Can you keep a secret?

The Stirling District Hospital

The Stirling District Hospital is a good example of a private community hospital which has not only survived but grown into a thriving organisation since its beginnings in 1926. It was developed and opened by a group of community minded people with support from the local doctors, at a time prior to the building of the South-Eastern Freeway, when visiting a doctor in Adelaide was a whole day trip. It has maintained its position as a thriving community hospital run by a board of directors who manage full financial control, employment of staff and increasing facilities year by year. It incorporates some aged care and rehabilitation services, alongside full surgical, maternity and medical inpatient care. Having a bed capacity of 36 with added Day Surgery facilities, it is much loved and supported by its community and benefits from its proximity to Adelaide. Many patients seek services there and are happy to travel from Adelaide to access such services. It is a stand-alone hospital, not co-located with any public facility.

Most private hospitals co-located within government public hospitals, while nominally having their own board of directors, have very little control of finance and staffing of their organisation. One might sometimes wonder exactly what role such Boards play.

It has been stated by Healthscope and others, that size and scope of practice are critical to the survival of private hospitals, those hospitals with low bed numbers cannot be viable.

Mount Gambier Private Hospital

Such was true of the Mount Gambier private hospital which recently went into voluntary administration, following lengthy discussions with the Local Health Network about funding difficulties and uncertainties. The private hospital has been well supported by the community with many donations from local benefactors and charitable organisations within the region, but with little input to the running and management of the hospital

Mount Gambier Private Hospital is co-located within the regional public hospital. The private hospital opened within the new public hospital, developed when the existing public hospital was considered unsafe and difficult to manage. The new hospital was built on a different site and opened in 1997. It was licensed for 98 beds, a reduction from the previous hospital which had 216 beds when it opened. An additional 17 beds were added to the new hospital as a private facility in a separate ward within the new building. The new public hospital had 4 operating theatres and an emergency department. It had a strong maternity unit with a birthing rate of 350 births per year.

The private hospital was a source of income for the general hospital funds, as privately insured patients could use their medical benefit funds to offset their private charges. If patient numbers exceeded the available number of beds in the private ward, people were advised that they could be admitted as "private in public" patients. This afforded them some choice in medical care, although some of the general practitioners were accredited to the private hospital but did not hold status in the public system and so were unable to care for their patients if they were admitted as "private in public". The patients were charged a private fee and allocated their medical benefit funds to the public hospital – a double cost to the government which was already financially supporting the hospital.

Upon going into voluntary administration, the Private Hospital board was instructed to maintain silence about what was happening pending a suitable outcome for the situation. In considering the histories of hospitals outlined in this paper, one wonders what plans the Local Health Network and indeed SA Country Health have for the extra 17 beds which may now be at their disposal. The public is assured that there will be no change to what they have been able to receive, but one wonders how this can be when they were running at such a deficit. In the present situation, the general practitioners currently providing services throughout the region will no longer have access to any hospital beds if they wish to provide continuity of care to their patients and families.

Can we keep a secret? I don't believe that we can sit back and watch these recurring developments with so-called private organisations being co-located within public hospitals without autonomous control and budget arrangements.

Questions must be asked, and satisfactory answers must be given.