KordaMentha Report

The Hon. K.J. MAHER (Leader of the Opposition) (15:00): I seek leave to make a brief explanation before asking a question of the Minister for Health and Wellbeing regarding cuts to hospital services.

Leave granted.

The Hon. K.J. MAHER: At the top of page 34 of KordaMentha liquidators' report, it states in the first dot point that management estimates that inpatient activity was 18,000 NWAU above the cap in financial year 2018. The report recommends cutting these 18,000 national weighted activity units over the commissioned levels. This is equivalent, I am informed, of cutting about 4½ thousand hip operations or 3½ thousand coronary bypasses each year. My question to the minister is: given the Liberals went to the election saying they would reduce waiting times, why is he and his government cutting the equivalent of 4½ thousand hip operations or 3½ thousand coronary bypasses each year?

The Hon. S.G. WADE (Minister for Health and Wellbeing) (15:01): First of all, I emphatically refute the use of the word 'cuts'. This recovery plan is all about addressing inefficiencies we inherited from the previous government so that we can deliver services more efficiently. Living within its budget will mean that CALHN, the central hospitals, will need to deliver services within funded levels. I'm advised that, through innovative care pathways, patients will still receive care but in a different and more effective way.

Many of these improved care pathways are already in use in other networks across Australia, with a strong evidence base to support them. Improved management of the NRAH activity that we are referring to will be an important part of the organisational and financial recovery. However, this does not mean that patients will be turned away or that services will not be provided. These improvements will be achieved through, firstly, providing patient pathways that ensure services are delivered in the most clinically appropriate way. For example, the development of community-based care options involving patient care at home or in the community will enable the avoidance in many cases of a hospital admission.

Secondly, there will be improved assessment of surgical patients. For example, some patients may benefit from presurgical physiotherapy or other alternative care pathways that enable the patient to avoid some forms of elective surgery. For example, I was at the Royal Adelaide Hospital this morning and I was discussing with a clinician the fact that a patient might present at the ED and, rather than them being referred to a clinic for orthopaedic surgery, they might be referred to a physiotherapist for rehabilitation that might well avoid that surgery.

I would like to note the fact that in some areas of elective surgery South Australia rates well above interstate. There is real interest, in the orthopaedic and other surgical disciplines, in looking at care pathways which make sure that patients get the service they need, not necessarily in a surgical form. Thirdly, the NRAH issue will be addressed by reducing the average length of stay in hospitals because doing so reduces the risk of complications. Reduced admissions will assist in reducing activity due to avoidable interventions.

The Hon. K.J. Maher: Cuts—reducing means cuts, Stephen.

The Hon. S.G. WADE: So if the honourable member is suggesting that reducing hospital infections and then, when people don't actually get infected, 'Oh, what a shame; they're not getting admitted to hospital,' I'm sorry; healthy people don't need a hospital bed.

Fourthly, we'll be improving efficiency to ensure that CALHN is operating at or below the national efficient price, enabling additional activity at a lower price. This means that additional activity can be undertaken within funded levels. My next point refers back to the question of the Hon. Frank Pangallo. It is also the view of the government that improved coding of current patient activity will demonstrate the true complexity of patients that are seen within CALHN, and therefore that means that CALHN will then receive appropriate levels of funding for these complex patients and be able to again maintain services.