❓ Shadow Minister Cook questions the Minister for Health regarding the location of a major trauma unit. Minister Hames responds with a lengthy explanation of conflicting advice from medical professionals and the complexities of the decision-making process.
AnsweredQoN 229Legislative Assembly
QuestionView source ↗
FIONA
STANLEY HOSPITAL — MAJOR TRAUMA UNIT
229. Mr R.H. COOK to the Minister for Health:
I refer to reports over the weekend about Fiona Stanley
Hospital's trauma unit.
(1) Are the
reports in The Weekend West true that
the government is considering going against the recommendation of the
Department of Health's trauma working group and the Health Reform
Committee's report by withdrawing the new major trauma unit from Fiona
Stanley Hospital?
(2) Given that
the rates of trauma admission have increased steadily at around three to four
per cent and the state's strong growing population, especially in the
outer suburbs, does the minister concede that there is sufficient evidence for
a major trauma service both north and south of the river?
STANLEY HOSPITAL — MAJOR TRAUMA UNIT
229. Mr R.H. COOK to the Minister for Health:
I refer to reports over the weekend about Fiona Stanley
Hospital's trauma unit.
(1) Are the
reports in The Weekend West true that
the government is considering going against the recommendation of the
Department of Health's trauma working group and the Health Reform
Committee's report by withdrawing the new major trauma unit from Fiona
Stanley Hospital?
(2) Given that
the rates of trauma admission have increased steadily at around three to four
per cent and the state's strong growing population, especially in the
outer suburbs, does the minister concede that there is sufficient evidence for
a major trauma service both north and south of the river?
AnswerView source ↗
(1)–(2)
I am very, very pleased that the member has asked me this question. I am almost
ready to call him Dorothy. When did we go to the Australian Medical Association
function?
Mr R.H. Cook : It was
Monday night.
Dr K.D. HAMES : On
Monday night at the AMA cocktails I had reason to have words with the outgoing
president of the AMA, who severely criticised me in the press for rumours going
around that there would be a single major trauma service at Royal Perth
Hospital and that the proposal to have two services had been ditched by the
government. I saw fit to remind him that it was my proposal to have two major
trauma units, one at each hospital. The AMA members, the senior clinicians in
this town, voted unanimously at a meeting I was at not to do that. It was a
really good opportunity for me to explain the problem. If the shadow Minister
for Health is ever in my seat, he needs to understand this really clearly
because it is one of the most difficult issues I have ever had to deal with. It
is a bit like herding cats. Trying to get all the specialists to agree on how
it should work has been extraordinarily difficult. More than 18 months ago I
had issues with the cardiothoracic surgeons and the major trauma unit.
Mr
W.J. Johnston : This is an industrial dispute.
Dr K.D. HAMES : To
a degree it is. I am very unpractised at having to deal with this. I will try
to keep the answer short so we do not go on for too long. We have been going
for a fair while. The major trauma numbers have actually been going down, not
up. There are fewer. The shadow minister quoted trauma numbers; we are talking
about the major trauma unit. Major trauma numbers have reduced in recent years.
A report was done five or six years ago that said by 2018 we would need a
second major trauma unit, which is what I based my proposal upon. I could not
get agreement about what side it should be on. In particular, I could not get
agreement from the cardiothoracic surgeons. Each of the groups at Sir Charles
Gairdner Hospital, Royal Perth and Fremantle Hospitals gave very good reasons
why they needed cardiothoracic services in their hospitals. I said we would
split the major trauma unit over two sites and then we will have a single
cardiothoracic surgery unit that will provide services across the three sites.
The trouble they have is that the numbers are going down, particularly the
number of doctors, and they are finding it extraordinarily difficult to provide
that service. I put that forward. That did unite them all. They were united in
thinking that I was an idiot.
Several members interjected.
Dr K.D. HAMES :
What an unlikely conclusion! They all agreed with each other on that fact.
Since that time, they have gone to a lot of effort proving to me that they are
right. We got the proposal from the clinical leads so we had a study done by
all the senior specialists in all the specialities making recommendations on
what they should do. They recommended a single major trauma service. They said
that we would not need a second one until about 2022, and to split up the one
that we have now, which is one of the best in the world and getting the best
results in the world, into two across two hospitals was not sustainable. We
needed one. In their view, the best location for that was at Fiona Stanley
Hospital.
Mr
W.J. Johnston : What's your view?
Dr
K.D. HAMES : I am getting to that. They also recommended that the
cardiothoracic services should be a single unit, and they were unanimous in
this view, whatever the distribution was, and that that should all be at Royal
Perth Hospital.
Dr J.M. Woollard :
Ha, ha, hah!
Dr
K.D. HAMES : Yes, exactly—ha, ha, hah! Mr Speaker, the interjection
from behind me might have given you some reason for my concern about that
proposal.
Mr R.H. Cook : Can
we just get something straight—you are the minister?
Dr K.D. HAMES : No,
I will not have time. People will sit me down in a minute. The reality is, like
the member behind me, I thought that that was unreasonable because this is for
the south metropolitan region. We will still have some cardiothoracic surgery
at Charlies. We have to because that is where the cancer patients are located.
Through the member for Ocean Reef, we have talked about spreading some to
Joondalup. The northern suburbs will still be well serviced. The specialists
said that they would prefer the other option, which is the other way around,
which is acceptable. We would then get the major trauma unit that is currently
at Royal Perth in between the northern suburbs and the southern suburbs and the
eastern corridor. There would be great access from every direction and it is
already well established. That is where those specialists want to stay. It is
reasonable to leave them there. That is where a lot of the patients are. We already
have some cardiothoracic services north of the river. It is proposed to have
the single unit for cardiothoracic surgery, including heart and lung
transplants, moved to Fiona Stanley Hospital. They will start with some major
trauma because burns will be there as well. There is a major trauma requirement
associated with burns. We will need the second unit about six to eight years
after Fiona Stanley Hospital opens in terms of the growth in numbers. Even
though the major trauma rate is going down, the population is going up. We will
start some major trauma there, with some senior specialists who are currently
involved in managing burns, and the ones that come via Jandakot.
Mr R.H. Cook : Is
that five or six?
Dr K.D. HAMES :
There are not a lot—only five or six—but some patients will
also come from Jandakot. A lot of the major trauma cases come through Jandakot.
For some, care will be urgent. We will start building that service as soon as
Fiona Stanley Hospital opens. Over the following six years, until we get to the
stage at which we have the numbers to manage two, we will have to do this. That
way we will get major cardiothoracic surgery and heart–lung transplant
facilities at Fiona Stanley Hospital. The major trauma site unit will stay at
Royal Perth Hospital. The silly thing would be to move it all to Fiona Stanley
Hospital because in eight years we would have to retrofit a new one at Royal
Perth Hospital.
Mr
R.H. Cook : Why would you put it at Royal Perth and not somewhere else?
Dr
K.D. HAMES : Because it is there. The previous Labor government spent $17 million
turning it into one of the best major trauma centres in Australia, if not the
world.
Mr R.H. Cook : The
recommendation from the Trauma Working Group was that it would not go beyond
the commissioning of Fiona Stanley, which at that stage was planned for 2012.
Dr K.D. HAMES : We
were going to have two. The last statement I made 18 months ago said that we
would have two, but the specialists have recommended to me that we do not do
that because splitting them over two sites is not in the best interests of the
patients. That is what this is all about—providing the best services
for patients. The major trauma facility will remain where it is. A new one will
start its gestation when Fiona Stanley Hospital opens, and it will take about
six years to get to full capacity. Cardiothoracic surgery will be conducted
south of the river at that hospital and some services will be performed at Sir
Charles Gairdner Hospital and at Joondalup to provide for people living north
of the river. I think that is a good outcome for everyone and makes the best
use of taxpayers' dollars.
I am very, very pleased that the member has asked me this question. I am almost
ready to call him Dorothy. When did we go to the Australian Medical Association
function?
Mr R.H. Cook : It was
Monday night.
Dr K.D. HAMES : On
Monday night at the AMA cocktails I had reason to have words with the outgoing
president of the AMA, who severely criticised me in the press for rumours going
around that there would be a single major trauma service at Royal Perth
Hospital and that the proposal to have two services had been ditched by the
government. I saw fit to remind him that it was my proposal to have two major
trauma units, one at each hospital. The AMA members, the senior clinicians in
this town, voted unanimously at a meeting I was at not to do that. It was a
really good opportunity for me to explain the problem. If the shadow Minister
for Health is ever in my seat, he needs to understand this really clearly
because it is one of the most difficult issues I have ever had to deal with. It
is a bit like herding cats. Trying to get all the specialists to agree on how
it should work has been extraordinarily difficult. More than 18 months ago I
had issues with the cardiothoracic surgeons and the major trauma unit.
Mr
W.J. Johnston : This is an industrial dispute.
Dr K.D. HAMES : To
a degree it is. I am very unpractised at having to deal with this. I will try
to keep the answer short so we do not go on for too long. We have been going
for a fair while. The major trauma numbers have actually been going down, not
up. There are fewer. The shadow minister quoted trauma numbers; we are talking
about the major trauma unit. Major trauma numbers have reduced in recent years.
A report was done five or six years ago that said by 2018 we would need a
second major trauma unit, which is what I based my proposal upon. I could not
get agreement about what side it should be on. In particular, I could not get
agreement from the cardiothoracic surgeons. Each of the groups at Sir Charles
Gairdner Hospital, Royal Perth and Fremantle Hospitals gave very good reasons
why they needed cardiothoracic services in their hospitals. I said we would
split the major trauma unit over two sites and then we will have a single
cardiothoracic surgery unit that will provide services across the three sites.
The trouble they have is that the numbers are going down, particularly the
number of doctors, and they are finding it extraordinarily difficult to provide
that service. I put that forward. That did unite them all. They were united in
thinking that I was an idiot.
Several members interjected.
Dr K.D. HAMES :
What an unlikely conclusion! They all agreed with each other on that fact.
Since that time, they have gone to a lot of effort proving to me that they are
right. We got the proposal from the clinical leads so we had a study done by
all the senior specialists in all the specialities making recommendations on
what they should do. They recommended a single major trauma service. They said
that we would not need a second one until about 2022, and to split up the one
that we have now, which is one of the best in the world and getting the best
results in the world, into two across two hospitals was not sustainable. We
needed one. In their view, the best location for that was at Fiona Stanley
Hospital.
Mr
W.J. Johnston : What's your view?
Dr
K.D. HAMES : I am getting to that. They also recommended that the
cardiothoracic services should be a single unit, and they were unanimous in
this view, whatever the distribution was, and that that should all be at Royal
Perth Hospital.
Dr J.M. Woollard :
Ha, ha, hah!
Dr
K.D. HAMES : Yes, exactly—ha, ha, hah! Mr Speaker, the interjection
from behind me might have given you some reason for my concern about that
proposal.
Mr R.H. Cook : Can
we just get something straight—you are the minister?
Dr K.D. HAMES : No,
I will not have time. People will sit me down in a minute. The reality is, like
the member behind me, I thought that that was unreasonable because this is for
the south metropolitan region. We will still have some cardiothoracic surgery
at Charlies. We have to because that is where the cancer patients are located.
Through the member for Ocean Reef, we have talked about spreading some to
Joondalup. The northern suburbs will still be well serviced. The specialists
said that they would prefer the other option, which is the other way around,
which is acceptable. We would then get the major trauma unit that is currently
at Royal Perth in between the northern suburbs and the southern suburbs and the
eastern corridor. There would be great access from every direction and it is
already well established. That is where those specialists want to stay. It is
reasonable to leave them there. That is where a lot of the patients are. We already
have some cardiothoracic services north of the river. It is proposed to have
the single unit for cardiothoracic surgery, including heart and lung
transplants, moved to Fiona Stanley Hospital. They will start with some major
trauma because burns will be there as well. There is a major trauma requirement
associated with burns. We will need the second unit about six to eight years
after Fiona Stanley Hospital opens in terms of the growth in numbers. Even
though the major trauma rate is going down, the population is going up. We will
start some major trauma there, with some senior specialists who are currently
involved in managing burns, and the ones that come via Jandakot.
Mr R.H. Cook : Is
that five or six?
Dr K.D. HAMES :
There are not a lot—only five or six—but some patients will
also come from Jandakot. A lot of the major trauma cases come through Jandakot.
For some, care will be urgent. We will start building that service as soon as
Fiona Stanley Hospital opens. Over the following six years, until we get to the
stage at which we have the numbers to manage two, we will have to do this. That
way we will get major cardiothoracic surgery and heart–lung transplant
facilities at Fiona Stanley Hospital. The major trauma site unit will stay at
Royal Perth Hospital. The silly thing would be to move it all to Fiona Stanley
Hospital because in eight years we would have to retrofit a new one at Royal
Perth Hospital.
Mr
R.H. Cook : Why would you put it at Royal Perth and not somewhere else?
Dr
K.D. HAMES : Because it is there. The previous Labor government spent $17 million
turning it into one of the best major trauma centres in Australia, if not the
world.
Mr R.H. Cook : The
recommendation from the Trauma Working Group was that it would not go beyond
the commissioning of Fiona Stanley, which at that stage was planned for 2012.
Dr K.D. HAMES : We
were going to have two. The last statement I made 18 months ago said that we
would have two, but the specialists have recommended to me that we do not do
that because splitting them over two sites is not in the best interests of the
patients. That is what this is all about—providing the best services
for patients. The major trauma facility will remain where it is. A new one will
start its gestation when Fiona Stanley Hospital opens, and it will take about
six years to get to full capacity. Cardiothoracic surgery will be conducted
south of the river at that hospital and some services will be performed at Sir
Charles Gairdner Hospital and at Joondalup to provide for people living north
of the river. I think that is a good outcome for everyone and makes the best
use of taxpayers' dollars.
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