❓ A WA parliamentary question on notice regarding cardiothoracic services and major trauma capabilities at Royal Perth, Fremantle, and the new Fiona Stanley Hospitals. The Minister provides data on past procedures and discusses the ongoing debate about service distribution across hospitals.
AnsweredQoN 39Legislative Assembly
QuestionView source ↗
CARDIOTHORACIC
SERVICES
39. Dr J.M. WOOLLARD to the Minister for Health:
(1) From 1 July 2010 to 1 July 2011 —
(a) how many lung transplants were
conducted at Royal Perth Hospital; and
(b) how many cardiac transplants were
conducted at Royal Perth Hospital?
(2) From 1 July 2010 to 1 July 2011 —
(a) how many
operations were carried out by surgeons at RPH that were classified as thoracic
cases;
(b)
how many operations were carried out by surgeons at RPH that were classified as
cardiac cases;
(c) how many
operations were carried out by surgeons at Fremantle Hospital that were classified
as thoracic cases; and
(d) how many
operations were carried out by surgeons at Fremantle Hospital that were
classified as cardiac cases?
(3) Will the
minister confirm whether Fiona Stanley Hospital will have cardiac surgery and
major trauma when it opens; and, if not, why not?
SERVICES
39. Dr J.M. WOOLLARD to the Minister for Health:
(1) From 1 July 2010 to 1 July 2011 —
(a) how many lung transplants were
conducted at Royal Perth Hospital; and
(b) how many cardiac transplants were
conducted at Royal Perth Hospital?
(2) From 1 July 2010 to 1 July 2011 —
(a) how many
operations were carried out by surgeons at RPH that were classified as thoracic
cases;
(b)
how many operations were carried out by surgeons at RPH that were classified as
cardiac cases;
(c) how many
operations were carried out by surgeons at Fremantle Hospital that were classified
as thoracic cases; and
(d) how many
operations were carried out by surgeons at Fremantle Hospital that were
classified as cardiac cases?
(3) Will the
minister confirm whether Fiona Stanley Hospital will have cardiac surgery and
major trauma when it opens; and, if not, why not?
AnswerView source ↗
I have received notice of the first two components of the
question, but the answers are fairly dry. Notice of the third question was not
given, but it is probably the more interesting of the three. I will quickly go
through the figures I have for the first two components of the question.
(1) (a) The
answer to how many lung transplants were conducted at Royal Perth Hospital from
1 July 2010 to 1 July is 14.
(b) The answer to how many cardiac transplants
were conducted at Royal Perth Hospital is seven.
(2) The second
component of the question asked how many thoracic cases were carried out at
RPH. Specific figures on thoracic cases are not taken on their own; therefore
my answer refers to cardiothoracic cases as opposed to plain cardiac cases.
(a) How many cardiothoracic cases
were at Royal Perth Hospital? There were 525.
(b) How many cardiac cases? There
were 693.
(c) For Fremantle Hospital that
figure is 324.
(d) The figure is 202.
I do not know that those answers
do the member a great deal of good.
(3) The much
more interesting question is: will cardiothoracic surgery and major trauma
services still be done at the new Fiona Stanley Hospital? The member for Alfred
Cove will know that I am in somewhat of a dilemma. We went through this issue
at length about 18 months ago when the cardiothoracic surgeons all put up
excellent cases as to why they should be continued in all three hospitals—Fiona
Stanley Hospital, Royal Perth Hospital and Sir Charles Gairdner Hospital. Sir
Charles Gairdner Hospital is largely associated with cancer patients,
particularly for things like pulmonary emboli. Because it is proposed, a major
trauma unit will be at Fiona Stanley Hospital and there will need to be
cardiothoracic surgery. It has been done at Fremantle Hospital, which currently
provides services for south of the river and at Royal Perth Hospital, because
that is the centre for major trauma in this state.
Each of them had an excellent
argument. The proposal I had is that there should be two and not three, and
each of the three proposed theirs and the other remaining, not all three, which
created a bit of a dilemma. Then we came to major trauma services. The previous
government spent a lot of money on upgrading the major trauma centre at Royal
Perth Hospital; I think it was about $12 million, something like that. It built
an excellent facility, and the specialist running that has an excellent team
behind him. In fact, the centre's figures compare with anyone in the
world and certainly anyone in Australia in the quality of the service it
provides at Royal Perth. The proposal through the review was that there be one major
trauma centre in this state, at Fiona Stanley Hospital, and that there should
be one cardiothoracic surgery service in this state—at Fiona Stanley.
That is fine for someone managing Fiona Stanley, but if someone is north of the
river and wants things in either of the other two hospitals, it creates
somewhat of a difficulty.
What I have had put before me,
member for Alfred Cove, from the clinical lead to the senior specialist in all
these groupings, who have been looking at the figures of where the growth is
going to be, where surgery ought to be and the size of the new hospital, is
that there should be one major trauma service, not two as I determined. About
18 months ago when this came before me, I said that as the population grows we
will need two major trauma centres; I will keep the one at Royal Perth Hospital
and have another one at Fiona Stanley Hospital. What they are telling me again
is that I should have only one major trauma centre. What I said about
cardiothoracic surgery is that I am going to have a single service spread
across three hospitals covering Fiona Stanley, Sir Charles Gairdner and Royal
Perth. The clinical leads have come back to me and said that that is not in the
best interests of patients in this state, because we would need about 400 cases
at one location to have the best service possible, so it should be at one location.
They put to me that major trauma services should be at Fiona Stanley Hospital
alone, not at Royal Perth where the current service is, and cardiothoracic
services should be at Royal Perth alone, not south of the river. So I am
clearly left with a dilemma!
Several members interjected.
Dr K.D. HAMES : In
my view, this is a very difficult decision. I intend to have a lot of further
discussion. What the member has said to me, and the people around her and
particularly the cardiothoracic surgeons associated with Fremantle, is that they
would go ballistic if we did not have cardiothoracic services at Fiona Stanley
Hospital. If I do that, then there is not sufficient room in the total
complexity of services that will be provided south of the river to have also
the single major trauma service unit at that site—that should stay at
Royal Perth where it is. Or vice versa; if I leave cardiothoracic services at
only Fiona Stanley and not anywhere else, my only other option is to have the
major trauma service stay where it is, meaning that would be metropolitan
trauma, so still significant trauma and particularly any burns involved,
because the burns unit is certainly going to be at Fiona Stanley. In about
2026, we will need two major trauma centres and it would clearly be Fiona
Stanley that would move from metropolitan trauma, as it is called, which is
still a significant level of trauma to major trauma.
Member for Alfred Cove, I have not made up my mind yet; I am
still very tempted to stick with what I have said, which is spreading it out, but
that is not what all the experts are telling me I should be doing.
question, but the answers are fairly dry. Notice of the third question was not
given, but it is probably the more interesting of the three. I will quickly go
through the figures I have for the first two components of the question.
(1) (a) The
answer to how many lung transplants were conducted at Royal Perth Hospital from
1 July 2010 to 1 July is 14.
(b) The answer to how many cardiac transplants
were conducted at Royal Perth Hospital is seven.
(2) The second
component of the question asked how many thoracic cases were carried out at
RPH. Specific figures on thoracic cases are not taken on their own; therefore
my answer refers to cardiothoracic cases as opposed to plain cardiac cases.
(a) How many cardiothoracic cases
were at Royal Perth Hospital? There were 525.
(b) How many cardiac cases? There
were 693.
(c) For Fremantle Hospital that
figure is 324.
(d) The figure is 202.
I do not know that those answers
do the member a great deal of good.
(3) The much
more interesting question is: will cardiothoracic surgery and major trauma
services still be done at the new Fiona Stanley Hospital? The member for Alfred
Cove will know that I am in somewhat of a dilemma. We went through this issue
at length about 18 months ago when the cardiothoracic surgeons all put up
excellent cases as to why they should be continued in all three hospitals—Fiona
Stanley Hospital, Royal Perth Hospital and Sir Charles Gairdner Hospital. Sir
Charles Gairdner Hospital is largely associated with cancer patients,
particularly for things like pulmonary emboli. Because it is proposed, a major
trauma unit will be at Fiona Stanley Hospital and there will need to be
cardiothoracic surgery. It has been done at Fremantle Hospital, which currently
provides services for south of the river and at Royal Perth Hospital, because
that is the centre for major trauma in this state.
Each of them had an excellent
argument. The proposal I had is that there should be two and not three, and
each of the three proposed theirs and the other remaining, not all three, which
created a bit of a dilemma. Then we came to major trauma services. The previous
government spent a lot of money on upgrading the major trauma centre at Royal
Perth Hospital; I think it was about $12 million, something like that. It built
an excellent facility, and the specialist running that has an excellent team
behind him. In fact, the centre's figures compare with anyone in the
world and certainly anyone in Australia in the quality of the service it
provides at Royal Perth. The proposal through the review was that there be one major
trauma centre in this state, at Fiona Stanley Hospital, and that there should
be one cardiothoracic surgery service in this state—at Fiona Stanley.
That is fine for someone managing Fiona Stanley, but if someone is north of the
river and wants things in either of the other two hospitals, it creates
somewhat of a difficulty.
What I have had put before me,
member for Alfred Cove, from the clinical lead to the senior specialist in all
these groupings, who have been looking at the figures of where the growth is
going to be, where surgery ought to be and the size of the new hospital, is
that there should be one major trauma service, not two as I determined. About
18 months ago when this came before me, I said that as the population grows we
will need two major trauma centres; I will keep the one at Royal Perth Hospital
and have another one at Fiona Stanley Hospital. What they are telling me again
is that I should have only one major trauma centre. What I said about
cardiothoracic surgery is that I am going to have a single service spread
across three hospitals covering Fiona Stanley, Sir Charles Gairdner and Royal
Perth. The clinical leads have come back to me and said that that is not in the
best interests of patients in this state, because we would need about 400 cases
at one location to have the best service possible, so it should be at one location.
They put to me that major trauma services should be at Fiona Stanley Hospital
alone, not at Royal Perth where the current service is, and cardiothoracic
services should be at Royal Perth alone, not south of the river. So I am
clearly left with a dilemma!
Several members interjected.
Dr K.D. HAMES : In
my view, this is a very difficult decision. I intend to have a lot of further
discussion. What the member has said to me, and the people around her and
particularly the cardiothoracic surgeons associated with Fremantle, is that they
would go ballistic if we did not have cardiothoracic services at Fiona Stanley
Hospital. If I do that, then there is not sufficient room in the total
complexity of services that will be provided south of the river to have also
the single major trauma service unit at that site—that should stay at
Royal Perth where it is. Or vice versa; if I leave cardiothoracic services at
only Fiona Stanley and not anywhere else, my only other option is to have the
major trauma service stay where it is, meaning that would be metropolitan
trauma, so still significant trauma and particularly any burns involved,
because the burns unit is certainly going to be at Fiona Stanley. In about
2026, we will need two major trauma centres and it would clearly be Fiona
Stanley that would move from metropolitan trauma, as it is called, which is
still a significant level of trauma to major trauma.
Member for Alfred Cove, I have not made up my mind yet; I am
still very tempted to stick with what I have said, which is spreading it out, but
that is not what all the experts are telling me I should be doing.
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