1. DELIVERING TRANSFORMING HEALTH OUR NEXT STEPS UNION BRIEFING 16 March, 2015

2. What we have heard

3. Creating the Opportunity for Feedback Consultation and Feedback has been on- going since mid-2014 Feedback on the Proposals Paper occurred between Tuesday 3 February and Friday 27 February 2015 A significant response was achieved. –Over 2,400 responses were received: Community members (53%) SA Health staff (36%) Other interested parties (11%)

4. Feedback Themes Consistent support for the need to transform the health system to achieve the principles and standards essential for a quality driven system Issues raised: –How transformation should be undertaken –Best fit-for-purpose models for the future, including role of Primary Health Care –Detailed planning for implementation and managing the practical impacts of change –How consultation will occur with those impacted by change

5. Governmen t’s Response Draft confidential V6

6. Government’s Response to Feedback Considered suggested alternatives to meet the Standards. For example: The ANMF proposed an alternative to relocating Rehabilitation Services at Flinders Medical Centre –Transforming Health set up working parties with stakeholders –Alternative model objectively assessed against standards and principles –Consensus reached that alternative did not meet the standards to the same level –Rehabilitation Services will relocate to Flinders Medical Centre as planned

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8. Government’s Response to Feedback Neonatal services at Flinders Medical Centre, Lyell McEwin Hospital and Women’s and Children’s Hospital, will work in partnership with a Statewide governance to be established as a priority. Level 6 Neonatal Intensive Care will continue at Women’s and Children’s Hospital and Flinders Medical Centre

9. Government’s Response to Feedback Detailed planning, and genuine consultation about the implementation of change will occur in consultation with key stakeholders: ▪ Staff and Unions ▪ Consumers and Community ▪ Clinicians ▪ Universities, Research, Professional and Industry bodies Phasing of change is based upon creating the required capacity in the system to ensure safe transition. It is recognised that improving the health of the community requires integration and collaboration with all providers within the continuum of care (not just acute metropolitan services). Draft confidential V6

10. Next steps

11. What our Transformed System Looks Like: Next Steps Nothing will move or reconfigure until capacity has been unlocked across the system. To support this, work has already started on Emergency Care pathways, Elective Surgery, and Mental Health pathways. The Royal Adelaide Hospital is the major complex multi-trauma 24-hour Emergency Department for the state The Women’s and Children’s Hospital will continue to provide 24/7 major emergency and trauma care for children. Two other major 24-hour Emergency Departments at Flinders Medical Centre and Lyell McEwin Hospital

12. What our Transformed Health System Looks Like 24-hour Emergency Departments at The Queen Elizabeth Hospital and Modbury Hospital Noarlunga Emergency Department will become a 24-hour Community Emergency Department and will continue to provide care to the community

13. What our Transformed Health System Looks Like Three dedicated elective surgery centres at The Queen Elizabeth Hospital, Noarlunga Hospital and Modbury Hospital with surgery at other hospitals Noarlunga Hospital will be day surgery only Day surgery continues at other sites Detailed modelling needs to occur

14. What our Transformed Health System Looks Like A 24-hour on site acute stroke team at the Royal Adelaide Hospital (then the new Royal Adelaide Hospital) with dedicated stroke services 8am to 8pm, 7 days a week at Flinders Medical Centre and Lyell McEwin Hospital Services from Hampstead Rehabilitation Centre and St Margaret’s Rehabilitation Hospital to be integrated into our major hospitals

15. What our Transformed Health System Looks Like Planning will commence to evaluate the earlier relocation of a new Women’s and Children’s Hospital within the South Australian Health and Biomedical Precinct, with the new Royal Adelaide Hospital New model of care for mental health consumers to be developed in consultation with clinicians State-wide networks and state-wide governance for a number of specialty services will be established.

16. What our Transformed Health System Looks like Most clinical services currently provided at the Repatriation General Hospital will continue but at different locations across the metropolitan hospitals Orthotics and Prosthetics SA (OPSA) will continue at the Repatriation General Hospital site The Chapel, Museum and Remembrance Garden will remain on site. Daw House Hospice will be relocated, in consultation with clinicians and the community.

17. What our Transformed Health System Looks like Under Transforming Health, new mental health models of care will be developed in consultation with clinicians enabling direct admissions to acute mental health units where appropriate. The Government has already: Set new targets for the mental health sector Committed to introducing new governance structures Established a new Mental Health Advisory Group with mental health clinicians 16

18. What our Transformed Health System Looks Like More than $250 million in new and enhanced infrastructure Additional paramedics and support staff, 12 new ambulances and investigation for new ambulance stations A new $15 million Centre for Excellence for Post-Traumatic Stress Disorder For specialties or services not explicitly detailed in the Next Steps document, consultation will occur to plan for any potential change

19. 18 ENGAGEMENT, CONSULTATION AND MANAGEMENT OF CHANGE

20. Transforming Health Governance Structure 19

21. STAFF AND UNION ENGAGEMENT AND CONSULTATION This is critical to successfully transform our health system. Next Steps describes our commitment to genuine and respectful engagement and consultation. An Employee and Union Engagement and Consultation Strategy will be developed in partnership with staff and unions. It will detail our commitment to: Creating and sustaining a positive culture where staff are valued, and confident that their input will be genuinely sought and listened to. Not initiating change where there is evidence it would result in patient harm. Enabling consultation through transparent and consistent pathways and consultative arrangements, including a Peak Consultation Forum. Providing staff with sufficient time to understand proposed changes and provide their response, as well as supporting them through the change that follows.

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23. ENGAGEMENT WITH EDUCATION, RESEARCH AND INDUSTRY PARTNERS Our excellence in education, research and clinical practice will continue, supported by the: Establishment of the SA Health Research and Translation Committee at the highest level of our governance. It will be a collaborative network, comprising the State’s academic, research and health care delivery agencies, with the role of: Supporting research and advancing the translation of evidence into clinical care Building capacity, data linkage and systems for the evaluation of our health reforms Working together to develop work ready health graduates and quality clinical experience for students. 22

24. Clinician Engagement Clinical engagement as of today –60 clinicians on Ministerial Clinical Advisory Committees –50 clinicians on the Clinical Senate –Hospital events –CE Direct Forums Clinical engagement will evolve further, auspiced by the peak Clinical Advisory Forum.

25. Governance for Clinician Engagement Clinical Executive Advisory Group –Chair – Professor Dorothy Keefe –One clinical expert from each area of work Clinical expert to lead a working group –All interested parties –Mix of Local Health Networks –Mix of professional groups Models of care to be endorsed by the Clinical Executive Advisory Group and approved by the Transforming Health Program Board

26. Implementation

27. Indicative timeline Implementation of main service changes and moves starts 2015/16 to 2018/2019, but only if capacity is created Beyond this, Transforming Health is a journey of continuous improvement applied across the system

28. Unlocking capacity System changes will only occur once enough capacity has been created to accommodate these changes –Patient access and flow improvement initiatives will assist in streamlining the journey of patients through the system –It will unlock capacity across metropolitan hospitals We cannot move or change services until beds are available –No changes to ED flows or Ambulances until bed capacity available

29. Priorities Stroke Acute Coronary Syndrome Emergency Departments Elective Surgery Mental Health Orthogeriatrics Neonatal Care Paediatric Surgery

30. Education and Training Education and Training will support and underpin our transformative capacity. Our workforce planning will identify the capacity we require now and into the future Our workforce development and investment will focus on building these core capabilities Our culture will be based upon the principles of a Learning Organisation, so that all parts of our system are empowered to innovate in achieving quality care. Our partnerships with Universities and other Teaching Organisations will ensure that the impacts on students and trainees is well managed.

31. Research Research is an integral part of a high quality health system. It is key to delivering our vision for Transforming Health. With our Clinicians, Universities and Research Partners including SAMHRI, we are committed to leading the translation of research into clinical practice. A specific Research, Education and Translation focus will be at the highest level of our governance of Transforming Health.

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