Clinical Services Consultation 2005 Update

Clinical Services Planning

In April 2005, the Health Reform Implementation Taskforce (HRIT) released a Metropolitan Clinical Services Framework (PDF 3.71MB) for consultation, as a preliminary stage to developing the WA Health Clinical Services Framework 2005-2015.

All health system staff, the community and key stakeholders were encouraged to provide comments as part of the Clinical Services Consultation 2005 process. A summary of the Clinical Services Consultation 2005 is provided below.

Clinical Services Consultation 2005

The goal of Clinical Services Consultation 2005 was to engage and seek feedback from stakeholders regarding the Metropolitan Clinical Services Framework – a guide outlining implementation of key recommendations of the Health Reform Committee's final report (the Reid report). The Consultation phase was the first stage in developing the final Framework and provided an opportunity to:

Discuss options for configuration of key clinical services.
Identify transitional considerations and operational impact of proposed changes.
Examine models of care for delivering clinical services.
Raise key questions.
Provide general comments on the content of the Metropolitan Clinical Services Framework.

The Clinical Services Consultation 2005 (CSC 2005) document was released on 26 April 2005. The HRIT undertook extensive consultation during an eight-week period that concluded on 21 June 2005. The document was publicly available on the HRIT website and printed copies of the document were made available at the group consultation sessions, or for those who didn't have access to the internet.

The consultation methods used included:

Group Consultation

A total of 16 open group consultation sessions on individual key clinical areas were held throughout May, with approximately 400 people attending these sessions. Six clinical leaders, independent of HRIT, were engaged to facilitate the group sessions as they were more likely to be familiar with the issues raised by clinicians.

Public Submissions

Approximately 200 public submissions were received – largely from clinicians working within the health system, with some also from community members. The public submissions clearly demonstrated the willingness of clinicians to work together to achieve the benefits of change. There were a number of joint submissions from clinical departments across different hospitals, with some submissions stating that there has been a general acceptance of the need for change since the Reid report was released. Clinical Staff Associations and Medical Advisory Committees participated in consultation, with many convening their own meetings to specifically discuss the CSC 2005, and subsequently submit summaries from these meetings. The high quality and depth of the information provided will be valuable in the ongoing reform process.

HRIT Working Groups

A number of working groups, including the WA Cancer Services Taskforce and the Palliative Care Advisory Group were convened to discuss the way forward for clinical services and provided recommendations for models of care and transitional arrangements. The rationale for cancer and palliative care being addressed at this stage of the planning process links back to the recommendations in the Reid report.

Clinical Consultation

Each of the Area Health Services undertook consultation directly with clinicians within their region. For example, Women's and Children's Health Service held a number of sessions for staff to discuss future delivery of paediatrics, neonatology, obstetrics and gynaecology services. Feedback from Area Health Services was provided directly to HRIT.

In addition, HRIT received and accepted many requests for meetings with clinical staff at various hospitals to receive comments on the CSC 2005.

A workshop with the Clinical Senate was held on 26 and 27 May 2005. The Clinical Senate debated and discussed key issues relating to CSC 2005 and developed recommendations for consideration by HRIT. The topics discussed by the Clinical Senate were a summary of the initial key issues identified from the group consultation sessions, and included:

Workforce implications;
Role of the General Hospitals;
Research implications;
Trauma / ED / critical care; and
Rehabilitation and aged care.

Briefing Sessions with Key Stakeholders

Key stakeholders including the Australian Medical Association (WA Branch), universities, Clinical Staff Associations, the Health Consumers' Council WA and non-government organisations were briefed on the CSC 2005, and continue to be involved in the reform agenda for reconfiguring clinical services.

Other Considerations

The formal CSC 2005 process undertaken from April to June 2005 was just one aspect of the Department of Health's commitment to involving the community, clinicians and key stakeholders in delivering reform of the health system. Prior to the Reid report being released in March 2004, extensive consultation with local clinicians, the community and other major stakeholders was undertaken. Given the breadth of the consultation undertaken during the Reid process, and the purpose of the CSC 2005 document, the Health Consumers' Council WA advised that the CSC 2005 consultation would be best directed to clinicians, with ongoing information being provided to the community.

Key Consultation Outcomes

The Health Reform Implementation Taskforce is fully committed to continuing the involvement of clinicians, the community and key stakeholders in the development and implementation of reform projects to ensure high quality health care continues to be provided. The CSC 2005 is only one stage of engagement in reconfiguring the location and distribution of specific clinical services. Progressively, the reconfiguration will become more detailed and the views of clinicians, the community and key stakeholders will be sought on a range of issues from building the new Fiona Stanley Hospital to strategies to retain and increase our workforce.

All those who participated in the CSC 2005 process provided extensive and valuable input. The breadth and depth of information received will be extremely useful as reference material to guide the next stages of clinical services planning.

A snapshot of the main themes arising from the consultation process are provided below:

North Metropolitan Area Health Service

The vast majority of feedback from consultation supported option two proposed in the Clinical Services Consultation document, that is for Royal Perth Hospital (RPH) being relocated to the Fiona Stanley Hospital (FSH) and the closure of inpatient services at the RPH campus, as opposed to option one where services at RPH would be relocated to Sir Charles Gairdner Hospital (SCGH) and FSH with some inpatient services retained at the RPH campus. Many of the reasons for supporting option two related to recognising and valuing cohesive, integrated and well-established services that currently exist at RPH.

There was some concern expressed that the eastern suburbs may be left without sufficient services if transitional planning did not address the movement of RPH services. Suggestions included building up Joondalup Health Campus to become a tertiary hospital sooner, and implementing strategies for Swan District Hospital to retain a higher proportion of the catchment population.

In light of the large majority of consultation supporting option two for RPH, which will result in nil inpatient services at the current RPH site, a number of comments were received suggesting that Osborne Park Hospital (OPH) become the elective surgery centre for the North Metropolitan Area Health Service. This would align with OPH continuing to undertake sameday surgery and provide an opportunity for elective surgery to be undertaken without the pressures of an on-site emergency department.

The CSC 2005 had proposed that acute rehabilitation currently located at Shenton Park be relocated to Osborne Park Hospital. However, strong representation from clinicians working in rehabilitation opposed this suggestion and instead recommended that the State Rehabilitation Centre should be co-located with an adult tertiary site, namely SCGH or FSH – with preference for co-location with the major trauma site. The reasoning behind this is to ensure links with essential medical services, such as radiology, orthopaedic surgery and trauma.

South Metropolitan Area Health Service

The proposal to develop the Fiona Stanley Hospital (FSH) at Murdoch was generally accepted in the feedback received. There was strong support from clinical representatives of RPH and Fremantle Hospital to commence planning the FSH as a partnership, with the assumption that option two for RPH is accepted as the preferred option for relocating inpatient services from RPH.

Numerous requests for further information on how future staff appointments at FSH would be undertaken were received. It was commonly acknowledged that staff needs to be engaged in the planning process from the outset for relocation of clinical services to be successful.

Some concern was raised that the proposed bed capacity at FSH in 2010/11 (approximately 600 beds) would be insufficient to relocate both inpatient services from RPH and Fremantle Hospitals. Other comments were received that this would be possible by relocating the relevant quaternary services to FSH, and tertiary services that are appropriate for the SMAHS, combined with secondary services relevant for the local FSH catchment population. All other secondary services would be required to be relocated to the appropriate General Hospitals.

Many valuable suggestions were received relating to the planning of the new Fiona Stanley Hospital at Murdoch, particularly to ensure that the hospital includes well-planned and adequate facilities. For example, the need for single rooms and isolation rooms for infectious diseases and the provision for teaching and research facilities. Furthermore, the opportunity to build a new hospital in the future provides the opportunity to integrate new patient management systems, such as electronic patient records.

Feedback relating to the proposed future services at Bentley Hospital was received, particularly relating to the proposal to relocate sameday surgery currently operating at Bentley Hospital, as this was different to the suggestion from the Reid report.

Women's and Children's Health Service

Strong support from key clinicians for option one presented in the CSC 2005 document – namely that the co-location of obstetric, gynaecological, neonatal and paediatric services, in particular with an adult tertiary hospital, would provide the optimal model for providing health care to women and children. In essence, it was recommended that Princess Margaret Hospital (PMH) and King Edward Memorial Hospital (KEMH) should be co-located together with an adult tertiary site.

Through discussions with other key stakeholders, it was however suggested that given other considerations such as infrastructure, transport and access, a second workable option could be to relocate PMH to a new site (north block at RPH has been suggested as a possible site once adult services at RPH are transferred), and co-locating KEMH with an adult tertiary hospital, namely SCGH or FSH. This option would provide a split of neonatology services. Further, it was suggested that since KEMH will be relocated in the longer term, there is a possibility that KEMH could relocate to the vacated RPH site following a relocation of PMH. This option may be more practicable if a private sector provider was involved in delivering inpatient care from part of RPH.

Strong feedback was received that paediatric and neonatal units at General Hospitals must be of a sufficient size to attract and retain workforce. Fragmentation must be avoided. Demand for these services at PMH and KEMH is high – however it was recognised that establishing capacity in the North and South Metropolitan Area Health Services may relieve some of this pressure.

Workforce

A common theme that ran throughout the consultation was that workforce planning is urgently needed to detail how workforce supply can align with the reconfiguration of clinical services. Workforce shortages – for doctors, nurses and allied health, combined with an ageing population means that attraction and retention strategies will be critical. Innovative strategies are needed to tackle workforce issues. Some suggestions received included investigating the design of hospital/facilities, family friendly workplaces, positive workforce environments and resourcing people to deal with the change.

There is also a need to take into account workforce strategies required to retain staff during the change process that will take place with the reconfiguration of clinical services. Other workforce considerations include safer working hours and the subsequent impact on on-call rosters. In addition, the medical workforce will grow in 2008 with the release of medical graduates from Notre Dame University. This has implications for the current workforce in terms of teaching and training demands.

Comments were also received regarding staffing in the General Hospitals, in particular the possibility of a shortage of general physicians as less medical students are opting to train as generalists.

Establishment of clinical networks across the metropolitan and rural areas, and offering rotation of staff across different sites, was suggested as a strategy to up-skill workforce in non-tertiary centres.

General Hospitals

There was general support for the development of the General Hospitals (Joondalup, Swan, Armadale and Rockingham). Some suggestions were received to stagger the building up of the General Hospitals as a strategy to manage workforce demands and the building up of clinical expertise at these sites. Specific comments were made that there is a lack of general physicians currently in the system and projected to be available in the future. This was seen as crucial to delivering the services at General Hospitals. Some General Practitioners were interested to know how their admitting rights at General Hospitals might be affected. They felt that as key community care providers they have a significant role to play in the development of the General Hospitals and voiced interest in being involved in the planning for the model of care development and implementation of this strategy.

Research and Training

General concern was expressed over the lack of acknowledgement of research and training within the CSC 2005. Comments were received that research must underpin clinical services to ensure the best possible patient care is provided. In addition, a commitment to research can assist to attract and retain clinicians by offering opportunities for research and transforming research into practice. Added to this is the recognition of high quality teaching and training that must be explicit in planning clinical services.

It was recognised that the establishment of the State Health Research Advisory Council, chaired by Professor Bruce Robinson, offers an opportunity for health and medical research to be addressed at a strategic level. There was a general consensus that research must be undertaken at the tertiary hospitals, namely SCGH, FSH, PMH and KEMH. In addition, clinical training and education must occur at the General Hospitals (Joondalup, Swan, Armadale and Rockingham).

Clinical Services

A wealth of information was provided on a number of clinical specialty areas (eg. infectious diseases, obstetrics, haematology, aged care). The key themes across the clinical areas included:

Workforce – concern was raised from a large number specialty areas regarding how workforce shortages might be addressed, how General Hospitals might meet the projected demand and increase in services, the need for Allied Health practitioners to be included in the planning for new services.
Modelling projections – some questions were posed regarding the accuracy of modelling projections and the assumptions made.
Integration with other clinical areas – a large number of submissions highlighted the need for greater integration of services across the continuum of care.
Models of care – some specialties highlighted the need for more detailed planning with regard to specialty specific models of care, which will be the ongoing work of the Clinical Networks under Dr Simon Towler.

Further, non-government organisations suggested that clinical reforms would provide opportunities for strong partnerships to be established to deliver a continuum of care. For example, if the State Rehabilitation Centre is to be co-located with an adult tertiary site, as consultation recommended, this provides opportunities for seamless care for patients to be addressed from the ground up.

Other concerns stemmed from definitions of services – for example if the major trauma centre were to be located at the Fiona Stanley Hospital, how would emergencies from the northern suburbs access trauma services in a timely manner? The trauma working group has advised that SCGH would have capacity in this situation as it is currently delineated between RPH and SCGH, with RPH designated as the major trauma centre.

A number of submissions from the clinical specialty areas presented information and recommendations obtained through collaborative planning processes across Area Health Services. This information will be vital to the final Framework implementation process to follow and will be made available to the relevant stakeholders.

Social Impact

A number of comments were received relating to the social impact of clinical reforms, namely transport and access considerations (for patients and staff). Suggestions included the need for the development of a transport strategy in response to the concerns of how the community will access health services in the future. This was suggested in response to concerns raised about how the community and staff will access services during the transition period and after the reforms are implemented and incorporated both public and private transport issues. Other comments received included the need to consider accommodation, in particular for rural patients, in planning for new health services.

Further comments related to the importance of cultural considerations when planning new health services, including the needs of Aboriginal patients and their families. This included issues relating to access, transport, accommodation, environment, cultural specific care and participation in the planning process.

A number of submissions raised concern regarding the impact of proposed changes to RPH, Bentley and Osborne Park Hospitals on access to services for those people residing in the eastern metropolitan corridor in particular for lower socioeconomic areas. Suggestions to address these concerns included the need to build up the General Hospitals (particularly Joondalup, Swan and Armadale hospitals) before any changes are made to other hospitals currently servicing the eastern corridor.

Next Stages

Feedback received through the CSC 2005 is currently being reviewed as part of the process of creating the WA Health Clinical Services Framework 2005-2015 due for completion in late August 2005. This process will also consider the many factors impacting upon the provision of clinical services such as financial, workforce supply and community needs.

The final Framework will form just one aspect of the continuous strategic and operational health system planning and reform process. This strategic document will describe the model of care needed to deliver quality care at the right time in the appropriate setting. The Framework will also incorporate other priority areas that impact on planning for clinical services, including workforce, ambulatory care, recurrent costs and demand management strategies.

The WA Health Clinical Services Framework 2005 - 2015 will delineate the level of clinical services to be provided at our metropolitan hospitals over the next five, ten and fifteen years according to the recommendations of the Reid report and the feedback received throughout the planning process in order to ensure the delivery of health care services that are integrated, coordinated and sustainable.

Along side the final Framework , ongoing work will continue to detail the operational stages of reconfiguring health care, namely workforce planning and transitional arrangements. At each stage of the reform process health system staff, the community and key stakeholders will be involved. If you would like further information, please contact your line manager or Area Health Service Chief Executive, or alternatively the Health Reform Implementation Taskforce on (08) 9489 6111.

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