I am delighted to attend the AGM of such a fine Hospital and Aged Care Facility as St Luke’s and Lulworth House. I am very aware of the great reputation for exceptional care that you have in Sydney. It is a great tribute to your current Board, Management and Staff and for the many who have worked here over the years.
I also acknowledge the traditional owners of the land where we meet and pay respect to their elders past and present.
I spoke to your CEO Cindy Woods last week and she suggested I may speak about some of the challenges and opportunities that may face St Luke’s Hospital and Aged Care in the future.
But first it may be worth looking briefly into the past.
I note that you will be celebrating the 100th anniversary of the establishment of St Luke’s next year.
Of course, centenaries are on our mind at the moment with the 100th anniversary of the end of WW1 last Sunday on November 11.
To mark the occasion just before 11am I went up to the local Memorial Garden at Ryde and tried to imagine the joy and relief that must have been felt on that first Armistice morning. I found it very difficult.
It was a beautiful early summer morning; spring flowers were out, and the Currawongs were calling. Our world has changed so much in the intervening years.
WW1 seemed impossibly distant and 100 years such a long period of time. Yet that is what you will celebrate in a few months time.
I understand that it started at a time when health and hospital services were going through a period of rapid change because of that terrible war that had just exhausted itself. The unforeseen brutality and unimagined mechanized destruction of WW1 overwhelmed medical services at the front and at every stage back to Australia.
My research didn’t show whether St Luke’s was ever used for the care of veterans, but it is highly likely that some of the earliest patients were recovering from war injuries or conditions. If you look around at the health and hospital system we enjoy today, a significant amount of the infrastructure was built at that time to attend to returned soldiers, for example Ryde Hospital.
Perhaps more telling was the impact WW1 had on medical practice in those hospitals including St Luke’s. Many aspects of medicine taken entirely for granted today, emerged from the lessons learnt in the casualty clearing stations and field hospitals of that most terrible conflict.
The change in health care in those war years and years that immediately followed was dramatic.
For example, the development and widespread use of ambulances for rapid retrieval, antiseptic to control infection and anaesthesia to reduce trauma and shock in operations saved countless lives and thousands of unnecessary amputations on the battlefields and back here in hospitals across Australia.
I was amazed to read that just rolling out the use of the Thomas splint to protect shattered thigh bones meant that the death rate of 80% in 1914 from a smashed thigh turned around to an 80% survival rate in 1916.
And new surgical procedures such a facial reconstruction surgery saw leaps forward in technique that benefit plastic surgery to this day. The use of X Rays, vaccines to fight typhus and steps to combat sepsis, all still significant today owe their development to that time when St Luke’s was first opening its doors. And with those new discoveries came improvements in training, clinical controls and equipment and technique that have been taken up across our hospital system.
If St Luke’s had not changed with the times, kept up with new technologies and methods, adapted new practices and trained its staff, it would have, like so many other small hospitals, gone out of business. The fact that it has remained and flourished over the last 99 years is testament to the foresight and competence of the many directors, managers and clinicians who have worked here over those years. Clearly flexibility and resilience in the face of change will continue to be essential qualities for St Luke’s continuing success.
Of course, St Luke’s has changed though the years. I understand that for a period Nursing accommodation and training occurred on site. Then in 1926 a purpose-built hospital of 100 beds was opened and in 1935 Lulworth House was purchased and in 1938 converted to a Maternity Hospital, which operated till 1969. I understand that some residents of Lulworth House recall also having had their children here. In 1952 the hospital attracted Government funding and began to accept a limited number of public patients for a period of time. Again, a trend that we can expect to see more of in the future Development continued with upgraded operating theatres in 1971 and Intensive Care in 1972. Since then the hospital had be constantly renewed and reconstructed to keep up with changing tastes and medical needs.
So, what of the future?
Crystal ball gazing is as difficult for us as it would have been for those clinicians and administrators in 1919 but the need to plan strategically and minimize risk demands it.
So, what do we know?
We know that we are in a depressed market for private hospital activity and that this has been so for the past 2-3 years and at the moment there is little relief in sight. All providers are feeling the downturn, profit and not for profit. It is likely that this is partly due to: the changes in practice, the substantial drop in knee arthroscopies is just one example; partly the result of recent substantial investments in public hospitals, the luxurious Royal Adelaide Hospital being just one example; the increasing burden in out of pocket expenses and the failure of the private health insurance industry to provide viable consumer products.
Whatever the cause, the downturn has gone on sometime longer than was expected which has resulted in a reduced appetite and capacity for growth and of capital investment, both essential in modern private health delivery.
It seems that these pressures are going to remain in the system for some time.
It also seems clear that PHI will continue to exert strong and growing influence and control over the private hospital system. Some would suggest that already its behaviour has become demanding and intrusive. By using its incredible data collection capacity the industry will continue to make demands they want from their hospital partners such as improved clinical outcomes. Whilst wanting the best clinical outcome for patients is not something that any hospital operator would argue against, some would suggest that the PH Insurers may not be the best parties to drive that change.
The ALP has also promised to limit PHI premium rises and I am not sure that this will provide the relief that an incoming Labor Government is seeking. Reform of PHI is needed but the use of blunt tools to do so risks the further driving of costs to the patient, not a beneficial outcome.
There are other trends in health care that will if adopted will allow continued success for St Luke’s. I admit to being in awe of some of these trends and as I am not a clinician director, I admit to taking advice from people like the Calvary NCEO Martin Bowles, former Secretary of the Federal Department of Health. He suggests that the rise of surgical robotics and increasing use of prosthetics will mark our hospital system. The continual development of precision or personal health care will see the increasing customization of that health care. Finally, the future belongs to health care that is innovative and unique, that shows a willingness to work closely with health funding providers such as PHI and Governments to demonstrate and develop those innovations.
In Aged Care, the looming Royal Commission is clearly causing deep anxiety and concern with providers. Operators are trying to figure what sort of RC it will be; a Name and Shame type that will use sensational revelations to make its points like the recent Banking and Financial Institutions Royal Commission or whether it will be one more intent on looking seriously at the funding, quality and policy issues facing the industry.
Finally, perhaps the greatest threat to the operating environment of hospitals like St Luke’s and aged care facilities such as Lulworth House is the one of Australia’s rapidly changing demographics.
As a nation we are ageing so rapidly and the impact of that change, is having an incredible impact on our health and ageing industries.
The baby boomer generation has been problematic at every stage and remains so. There are so many of us around and we are living so much longer. For example, at the end of WW1 life expectancy for men was 58 and for women 60. Today it is 80 for men and 84 for women. The result of this demographic bulge of Australians living so much longer means that today in Australia there are about 4,000 Centenarians and that in 2050 there will be 70,000!
The ageing of the baby boomers will impact on all aspects of health care. It will drive more treatment into private hospitals as public hospitals struggle to cope with the burden and of course it will see an increased demand for RACF placement. Hospital in the home will increase as will he number of community care packages, though not before time. I understand that currently there is a 50,000 shortfall in funded community care packages, something I trust the Royal Commission considers carefully.
Putting it bluntly, the ageing of the Australian population is a tsunami that without planning and preparation will engulf our health and aged care system and test it as dramatically as it was in those post WW1 years.
The biggest factor in that impact will be dementia. As our research, academic and clinical communities have impacted beneficially on the big killers of the last century; heart disease, stroke and cancer; dementia has stubbornly refused to give up its secrets and is now the second leading cause of death of all Australians and the leading cause of death of Australian women.
In 2018 there is an estimated 435,000 Australians living with dementia. That number is expected to reach one million before 2060.
An incredible number and a huge increase that will change the face of Australia and continue to impact dramatically on St Luke’s and Lulworth House and every other health and ageing facility in the nation.
So, what will save us?
It will be those same qualities that saved our health system from being engulfed by the deluge of WW1.
The skills of our clinicians, the loyalty of our volunteers, the compassion of our ancillary staff, the quality of our hospital administrators, and the vision of our directors. These qualities have always been at the heart of all successful hospitals and aged care facilities and clearly that includes St Luke’s Hospital and Lulworth House. Long may it be so.
Image credit: St Luke's website
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