S9 EP1: Jack Reynolds, Government Goodies

Jack discusses planning and construction of some of the largest projects in Australia.

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Transcript

[00:00:16] David Cummins: G'day. Welcome to the AHDC podcast series, Health Design on the Go. I'm your host David Cummins, and today we're speaking to Jack Reynolds, who is an architect from the University of Adelaide. For over 15 years, Jack has exclusively worked in health, ranging from private to public, and currently the health facilities planner at SA Health.

[00:00:37] We look forward to speaking to Jack as part of our Government Goodies podcast series. Welcome Jack. Thank you for your time to be here. 

[00:00:42] Jack Reynolds: G'day David. Good to be here. 

[00:00:44] David Cummins: How long have you been at SA Health for?

[00:00:47] Jack Reynolds: I'm coming up for about five years now. I originally started in 2018 and extensively at the time, that was to work on the Women's and Children's project. As things go, I end up getting involved in a lot of other projects. 

[00:01:00] Worked for a while on the Repat reactivation, a lot, significantly in our covid response in the medi-hotels, a lot of broader planning across the system. Recently transitioned across from SA Health Central into one of our local health networks.

[00:01:13] So, as of the last couple of weeks, been working with Barossa Hills Fleurieu, a Local Health Network, which is one of the service delivery arms of SA Health as a state public health provider. 

[00:01:23] David Cummins: That is a big bio for just a short period of time of five years. There's so many questions there.

[00:01:28] Maybe just starting from scratch... you talked about the Women's and Children's H ospital in South Australia. For those that aren't really aware of it, do you mind just explaining a bit more about that and your involvement? 

[00:01:37] Jack Reynolds: Yeah, sure. 

[00:01:38] Women's Children's Health Services are relatively unique in South Australia in the sense that obstetric and pediatric services are provided from a single dedicated health network. 

[00:01:47] That's been the case for a number of decades now in South Australia, and that's Women's Children's Hospital in North Adelaide.

[00:01:54] It is a fairly challenged and fairly constrained asset. And, being quite unique, that provision of obstetric and pediatric services together, it suffers to some extent from the dislocation from a more general tertiary adult service.

[00:02:07] So it was a commitment really spanning across a couple of governments now to relocate the Women's Children's Hospital and to site that facility closer to the Royal Adelaide Hospital. So that you had better services from the perspective of access for mothers to adult ICUs access to a helipad, which they don't have in, North Adelaide, so a whole range of factors. 

[00:02:33] So a lot of opportunities there. Obviously it's a huge project and it's only got bigger in the time that the project's been under development, so I'm not on that team, but the team working on it have been very busy. 

[00:02:42] There's been, with the current change in government, a recent policy decision to pull the hospital across to the other side of the railway line. Still close to the RAH, but gives them some additional development space so that's all fairly well publicised now, but it's kind of led then to another step change in the size and scale of the project where it's got bigger again.

[00:03:03] So it's now notionally, in that 3 billion type project range. And it's a big job.

[00:03:07] David Cummins: They're phenomenal figures. 3 billion for there, it was a couple of billion for the Royal Adelaide Hospital. 

[00:03:12] Is there that demand in SA for that level of treatment for that many people. Where's that demand coming from? 

[00:03:18] Jack Reynolds: I think it's important to note that these are the tertiary quaternary health centres for the whole state. So they are serving a very large catchment.

[00:03:25] It's really important to note with these services that (WCHN), the Women's and Children's Health Network is a whole-of state services provider. So it's providing Women's/children's health services really to the whole of Adelaide and the whole of regional South Australia. 

[00:03:39] And that leads to significant demand on services but also a high degree of specialisation that, you're providing to a catchment population of roughly 1.6 million people across the state.

[00:03:50] David Cummins: It's really interesting that Adelaide, actually Australia, I know WA, I certainly know Queensland Victoria, actually everywhere in Australia except probably Northern Territory are doing these bigger hospitals are X billion dollars. 

[00:04:02] But overseas a lot of people seem to be going from a more decentralised model and smaller hospitals.

[00:04:08] What do you think it is about Australia that is lending itself towards these bigger hospitals at the moment? 

[00:04:13] Jack Reynolds: Look, I think it's an interesting question. We are trying to do a bit of both. So we have a principle of providing care, close to the home in South Australia. I don't think there's a one size fits all approach.

[00:04:21] We do need the bigger quaternary services, and I think there's certain economies of scale and specialisation in particular procedures that are leading towards those big facilities. So I think there'll always be demand for, what I'll call the 'royal hospitals' which exist in all the major cities.

[00:04:37] In my role now at Barossa Hills Fleurieu, the focus is very much actually on net care and the community care close to the homes. So it's what's safe and appropriate to do in the community, in the regions close to where people live.

[00:04:50] And that's very much focused on identifying what are the services people need to access close to home, what are the demands locally, and how do we identify them and provide them in the community and support those lower volumes, but provide the care at a high standard and sustainably.

[00:05:06] I think what you've touched on there about caring community is really important because we know that if people have to travel great distances to receive healthcare, then there's a whole lot of negative externalities to that.

[00:05:17] They miss out on work. There's financial cost to it. In the pediatric space, they miss out on education. So as much as possible I think we need to support in infrastructure delivery provision of care in the community and close to where people are living but there will always be a space for the big mega hospitals in the city. 

[00:05:34] David Cummins: And I think especially in South Australia, from an infrastructure point of view, correct me if I'm wrong, but over the last few decades we've never seen this much support for the growing demand. I would probably say in Australia it's probably by far, the most infrastructure besides potentially Queensland, but the most infrastructure helping out with the demand based on the last few decades.

[00:05:54] Queensland's definitely had a lot of growth in the last few decades. I would say the government over there is putting a significant amount of prioritisation to the growing demand in Australia at the moment, correct?

[00:06:04] Jack Reynolds: Yeah, I think that's a pretty fair assessment, David. I think there's probably a backlog of investment over a few years now that we're catching up with.

[00:06:12] So I think that's part of what's driving this and it is needed in the system. I guess the other component to that is we talk about levels of investment between the states. I haven't done the numbers on what other states are spending. I know they're investing a lot, but you may be right in your assessment that at a per capita basis, South Australia's right up there.

[00:06:28] We do probably unique amongst the mainland states, we've got a significant aging population and, as all of your listeners would understand that drives demand on the health system. So it's a combination of population growth pressures, which we're seeing alongside other states, not at the level that someone like Queensland would be experiencing, but we're seeing it, but it's also our aging population and the kind of pressures that places on the health system.

[00:06:52] David Cummins: Yeah, it's really interesting. I think globally there is this huge demand on the aging population. 

[00:06:57] So where does like health planning and design come into that? Especially to help reduce the burden of that extra demand on the health system and disease and that extra demand that's coming over the next 10 to 15 years.

[00:07:09] How important is it, that government understand in a design? 

[00:07:13] Jack Reynolds: I think philosophically it's about designers really seeing themselves as having a health and wellbeing responsibility across the continuum. There's people like us that are working in the delivery of the pointy end of health infrastructure.

[00:07:26] So your hospitals, your diagnostics, your primary healthcare centres. But in terms of actually easing the pressure on that really expensive part of the health system, we need to take some of those principles and look at how we can implement them really across the whole environment so that we are providing better support.

[00:07:45] And when I say we, I mean the entire design industry here for older people to have really high quality lives living in their communities. And that's about thinking aging in place, in residential design. It's about looking at shopping centres, public infrastructure, community areas about how we embed dementia, enabling and accessible design principles into them.

[00:08:04] How we make sure that there's really good outreach services in the health and aged care system and that aged care facilities are really well designed from a health design perspective that actually the aged care infrastructure is fit for purpose, to care for people with more challenging needs, and they don't find themselves bumped into the health system because of complex dementia needs or because of challenging medical comorbidities.

[00:08:27] So I think that's an overarching level how Australia and how the built environment needs to respond.

[00:08:37] The aging of the population is gonna continue for some years to come and in terms of those people moving into the last few years of life where we all become really significant users of the health system, that's probably at its peak in the mid 2030s when you have that baby boomer cohort.

[00:08:53] Moving into that end of life care period. If we don't do health design better, it's gonna be really challenging for the health system and for the Australian economy more generally. 

[00:09:04] David Cummins: You're also talking about, and correct me if I'm wrong, you're talking about the models of care there as well.

[00:09:07] So it sounds like we as a society, if not globally, need to challenge our current and existing models of care to complement design and actually enhance the need and care for this aging population. How important is it for a government organisation to be challenging these models of care or pretty much it's just like, put your head down, she'll be right.

[00:09:27] We're not gonna challenge it... what's been done the last six years is gonna work out. How does one get their head around that? 

[00:09:32] Jack Reynolds: I think government has to be the leader here and it's all levels of government as well from Commonwealth down to Local Government. I'll use the Aged Care Royal Commission as an example where there's obviously recommendations that came out of that. 

[00:09:42] A lot of the recommendations were facility based and it were things that a lot of people have known for some time, but there's never been the impetus to actually really put them into action. So For example, there's a push towards having an aged care accommodation framework. 

[00:09:56] Now I think things like that ensure that aged care infrastructure has a level of robustness that they can properly support the health and wellbeing of older Australians with more complex care needs is really critical.

[00:10:06] And there's obviously a requirement for the Commonwealth to be the leader in that space. And I think they're coming to the party through the Royal Commission and through the response to the current work to establish that accommodation framework. 

[00:10:17] David Cummins: Correct me if I'm wrong, a lot of those recommendations haven't been taken up by many governments.

[00:10:21] Is that not correct? 

[00:10:22] Jack Reynolds: Look, I probably wouldn't speak to all of them. I know the one around the accommodation framework is being progressed. And that's the one that sits within the infrastructure space or the big one that sits within the infrastructure space.

[00:10:34] As a provider of aged care services, I can speak to SA Health and we do provide aged care in our regional hospitals as a component of the NPS Model and as commonwealth licenced beds in some of our regional hospitals, we're certainly very cognisant of the quality and condition of those assets, how they align with the Royal Commission recommendations and how we actually start looking at modifying them to meet what's described as a small household model of care.

[00:10:59] Jack Reynolds: There's aged care providers, particularly some of the not-for-profit providers who do it really, really well and it's interesting to look at how they're delivering that care. But we know that that does actually have, not just qualitative outcomes in quality of life for residents, but also quantitative outcomes in terms of ability to maintain independence to continue to live outside of the acute health system.

[00:11:21] David Cummins: I mean, it's fantastic. Whats next on the horizon for SA Health because it's a big stay and as you just said, a growing population. Obviously a $3 billion project is phenomenal, but what else is on the pipeline for you guys? 

[00:11:33] Jack Reynolds: What I'm really excited about is, I'm currently leading with Barossa Hills Fleurieu Local Health Network, which is the new Mount Barker Hospital.

[00:11:39] So Barossa Hills Fleurieu is one of our local health networks. Previously all country health was kind of consolidated as a single LHN, equivalent to local health district for those in the Eastern states. Couple of years back now, there was a decision to really break those up into smaller, more meaningful components.

[00:11:57] And one of the local health networks was Barossa Hills Fleurieu. Those not familiar with the geography of Adelaide.. Essentially, it's a network that covers the entire peri-urban region, stretching around Adelaide. 

[00:12:07] So from Gawler and the Brossa Valley in the north through the Adelaide Hills, and then down to the Fleurieu Peninsula and Kangaroo Island.

[00:12:15] That's essentially, as anyone broadly familiar with Adelaide will understand is really the peri-urban growth corridor that stretches around the city. So it's the network that's experiencing the highest population growth and some of the most critical growth in health demands as a result.

[00:12:31] And also some significant opportunities to relieve pressure on metro hospitals by providing and coming back to that point around care closer to home, but by providing health services close to where people are living. So I'm particularly involved in the new Mount Barker Hospital, which is a $320 million commitment.

[00:12:48] The South Australian government to significantly expand the scale and capacity of the existing Mount Barker hospital from what it is today, which is a 34 bed regional hospital into 102 bed peri-urban per metro hospital. 

[00:13:02] I think there's just enormous opportunity here both to deliver for the Mount Barker and community the Adelaide Hills community, which are particularly high growth regions of the state but also to use that to actually reverse some of the flows. 

[00:13:15] So where people in these catchments are typically accessing healthcare in Adelaide we can actually reverse those flows and keep people close to their home. Up in the Adelaide Hills, in Mount Barker. In so doing, really reduce some of the pressures on our metro hospitals and provide care in a planned manner, in a low cost setting close to home rather than in the super expensive metros in the city.

[00:13:36] Which I guess, comes back to where we started this discussion. 

[00:13:39] David Cummins: And getting back to where we started the discussion, you also mentioned at the start SA Repat, which I know is really important to a lot of people from Adelaide. It's a phenomenal district and it's really important to a lot of people.

[00:13:50] Do you mind just touching base on that one as well, please? 

[00:13:53] Jack Reynolds: Yeah, sure. The Repat really stretches back a number of years now. It was formerly a repatriation general hospital, which is one of a number of repatriation hospitals that were built following the war for repatriation rehabilitation of return service people.

[00:14:07] There was a decision to close the repatriation general hospital. That was a very controversial decision within South Australia.. Ultimately there was an election. Governments changed on the back of a commitment to reactivate the Repat. I got involved with a number of colleagues quite early in that process, and we were left with our hospital that had really been emptied with a number of heritage listed buildings on the site, which were no longer fit for purpose to run an acute hospital. 

[00:14:33] And also certainly no desire to reactivate that acute hospital in its former format which wasn't, wasn't working. But what it did give us the opportunity to do is with a really strong DNA at the site a lot of community goodwill and love of the former repatriation general hospital to actually rethink what is needed to provide health services in the 21st century. 

[00:14:54] And to redefine how that site would operate and what we established, with a lot of collaboration across the entire health system and outside of government as well, the Reaper Health Precinct, which was formulated around the principle of providing complex care for people with long-term health needs. 

[00:15:13] So we established services like specialist brain and spinal cord injury, rehabilitation services, specialist dementia services a range of other transitional care opportunities but really all formulate around the principle that there's people who will have long-term and relatively complex health needs, but will benefit from not being on an acute hospital site. 

[00:15:34] And that's what we could deliver with the Reaper Health Precinct, really because of the availability of space, the preponderance of heritage listed buildings and green open spaces around those buildings, the kind of campus community setting.

[00:15:46] For anyone in Adelaide, I really do urge you to go out and have a look at it. It's a great site and it's quite intentionally quite permeable. 

[00:15:52] You can move through it, it has things like cafes and playgrounds in the middle of the health precinct site by intention because if you've got people there who are there for a long time who may be recovering from a spinal cord injury following a traffic accident, just as having that sort of environment where their families can actually interact them in a non-institutional, non-hospital setting while they go through that rehabilitation journey is so important. 

[00:16:15] And having a site there as a health precinct really opens up is an opportunity to work with a lot of partners. So Hammond Care have established specialist age care facilities on site.

[00:16:26] We're looking at opportunities for things like NDIS housing for people who may at the right point to discharge from the spinal cord injury and brain injury rehab services, but may not be ready to return back to their own homes. 

[00:16:40] So it's that kind of transitional housing arrangements as mods are done on people's own homes. Arrangements around day surgery facilities on site, so there's a whole lot of partnership opportunities, which were really the repat health precinct and are being implemented one by one.

[00:16:55] HammondCare have just finished their age care housing and it's kind of a real game changer in the way aged care is provided in South Australia and I think they've got a lot to add to the industry within the state being a new player within South Australia. 

[00:17:07] It's a fantastic precinct. It is worth kind of getting out there and having a look at it for people who are in Adelaide or find themselves in Adelaide.

[00:17:14] David Cummins: Yeah, I totally agree.

[00:17:15] It's a phenomenal precinct and just I'm asking Adelaide as a whole, South Australia as a whole with the level of infrastructure and the level of commitment SA Health has put behind it is just phenomenal. 

[00:17:25] Some of the models of care, the challenges, the innovation is fantastic.

[00:17:30] I think it's people like you and the team that you support and behind you is making it South Australia, certainly on the forefront, not only from Australian scale, but a global scale, especially with that innovation piece. It's just fantastic what you guys have done and especially identifying and answering the call for that aging population and the needs of the state.

[00:17:47] So thank you so much for that. 

[00:17:48] Jack Reynolds: Thanks, David. 

[00:17:49] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:17:54] To learn more about the AHDC, please connect with us on our LinkedIn or website. 

[00:17:58] Thank you for listening.