Fixing hospitals is not the solution to fixing the hospital crisis

There is little doubt that a hospital crisis is imminent and the solution to the hospital crisis lies in finding alternatives to hospital.

Australia’s health system is one of the best in the world. Gold-standard hospitals are matched with some of the best-trained and most sophisticated clinicians on the planet. However, the same or better health outcomes can often be achieved at overall lower cost through integrated services that enable people to be treated in their homes and communities.

Silver Chain Group CEO, Chris McGowan, said hospitals alone will never be able to meet the growing demand for beds and believes an integrated offering of community care combined with hospital care is the only way to ensure the health care system is fit for the future.

Findings from audits of medical admissions using Medworxx Clinical Criteria routinely find that 15 to 20 per cent of admissions are potentially avoidable. The audits also indicate 35 to 40 per cent of bed days are occupied by patients who, clinically, do not need to be in an acute setting.

Generally speaking, home or community-based care can be delivered at around half the cost of a hospital bed – with the added advantage of services being extremely flexible in location and volume.

“We can continue to meet demand, within an increasingly-constrained budget, through an innovative combination of hospital and community health services,” Mr McGowan said.

“And studies around the world show that patients, once they have experienced home-based care, welcome the choice and control it affords.”

There are many examples of services which, through a deeply-connected approach, direct people towards an appropriate setting while also ensuring care is safe and high quality. These models incorporate doctor oversight, specialist training for community-based clinicians and sound technology platforms for monitoring and data sharing.

“In Western Australia, for example, non-government organisations like Silver Chain Group partner with WA Health to deliver community care services that help people stay in their own home rather than taking up a hospital bed,” Mr McGowan said.

Western Australia is recognised nationally as having the best palliative care services available. Three-quarters of people diagnosed with terminal cancer would prefer to die at home. Across Australia, the average death-at-home rate is 20 per cent; in WA it is 70 per cent. This result is achieved thanks to a long standing service, led by Silver Chain but funded by WA Health and delivered in partnership with GPs and other elements of the health service.

A further example is the ‘virtual hospital’ funded by the WA Health that treats more than 900 patients on any one day. The Friend in Need – Emergency (FINE) Scheme supports 500 people who would otherwise be in an acute hospital bed – making the scheme one of Perth’s largest – albeit invisible – hospitals. FINE is delivered by a multi-disciplinary team including doctors and nurses, and interconnected with physical hospitals, GPs, other health providers and sophisticated technology.

In recent years, Silver Chain has translated its models to South Australia, Queensland and New South Wales, where the organisation now delivers home hospital, palliative care and other home health services in partnership with the public and private sector.

“There are already examples of excellent integrated care, helping people stay out of hospital and delivering an economic benefit to the taxpayer. But these are in the minority; there are still many, many services being delivered in hospitals that could be delivered at – or close to – home,” Mr McGowan said.

“The solution to the imminent hospital crisis does not solely lie in fixing our already-outstanding hospitals or in relying on ever-growing funding.

“The solution to the hospital crisis can be found in redirecting some patients to a clinically-appropriate virtual setting, freeing-up capacity for our stretched acute hospitals.”

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