health Care Plan. Our strategy is twofold. Firstly, we are increasing capacity within the system through a major investment in redeveloping our infrastructure. I note that we have increased the number of beds in the metro area by about 250 since we have been in government and we are also committing $2.2 billion worth of expenditure to create new infrastructure, particularly the Marjorie Jackson-Nelson Hospital. Secondly, we are also reducing further growth in demand for our hospital service. We will achieve this by building our primary health care capacity and increasing prevention measures right across our state. Every step of the way, I have to say, we have been opposed by the opposition.

This year, the government ran a major television campaign urging people not to go to EDs in winter if they had minor ailments. I have already gone through the figures, but there has been a reduction in the number of people who attended ED presentations—something like 95 fewer patients a day in the lower categories. We have also implemented a number of other strategies aimed at reducing the burden on South Australia's metropolitan hospitals. For example, we provided 9,822 hospital avoidance packages in 2007-08 and 10,637 supported home discharges. We have increased these programs again this year by providing 462 more hospital avoidance packages this August compared with last year (a 61.8 per cent increase) and an additional 445 supported home discharges (a 63.2 per cent increase).

It is important that we invest in these strategies, because it is by doing these things that we keep people out of hospital beds, and that helps the emergency departments, intensive care units, elective surgery and so. More flu vaccine has also been distributed by GPs in the most recent years to people aged over the age of 65. We have gone from 225,000-plus inoculations in 2007 to 229,000-plus in 2008. Our GP Plus health care centres are being established, of course, to provide chronic disease management programs, in addition to other primary health care services in our communities. Centres are already operational at Aldinga and Woodville, at an investment cost of $5.2 million, and a further $26 million is being committed to building GP Plus centres at Marion, Elizabeth and Port Pirie.

We know that, 10 months after the opening of the Aldinga GP Plus centre, for example, 156 fewer people from the Aldinga area presented to the Noarlunga emergency department than in the 10 months prior. There was less demand at the service as a result of fewer people attending compared with the prior 10 months. That is a 16 per cent reduction, while all ED attendances for all other areas that feed into the Noarlunga Hospital actually grew by 16.8 per cent. These are stark figures. A 16 per cent reduction from the area where the GP Plus centre is in place: a 16.8 per cent growth from all the other centres which provide patients to that hospital.

The Hon. P.F. Conlon: Excellent indications.

The Hon. J.D. HILL: It is a great indicator. We have also introduced programs aimed at keeping people out of hospital in the longer term by promoting healthier lifestyles. The effect of these measures has been to address the growth in hospital demand.

For the 2007-08 financial year, emergency department attendances at metro public hospitals totalled 362,901, which is an increase of 2.1 per cent in comparison to the previous year. This compares very favourably to the average increase over the previous three years of 4.7 per cent. So, we have seen a tapering off in the growth in demand in terms of attendances at emergency departments. That is not to say it is all fixed, by a long shot, but we have seen that reduction in demand. We have reduced the growth in demand but have not yet achieved a reduction in demand in gross terms.

Yesterday the Deputy Leader of the Opposition referred to figures in the Auditor-General's Report that showed that there were fewer same day patients to South Australian metropolitan hospitals during 2007-08. This reduction is, in part, explained by a policy decision to fund chemotherapy and selected scopes as outpatients instead of same day activity from 1 July 2007.

Periodically, of course, it is necessary to change how we code procedures to reflect improved clinical practices and improved technology. For example, many years ago to have relatively minor eye surgery a patient would have to spend two weeks in hospital with their head in sandbags kept absolutely still while they recovered.

Mr Hamilton-Smith interjecting:

The Hon. J.D. HILL: Your wit is profound, Leader of the Opposition. Now, of course, those same procedures (cataract removals) can be done in relatively few minutes in an outpatient clinic, so the nature of the services do change. Over the past year we have rescheduled the way some of these things happen, so some procedures previously provided as inpatient settings can now be provided in non-inpatient settings.

In the future we would expect some of these procedures to occur in GP Plus-type facilities. So, we have a broad range of strategies in place and I am pleased the inform the house, in more detail than I was able to do yesterday, that these strategies are beginning to bite.