From six beds to a city gem: how we’ve grown

It would be difficult to find a Victorian whose life has not been touched by The Royal Children’s Hospital. Wednesday 9 September 2020 marked a significant milestone for this great institution — 150 years of providing dedicated care that has changed the lives of countless children and their families.

When Drs Smith and Singleton opened the Melbourne Free Hospital for Sick Children in 1870, there were just six beds, funded through the efforts of a formidable group of women led by Frances Perry. The founders shared a focus: to provide healthcare for children irrespective of need or status.

Today the beds are abundant and the hospital spectacular, yet that same pursuit continues to drive every action.

The RCH has been at the forefront of paediatric advances globally. From John Colebatch AO performing the world’s first chemotherapy trial on childhood leukaemia patients in 1948, and Professor Ruth Bishop OAM’s history-changing discovery of the rotavirus vaccine, to most recently, in 2019 becoming the first in Australia to provide children with revolutionary CAR T-cell therapy, for some the last option in cancer treatment.

Along the way, enduring and successful partnerships have been built, most notably with campus partners Murdoch Children’s Research Institute and The University of Melbourne.

None of this would have been possible without the support of government and community, most importantly The Royal Children’s Hospital Foundation and Good Friday Appeal. Our supporters ensure the hospital is able to attract and retain the best healthcare professionals, and enable research to better understand the diseases and conditions that impact on children’s health.

Oftentimes, advances in medicine have been fuelled by clinicians thinking outside the square and taking a leap of faith to test new ways, backed by community support. Philanthropy allows us to do more than we could with government funding alone. The reality is government funding often follows innovation.

But it’s milestones like these which should also challenge us to look to the future and design changes which build on the foundations of history and enable us to continue to improve the health outcomes and experiences we provide.

There are changes we already know need to happen, and can happen. This year alone, through the disruptive nature of the COVID-19 pandemic, some of those changes have been brought to the fore.

Telehealth is a prime example. The pandemic moved us toward virtual healthcare almost overnight, with clinicians adapting quickly to provide consultations online.

At the height of the pandemic, more than 70 per cent of outpatient appointments were delivered via telehealth, up from just 8 per cent in previous years. Or in real terms, more than 700 appointments per day since the start of the pandemic.

Most importantly, this service has not only proved highly satisfactory in terms of clinical outcomes, but hugely beneficial for families.

The opportunity we have is to maintain and enhance the concept of using technology to diagnose, treat and monitor patients.

Of course, there are times when acute inpatient care is the only option. But telehealth has the capacity to increase those options, and provide access and equity for children and families who may never previously have been able to benefit.

Today, a profound challenge is to significantly improve and increase mental health care for children and young people. We know more than 50 per cent of mental health problems emerge in childhood and early adolescence.

At the RCH alone, we have seen a 30 per cent increase in mental health presentations in recent months and, sadly, at the highest acuity. The current focus of public policy and funding of adult mental health services ignores the fact these issues emerge early in life for many in our community.

In the medium term, our focus must shift to preventive and precision medicine.

An example is our ever-evolving capabilities in genomics, which can provide a glimpse into the future and an opportunity to find genetic conditions ahead of time.

Despite the outcomes, we know there is value in providing a diagnosis for families. This will also give our clinicians the chance to respond early in ways which help patients to avoid a range of tests, pain and suffering.

Ongoing, our challenge is to minimise health outcomes affected by social status. As health professionals we should consider how we can use our great intellectual capacity to be a driver for good in improving health literacy for all.

We must build a funding system that not only facilitates but encourages these advances.

COVID-19 has presented us with enormous challenge – and along with it, unprecedented opportunity.

Let us all leverage the agility, adaptability and innovation we have shown in 2020 to create a great future for the generations ahead.

Article by: Rob Knowles AO, Board Chair, The Royal Children’s Hospital