ACT needs sub-acute hospital
Photo: Pat Campbell
The decision to build a dedicated sub-acute hospital deserves strong support from the people of Canberra and the surrounding region. The local population, like the Australian population in general, is ageing. In 2011, 10.7 per cent of the ACT population was over 65 (39,000 people) - by 2021 it is predicted to be 14.3 per cent (59,000 people) - which is an additional 20,000 people in that age group in just 10 years. An older population means more people with chronic disease and more people needing rehabilitation services - and a dedicated sub-acute hospital is the right move to ensure we have the high quality of care we need in Canberra for this population.
A dedicated sub-acute hospital offers us the opportunity for a centre of excellence in rehabilitation and the management of chronic disease. And let's not forget this is about people of all ages living with disability or disease. And it is not just about the ''patient'' - it is about the quality of life and often the independence of their family members - the spouses, children, parents, grandparents and grandchildren. The idea of a sub-acute hospital is not well understood, and there is sometimes disagreement about definitions. But there are widely agreed upon elements.
A sub-acute hospital is about rehabilitation and the management of chronic disease, and it aims to maximise functional ability and quality of life. It should be strong in assessment skills. It is a multi-disciplinary environment where health professionals work together on complex problems as well as some that are relatively straightforward. There are also things that a sub-acute hospital is not. Sub-acute hospitals do not have emergency departments. They do not, by and large, have operating theatres. In this case the proposed location close to Calvary means there is no need for an operating theatre and hence no need to duplicate such expensive services.
Why then, does Canberra need a separate sub-acute hospital? The evidence is clear. Where sub-acute hospitals are co-located with acute hospitals there is a drift of resources - finances, space, and particularly expert staff - from the less urgent areas of sub-acute to the urgent acute areas of the hospital. When there are shortages of staff, intensive care and operating theatres will be prioritised over other areas of the hospital. Some may say this is as it should be. But where the urgent is prioritised consistently over the non-urgent - but equally important - we have the situation where sub-acute care becomes the poor relation of our healthcare system - underresourced, understaffed and undervalued.
Let's look at an example. Three days post stroke, in an acute care ward, an 80-year-old whose eyesight and ability to read have been affected, lies in a ward with three other elderly patients with acute care needs or dementia. She can't read the menu to order food and so her nutrition is less than adequate. She lives alone, and as the acute hospital is short on beds, everyone agrees it is time she moves to a nursing home. Except that three days after a stroke, there is no way of knowing how much function will return. The hospital is not set up with enough rehabilitation capacity to provide support over the critical two to four weeks that follow, because the sub-acute part of the hospital has been starved of resources.
The proposed move to a nursing home of someone with a life expectancy of say 10 years will cost the tax payer $450,000 dollars - without getting into the patient's contribution or the quality of life she may lose as a result of leaving her home. With luck and rehabilitation that same woman could be back at home in three weeks, living reasonably independently, learning to read and function independently in the community. The difference could lie in a few weeks of rehabilitation care and some community based follow up. And of course individual circumstances. But at the individual level - doesn't everyone deserve that chance? And at the societal level - why would we want a health system that makes people more dependent and costs society more money to support them for long periods of time?
This is why the national health reform agenda is focused on primary care, on preventive care, on care in the community and on rehabilitation. It is why there is a need for rehabilitation health care that focuses on the transitions between acute care and the community and between acute care and nursing home care. There is more than enough evidence that step-down care and rehabilitation care is important - and that is what we stand to gain with a top quality sub-acute hospital.
And the quality of sub-acute care is an important issue. There are many factors that determine quality of care, and the right physical set-up, the quality of staff and sufficient funding are clearly central. Co-location of the sub-acute hospital with the University of Canberra brings some ''over and above'' to the mix. It offers the opportunity to attract and train the best students, attract the best health practitioners, and by bringing together research with training and service delivery, develop new ways of providing better care. We need more excellent neurologists in Canberra, and rehabilitation physicians, and geriatricians.
We also need nurses, psychologists, physiotherapists, occupational therapists, dietitians, and speech therapists who focus on, and are expert in the care of chronic disease - for people of all ages.
High-quality and well-trained staff are at the core of rehabilitation and management for those with chronic health conditions, with disability, and recovering from accidents.
In recent years, the University of Canberra has had to limit access to sought-after health courses because of constraints on the clinical placements available to our students.
High-quality clinical placements are critical to high quality clinical training.
With the increased access to training places provided by a sub-acute hospital, there will be more opportunities for local students, and more reasons for students to come to Canberra to train.
We already have local health work force shortages in a number of areas, including physiotherapy and occupational therapy, and we will need more skilled nursing and medical professionals, both locally and nationally, in the years to come.
The University of Canberra Public Hospital is an important step forward.
Professor Diane Gibson is Dean of the Faculty of Health, University of Canberra.