The Southern Region Orthopedic and Urology Surgical Services are the largest in the state.
That is to say they have the largest caseload of all of the other hospitals combined.
They also had the largest caseload
of all the surgical specialties that used to call the Repat "home".
They also exhibited the Gold Standard of Care
and were recognised Australia-wide as being Centres of Excellence.
With innovative evidence-based care pathways,
integrated services on-site for the majority of patients and staff,
it was a one-stop shop.
Appropriately trained and resourced multidisciplinary staff,
robust research,
embedded evaluation of outcomes and monitoring of Key Performance Indicators,
and reputation of excellence which attracted medical trainees from across the globe.
Most importantly it was separated from the demands of a complex
Emergency and Trauma Service at Flinders Medical Centre,
which was already operating at capacity.
So we didn't have to compete for beds and theatre time.
This was and remains world's best practice, certainly for Orthopaedics.
A much used phrased in healthcare for years has been "patient centred care".
And of course what this literally means is,
you take a patient, you put them in the middle of the care,
and you bring the services to them.
So to summarise, before the Repat was closed, we had an integrated Gold Standard of Care,
and as Sue has said, one of the really important things,
we had ease of parking and access for the elderly and the disabled.
And its staff had immediate face-to-face access to, and support from each other,
in the multidisciplinary teams.
So what happened in December 2017,
the elective Orthopaedic and entire Urology Service was relocated
to Flinders Medical Centre, Flinders Private Hospital, and Noarlunga Health Service.
But it very soon became apparent that this fragmentation of services
was not going to be able to continue to deliver the seamless Repat models of care.
The barriers to this,
it was "foreign soil",
it was a foreign country to a lot of the Repat staff.
There were new IT systems, a new culture, new management systems to come to grips with.
They were trying to manage multiple sites instead of one,
with existing resources, there was no new money.
Geographical challenges of travelling from one site to another,
and increasing budget pressure on the high cost of outsourcing joint replacement surgery
to Flinders Private Hospital became apparent.
For patients, and you can have a look at this,
a patient goes on a journey. They start with a referral,
they go to Outpatients,
they then have their surgery, they have their post-op care, and they have their post-discharge care.
They could go to any one of these sites for any of these,
and so many patients said to us:
"I don't understand why I have to go to Noarlunga for something,
I have to go back to Flinders Medical Centre for something else,
and then I go to Flinders Private to have my surgery,
then I go back to Noarlunga for something else.
I don't understand why I just can't have it done in one place?"
And why does this matter?
Because essentially there are two main drivers of efficient and timely service delivery:
Outpatient Waitlist Management and Surgery Waitlist Management.
Why is timely outpatient review important?
Because if you don't have it, you risk a missed or a late diagnosis,
you may not even need review by a surgeon,
you can have undetected and unmanaged depression,
an irreversible deterioration of quality of life,
and it also perpetuates a contrived bottleneck for waiting list management.
Patients wait to wait.
They wait months, sometimes years for an outpatient appointment,
and then they have to wait for their surgery.
And why is timely surgery important?
To improve quality of life, well there is a motherhood statement if ever we heard one.
But what it actually means is you do that.
A hip replacement is the second most successful operation in improving patients quality of life.
If you can operate on a patient with a,
who needs a joint replacement in a timely fashion,
they don't decondition, they don't need additional services.
they quickly return to a productive and active life.
So what do we really need?
We need the commitment and resources to reintegrate these vital services,
and it's difficult to envisage how this is possible in the current context of the fragmentation
that the relocation has wrought.
In the context of returning to the Repat, as Sue very rightly said,
there is always going to be a need for support from Fliners Medical Centre
for some of the patients in these groups, and it is appropriate that they continue to be cared for there.
But for the vast majority of elective patients, a complex busy tertiary centre is not what they require.
What they need is what they had at the Repat.
We cannot mend everything that ails this health system.
But I ask you to reflect on what Einstein said:
"We cannot solve our problems with the same thinking we used when we created them."
And there is now a real opportunity to harness our energy,
refocus our minds, and work collaboratively to come full circle
and to go back to the future.
Thank you.