Nurses protesting in 2018 outside the new $2.4 billion Royal Adelaide Hospital at the western end of North Terrace, Adelaide, about the long waiting times for patients in emergency departments.
 

A LEADER IN MEDICAL KNOWLEDGE, QUALITY
TREATMENT 
but South Australia struggles to
transform supply of resources to public system


SOUTH AUSTRALIA'S HEALTH THEME has been: Building cutting-edge medical knowlege and quality treatment at the top level but struggling with adequate or efficient resources for the public hospital system.

South Australia shared with many other places the 19th Century public health burden of filthy conditions. But the colony managed, through factors such as its medical school and research institute, to keep abreast and  contribute to medical knowledge and treatment

The Labor state government in the 21st Century made a leap towards fixing the continuing shortfall of resources in the public system with Transforming Health, centred around a new $2.4 billion Royal Adelaide Hospital. Technical and medical glitches, plus political threats, eroded and ended Transforming Health even before a Liberal government was elected in 2018 on promises of a new approach. Any new transforming-the-transforming approach will be challenged by the added problems of an ageing population and mental health.

As in other areas, South Australian health had its distinctive aspects. One of those was homeopathy in the 19th Century. Homeopathy tied in with the nonconformist Dissenting Protestant Christianity that was a driving force in founding South Australia. This merging of homeopathy and a practical anti-establishment Christianity, concerned about social issues, brought public health to the fore. Allan Campbell, a homeopath but also an officially qualified doctor, led this public health crusade and started the Adelaide Children’s Hospital in 1879.

As homeopathy faded in the 1870s, a new South Australian-born batch of doctors questioned their colonial predecessors and demanded more scientific rigour. This group was the first in Australia to set up official links with British medicine and its advances. They paved the way for an Australian Medical Association. South Australian medicine continues to welcome and learn from its international links.

But always swirling in the background of South Australian medicine and health have been disputes between doctors and government administrators over authority and funding. 

 

ADELAIDE HOSPITAL OPENS NEAR HACKNEY ROAD IN 1841

EARLY POOR CONDITIONS/DISPUTES HIT ADELAIDE HOSPITAL
but it gains from medical school in 1883 and its research institute

After awful infirmary, basic Adelaide Hospital opened in 1841 and expanded in 1856

After a public outcry about the awful state of the colony's first infirmary, the Adelaide Hospital near Hackney Road was built with £2,230 allocated by second South Australian governor George Gawler and occupied in 1841. It was replaced by a larger version in 1856. The hospital's first honorary doctors included William Wyatt and George Mayo, with James Nash as colonial surgeon. Insanitary conditions at the hospital were an ongoing theme. Another theme was disputes between the management board and the honorary doctors at the hospital. After the Adelaide Medical School opened in 1885, honorary doctors also took on instructing the medical students within the hospital.

Children's hospital born out of concerns over appalling lives/early deaths in poor areas

Adelaide Children's Hospital was a response to the appalling quality of life for young poor South Australians and the highest infant mortality rate — about 180 deaths per 1,000 live births – in the Australian colonies. Health campaigner Dr Allan Campbell in 1876 met with the wives of prominent citizens, including Mary Colton, to get funding started for what the new Health Board agreed was a desperately needed hospital. With support from the medical profession and luminaries such as Robert Barr Smith, land for the hospital was secured in North Adelaide for £2,500. The hospital also later ran the Queen Victoria Convalescent Home for Children at Mount Lofty, Mareeba Babies Hospital and Estcourt House at Tennyson.

 

Amid fighting over authority, funding and conditions, hospital gets medical school in 1883

Adelaide Hospital endured constant squabbles between the board and honorary doctors over authority, overcrowding, unclean conditions and funding in the second half of the 19th Century. In 1867, the board had to deal with allegations the hospital was being used for free treatment by people who could afford to pay. The hospital progressed by setting up its medical school, with Adelaide University, in 1883, but it was embroiled in the most famous of its disputes in the 1890s. The fight deepened when premier Charles Cameron Kingston became involved and it became complicated by personal matters.

Calvary and Wakefield both start in 1883 on way to 21st Century merger of hospitals

Calvary Hospital at North Adelaide and Wakefield Street Private Hospital – original parts of what would become the 21st Century second largest private health care provider in South Australia  – started in 1883. Parkwynd (1915), Memorial Hospital (1920) in North Adelaide, Ashford (1935), ad St Andrew’s (1936) and Burnside War Memorial Hospital (1943) are other surviving private and community hospitals. One of the early non survivors was the German and British Hospital, opened in 1850 in Carrington Street, Adelaide. Burnside War Memorial Hospital started in Toorak Gardens'  most extravagant mansion. It was donated free to Burnside Council in 1944 by  Otto George Ludwig von Rieben.

First public maternity hospital in 1902 after resistance by doctors and state government

The governor's wife Audrey Tennyson led the push to get South Australia’s first maternity hospital in 1902. Premier Frederick Holder refused government money but Tennyson secured land on Fullarton Road, Rose Park, from the South Australian Company and £500 from Robert Barr Smith. The biggest opposition come from the medical profession whom Tennyson criticised for being “furious at losing a few fees”. Tennyson oversaw what opened as the Queen's Home but eventually became the Queen Victoria Hospital. 

Hospital keeps up with technology/research but takes painful path to its big 1960s expansion

Royal Adelaide Hospital ("Royal" was added in 1939) kept pace with continuous advances in radiology and radiotherapy into the 20th Century but struggled with the demand for increasing space. Its Institute of Medical and Veterinary Science was founded in 1938. As a hospital suitable for patient care, it was failing by the 1950s. Beds were inadequate, waiting lists at concerning lengths and the older parts of the hospitals unacceptable. This prompted painful progress – with the state government, hospital management, Adelaide University and doctors bogged down in disputes – towards major hospital expansion in the 1960s. In 1963, the major demolition of old buildings began. The new buildings were occupied progressively between 1966 and 1969.

 

19th CENTURY CONCERN FOR CHILDREN IN APPALLING CONDITIONS

SEWAGE/SANITATION START AFTER PUBLIC HEALTH WORRIES
over filth on the streets and in backstreet slums of Adelaide city

Quarantine station on Torrens Island an early public health reaction by the colonists

One of South Australia's earliest preventative public health initiatives was a quarantine station on Torrens Island. It was proposed as early as 1850 and was operating by 1855 as a tent city. Isolated at the Port River mouth, Torrens Island was ideal for a quarantine station, enlarged in 1879. It could be reached only by launch or barge and had its own power, water and sewage. In 1886, insanitary conditions at Adelaide Hospital meant mattresses were taken to the quarantine station and disinfected.

Adelaide first in nation to have deep sewage in 1870s but the poor still suffer filthy conditions

Adelaide became the first Australian capital to have a deep drainage sewage in the 1870s. But the drainage and the Public Health Act in 1873 weren't instant fix to the problems. In the 1870s, mortality rates in Adelaide were declared higher than in central London. Primitive disposal of human waste into the parklands until the 1880s, pungent fumes from the cemetery, and toxic fumes from factories, all contributed to the poor environment of the city.

Health Act 1873 enables boards to enforce sanitation but private streets hosting slums

The Public Health Act in 1873 was crucial in starting a change to conditions in Adelaide city. It set up central and local health boards and allowed homes to be inspected and checks on household rubbish disposal. Many private streets and laneways had been created in the 1840s and 1850s by subdividing the original town acres of William Light’s city plan into small allotments for tiny dwellings. In many early private streets, tenants continued to live in appalling conditions.

Laura Corbin starts day nursery in city's poor south with a stress on health and hygiene

Laura Corbin, wife of Dr Thomas Corbin who practised in Adelaide city’s poorest southern area, in 1876 had joined Mary Colton and others on Dr Allan Campbell's committee planning what became Adelaide's children's hospital. Corbin became deeply concerned at the plight of poor mothers, often widows, forced to leave children at home alone, while they worked at charring, laundering or office cleaning. In 1887, she founded the South Adelaide Day Nursery to help working mothers and their children. Health and hygiene were paramount concerns. Corbin devoted herself to every aspect of the creche whose pioneering rules were adopted in other colonies. The crèche became a South Australia-wide cause.


 

Helen Mayo lowers infant mortality with Mothers and Babies Health Association

Helen Mayo pioneered maternal and infant health and welfare in South Australia and Australia. After matriculating at the Advanced School for Girls (later Adelaide High School) on Grote Street in 1895, she became the University of Adelaide’s second graduate in medicine in 1902. She topped her class and won the Davis Thomas scholarship and Everard scholarships. Mayo spent two years working in infant health in England, Ireland and India. Returning to Adelaide in 1906, she starting a private practice and worked in honorary roles at the Adelaide Children’s Hospital and Adelaide Hospital. In 1909, Mayo addressed an interstate conference on South Australia’s high infant mortality rate and argued the need to educate women for motherhood. Later that year, she and Harriet Stirling (the daughter of professor Edward Stirling) founded the School for Mothers in a small clinic in Franklin Street, Adelaide. Despite criticism that spinsters couldn’t teach mothers, the organisation flourished from a cottage in Wright Street, Adelaide. The school became the Mothers' and Babies' Health Association (MBHA). By 1927, it had branches throughout South Australia and a training school for maternal nurses. The MBHA eventually became part of the state health system. Because Adelaide Children’s Hospital wouldn't admit infants aged under two, Mayo and her group in 1914 rented a two-storey St Peters house as a hospital for infants. Mayo set up strict anti-infection protocols for what later became the 70-bed Mareeba Hospital, run by the state government at Woodville.





 

Gertrude Halley brings mass health checks to South Australian public education system

Gertrude Halley was chosen in 1913 to set up the medical branch of the government education department in South Australia. Accompanied initially by one nurse, Halley began examining 50,000 children at the rate of 100 a day. Like colleague Lydia Longmore, inspector of infant schools, Halley believed educating mothers and fathers was one of the best ways to improve children’s health. Longmore and Halley  pioneered intelligence tests in schools. Halley also promoted model playgrounds for children. In 1920, Halley became a founding member of the South Australian branch of the National Council of Women and was convener of its standing committee on public health 1927-29.

CHILDREN'S HOSPITAL AMONG SPINOFFS OF 1860s HOMEOPATHY PHENOMENON

HOMEOPATHY, ALLAN CAMPBELL AND PROTESTANT DISSENT
push health into the public conscience as issue of social concern

Adelaide's Protestant dissenting middle class embrace homeopathy as public health care

Homeopathy was a strong theme behind South Australian 19th Century health concerns. Adelaide Homeopathic Dispensary was prominent on King William Street. Prime mover behind the dispensary was Dr Allan Campbell, who also instigated the Adelaide Children’s Hospital. South Australia's founding on Protestant nonconformist Dissent made it a fertile place to combine 19th Century social and medical reform with religious revival and religious philanthropy.

Adelaide homeopathy challenges 19th Century 'official' medicine that still treated with leeches

Dr Henry Wheeler had his qualifications questioned by the South Australian Medical Board in 1862 because he also practised homeopathy. Yet homeopathy was part of medical reform against "orthodox" treatments such as using leeches. The reform wanted a shift to public health to help the poor.When Dr Allan Campbell joined Wheeler's practice in 1867, they set up the Adelaide Homeopathic Medical Charity, funded by wealthy donors, to offer medicinal help to those unable to pay.

Allan Campbell uses homeopathy to advance public health and start the children's hospital

Adelaide’s leading homeopath Dr Allan Campbell was a major early influence on Adelaide public health. His ideas underpinned an 1876 report to the government on sanitation. He formed a committee to start Adelaide Children’s Hospital. He tended the poor at the Adelaide Homoeopathic Medical Charity in King William Street. In 1893, Campbell helped devise a home-nursing scheme for Bowden, one of the poorest suburbs. From this came the District Trained Nursing Society.


 

TUBERCULOSIS AND THE MAKING OF THE MEDICAL PROFESSION FROM RUGGED RAGGED START

EDWARD STIRLING, JOSEPH VERCO, JOHN CLELAND PAVE WAY
for the relentless scientific approach of TB fighter Darcy Cowan

Thomas Young Cotter the colony's colourful first doctor sacked in 1839 after complaints

With a licence from the Company of Apothecaries, Thomas Young Cotter was appointed South Australia's first colonial surgeon in London in 1835. He arrived  at Holdfast Bay in January 1837. His was expected to care for all government officers and immigrants in a small hut as the infirmary on North Terrace near the Anglican Trinity church. Cotter had little patience with newcomers with imagined ailments or malingering prisoners in Adelaide Gaol. After complaints, the newspapers charged him with neglect and he was censured by a board of inquiry. Cotter was also out of favour with first governor John Hindmarsh and in 1839 he was suspended.

Early doctor Charles Everard becomes farmer; Edward Wright tried for manslaughter

Charles Everard and Edward Wright were two of the earliest doctors in the colony, arriving with free passage on the Africaine and Cygnet  in 1836. Everard made the most of the five acres bought in Adelaide city and established “Ashford”, a farm in what is now the suburb of Everard Park. Edward Wright’s background was less stable. In 1830, he’d been dismissed as superintendent of London’s Bethlem Hospital (Bedlam) for drunkenness, neglect and undue familiarities. In 1845, Wright was tried for manslaughter in the South Australian supreme court for having prescribed, while seemingly intoxicated, heroic doses of morphia to a Thebarton hotel landlord who was in Adelaide Gaol as a mental case.

The Gosses – father William and son Charles – add to the prestige of medicine in community

William Gosse and his son Charles boosted the prestige of the South Australian medical profession in the second half of the 19th Century. William Gosse was first president of the South Australian Medical Society, only the second branch of the British Medical Association established outside the United Kingdom in 1879. An ophthalmic surgeon, Charles Gosse joined the board of management of Adelaide Hospital in 1877. His special interest was childhood mortality at a time when South Australia had 20% of infants dying within three months of birth. In 1885, Charles Gosse was involved in a serious horse carriage accident in Hutt Street, Adelaide. Gangrene set in and he died two days later after his leg was amputated.

Adelaide doctors lead in 1870s-80s scientific approach that opens way to forming AMA

As the heyday of homeopathy passed in the 1870s-80s, a new generation of mainly Australian-born Adelaide doctors wanted with a more scientific approach to medicine. These included Edward Stirling who returned to Adelaide in 1881 – after graduating from Trinity College, Cambridge, and being admitted to the Royal College of Surgeons – to help found, with Joseph Verco, the university's medical school. They and others, including William Gosse, George Mayo, Thomas Corbin, John Davies Thomas and William Hayward, set off a movement that would ultimately lead to the first annual general meeting of the Australian Medical Association (AMA) in 1962 at the University of Adelaide.

 

Thomas Whittell brings microscopy/bacteriology knowledge to Adelaide sanitation in 1890s

Dr H. Thomas Whittell brought back from a trip to Europe (1879-81) the latest in microscopy and bacteriology, including meeting the great scientists Robert Koch and Louis Pasteur. As president of South Australia’s central board of health from 1883, Whittell applied microscopy to solving many problems of Adelaide’s public sanitation. Whittell was loaded with the extra roles (without extra pay) of city coroner, vaccination officer, inspector of anatomy plus registrar of births, marriages and deaths. One of Whittell's pratice partners was Dr Davies Thomas who had a background of working at London's Brompton Hospital with significant English physician William Jenner, primarily known for discovering the distinction between typhus and typhoid.



 

Mark Johnston Symons' rooms a Gothic gem from North Terrace's halcyon medical days

Dr Mark Johnston Symons, “the first trained eye specialist to practise in Adelaide”, left the lasting memorial of a rare Gothic secular building that was his consulting rooms, designed by Edward John Woods and completed on North Terrace in 1901. When Symons' premises were built on North Terrace in 1901 it was becoming fashionable among the medical fraternity to have professional rooms between King William Street and the Botanic Hotel. This building is one of few surviving reminders of eastern North Terrace's links with the medical profession. Symons lectured in ophthalmic surgery at the medical school at Adelaide University and became dean of the faculty of medicine.

 

Joseph Cooke Verco starts distinguished Adelaide dynasty in medicine and dentistry

The Verco dynasty  – started in 1840 when young stonemason James Crabb Verco arrived in Adelaide – became a major influence on South Australian medicine and dentistry. James Crabb Verco’s' fourth son, Joseph Cooke Verco, went to London to study medicine. He returned to Adelaide in 1878, coinciding with the rise of the new university. In 1885, with Edward Stirling, he helped found Adelaide University's medical school and was pivotal in setting up the university's dental school after World War I. Robin Warren, 2005 Nobel medicine prize winner, is part of broader family that contains other notable Adelaide names including Margarey, McMichael and Ludbrook.

 

John Cleland a giant of pathology/diseases as Adelaide University professor from 1920

Norwood-born John Burton Cleland in 1920 was appointed first Marks professor of pathology at Adelaide University. He began one of the largest series – more than 7000 – of meticulous autopsies by one person. Cleland’s unrivalled experience in aspects of pathology was supplemented by an interest in anthropology and many papers on the diseases of Australian Aboriginals. Yet Cleland’s scientific interests, including botany, pursued through a huge amount of committee work, have proved of even more lasting value than his medical studies.  Cleland Conservation Park in the Mount Lofty Ranges is named after him.

 

Tuberculosis brought out on first colonial ships: William Light among early victims

Tuberculosis was a scourge from South Australia's earliest colonial days. It killed Harriet, wife of colonial secretary Robert Gouger, at Glenelg in 183. Three years later, Colonel William Light died of the same cause. (South Australia perversely benefited from the arrival of tuberculosis sufferers such as significant pioneer John Howard Clark and family, and brilliant Adelaide University academic and vice chancellor William Mitchell. Illness forced others – from Julia Farr to Julia Gillard – to migrant to South Australia.) Tuberculosis remained the main killer of young adults until almost World War II. In 1870, when the lunatic asylum moved from the Botanic Gardens site to Parkside, its Dickensian building became the consumptive home and cancer block of Adelaide Hospital. It continued as the place for patients in the terminal stages of tuberculosis and cancer until 1932 when it was closed and demolished in 1938.

 

Dr Darcy Cowan leads Australia in push for BCG vaccine to be made at Adelaide institute

Dr Darcy Cowan was a driving force in the organised rehabilitation in South Australia for tuberculosis patients.  He encouraged Dr Nancy Atkinson at the Institute of Medical and Veterinary Science, part of Adelaide Hospital, to produce the BCG vaccine. This made the vaccine available to tuberculosis patients for the first time in Australia. With Dr Cowan in charge, Frome Ward was opened in 1942 as the first  at Royal Adelaide Hospital exclusively for tuberculosis patients .

 

Cowan's work to rid tuberculosis includes founding Bedford Industries for rehab

Darcy Cowan made tuberculosis and chest diseases his life work. As South Australian branch president of the British Medical Association, Dr Cowan’s constant forthright pressure saw Royal Adelaide Hospital get a chest clinic in 1938. He founded the South Australian Tuberculosis Association and helped form the National Association for the Prevention of Tuberculosis. In 1950, Cowan founded Bedford Industries, rehabilitating those with tuberculosis. Bedford Group is now Australia's second biggest employer of disabled people.

Cowan and Wunderley groundwork sees TB cases cut to near zero in the early 21st Century

The chief personalities in the conflicts over tuberculosis treatment methods at Royal Adelaide Hospital's Frome Ward in the 20th Century were doctors Darcy Cowan and Harry Wunderley.  Serving in the army in World War II, Wunderley set up the routine chest X-ray for the armed services on enlistment and discharge. The BCG vaccinations pioneered by Cowan were expanded to all schoolchildren in the 1950s.  South Australian TB cases were down to around 10 in the early 21st Century.

ANOTHER ONGOING PROBLEM FROM START OF COLONIAL SETTLEMENT

MENTAL HEALTH MOVES FROM 'LUNATIC ASYLUM' ATTITUDE  to shock treatment to major community problem in 21st Century

'Lunatics' moved from gaol to Adelaide and then Parkside asylums in the 19th Century

In 1852, Adelaide Lunatic Asylum opened at the eastern end of Adelaide Hospital in what is now the Botanic Garden. Parkside Lunatic Asylum in 1870 became the home for Adelaide's chronic mental health patients but also those nearing death, suffering undiagnosed conditions, unmarried mothers and prostitutes. The Parkside asylum also held people with intellectual disabilities and medical conditions like epilepsy. In 1898, the government’s Minda Home for Weak-minded Children was opened at Fullarton. 

 

Parkside asylum 'The Bin' for all those who didn't fit society norms: 1,769 patients in 1958

Parkside Lunatic Asylum was nicknamed “The Bin”: a dumping place for those who didn’t fit into society. It opened in 1870 during some mental health enlightenment. Patients were no longer chained up or put in baths to be cleansed of the Devil. Syphilis-related dementia provided up to 20% of patients through to the 1900s. In 1915, Parkside’s population was 1,157. (It peaked in 1958 at 1,769.) Overcrowding was normal with hallways used as wards. It was called Parkside Mental Hospital from 1913 and Glenside Mental Hospital from 1967.

Parkside hospital the first in Australia to use electro-convulsive shock treatment

Parkside in 1941 was Australia's first mental health hospital to use electro-convulsive shock treatment (ECT). With World War II in the early stages, timing devices needed for ECT machines were reserved for bombing mechanisms. The University of Adelaide physics department hit upon the idea of substituting timers with the dial mechanism from a rotary telephone. By the late 1950s, breakthroughs in drug treatments began to show results and patient numbers began to fall.

 

Jamie Larcombe Centre at Glenside specialises in treating veterans for post traumatic stress

A $15 million veterans’ mental health precinct opened at Glenside Health Service in 2017 includes Australia’s first post-traumatic stress research centre. The Jamie Larcombe Centre, named after a Kangaroo Island soldier killed in action in Afganistan in 2011, was built to accommodate services previously provided by Ward 17 at the Repatriation General Hospital. The centre gives inpatient and outpatient treatment. It has research spaces, a gymnasium, a memorial garden and children's playground for families. A partnerships hub in the heritage building next door enables veterans and their families to access information and services to support their individual needs.

 

Adelaide University part of study with USA and UK bodies into addiction and mental health

Adelaide University is working with two other of the world’s leading research universities in addiction science – Virginia Commonwealth University in the USA and the Institute of Psychiatry, King’s College, London – with its its close connection to mental health. Mental health links have has seeped into a wide range of 21st Century Adelaide research and study courses. Another example is Royal Adelaide Hospital department of gastroenterology and hepatology looking at psychological support as a third way of treating sufferers of inflammatory bowel disease by reducing anxiety and depression..



 

Hundreds of mental health patients still testing emergency departments' capacity

Hundreds of mental health patients were still waiting more than 24 hours for treatment in the state’s hospital emergency departments in 2016. SA Health’s July 2018 target was that 90% of mental health patients would not wait more than eight hours. The Sout Australian Mental Health Commission was launched in 2015. With one in five South Australians experiencing mental illness, the commission advises on government services such as education, employment and housing.

SOUTH AUSTRALIA'S PUBLIC HEALTH SPENDING AT $5.9 BILLION IN 2015

TRANSFORMING HEALTH A BOLD ATTEMPT AT CUTTING COSTS
as biggest department threatens to chew up half of state's budget

Streamlining the metro hospitals aimed to trim $900m off state's $5.9 billion health budget

The extensive and controversial Transforming Health system was announced by the Labor state government in 2015 with the slogan “Best Care. First Time. Every Time”. The system was designed to trim $900 million off the state's $5.9 billion annual health budget, with federal funding not expected to rise greatly. Transforming Health aimed for a two-tier metropolitan hospitals system, with the new Royal Adelaide Hospital, Lyell McEwin Hospital at Elizabeth and Flinders Medical Centre on the top tier.

SA Health in combat with doctors' and nurses' unions over Transforming Health

The Labor state government's Transforming Health project became a 21st Century battleground of state politics. In the health system, criticism of Transforming Health, feeding constant media attention, was led by the SA Salaried Medical Officers Association (doctors working in hospitals), Nursing and Midwifery Federation, Australian Medical Association and individuals such as Warren Jones, a Flinders Medical Centre emeritus professor. The government's biggest  department, SA Health, was charged with bringing in Transforming Health. SA Health took over from South Australian Health Commission, created in 1975, that replaced the Hospitals Department. SA Health had 26,942 medical staff and 13,590 administrative workers in 2015 in the Central Adelaide, Northern Adelaide, Southern Adelaide, Women’s and Children’s, Country Health SA local health networks (LNHs) and SA Ambulance Service.

Labor government rolls back Transforming Health aspects before losing office in 2018

The state Labor government was rolling back aspects of its Transforming Health system even before it lost office in 2018. The rollbacks included not axing cardiac services at the Queen Elizabeth Hospital, not moving Noarlunga Hospital’s emergency department and restoring an eight-bed emergency extended care unit for Modbury Hospital. This eroded the original intent of having emergency department resources concentrated at the Royal Adelaide, Lyell McEwin and Flinders Medical hospitals. Transforming Health was also being questioned for not meeting savings targets and also its spending on hospitals at the expense of community health centres. SA Health pointed to GP Plus Health Care Centres and GP Plus Super Clinics providing a broad health care services to local communities.
 

Liberals take over but face same health costs of ageing population and mental health blight

The state Liberal government, elected in 2018, started its promised remedy by appointing a new head of SA Health while five other senior executives departed the largest government department with a $5.9 billion annual budget. The new administration will face the same funding and demographic crunch with the state heading towards health taking up 50% of government spending in about 2030. Australia’s oldest population and mental health are among factors that threaten to overwhelm the level of resources. About 70% of Transforming Health goals were achieved but the new government would have to do more to make the system more efficient with South Australia having one of the most expensive cost-per-head health systems in Australia

 

Governing councils will monitor 10 local health networks from 2019 in shift to decentralising

Governing councils for 10 local health networks are a part of a decentralising push by the new Liberal South Australian government elected in 2018. The governing councils will oversee three Adelaide metropolitan health networks (Central Adelaide, Southern Adelaide, Northern Adelaide), six regional and one state-wide (Women’s and Children’s). This is a push away from central governance with authority and accountability resting with the chief executive of the SA Health government department. The state government saw strong community support, particularly in regional South Australia, for the return of local health councils.
 

Adelaide's big research network, backed by fundraising, keeps medicine at cutting edge

Advances in 21st Century South Australian health knowledge and procedures benefit from a complex mesh of links between universities, research precincts, hospitals and private industry – with the local mesh extending nationally and globally. Adelaide’s biomedical research precinct on North Terrace integrates health knowledge from hospitals, the South Australian Health and Medical Research Institute and the three Adelaide universities. The buildings in the precinct are dominated by the $2.4 billion new Royal Adelaide Hospital. Fundraising foundations attached to the Royal Adelaide, Queen Elizabeth, Women’s and Children’s and Flinders Medical Centre hospitals generate millions of dollars for research.

CHANGE OF STATE GOVERNMENT IN 2018 PROMISES CHANGE OF PUBLIC HEALTH STRATEGY

HOSPITALS READJUST AFTER TRANSFORMING HEALTH ENDS;
Repat makes a comeback and Calvary leads a private resurgence 

New Royal Adelaide Hospital suffers early snags but brings major care improvements

The new Royal Adelaide Hospital, opened in 2017 with a transfer of patients from the east to the western end of North Terrace, was central to the Transforming Health vision as a super site for treating major accidents and emergencies such as heart attacks and strokes. Aside from early glitches including a power outage from a software failure and ongoing overcrowding and workspace problems in the emergency department, the hospital brings significant overall improvements to patient care.

Flinders Medical Centre retains its renowned neonatal unit – plus a $17 million upgrade

Flinders Medical Centre retains its renowned neonatal intensive care unit – with a $17 million upgrade – under a reversal of a Transforming Health plan to shift it to the Women’s and Children’s Hospital. The neonatal union has a national reputation for world-class care of high-risk preterm babies and their families. During Transforming Health, Flinders Medical Centre did take over the Repatriation General Hospital’s role with a rehabilitation centre including gyms and pool, a palliative care ward and an older person’s mental health unit. Flinders also had its emergency department upgraded, gained two operating theatres and an added 1,820-space carpark.




 

Lyell McEwin now offers full range of care as major hospital for the northern suburbs

Lyell McEwin Hospital has become the major hospital for Adelaide’s northern suburbs and one of the three in the metropolitan area to have a super emergency department under Transforming Health project. Opened in 1959 as a small hospital for the new city of Elizabeth, the Lyell McEwin now offers the a full range of medical, surgical, diagnostic, maternity, emergency and support services. In 2002, the hospital started its $336 million three-part redevelopment. State-of-the-art maternity, obstetrics and gynaecology sections were added.


 

Queen Elizabeth regains its 24/7 cardiac services; remains stronghold for teaching and research

The Queen Elizabeth Hospital at Woodville won a reprieve in 2017 when the then-Labor state government backed down from a Transforming Health plan to shift its 24/7 cardiac services to the new Royal Adelaide Hospital. The hospital also retained its respiratory and cancer services. It also got a new emergency department, operating theatre, day surgery suite, new outpatients and medical imaging services, the state’s most advanced brain and spinal injury rehabilitation services and an extra multi-storey carpark. The 24/7 cardiac services, with extra equipment and additional staff recruited, resumed at Queen Elizabeth Hospital in June 2018 under the new Liberal state government.

 

Modbury a centre for elective surgery but regains emergency and surgical offerings

Modbury Hospital, serving the north-eastern Adelaide suburbs, will regain a high dependency unit under the Liberal state government elected in 2018. This reverses the Transforming Health move to downgrade Modbury’s emergency department’s 24/7 care to non-life-threatening cases, with the hospital concentrating on becoming a centre of excellence for elective surgery. The Liberal government said it would also restore surgical capacity and upgrade emergency services at Modbury.

Noarlunga Hospital reopened to general patients but focus on elective day surgery

General patients will be e admitted to a new 12-bed acute medical ward at Noarlunga Hospital, in a part reversal by the new Liberal state government of a Transforming Health move that transferred 29 beds to Flinders Medical Centre. The hospital did get a multi-million-dollar upgrade under Transforming Health to improve its elective day surgery capacity. For this day treatment, the hospital gained two extra operating theatres, a renal dialysis unit and a dedicated paediatric space. Noarlunga also has gained a GP plus super clinic and upgraded mental health ward and car, plus a 20-bed community rehabilitation centre.



 

Repat Hospital to be returned as a health precinct as $200m redevelopment axed

The Liberal state government, elected in 2018, axed $200 million plans for the Repatriation General Hospital’s Daw Park site and said it would reopen it as a genuine health precinct. The hospital’s shutdown had been the most emotive part of Transforming Health, with some war veterans protesting outside Parliament House for months. Ward 17 at the hospital closed in 2017 with complaints that its one-stop services plus general surgery – would be lost. The Liberals promised to reopen five operating theatres.

 

Calvary project tops St Andrew's, Ashford and Memorial private hospitals upgrades

The new $250 million 12-storey Calvary Hospital on the Angas-Pulteney streets corner, Adelaide, will be South Australia’s biggest of upgrade boosts for private hospitals including St Andrew’s, Ashford, Memorial and Calvary at North Adelaide. Adelaide Private Hospital Catholic health group is moving its Wakefield Street hospital and day surgery and South Australia’s only private emergency centre, as well as its Walkerville rehabilitation hospital, to the new 350-bed hospital. Wakefield Street was the oldest private hospital in Adelaide, first built in 1883. Another large CBD private hospital, St Andrew’s, had a $45 million expansion in 2016. It involves day surgery with two operating theatres, three procedure rooms, two angiography suites with recovery beds, a 28-bed ward, a staff gym and a three-level carpark. Ashford Hospital on Anzac Highway more than doubled from a $33 million development started in 2018. It includes a six-bed chest-pain clinic. North Adelaide’s Memorial Hospital gained an extra operating theatre among a general upgrade.



 

Women's and Children's Hospital mooted for move next to the new Royal Adelaide in 2024

The Women's and Children’s Hospital has been slated to move into a new building in the biomedical precinct at the western end of North Terrace, next to the Royal Adelaide Hospital, opening some time after 2024. The Women's and Children’s Hospital would be linked to the Royal Adelaide Hospital, overcoming its North Adelaide site's lack of a helipad and giving its access to other services. The Liberal state government, elected in 2018, had a taskforce choose the location, looking at factors such as the nearby rail lines and aircraft flight paths. Adelaide is the only mainland capital where the women’s and children’s hospital is not with a teaching hospital. Being part of the Adelaide biomedical precinct gives it proximity to the research and teaching resources. The Women's and Children's Hospital, on its King William Road, North Adelaide, site dating back to its opening as the Adelaide Children’s Hospital in 1878, is a teaching hospital for the Adelaide, South Australia and Flinders universities. The children's and adolescents' wards offer all paediatric specialities. The women's wards cater for antenatal, gynaecology, neonatal and postnatal disciplines. Currently 19,000 children, plus 5,000 born there, are admitted annually to the hospital.



 

PERSISTENT PROBLEMS AMONG CONSTANT IMPROVEMENTS

EMERGENCIES RAMPING AND ELECTRONICS RECORDS DELAY
the big downsides of general forward shift for state's healthcare

Ambulances caught in ramping squeeze as emergency departments struggle with bed block

Ambulance services have been caught in the middle of the Transforming Health plan and its aftermath. Transforming Health emphasised the role of ambulances in restricting super emergency departments for life-threatening cases to Lyell McEwin, Royal Adelaide and Flinders Medical hospitals. (Queen Elizabeth Hospital later kept its emergency department.) The new Royal Adelaide Hospital failed to stop ramping or queuing problems for ambulances with a logjam for getting patients into its emergency department. Ambulances attend only urgent cases when all metropolitan hospitals are over-capacity/code white. Australian Institute of Health and Welfare 2016-17 data showed, while all people needing to be resuscitated were treated immediately, only 67% of emergencies were seen within the recommended 10 minutes – down 70% on 2015-16. The new Liberal state government in 2008 took several measures in an attempt ease the block to getting patients from the emergency departments into ward beds. Reasons for the bed blockage include few places outside hospitals for mental health patients. A lack of beds and services for disability and aged care, the rising cost of seeing a doctor and that one in 10 patients in emergency departments is using private insurance, all add to the problem. 


 

Tradition from Joanna Briggs to Kirsty Bowden; state's nurses become outspoken on conditions

Transforming Health era hospital conditions have brought South Australian nurses into the most high-profile and outspoken protest phase of their tradition that goes back to Joanna Briggs in the 1840s. Joanna Briggs, married to the pharmacist, was the first of Adelaide Hospital’s female staff recognised as a nurse and was made matron by the colonial surgeon in 1849. Kirsty Bowden, a high achiever at Flinders University, added a sad but stirring milestone to the nursing tradition. In 2017, the state government announced the Kirsty Bowden scholarship to honour Loxton-born nurse killed in the London Bridge terror attack as she rushed to aid victims.




 

State-wide electronic health records (EPAS) system paused due to rising costs/delays

SA Health’s EPAS (Enterprise Patient Administration System), an electronic health record of patient history, has run into schedule and cost blowouts (from $220 to $500 million) and patient safety concerns. The incoming Liberal government paused the rollout of the system in 2018. EPAS, besides replacing paper records, also aimed to be a single state-wide system unlike in Victoria, NSW and Queensland where individual hospital systems cannot talk to each other.

More interns, telehealth 
links, haemodialysis
 chairs help overcome 
country resources lag


In a sector often battling for resources, South Australian country centres are gaining health services through advances such as more interns, telehealth and mobile dialysis units. In 2019, the numbers of junior doctors training in country South Australian hospitals will more than double to 12. A telehealth video conferencing network is bringing instant extra expertise to Country Health SA’s 64 regional and remote hospital across the state. Fifty-seven haemodialysis chairs in country centres allow more people to receive lifesaving treatment closer to home.


 

Government spending $45 million to cut long wait for elective surgery in public hospitals

A $45 million investment was promised by the new state Liberal government in 2018 to significantly reduce the list of overdue elective surgery patients in South Australian public hospitals. This came when more than 1300 patients were overdue for elective surgery procedures in South Australia and around 4100 were waiting for a colonoscopy beyond recommended clinical timeframes. Most patients overdue for elective surgery were on the waiting lists at the Royal Adelaide Hospital or Flinders Medical Centre. Figures released in 2018 showed average waiting times of several years for some surgeries with maximums of at least 16 years.

 

Public dental and eye care standards fall as treatment waiting lists keep on stretching

South Australians have the worst dental health of mainland states, according to the 2018 Medibank Better Health Index. In South Australia, 32.3% of people have at least one dental problem, above the national 30.4%. Tooth decay is suffered by 16%, above the national average and only better than Queensland. A year’s wait for public dental and eye treatment is common. In 2016, waiting times more than a year across most of South Australia's public health system and as long as 17 months in the state's south east.




 

21st CENTURY PUBLIC HEALTH ADVANCES

SMOKING BANS AND CANCER SCREENING RATES EXPANDING
as South Australians keeping up and ahead of the national levels

Smoking bans extended but passive effects still high; e-cigarettes present new challenge

Smoke-free outdoor dining came into effect in South Australia in 2016 and the ban was extended to more public places. Smoking continues to decline in the community. But the state government moved in 2018 to strengthen South Australia’s tobacco laws after a South Australian Health & Medical Research Institute (SAHMRI) survey of 3000 South Australians revealed 66.4% of respondents had been exposed to someone else’s cigarette smoke in the past two weeks, compared to 63% in 2016. This follows measures to reduce the harm associated with e-cigarettes and bring South Australia into line with most other states.
 

Free mammograms to continue as South Australian women's usage tops nationally

South Australian women aged between 70 and 74 will continue to receive free biennial mammograms as part of the BreastScreen Australia program, as part of $4.2 million agreement in between the state and federal governments in 2018. More than 90,000 South Australian women have free screening mammograms each year at BreastScreen SA. South Australia has some of the best breast cancer and cervical cancer screening rates in Australia. For those aged 50 to 74, the rates have been measured as the highest in the country at 58.4%, well above the national average of 53.7%.

 

From auto-transplant surgery to improving neonatal birth rates, it all adds up to positives

The Royal Adelaide Hospital is the only place in Australia where people suffering severe and hereditary pancreatitis can have potentially lifesaving islet auto-transplant surgeries. For 10 years,The Hospital Research Fund has given more than $1.5 million to renal transplant research and ground-breaking islet transplant research. Meanwhile, the survival rate for premature babies in South Australia keeps improving with a 2015 report showing there were 35 neonatal deaths, at a mortality rate of 1.7 per 1,000 live births. These are two examples of the positive side of South Australia's healthcare and the skill and work of its clinicians, researchers, nurses, support staff and fundraisers. Outstanding staff achievements, projects and innovations are highlighted in the annual South Australian Health Awards.


 

Meningoccocal B worry to be met with free jabs; general vaccination rate for the state at 94%

South Australia became the first Australia state in 2018 to introduce a free vaccination program for babies and young people against the potentially deadly meningococcal B disease. There have been 372 cases of meningococcal B disease in South Australia since 2000, including 14 deaths, and more than 60% of those affected were aged under 21. Against the national trend, the disease has not declined in South Australia over that time. South Australia was up with national benchmarks for immunisations generally in 2017 with nearly 94% of five year olds vaccinated.

From South Australian origins, Flying Doctor now part of aeromedical base at Adelaide Airport

Royal Flying Doctor Service is now at a $13 million aeromedical base, including a medical precinct with all members of retrieval services, at Adelaide Airport. The flying doctors' start is linked to South Australia. In 1911, the Rev John Flynn arrived at a Beltana mission where he saw the lack of medical care for in the outback. South Australians Alfred Traeger, who invented a pedal-operated generator for radio, and fundraiser Adelaide Meithke were key figures in starting the Flying Doctor. Its Adelaide Airport base will include a six-aircraft hangar, an enhanced patient care area with private bays and a corporate office.The South Australian Ambulance Service’s Medstar team now share sthe same precinct at Adelaide Airport. This move saves seven to nine minutes of travel time for medical teams.


 

BEYOND SOUTH AUSTRALIAN PROBLEMS WITH EVERYDAY SERVICE DELIVERY

AT THE CUTTING EDGE OF RESEARCH/TREATMENT ADVANCES
in areas such as combatting deadly chronic myeloid leukaemia

Adelaide's craniofacial unit becomes centre of excellence for patients from around the world

The South Australian (later Australian) Craniofacial Unit was started at the Adelaide Women’s and Children’s Hospital in 1975 by craniofacial surgeon professor David David to serve South Australian, interstate and overseas patients. The Australian Health Ministers' Advisory Council designated the unit as a national centre of excellence in 1988 for its work on patients with rare and/or complex congenital or acquired anomalies affecting the head and face. David David, who retired as head of the unit in 2017, was named 2018 South Australian of the Year, after his South Australian of the Decade title in 1988. The multidisciplinary unit remains a centre of international excellence for craniofacial disorders, seeingfrom throughout Australia and the world. The South Australian government funds placements for international patients. This includes treatment, accommodation, expenses and transport. Based at the women’s and children’s hospital and also operating at the Royal Adelaide Hospital, the unit is one of two standalones worldwide and the only one of its kind in Australasia. It manages the craniofacially deformed, by pursuing excellence in clinical, scientific and educational disciplines. It treats children and adults with disorders such as distorted skull and facial shapes; cleft lip and palate; tumours and trauma cases. Its scientists work as a team studying phenotype (appearance) and recording genotype (genes) of craniofacial pathologies. Other research includes: Craniofacial morphology, clinical cephalometrics, biomedical engineering, genetics, biology of craniofacial deformities and bone distraction.

Professor Tim Hughes of SAHMRI a world leader in chronic myeloid leukaemia treatment

Adelaide-based professor Tim Hughes has become one of the world’s leading experts on dedicating his career to its study since arriving in the city in 1993. His chairmanship of the International Chronic Myeloid Leukaemia Foundation and the prestigious 2017 GSK Award for Research Excellence are testament to Hughes’ global status in this field. In Adelaide, Hughes is cancer theme leader at the SA Health and Medical Research Institute (SAHMRI) and consultant haematologist in the haematology division at SA Pathology. Hughes saw chronic myeloid leukaemia (CML) prove fatal for most people diagnosed 20 years ago. Now, about 80%  survive. Hughes unlocked one of the most significant discoveries in leukaemia research: the use of tyrosine kinase inhibitors (TKIs). His methods with TKI therapy have ensured a system that can measure affected cells in blood more accurately, enabling more detailed analysis of specific cancer-fighting drugs. While 80% of patients with CML beat the disease, two thirds remain on therapeutic drugs for the rest of their lives but about 30% of patients can finish taking drugs for therapy and remain in remission. Hughes’ team at SAMRHI has pioneered a process to get patients off their TKIs although with significant adverse side effects. Important work is developing next-generation drugs that are even more targeted and effective in beating the cancer. CML affects about 3000 patients a year in Australia but, by 2040, it could be more than three million people worldwide. Hughes is intent on beating the disease completely and believes that goal is within reach.

John Greenwood uses world-first treatment in Adelaide to restore skin of 95% burns victim

A man who suffered serious burns to 95% of his body received world-first treatment at Royal Adelaide Hospital Adelaide in 2019 after doctors were able to grow his skin in a lab. Glenn Ogg was injured in a house fire in South Australia's mid north and then spent only nine days in intensive care at the hospital. His treatment involved two cutting-edge technologies developed in Adelaide by the hospital's burns unit director and 2016 South Australian of the Year John Greenwood. The first technology, biodegradable temporising matrix (BTM), is a skin dermal replacement and involved immediately removing Ogg's deep burns – 85% of his total body surface – and then applying the treatment. The second technology was to grow composite cultured skin in the laboratory. To grow the skin over about five weeks, a graft was taken from Ogg's scalp to create 26 pieces. BTM holds the burn wounds healthily and improves them during the five weeks it takes to grow the skin.The composite cultured skin was applied to 50% of Ogg's body surface and the rest was covered by standard grafting. Ogg then had surgeries to completely close his burn wounds. Despite having no skin and only BTM in his wounds, Ogg took his first steps in hospital just 28 days after the fire.  Greenwood began researching the two techniques after becoming distressed by patients with injuries so severe they couldn’t be treated. Patients with burns to more than 80% of their body usually don’t have enough unburnt skin that can then be used for skin grafts. A clinical trial of the cultured skin technique has begun at Royal Adelaide Hospital.

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