Estimates Vote

Department for Health and Ageing, $3,748,814,000

Minister:

Hon. J.J. Snelling, Minister for Health, Minister for The Arts, Minister for Health Industries.

Departmental Advisers:

Ms V. Kaminski, Chief Executive, SA Health, Department for Health and Ageing.

Mr J. Woolcock, Chief Finance Officer, Department for Health and Ageing.

Mr D. Frater, Deputy Chief Executive, Finance and Corporate Services, Department for Health and Ageing.

Ms L. Cowan, Acting Deputy Chief Executive, Transforming Health, Department for Health and Ageing.

Mr M. Baccanti, Chief Executive Officer, Health Industries, Department of State Development.

Mr P. Marcuccitti, Director, Health Industries, Department of State Development.

The CHAIR: Good morning, everyone, and welcome to committee A as we gather on Kaurna land for the estimates committees, which are a relatively informal procedure and, as such, there is no need to stand to ask or answer questions. I understand that the minister and the lead speaker for the opposition have agreed to an approximate time for the consideration of the proposed payments, which will facilitate a change of departmental advisers. Can the minister and lead speaker for the opposition confirm that the timetable for today's proceedings previously distributed is accurate?

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: It sounds good to me.

The CHAIR: Changes to committee membership will be notified as they occur. Members should ensure that the Chair is provided with a completed request to be discharged form. If the minister undertakes to supply information at a later date, it must be submitted to the committee secretary by no later than Friday 27 October 2017. This year, estimates committee responses will be published during the 14 November sitting week in the corrected Daily Hansard over a three-day period.

I propose to allow both the minister and the lead speaker for the opposition to make opening statements of about 10 minutes each, should they wish. There will be a flexible approach to giving the call for asking questions based on about three questions per member, alternating each side. Supplementary questions will be the exception rather than the rule.

A member who is not part of the committee may ask a question at the discretion of the Chair. Questions must be based on lines of expenditure in the budget papers and must be identifiable and referenced at the beginning of the question. Members unable to complete their questions during the proceedings may submit them as questions on notice for inclusion in the assembly Notice Paper.

There is no formal facility for the tabling of documents before the committee; however, documents can be supplied to the Chair for distribution to the committee. The incorporation of material in Hansard is permitted on the same basis as applies in the house, that is, that it is purely statistical and limited to one page in length. All questions are to be directed to the minister, not the minister's advisers. The minister may refer questions to advisers for a response.

During the committee's examinations, television cameras will be permitted to film from both the northern and southern galleries, and I do ask anyone up there to make sure their phones are on silent; that would be lovely, thank you. I will now proceed to open the lines for examination after I have been advised of the new construction of the committee. The members for Ashford, Mitchell and Finniss have asked to be replaced by the members for Davenport, Elder and Schubert.

The portfolio we are opening this morning is SA Health and Health Industries SA. The minister appearing is the Minister for Health and the Minister for Health Industries SA. I declare the proposed payments open for examination and refer members to the Agency Statements, Volume 3. I call on the minister to make a statement, if he wishes, and introduce his advisers.

The Hon. J.J. SNELLING: It is obviously a very exciting time for South Australia with, to quote the Hon. Stephen Wade, our 'world-class new Royal Adelaide Hospital' opening its doors to the public in a matter of weeks. It signals a new phase of modernising our public hospitals to dramatically improve health care for South Australians. The opening of the new RAH will be one of the most iconic moments in our state's history.

Our vision is to ensure that the standard that is set by the new RAH is not the exception to our healthcare system but the norm across all our hospitals. There has been and continues to be an incredible amount of work being done across the whole health system to ensure that the move goes smoothly and safely for patients. I want to thank our hardworking doctors, nurses, midwives, paramedics, allied health professionals and all other SA Health staff for both the work they have done to prepare for the move and everything they are doing to ensure that this significant and challenging move happens safely.

More than 5,500 South Australians have jumped at the chance to look inside the new Royal Adelaide Hospital during the tour days we have had over the last few weeks. Overwhelmingly, the South Australian public have embraced the new hospital with a hugely positive response. I am sure that all South Australians will be as proud as I am when the hospital opens its doors on 5 September.

Over the past few years, the government has embarked on ambitious health reform driven by the need to make improvements in quality across our health system to make sure the people of South Australia receive the best possible care. Transforming Health has achieved a great deal, including the development and implementation of new models of care and clinical improvement projects. Many more patients are receiving their elective surgery as same-day or 23-hour procedure, in line with our interstate and international counterparts.

For example, in the north and north-east, where we have fully implemented these reforms, we have seen significant improvements. Modbury Hospital is now well and truly established as the elective surgery centre for the north and north-east and, as predicted, we have seen an increase in day surgery admissions. There has been an increase of around 44 per cent in the number of day surgeries performed at Modbury Hospital, which equates to an average of 53 extra day surgeries a month.

At the end of 2016-17, there were no patients overdue for elective surgery across Modbury and Lyell McEwin hospitals. This is because our patients are not staying in hospital for longer than they need and we can do more procedures for more people. Concentrating complex and emergency surgery at the Lyell McEwin also means fewer surgeries at Modbury are cancelled at the last minute, as the operating theatres do not need to be used for emergency patients. In fact, our data shows that 99 per cent of elective surgery patients at Modbury Hospital were admitted on the day that the surgery was planned.

The recent budget recognises significant reforms made in our health system over recent years, and that is now timed to focus our efforts on modernising our health infrastructure. With Transforming Health now nearing completion, we have committed to a health system that fosters ongoing clinical innovation and high-quality outcomes for South Australians. Our community expects nothing less. I would like to thank the staff who have worked on this generational reform, in particular our clinical ambassador, Professor Dorothy Keefe, for her hard work, dedication and support.

Since 2002, the government has invested over $4 billion to rebuild every metropolitan public hospital and every major country hospital. Importantly, we have brought Modbury Hospital back into public hands. We are now investing $1.1 billion in our public health system, ensuring it continues to be modern and cutting-edge.

We will spend $528 million to build a new Adelaide women's hospital to be co-located with the new Royal Adelaide Hospital. This will ensure mothers and newborns have access to the most modern facilities and the best care possible. The sum of $250 million will be invested in The Queen Elizabeth Hospital to provide modern world-class facilities for the western suburbs, as well as patients who need access to the most advanced specialised rehabilitation services in this state. We are also upgrading the Lyell McEwin Hospital, Flinders Medical Centre, Modbury Hospital and Mount Barker Hospital.

I repeat my sincere thanks to all our doctors, nurses, midwives, paramedics, allied health staff and other SA Health staff across the whole of our health system. Our reforms can only be achieved with their support, hard work and dedication.

The CHAIR: And your advisers, please, minister.

The Hon. J.J. SNELLING: Yes, I introduce the Chief Executive, Department for Health and Ageing, Vickie Kaminski; the Deputy Chief Executive, Mr Don Frater; Jamin Woolcock, Chief Financial Officer for the department; Lynne Cowan, Acting Deputy Chief Executive, Department for Health and Ageing; and Mr Marco Baccanti, Chief Executive of Health Industries South Australia, who is immediately behind me.

Ms BEDFORD: Do you have a statement?

Mr KNOLL: No, ma'am.

Ms BEDFORD: Straight to questions then.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, pages 26 and 27. In the 2017-18 budget, there are two capital projects in relation to TQEH: there is the new project costed at $250 million to The Queen Elizabeth Hospital redevelopment stage 3, and then there is an existing project of $22.4 million. How do these projects relate to one another?

The Hon. J.J. SNELLING: The $22.4 million project was announced when we announced the Transforming Health reforms. It was to be a new ambulatory rehabilitation building at The Queen Elizabeth Hospital. It was to enable us to relocate services—in particular, spine and brain injury services and rehabilitation services—from Hampstead to The Queen Elizabeth Hospital—the bulk of those services. Some services were going to go to the new Royal Adelaide Hospital.

In consultation with clinicians, it became apparent that that $22.4 million was not going to be sufficient to provide a service that was adequate, or certainly not superior, to what the clinicians had at Hampstead. As a result of those discussions, it was decided by the government to proceed with the full redevelopment of The Queen Elizabeth Hospital and the remaining patient-facing areas of the hospital, including rehabilitation, so that $22.4 million, or what was going to happen there, has been folded into this new project.

We will sit down with our clinicians to do the detailed planning work, but that will enable us to relocate those services from Hampstead to The Queen Elizabeth Hospital. It will enable us, in addition to that, to have a new emergency department, operating theatres and outpatient clinics.

Mr KNOLL: Just to pick up on that, minister, regarding the $22.4 million project, what parts of it will then be delivered?

The Hon. J.J. SNELLING: It will all be delivered as part of the $500-odd million announcement, so it will be folded into it. All of it will be delivered. In fact, not only will it be delivered but more than that will be delivered because we will end up with a rehabilitation service and the brain and spine injury services providing what the clinicians say they need and, in addition to that, everything else. It is $270 million in total: $250 dollars is new money and the $20-odd million is the money that had already been budgeted to do the ambulatory rehab.

Mr KNOLL: What was supposed to be delivered as part of the $8 million in 2017-18?

The Hon. J.J. SNELLING: Do you mean originally, when the announcement was made?

Mr KNOLL: No. In the budget, there is $8 million to be spent this year in 2017-18 under the $22.4 million capital project.

The Hon. J.J. SNELLING: We will commence works this year. Part of the works is car parking. We have to increase the size by adding another level to the car park at The Queen Elizabeth Hospital, which is part of the building works. Because, of course, where the new building will go will be on what is currently the car park, we have to increase the size of the existing car park before we can commence works on the new building. A large part of the $8 million will be to increase the size of the car park, plus other work commencements, which I am informed we would expect to be expending this financial year.

Mr KNOLL: Will any services or programs currently provided at TQEH need to be relocated to other parts of the hospital as part of this year's schedule of works? Are there going to be any interruptions?

The Hon. J.J. SNELLING: No, I would not have thought so because it is an entirely new build. The place physically where it is is currently the car park, so we are not redeveloping any buildings that are currently being used.

Mr KNOLL: The $22.4 million was to include a hydrotherapy pool and on-ward gyms. That has now been folded into the new project?

The Hon. J.J. SNELLING: That is right. That will be included in this new $570 million building.

Mr KNOLL: On ABC radio 891, on 20 July, you stated that the budget decision on the redevelopment of TQEH was made 36 hours before the announcement on 18 June. Who made that decision?

The Hon. J.J. SNELLING: Sorry, can you just repeat the question.

Mr KNOLL: On 20 July, you stated that on 18 June you announced this decision and said that the decision was made 36 hours before that announcement. Who made that decision?

The Hon. J.J. SNELLING: Me and the Premier.

Mr KNOLL: Was it taken at all to a special cabinet meeting, or was it subject to cabinet?

The Hon. J.J. SNELLING: We do not comment on what happens in cabinet, so I am not in a position to say, but it was something that had been discussed and reflected upon. A decision was taken not to proceed with the movement of cardiology services and we announced that on the Sunday.

Mr KNOLL: I am not asking you to comment on what happened in cabinet, and obviously a decision was made on 18 June, but you are not willing to confirm whether or not this decision was taken to cabinet at all?

The Hon. J.J. SNELLING: I will need to get some advice, but my understanding is that we do not normally discuss what was or was not taken to cabinet or discussed in cabinet.

Mr KNOLL: Was a cabinet submission put together and submitted?

The Hon. J.J. SNELLING: Again, I am not in a position to comment on what was or was not discussed in cabinet.

Mr KNOLL: In your previous answer, you suggested that it was you and the Premier who made this decision. Is it normal for quarter of a billion dollars worth of spending not to be taken in cabinet?

The Hon. J.J. SNELLING: Sorry, the quarter of a billion dollars spending? I thought you were talking about the decision to keep cardiology services. The quarter of a billion dollars spending was a decision through the budget process. The health spending went through all the normal budget processes you would expect budget processes to go through. Submissions go over roughly a six-month period, or three or four months. Departments put in bids. We have bilateral meetings with the Treasury. There are generally a number of meetings of the budget committee of cabinet, and indeed the full cabinet, to discuss the budget. Those decisions are canvassed at length. Sorry, I thought you were talking about the decision to keep cardiology services at The Queen Elizabeth Hospital.

Mr KNOLL: Just to break that out, does the decision to keep cardiology at TQEH have any impact upon the $250 million capital refurbishment program?

The Hon. J.J. SNELLING: It may because obviously the cardiology services will go into the new build, but we have no reason to think that it will have an impact on the outlay for the new building.

Mr KNOLL: Minister, why was this release in relation to TQEH the only Health announcement not subject to a press release?

The Hon. J.J. SNELLING: Sorry? Why was it not subject to a press release?

Mr KNOLL: Yes. There is $1.1 billion worth of spending, $900 million in capital spending, yet there is $250 million—

The Hon. J.J. SNELLING: I think there were lots of press releases about the spending.

Mr KNOLL: Sure, but not specifically in relation to TQEH upgrade.

The Hon. J.J. SNELLING: If we are here to talk about press releases—I know that the Premier and I had a press conference with the Treasurer, and with a number of other ministers, at The Queen Elizabeth Hospital on that Sunday—I am pretty sure I recall there being a press release.

Mr KNOLL: Considering the decision was made, we think, somewhere on 16or 17 June, if it is 36 hours before the Sunday June 18 announcement, which is less than a week before the budget was tabled, are there any statements or figures in the budget paper in relation to the new or existing projects that are now inaccurate?

The Hon. J.J. SNELLING: No.

Mr KNOLL: So there is nothing that would have changed as a result of—

The Hon. J.J. SNELLING: I would not anticipate the decision to keep cardiology services at The Queen Elizabeth Hospital to have any budget impact at this stage.

Mr KNOLL: On the same budget line, what is the government's commitment in relation to continuing respiratory services at TQEH?

The Hon. J.J. SNELLING: I think we have been working through these issues with our clinicians. The clinicians at The Queen Elizabeth Hospital are keen to have the specialist inpatient respiratory services moved, but we will continue to have respiratory services at The Queen Elizabeth Hospital, as we have indicated. There will be beds available for respiratory patients so that they can be admitted, and we will have respiratory physicians at The Queen Elizabeth Hospital looking after patients.

Mr KNOLL: Will the services be restored to pre Transforming Health levels?

The Hon. J.J. SNELLING: We are working through those issues with the clinicians. The clinicians are keen to consolidate and have services at the new Royal Adelaide Hospital but, as I said, we are working through these issues with the clinicians.

Mr KNOLL: Sorry, just to tease that out—

The Hon. J.J. SNELLING: We are going to have respiratory services at The Queen Elizabeth Hospital; that is the bottom line. We are working through the shape of them with our clinicians. It has been agreed that there will be beds available for respiratory patients. We will have respiratory physicians at The Queen Elizabeth Hospital able to provide services to patients. We certainly will have outpatient clinics at The Queen Elizabeth Hospital as well.

Mr KNOLL: Just to pick up on a point you made before that I want to clarify, you said that clinicians were keen to see services consolidated at NRAH.

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: But you are restoring them at TQEH.

The Hon. J.J. SNELLING: We are not shifting them. The plan was to shift all respiratory services to the new Royal Adelaide Hospital. The decision has been taken to retain respiratory services at The Queen Elizabeth Hospital.

Mr KNOLL: Hang on, you cannot have it both ways. Either the clinicians want the services to go to NRAH, be consolidated at NRAH, or the clinicians want the services to be retained at TQEH.

The Hon. J.J. SNELLING: Can you say that again?

Mr KNOLL: You were intimating that the clinicians were happy to see the services consolidated at NRAH, but you are also saying that clinicians want them to be kept at TQEH.

The Hon. J.J. SNELLING: No, the clinicians were keen to have the services at the new Royal Adelaide Hospital. What we are going to have is a single-service, two-site service. The service will be one service offered across two different sites. As I said, there will be inpatient beds available at The Queen Elizabeth Hospital for respiratory patients who require admission, and there will be respiratory positions at The Queen Elizabeth Hospital available to look after patients. There will be outpatient clinics at The Queen Elizabeth Hospital for respiratory patients as well.

Mr KNOLL: So with the single-service, double-site model, will those service levels be greater than what the service levels were pre Transforming Health or, indeed, more than we have today?

The Hon. J.J. SNELLING: They will be adequate to what the needs are for the hospital. Obviously we would expect the higher security patients, as is currently the case, to be transferred up to the new Royal Adelaide Hospital but, where it is possible to look after a patient at The Queen Elizabeth Hospital and do so safely, that is where they will be treated. I am not a health minister who goes telling doctors what is the best way to treat their patients. I allow clinicians to make those decisions and to decide where is the most appropriate place for their patients to go.

Mr KNOLL: Have all transfers out of respiratory services out of TQEH been stopped?

The Hon. J.J. SNELLING: No, they have not, because obviously we are realigning services between the two sites in line with what the clinicians tell us they want.

Mr KNOLL: Is part of the $250 million new project in relation to the commitment to retain respiratory services at TQEH?

The Hon. J.J. SNELLING: No, it is not. The $250 million is to build the new building, including the new rehab and new operating theatres and new emergency department, those buildings. I think it is entirely capital money. None of it is recurrent.

Mr KNOLL: Minister, you said publicly that the decision to restore cardiac services was a political decision.

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: Was the decision to restore respiratory services also a political decision?

The Hon. J.J. SNELLING: Yes, indeed.

Mr KNOLL: Is this a decision that is supported by clinicians?

The Hon. J.J. SNELLING: Some clinicians, but not all of them. Obviously, with regard to cardiology in particular, the clinical advice was mixed; some clinicians argued very, very strongly for cardiology to be completely consolidated at the new Royal Adelaide Hospital—at least the cath labs to be only at the new Royal Adelaide Hospital—and others, such as John Horowitz, had a different point of view. In the end the government made a political decision to retain cardiology at The Queen Elizabeth Hospital.

Mr KNOLL: I am quite interested in the fact that you admit both these decisions have been political, yet you are still unable to guarantee what sort of service levels there are going to be, whether they are back to pre Transforming Health levels—

The Hon. J.J. SNELLING: The job of a health minister is not to direct doctors on what is the most appropriate way and place to treat their patients. I leave that to the doctors to do. God help us if we should have a situation where a health minister tries to micromanage the way doctors care for their patients. It would be disastrous. My job as health minister is to listen to the clinical advice and make sure that we deliver services as safely and appropriately as possible.

Mr KNOLL: But hang on, you cannot have this both ways. You have said that these are political decisions, you have said they were made without clinicians' advice—

The Hon. J.J. SNELLING: No.

Mr KNOLL: You are saying now that there is divergent opinion about clinicians doing things.

The Hon. J.J. SNELLING: No, that is not true. What I have said is—

Mr KNOLL: You have admitted this is a political decision rather than a clinically led decision. You cannot have it both ways.

The Hon. J.J. SNELLING: That is not true.

Mr KNOLL: You cannot say that it is a political decision and then say—

The Hon. J.J. SNELLING: That is not true. What I said is the clinical advice was mixed. There was different clinical advice. There was clinical advice—

Mr KNOLL: You just chose to listen to a different set of clinical advice based on the political decision you wanted to make.

The Hon. J.J. SNELLING: Often, the job of a minister is to listen to different advice and to make a decision.

Mr KNOLL: So you only listen to clinical advice when it suits you?

The CHAIR: I would ask members to wait for the answer before you ask the next question.

Mr KNOLL: So, minister, you only listen to the clinical advice when it suits you?

The Hon. J.J. SNELLING: No, that is not a fair characterisation of what I have been saying.

Mr KNOLL: Does the Central Adelaide Local Health Network consider that there is enough room at NRAH to accommodate the respiratory services?

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: Saturday's Advertiser on 29 July just gone reported that the move of respiratory and cancer services from TQEH to NRAH is scheduled to commence on 18 September; is that still the case?

The Hon. J.J. SNELLING: That is my understanding, yes.

Mr KNOLL: So, again, you are unable to tell me at what levels respiratory services are going to be restored, but you are able to tell me that they are moving to NRAH on 18 September?

The Hon. J.J. SNELLING: There will be, as promised, cancer and respiratory services at The Queen Elizabeth Hospital.

Mr KNOLL: But you cannot tell me at what level of service that is going to be?

The Hon. J.J. SNELLING: What I can say is there will be inpatient beds available for both cancer and respiratory patients, and there will be cancer and respiratory physicians available at The Queen Elizabeth Hospital.

Mr KNOLL: You just do not know how many?

The Hon. J.J. SNELLING: We will work that out with our doctors, as I say. It is up to doctors to make decisions about the appropriate level of services at these sites.

Mr KNOLL: Well, we have to make a decision quickly.

The CHAIR: Order!

The Hon. J.J. SNELLING: What we are operating is a single service with respiratory and cancer, I would think, over two sites, all under the clinical governance of CALHN. These decisions about what is the most appropriate place to take patients are made by doctors. I am not going to stand looking over doctors' shoulders and telling them, 'No, this patient has to stay here. This patient has to go there.' These are decisions doctors make, not ministers.

Mr KNOLL: At what point in time, in the next six weeks before 18 September, is this decision going to be made?

The Hon. J.J. SNELLING: We will work through these issues. I understand the Chief Executive of Central Adelaide Local Health Network is working very, very hard with our clinicians to frame the shape of the services, and the heads of those services are working very, very hard, but the government's promise is that there will be respiratory, there will be cardiology and there will be respiratory services and cancer services retained at The Queen Elizabeth Hospital, and that is what is happening.

Mr KNOLL: How many beds will be transferred from 18 September?

The Hon. J.J. SNELLING: It is being decided and worked through with the Chief Executive of the Central Adelaide Local Health Network, as she works with clinicians.

Mr DULUK: Staying on page 26, what is the government's commitment in relation to continuing those oncology services at TQEH?

The Hon. J.J. SNELLING: Sorry?

Mr DULUK: What is the commitment in relation to continuing those oncology services at TQEH? Is it to restore them to a pre Transforming Health service level?

The Hon. J.J. SNELLING: Point of order, Madam Chair: is it in order for a member to ask exactly the same question that has just been asked?

Mr KNOLL: We are talking about oncology, not respiratory.

The Hon. J.J. SNELLING: The promise, and the government commitment, is to retain oncology services at The Queen Elizabeth Hospital. There will be oncology services there. As I said before, as with respiratory, there will be inpatient beds at The Queen Elizabeth Hospital for cancer patients who require it. We will be doing chemotherapy at The Queen Elizabeth Hospital. There will be oncologists, cancer doctors, at The Queen Elizabeth Hospital, so we will retain services.

Mr DULUK: Yes, but at the current—

The CHAIR: Order!

The Hon. J.J. SNELLING: It is a single service at The Queen Elizabeth Hospital—

The CHAIR: Please wait until the answer is finished.

The Hon. J.J. SNELLING: —a single service to site, so I will leave it to the doctors to make a decision about exactly what sort of patient goes where. I would expect the highest acuity patients would be going to the Royal Adelaide Hospital, and the lower acuity patients would be at The Queen Elizabeth Hospital in line with the service profiles of those two sites but, at the end of the day, these are decisions doctors make, not health ministers.

Mr DULUK: Is part of the $250 million for the new investment in capital projects related to your commitment to retain oncology services at TQEH and, if so, how much of that $250 million?

The Hon. J.J. SNELLING: No, it will not require any new money; as with respiratory, we do not expect it to. The $250 million, as I said, as with respiratory, is for the new capital build. That is to build the new rehabilitation service; the new emergency department; ambulatory care for outpatients; an operating theatre suite, including day surgery admissions; clinical support areas, including medical imaging and pharmacy; and brain and spinal injury rehabilitation, which is going to be transferred from Hampstead.

Mr DULUK: Was the decision to restore oncology services to TQEH a political decision as well?

The Hon. J.J. SNELLING: Yes.

Mr DULUK: Is it normal for you as the health minister to make decisions about services as political decisions?

The Hon. J.J. SNELLING: Occasionally, yes, particularly where you have conflicting clinical advice about what is the appropriate way forward.

Mr DULUK: Why was clinical advice followed in making the decisions around Transforming Health to strip oncology services at TQEH and now you are deciding to follow different clinical advice?

The Hon. J.J. SNELLING: There was never advice, nor was it ever the government's intention, to strip, as you say, oncology services from The Queen Elizabeth Hospital.

Mr DULUK: There was never any decision to strip oncology services?

The Hon. J.J. SNELLING: No.

Mr DULUK: So oncology services going forward will be exactly the same at TQEH as they were pre Transforming Health?

The Hon. J.J. SNELLING: No. Our hospital system is not static, although it was static during the Liberal Party's last time in office. I know from the comments of the Liberal Party—the Leader of the Opposition and the Hon. Stephen Wade—

Mr DULUK: Sorry, what budget line item are you referring to, minister?

The Hon. J.J. SNELLING: —they would prefer it to be static and, indeed, nothing change from the 1950s, but that is not my approach to health policy in this state. The way we run health policy is that we allow it to evolve and adapt to different needs of patients, changes in health care and changes in medical technology, so that is the way we will be proceeding. Most importantly, we listen to advice from clinicians about what is the best way to frame these services.

Mr KNOLL: On the same page of the hymnal, minister, will inpatient beds for cardiac services—let me be clear—at TQEH be restored to their pre Transforming Health levels?

The Hon. J.J. SNELLING: What we will do is we will work with clinicians about what their requirements are to continue to provide a cardiac service at The Queen Elizabeth Hospital. My understanding is that we are still working through those issues about exactly what their requirements are; it will depend upon the sorts of patients they are seeing.

My main commitment is the maintenance of the cath lab at The Queen Elizabeth Hospital. Obviously, there will be a need to have inpatient beds to support that cath lab, or access to inpatient beds, and that will be the case, but exactly how many inpatient beds we will require we need to work through with the clinicians who are providing the service.

Mr KNOLL: In relation to the cath lab, is the government going to refurbish or replace the current cath lab at TQEH?

The Hon. J.J. SNELLING: Yes, we will have to. We do acknowledge that the current equipment there will need to be replaced.

Mr KNOLL: How much will that cost and when will it be ready?

The Hon. J.J. SNELLING: We have a number of options available to us and, as I said, that will depend upon discussions with our clinicians about what their requirements will be.

Mr KNOLL: So there is nothing specifically in this year's budget about—

The Hon. J.J. SNELLING: We have not budgeted, but normally we would be able to meet these sorts of things within our existing equipment replacement budget or our normal programs. Our normal annual programs would be sufficient to replace this sort of equipment. I would not expect that it would be something that we would have to go back to budget for.

Mr KNOLL: But it has not been completed as yet?

The Hon. J.J. SNELLING: No, because we need to work through exactly what the requirements are with our clinicians at The Queen Elizabeth Hospital.

Mr KNOLL: Given that the clinical ambassador for Transforming Health, Professor Dorothy Keefe, told the Charles Sturt council in November 2016 that TQEH cath lab would be out of date by May 2017, when will it be updated?

The Hon. J.J. SNELLING: It will obviously be a priority, but we need to work through that with our clinicians. Obviously, the plan was not to have the cath lab there and now the decision has been made by the government to retain the cath lab at The Queen Elizabeth Hospital.

Mr KNOLL: Minister—

The Hon. J.J. SNELLING: If you could let me complete. You have asked a question; at least give me the courtesy of giving me an opportunity to answer it. Obviously, the decision was made that the cath lab, which we were not going to do, will need to be replaced. We acknowledge that. We will work with our clinicians to see exactly what their requirements will be. We will be in a position, hopefully, in the reasonably not too distant future to make a decision and make an announcement.

Mr KNOLL: Given the fact that Dorothy O'Keefe suggested that we have—

The Hon. J.J. SNELLING: It is not O'Keefe: it is just Keefe.

Mr KNOLL: —sorry, yes, Professor Keefe—a cath lab that is out of date now, what risks are there to patient safety and why has this not been dealt with before now?

The Hon. J.J. SNELLING: I do not think that is a reasonable characterisation of what she said. I think there is no doubt that the equipment will need to be replaced. We will do that as a priority, but we cannot do that work until we have made a decision with clinicians about exactly what their requirements are.

Mr KNOLL: Can you give a commitment that all the equipment that is there is in certification and in date?

The Hon. J.J. SNELLING: Absolutely, yes, and it is perfectly safe. There is no question over its safety or its suitability for the work that it is doing, but we certainly do acknowledge that it will need to be replaced as a priority, and that is why we are working through these issues with our clinicians.

Mr DULUK: On Budget Paper 4, Volume 3, page 27, looking at the NRAH project, about $111.4 million more was spent on the NRAH site works last year than was budgeted. What was this additional expenditure in relation to?

The Hon. J.J. SNELLING: The extra time in reaching technical completion and then commercial acceptance meant that we had to keep the project team in place longer. All those costs are related to that, our costs in keeping the project team in place longer than we were otherwise expecting, but it is important to point out that that was more than offset by the fact that we were not paying service payments as well.

From the previous estimates, this represents an increase of $112 million, which is primarily due to a 345-day delay in reaching technical completion, and reflects the revised opening date of 5 September. However, as I said, that was more than offset by the savings the government made because we were not paying service payments to the consortium. So we came out ahead.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, page 39, in relation to NRAH. By the time the hospital opens—and we assume that is 5 September—

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: —for how many days would the government have paid this service payment to the partnership?

The Hon. J.J. SNELLING: From commercial acceptance. We actually have not paid anything yet because the service payments are paid quarterly. I think the first payment is due—

Mr KNOLL: How much would you expect the invoice to be for between those two dates?

The Hon. J.J. SNELLING: You want to know how many days between commercial acceptance and 5 September? Is that basically what your question is?

Mr KNOLL: Yes.

The Hon. J.J. SNELLING: From 14 June to 5 September, basically. We think roughly 90 days.

Mr KNOLL: We do not need to do the maths on the fly.

The Hon. J.J. SNELLING: I should point out that it is important to note that, in that period, the hospital has not been sitting empty. We expect to start getting, hopefully, some patients in the next couple of weeks—hopefully, day surgery—and some radiotherapy for cancer patients. We are confident that will start happening in the next couple of weeks.

In addition to that, we have had an enormous amount of training going on, and the government has been completing its own schedule of works that needs to happen before we can start moving patients into the hospital. It has not been sitting there idle over this period of time.

Mr KNOLL: Minister, have you sought a discount to the daily rate that needs to be paid under the partnership agreement by the government to the consortium?

The Hon. J.J. SNELLING: Do you mean are we seeking remissions for other things?

Mr KNOLL: The cost of service is about $1 million a day.

The Hon. J.J. SNELLING: Roughly, yes.

Mr KNOLL: Have you sought a discount to that $1 million a day in relation to the—and I am not going to do the maths either, but it is somewhere over—

The Hon. J.J. SNELLING: In relation to the fact that we have not been able to move the—

Mr KNOLL: Yes.

The Hon. J.J. SNELLING: I have to be a bit careful with the commercial sensitivities around what I say, so I just need some advice. We are in discussions with Celsus about the first service payment. I cannot go into much detail about what those commercial negotiations involve and what they are about, but it certainly would be fair to say that we are in discussions and we are seeking a reduction in the amount we pay in this first quarter.

Mr KNOLL: Do you have a date when you expect those negotiations to be complete? I assume that they want some money at some point.

The Hon. J.J. SNELLING: We do not at the moment. I can find out. All these commercial discussions are very, very complex. We have a very strong contract with Celsus, and it does provide opportunities for the government to reclaim money where the consortium has not delivered the services we are paying for.

Mr KNOLL: What is the total amount of the annual service payment?

The Hon. J.J. SNELLING: The service payment is $396 million.

Mr KNOLL: What are the costs not covered by this annual service payment? What I am trying to get at is that the $396 million is for meals, maintenance and a whole heap of other things, but what is going to be the total cost to run NRAH on top of that service payment?

The Hon. J.J. SNELLING: The breakdown for this year, 2017-18, is $262,443,000, which is the service payment. That is the amount for the interest and the repayment of the principal. Separate to that, another $70 million pays for the non-clinical services and so on that are part of the contract.

Mr KNOLL: Sorry, the question was in relation to 'on top of that'. I am not talking about the 396, if that is what you are breaking down.

The Hon. J.J. SNELLING: On top of the cost of that are all our clinical services, which we cover and which already exist—payment of salaries for allied health, doctors, medical consumables, and all of those.

Mr KNOLL: How much is that?

The Hon. J.J. SNELLING: We do not have it. The annual budget of CALHN is over a billion dollars, so it is a significant amount of money for all those things.

Mr KNOLL: The hospital is going to open next week, or the week after, and completely open on 5 September, and you do not know how much it is going to cost to run the hospital?

The Hon. J.J. SNELLING: No, because it is going to cost what it is currently costing us to run the existing hospital. We already employ doctors and nurses and use medical consumables.

Mr KNOLL: Except for, obviously, decisions related to oncology, respiratory and cardiac, where issues still have not been resolved, as you said previously.

The Hon. J.J. SNELLING: No, they would all be met within the existing budget. We do not expect any of those decisions to have budget impacts. We do not expect us to have to go back to budget relating to any of those decisions, as I have already made clear.

Mr KNOLL: Except, for instance, in relation to cardiac under Transforming Health, six cardiac beds were cut at The QEH. You do not know whether or not they are going to be restored but you can tell me that there is no budget impact.

The Hon. J.J. SNELLING: We are talking about transferring beds. The number of beds we have in a hospital is not static; it is not something that does not change. The number of beds goes up and down according to the needs of our patients. Health is used to managing these sorts of changes, which can happen on a daily basis, and we do that very, very well. I am not quite sure what the member for Schubert is getting at, but we know what the service payment is, we know what it costs to run the existing hospital, and all the services from the current hospital are being shifted (the main part) to the new hospital and we are dealing with that.

Mr KNOLL: What proportion of the current RAH budgeted services will be covered by the annual service payment? You are paying an annual service payment in relation to a number of things that are non-clinician based. Those services are currently provided at the RAH but, given that we are moving to a new hospital, there is likely to be a difference in the cost from one to the other. I am asking about what proportion of the current RAH's budget will be covered in the new RAH by the annual service payment.

The Hon. J.J. SNELLING: Are you trying to ask how much extra we are going to have to pay for this new hospital over and above what we are paying for the old hospital? Is that essentially what you are asking?

Mr KNOLL: No, because you just said that everything should switch across, that there are no budgetary impacts and that these services are already there. The question I am asking is: in relation to the $396 million, which is going to be the cost in the new RAH—

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: —and obviously some of that cost is currently being expended at the old RAH, what proportion of the old RAH's budget is going to be transferred and paid for as part of this annual service payment?

The Hon. J.J. SNELLING: The cost of running the non-clinical services at the old Royal Adelaide Hospital is roughly $70 million, I am told. That money will go across to the new Royal Adelaide Hospital and form part of our payment to Celsus, the consortium, who are offering their non-clinical services. So it is roughly $70 million. As I said before, the $262 million is new money. That is the new money that covers the cost of the hospital, the repayment of the principal and the interest.

Mr KNOLL: If I can take you back to Budget Paper 4, Volume 3, page 27, in relation to the NRAH transition, is the ramp-down on track?

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: If that is the case—and on 24 July you said that the ramp-down was going to start, and at that point there were about 600 patients in the current RAH—as of 5.30 this morning there are 711 occupied beds with 36 people waiting and a capacity of only 684 beds. Would the minister like to revise his statement, given the fact that there are an extra 100 people in beds than when he started the ramp-down? Would you characterise this still as a ramp-down, or have we ramped up?

The Hon. J.J. SNELLING: We do not turn people away who present to our hospitals. When sick people turn up to any of our hospitals, we treat them, and I am certainly not going to turn people away. There is no doubt we have had a busy winter so far. We have started the ramp-down process, which is creating capacity in our hospitals. From day to day, our hospitals will have different levels of occupancy, but there is no doubt, particularly at the beginning of the week, that we are going to be very, very busy. I will invite the chief executive to make some remarks about ramp-down and where we are at and her confidence that we are on track.

Ms KAMINSKI: Thank you, minister. The ramp-down started on 24 July, and the idea is that across the health system we will do a few things—reduce the pressure on beds for the elective surgery components, so some of the less acute, elective surgeries will be delayed. We started that on the 24^th; if we had not done that, we would have seen a much greater demand for beds this morning when you checked the dashboard.

We do have a number of beds in our peri-urban hospitals that are vacant that we are going to be using when we get to the spot where we really empty out the Royal Adelaide Hospital to move it down North Terrace, so we are keeping an eye on those beds to make sure that the empty beds in peri-urban increase so that we can move people into those beds temporarily as we get closer to 5 September.

We have not done that yet because it is too disruptive, and the least disruption that we can have to patients when we move them around into peri-urban the better it is for them. As I say, we are keeping track of those empty beds, and we have a number of other contingencies lined up where we have private beds that we can move into and that we have actually contracted for.

I am confident that we are on track with the ramp-down, that the pressure we are seeing is winter demand and some of the flu impact, and that that will abate as we get closer to 5 September, and that we will have capacity to move our RAH patients to those other beds and reduce the number that we have to move down North Terrace.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, page 39. What is the total cost of the PR campaign currently underway in relation to the new Royal Adelaide Hospital?

The Hon. J.J. SNELLING: I will get back to you with the exact figure. I do not have it to hand and I would rather we make sure we get it correct.

Mr KNOLL: Could you also take on notice the elements of the campaign and the cost of each of the elements—a breakdown, if you will?

The Hon. J.J. SNELLING: If we are able to break down the detail, I am certainly happy to.

Mr KNOLL: We tried to ask these questions of the Premier last week, but he fairly and squarely pointed to you as somebody who could answer them.

The Hon. J.J. SNELLING: There is no doubt we can answer them. We just do not actually have that on us, and we would rather make sure we get it accurate than take a stab in the dark.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, page 39. What modifications to the hospital have been initiated, or planned to be undertaken, since commercial acceptance?

The Hon. J.J. SNELLING: Sorry, say that again?

Mr KNOLL: Commercial acceptance is on 16 June. What modifications have needed to be made or will be made since that point?

The Hon. J.J. SNELLING: We have certainly been undertaking our own works, which are already out there on the public record. We have been rolling out the CDI (clinical data integration). That is the system that runs in our operating theatres that provides information to surgeons and connections between the emergency department and the operating theatres, so that work is being undertaken. There has been other work to correct things. We have been doing things in the resuscitation rooms to meet the requirements of clinicians. A host of works has been undertaken, but all those works are on track. We do not expect any of them to have any impact on our ability to move on 5 September.

Mr KNOLL: Have any modifications been made or initiated to install an adult-sized change table?

The Hon. J.J. SNELLING: We anticipate that will be done after we open. We have certainly taken into account representations that have been made, mainly by the Hon. Kelly Vincent, to accommodate those needs, but they will happen after we move in.

Mr KNOLL: That will be something undertaken by the government, as opposed to the partnership?

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: Do you have an estimated cost of what that will be?

The Hon. J.J. SNELLING: I do not, but we do not expect that it would be significant.

Mr KNOLL: Has there been any need to have to rewire any of the surgical theatres?

The Hon. J.J. SNELLING: Only through the CDI, I think. The only rewiring that would have been done would be connected to the installation of the CDI. They are state works. They were always the responsibility of the state to install, so any rewiring that has been done has been part of that.

Mr KNOLL: Just to be clear, the cost of rewiring the CDI is all being borne by—

The Hon. J.J. SNELLING: It is all included as part of the normal state works; that is right. In the operating theatres, the only rewiring work that has been done, or any wiring that has been done, has been entirely related to our own state works and met within that budget.

Mr KNOLL: Have there been any modifications, besides the adult change table, that will need to be taken by the government—as in they are not part of works being done by the partnership?

The Hon. J.J. SNELLING: Any—

Mr KNOLL: Modifications.

The Hon. J.J. SNELLING: —modifications being done? With regard to modifications, obviously there have been some changes. You are talking about a hospital that was designed seven or eight years ago, so there has been some change in the requirements of the clinicians over that period of time, but it was always anticipated that that would happen. There will be some modifications after we move in that the state will have to deal with as part of our normal maintenance budget, but those are all pretty minor. Obviously, we had to make some changes to the resuscitation rooms in the emergency department, but those are near completion and will not affect our ability to move into the hospital.

Mr KNOLL: What is the total cost for this?

The Hon. J.J. SNELLING: It has all been met within the current budget, so we have not had to go over budget. It is all money that has been accounted for. We are talking about a very small amount of money in the context of the project.

Mr KNOLL: Sure, but my question was not where the money is going to come from; I am just asking how much more that is—

The Hon. J.J. SNELLING: It is coming from within the current budget.

Mr KNOLL: Sorry, that is not my question; my question is how much, not where?

The Hon. J.J. SNELLING: I will find out for you, but it is an insignificant amount of money.

Mr KNOLL: Are we talking about tens of thousands, or hundreds of thousands? When you are spending $2.3 billion on a hospital, a few million dollars seem insignificant.

The Hon. J.J. SNELLING: I will get the exact figure. We can get a breakdown of those costs for you.

Mr PISONI: I refer you to Budget Paper 4, Volume 3, page 27, which refers to the new Royal Adelaide Hospital. On 20 June, you were asked in the parliament about the cladding on the hospital. The question I asked you was, 'Will the minister now independently test the fascias to ensure that they meet Australian Standards?' This was after you were not able to tell the parliament where the fascias were made and where they were certified.

Yesterday, we heard from the Minister for Industrial Relations, Mr Rau, when he was giving evidence at a Senate inquiry into nonconforming building products, that there was a series of city buildings now that were receiving an audit after the Grenfell fire in London and that the new Royal Adelaide Hospital was one of those buildings. Yet, on 20 June, you said to the parliament, in answer to my question as to whether you would be seeking an independent test, that you would only do that or ask for that to be done if there were some uncertainty.

What has changed from your strong stance on 20 June, when you were convinced that the fascias met and conformed to Australian Standards, now the hospital is on the Minister for Industrial Relations' list of city buildings that are actually being audited in response to the Grenfell fire?

The Hon. J.J. SNELLING: Nothing has changed. At this stage, the audit is just to identify which buildings have cladding. The government has always been up-front: the new Royal Adelaide Hospital does have cladding. The audit has merely identified that fact. I can provide some more information about the cladding. All facade and curtain walling on the new Royal Adelaide Hospital is certified for use against the Australian Standards and Building Code of Australia requirements.

The BCA deals with the compliance for fire risk in construction and fire hazard properties. The cladding products were certified in Australia by CertMark International, a wholly Australian-owned, accredited certification body. Celsus (the consortium previously known as SA Health Partnership) is responsible for the design and construction of the new RAH, under the new RAH project agreement. The state set out, in its design requirements, that the new RAH facility must meet relevant Australian Standards and the requirements of the National Construction Code and the Building Code of Australia. The BCA deals with compliance with fire risk in construction and fire hazard properties.

The facade and curtain wall comprise a series of interlocking components including glass, metal, composite and aluminium. The components are extensively tested at the point of manufacture. In August 2013 the product used at the new RAH achieved a CodeMark Certificate of Conformity, which is current. CodeMark is a building product certification scheme that provides a nationally and internationally accredited process for assessment for compliance with the requirements of the BCA. That is the—

Mr PISONI: And the country of manufacture?

The Hon. J.J. SNELLING: My understanding is that it has been imported from China, but certified by CertMark International, an Australian-owned accredited certification body.

Mr PISONI: When was that certification?

The Hon. J.J. SNELLING: I do not have the date, but it is certified. If the member—

Mr PISONI: Was it before or after the Grenfell fire?

The Hon. J.J. SNELLING: It was August 2013 that it was certified.

Mr PISONI: So it was certified before changes to standards were implemented in 2016?

The Hon. J.J. SNELLING: All the advice I have is that the certification is current. If there have been changes to the standards, I am happy to check that out, but I am not aware of that. My advice is that the certification is current. If the member for Unley has some reason to raise any uncertainty about the certification process, I invite him to provide some evidence of that. I am certainly satisfied with the advice I have received that it has been appropriately certified and certified by an Australian company. There is no doubt in my mind of the appropriateness of the safety of the product but, as I said, if the member for Unley has some evidence contrary to that I would be happy to hear about it.

Mr PISONI: The Minister for Industrial Relations told the Senate committee yesterday that the audit process was a two-stage audit process and that the hospital would only receive the first stage of the audit process prior to the opening in September. What are the first and second stages of the audit process?

The Hon. J.J. SNELLING: You would need to speak to the Attorney-General, the Minister for Planning, although I can go through the information. Phase 1 is the identification of buildings suspected of having aluminium-composite cladding. That is the first stage—

Mr PISONI: So that is the first stage.

The Hon. J.J. SNELLING: Yes—and, yes, the new Royal Adelaide Hospital does have aluminium-composite cladding. Phase 2 is on-site inspection and desktop audit of associated documentation to identify, as far as is practical, responsibility for any noncompliance—designer, assessor, council, builder, owner. That is the second phase. I am providing that information to you here. We know who provided the material, where it came from, we know it has been certified and we know that it meets the Australian building standards with regard to fire risks. It does all those things, so while they will go through this process, we already know the answer to that.

Phase 3 is to respond based on the investigation findings, to undertake one or more actions; obviously, to do that. However, there is no information I have that it will not pass, that phase 3 would be necessary, because we already know who has provided it, we know it has been certified, we know it meets the fire retardancy standards. Indeed, I understand the Metropolitan Fire Service were in estimates and were specifically asked about the fire risks of the hospital, and they were quite emphatic that they were satisfied with the measures in place.

Mr PISONI: I will just take you to a media event where you were asked about the light poles in the grounds of the hospital, whether they were protected with a safety switch, as required under Australian Standard AS3000. Has it been confirmed that they did not, in fact, conform by having what is commonly known as a 'safety switch'? Has that been rectified?

The Hon. J.J. SNELLING: I can check that out, but I have to say the opposition are just so desperate to try to discredit this wonderful building and wonderful hospital that they will even come to criticising light poles. Of all the things that are happening in that hospital, you are worried about light poles. Goodness me!

I am happy to check out the light poles and make sure, but for anything that is being done by the builder the contractual requirements have been that they meet all the relevant building standards. To my knowledge, all those building standards have been met. If you have any evidence that they have not been met, I would be more than happy to hear it. If it were to be proven that building standards had not been met, then we would seek to make a recovery against Celsus for that, but I am not aware of any allegation where there is any substratum of fact that the light poles or anything else do not meet the required building standards.

Mr PISONI: Is there a dispute at the moment about the sign-off process? Were the light poles signed off as meeting standards before they were independently accredited? Is either your department or DPTI, which has been acting for you in some of these accreditation processes, now in dispute with the provider about who is responsible for making good the light poles?

The Hon. J.J. SNELLING: I am not aware of the independent certifier not certifying the light poles. I am happy to double-check that but, to my knowledge, there are no issues regarding the certification of light poles by the independent certifier. The way the process works is that the independent certifier tests everything and makes sure that the building meets what has been required of it from the contract, and then signs off on it. Through the commercial negotiations between Celsus and the government, we came to an arrangement that has already been made public whereby certain things were allowed to be completed post technical completion, so those works are being done, but there is no dispute with the independent certifier, to my knowledge, regarding the light poles.

Ms DIGANCE: I want to cross to the south and, in particular, I would like to go to the inner south. I was waiting for this topic to come up from those opposite, but it has not, so I will broach it. I have been doorknocking, and thanks to the member for Schubert for his advice on that. Minister, I was just wondering if you could please advise the committee about the future use of the Repatriation General Hospital site following handover of the site to the ACH Group. This is in reference to Budget Paper 4, Volume 3, page 33.

The Hon. J.J. SNELLING: I would be very happy to. The government entered into a contract for sale of the Repat General Hospital with the ACH Group on 8 June. ACH has said it will invest around $200 million on the site to deliver a unique health, education, ageing and veterans precinct. Importantly, a land management agreement is contained within the contract of sale describing what the land may be used for, and that land management agreement is in place for perpetuity. For example, the land must be used for healthcare, ageing and community-related purposes.

I am told the ACH Group's plan for the site includes some two to five-storey residential accommodation, including social and affordable housing; ageing in place; independent retirement living units; veterans' emergency housing; and student housing. However, despite the fear campaign and recent dissemination of flyers that insinuate that the site has been sold off as just a housing development, the ACH Group's vision for the site will ensure that the Repat remains a place where the community can access key health services.

The ACH Group has publicly stated that their vision for the site includes health and aged-care services, including transition care and day hospital services; both inpatient and outpatient services; education and training facilities; a research and innovation hub; veteran services; and allied health services, including medical imaging, pathology, podiatry and pharmacy. ACH is also committed to maintaining the heritage buildings on the site, particularly the chapel, the SPF Hall and the Peace Garden.

A small part of the site, incorporating the ViTA Buildings, Orthotics and Prosthetics SA and associated car parking is being retained by SA Health. The ACH Group's redevelopment is expected to generate up to 1,000 new jobs during construction and at least 250 ongoing health and other job opportunities. It is also expected to see more than 850 students participate in new service models and an additional $20 million per annum injected into the South Australian economy.

The CHAIR: Can I clarify the figure at the very beginning of that contribution, minister? Did you say $253 or $253 million?

The Hon. J.J. SNELLING: Do you mean $200 million as part of that answer?

The CHAIR: Yes, just at the very beginning.

The Hon. J.J. SNELLING: $200 million is being invested on the site.

The CHAIR: $250 million?

The Hon. J.J. SNELLING: $200 million is being invested on the site by the ACH Group.

Ms DIGANCE: I have a question that connects to this from Budget Paper 4, Volume 3, sub-program 2.3, page 47. Can you please advise the committee about how the Southern Adelaide Local Health Network will ensure ease of access to services at the Flinders Medical Centre, particularly for elderly or disabled persons who have previously accessed those services at the Repat?

The Hon. J.J. SNELLING: I certainly can. The Flinders Medical Centre will have increased car parking spaces with a brand-new 1,780-space multideck car park, with 1,220 more spaces than currently exist. The new car park is currently being constructed and will be available for use from October 2017. It will be located next to the new rehabilitation, palliative care and mental health building and will have 148 car parks for patients and visitors.

Within the patients and visitors' area, 14 of the car park spaces have been allocated as dedicated disability car parking, providing easy access for patients and clients. In addition, 10-minute drop-off zones are planned for the front of the new rehabilitation, palliative care and mental health building. Increased capacity for patients and visitors' car parking will also be made available within the Wilson's multistorey car park directly opposite the FMC main building. The staff parking is relocated to the new southern car park.

A dedicated free car park will be made available for families and visitors to the new palliative care unit. The area will be a monitored permit zone area, with permits for the area issued by the palliative care unit. There will also be more patient services transport staff to support the additional patients due to the relocation of services from the Repat to the FMC.

Mr DULUK: Sticking with Budget Paper 4, Volume 3, page 47, within the land management agreement is there a definition of 'community-related purposes'?

The Hon. J.J. SNELLING: I will have to get back to you on that, but my understanding would be that that is a fairly frequently used term and well understood. I do not think there are any issues with any uncertainty about that. In any case, I have complete confidence in the ACH Group to stick to the letter and certainly the spirit of what they have announced. I think any suggestion that ACH would deviate from what they have and turn it into some sort of housing development is a pretty terrible slander against—

Mr DULUK: Minister, there was no insinuation of that at all. I was just asking about a common—

The Hon. J.J. SNELLING: No, but your political party has certainly made that slander.

Mr DULUK: I was just asking about a definition within the land management agreement, minister; I am not asking about ACH.

The CHAIR: Order! I have a point of order on my right.

Ms DIGANCE: I would like to hear the answer, please.

Mr KNOLL: Point of order: which budget line is this commentary on?

The Hon. J.J. SNELLING: It was you who was asking the question. ACH Group has an excellent reputation in this state for delivering aged-care rehabilitation services. As I said, they will invest $200 million on that site. I think any insinuation that they would not stick to the agreement and stick to what is provided for in their contract is a slander against a very well-regarded South Australian not-for-profit.

Mr DULUK: Did the government instruct a valuation of the Repat site prior to preparation for sale?

The Hon. J.J. SNELLING: There was a valuation done on the site.

Mr DULUK: When was that done, this year, last year?

The Hon. J.J. SNELLING: I will check, but the Valuer-General, just as part of his normal course of things, would have an up-to-date valuation of the site.

Mr DULUK: So there was no third-party valuation of the site undertaken prior to sale?

The Hon. J.J. SNELLING: I would need to check, but there would be no reason to disagree in any way with what the Valuer-General's valuation was. Land valuation is derived very much from what the uses of the land are and, if you change how the land can be used, then obviously that will have an effect on the valuation. The government has been very clear about this: that any purchaser of the site would have contractual requirements placed on them about what could be placed on the site and that we would consult with the community, and in particular with veterans, about what could go on the site. All those things have happened. I think this has been an excellent process and we will see a significant improvement on the site from what is currently there—an increased range of services to local residents. I think it is a great outcome.

Mr DULUK: What price did the Valuer-General put on the land at that site?

The Hon. J.J. SNELLING: I will have to take that on notice and check. I would have thought that would be publicly available anyway, would it not?

Mr DULUK: I am just asking

The Hon. J.J. SNELLING: Anyway, I am happy to find out.

Mr DULUK: Was the sale of the land to ACH more than the Valuer-General's recommendation?

The Hon. J.J. SNELLING: I would need to check, but we went through a tender process; we invited people to put in tenders. However, I have to point out that a key requirement through the process, and a consideration in assessing the various expressions of interest, was actually what the plans were for services on the site. In fact, I think there was a higher value on that than there was on how much they were prepared to pay.

Certainly, from the government's point of view, it was far more important that, whoever the proponent was, what we would be looking most closely at was what they proposed to do with the site. We were not looking at some sort of fire sale where we were trying to get the highest bidder. If we were trying to do that, then obviously we would not have had the restrictions that we have placed on the site and we would have had proponents for a commercial redevelopment or a housing redevelopment or whatever on this site, but that is not what we were primarily interested in. Our interest was in what the services were, what was being proposed and how much they were proposing to invest. I can advise that a valuation was done by Knight Frank, an independent valuation, and that they valued the site at between $30 million and $34 million.

Mr DULUK: Did Knight Frank include any cost of remediation in the valuation?

The Hon. J.J. SNELLING: I would need to check. That was done in March 2016.

Mr DULUK: Have you read the Knight Frank report, minister?

The Hon. J.J. SNELLING: No, I have not, nor would I expect to. It is a pretty technical document.

Mr DULUK: I am just asking. In my previous life, I used to love reading Knight Frank valuation reports.

The Hon. J.J. SNELLING: Obviously, yes; you can take the boy out of the accountancy firm but you cannot take the accountancy firm out of the boy.

Mr DULUK: Not reading reports seems to be quite common in that department.

The Hon. J.J. SNELLING: Maybe one day in the next 100 years, the member for Davenport might have an opportunity to be a minister. You generally do not have time to sit reading through valuation reports that do not really concern you.

Mr DULUK: Are you saying that the sale of the Repat site does not concern you, minister?

The CHAIR: Order, member for Davenport!

The Hon. J.J. SNELLING: It does concern me, but the valuation report—

Mr DULUK: So would you not want to know what—

The CHAIR: Member for Davenport!

The Hon. J.J. SNELLING: —being done by Knight Frank does not. As I have said, my first concern was not over how much money the government was going to get from the land. We made that very, very—

Mr DULUK: The valuation report has nothing to do with how much money you are going to get for a site.

The CHAIR: Member for Davenport, I am on my feet. You are distressing me and I am not well. If you keep speaking over the minister, I will not give you the call.

Mr DULUK: Sorry, Chair.

The CHAIR: It is up to you whether or not you have another question today. Minister.

The Hon. J.J. SNELLING: Thank you, Madam Chair. Our first priority, our first concern, was what the various proponents who put in bids to partner with the government to redevelop the site proposed to do with the site. Without doubt, if we had taken a less restrictive policy we could have got a lot more for the site from a monetary point of view than we did, but that was not the policy the government wanted to pursue.

We were not interested in how much money we were going to get for the site or maximising the amount of money we were going to get for the site. Our interest was in who was going to redevelop the site, the sort of organisation that was going to do it, their reputability, their existing presence in delivering services of the sort we thought were appropriate and what they proposed for the site. Valuation was not at the front of my mind. Obviously, it had to be reasonable, but we were going through a full, open tender process.

The land is only really worth what someone is prepared to pay for it. As I say, we certainly could have got a lot more money for it if we had been less restrictive about what could be done with the site, but we were restrictive. We did take into account, in a significant way, what the various proponents were proposing for the site, and ACH had an excellent proposal. We are very pleased to be partnering with them. I think this is without doubt a huge win for the people of the inner southern suburbs.

Mr DULUK: Minister, can you confirm that the contract of sale is subject to the government approving a master plan for the site submitted by ACH?

The Hon. J.J. SNELLING: Yes, that is the case.

Mr DULUK: What parameters does the contract lay down for that master plan?

The Hon. J.J. SNELLING: We will have to get back to you with that sort of detail.

Mr DULUK: Will there be an opportunity for public comment on that master plan before the final approval?

The Hon. J.J. SNELLING: I will just need to check. We would follow the normal processes, whatever those are. I am happy to check and get back to you.

Mr DULUK: Are there any consequences if ACH does not submit a master plan in time?

The Hon. J.J. SNELLING: If they do not, then they cannot take it over.

Mr DULUK: Under the contract, what are the consequences if the government does not accept the master plan?

The Hon. J.J. SNELLING: I imagine that they would have to keep submitting master plans until they presented one we were satisfied with.

Mr DULUK: To date, is the government on track, or does it believe it is on track, for a handover and sale date in December?

The Hon. J.J. SNELLING: Yes, we are.

Mr DULUK: Are there any encumbrances on ACH Group in regard to their having the ability to onsell the land, or part of the land, at Daw Park to another party?

The Hon. J.J. SNELLING: They have freehold of the site, so they could, in theory, resell it, but whoever they sold it to would have to comply with the master plan.

Mr DULUK: And failure to comply in that regard?

The Hon. J.J. SNELLING: Then they would not be able to proceed with the sale. I presume that, through the normal planning process, whoever had purchased it would not be able to do whatever they wanted to do because they would not be able to pass the planning hurdles.

Mr DULUK: Staying on page 47, will you remove the prohibition on SA Health services operating on the Daw Park site, given the pressure on beds in hospitals, overflows and the fact that not all services currently provided there have found a new destination yet?

The Hon. J.J. SNELLING: Two services remain on the site: the prosthetics service, which we have always been up-front about, will continue on the site, and SA Medical Imaging has a presence on the site. We have taken the decision to allow that service to continue on that site for, I think, a period of three years. We have agreement from ACH on that as well.

Mr DULUK: You mentioned radiology. Will that be allowed to stay on the site?

The Hon. J.J. SNELLING: Yes, that is what I said: SA Medical Imaging will remain for a period of three years.

Mr DULUK: For a period of three years; and after that?

The Hon. J.J. SNELLING: Then we will review it, we will reassess it, but it will be providing outpatient medical imaging.

Mr DULUK: Is the three-year period in the ACH contract?

The Hon. J.J. SNELLING: I do not know the legalities of it, but we have agreement from ACH to allow for that to continue for a period of three years. At the end of the three years, we will reassess it. I do not want to put words in ACH's mouth, but I think it would be quite attractive for them to continue to have that presence there. There is no reason to think that they would not, but we are looking at what our needs are at the moment, so we have decided to keep and continue that presence there for three years, and then at the end of three years we will review it.

Mr DULUK: Did you receive any written advice on the suitability of Ward 18 for ongoing use as an older persons mental health facility?

The Hon. J.J. SNELLING: I did not get written advice because it was not something that we seriously considered. In any case, even if there were written advice by the department, it would probably go to the Minister for Mental Health. I spoke to the chief operating officer for SALHN about the suitability of Ward 18 for patients from Makk and McLeay wards, and his advice was quite emphatic, that it is not suitable for that. I am very confident that the solution the government has come up with to relocate patients to the new Northgate facility is far superior than we would be able to offer in the old Ward 18 for that particular cohort of patients.

Mr DULUK: Minister, please forgive my ignorance, but is the chief operating officer of SALHN a clinician?

The Hon. J.J. SNELLING: He is; he is a nurse.

Mr DULUK: Have there been any opposing clinician views in regard to the suitability of Ward 18?

The Hon. J.J. SNELLING: Not that I am aware. Certainly, no-one has come to me who has any knowledge of the matter.

Mr DULUK: Nobody within the whole of SA Health came to you and said, 'We should look at this as a possibility'?

The Hon. J.J. SNELLING: In a department of 30,000 people, no-one has come to me, no. You are talking about a department of 30,000 people, and of that 30,000 people I imagine they would think all sorts of things. There is no-one of any knowledge of this matter or whose advice I would seek who has approached me to suggest that the advice I have received from the chief operating officer of SAHLN is wrong.

Mr DULUK: What will be the net loss of inpatient beds in SAHLN when the Repat closes?

The Hon. J.J. SNELLING: It will be between 117 and 125.

Mr DULUK: To confirm, when the Repat closes, SAHLN will be down between 117 and 125 beds?

The Hon. J.J. SNELLING: That is right, but that does not mean that there will be fewer services or fewer procedures: we are massively increasing. We have two extra operating theatres at the Flinders Medical Centre and we have increased operating theatre capacity at Noarlunga Hospital. We expect the number of procedures being done at Noarlunga Hospital to significantly increase. We are also building the new rehabilitation and palliative care building at the Flinders Medical Centre. There are 70 new beds in the new rehabilitation and palliative care building at the Flinders Medical Centre. New developments at FMC include 55-bed rehabilitation, 15-bed palliative care and 30-bed Older Persons Mental Health Service in the new building to offset the—

Mr DULUK: To offset the 117 loss?

The Hon. J.J. SNELLING: No, to offset the closure of the beds at the Repat.

Mr DULUK: How many beds are there in Ward 18 at the moment?

The Hon. J.J. SNELLING: I do not have the exact number of beds; I can get that for you.

Mr DULUK: Is it about 30?

The Hon. J.J. SNELLING: I am not sure; I would need to check. I do not know the exact number of beds.

The CHAIR: You have one to finish off.

Mr DULUK: Minister, is the government still committed to honouring its undertaking to the ANMF that no bed would close in SAHLN until the need for that bed had been demonstrated to have been removed and warranted?

The Hon. J.J. SNELLING: Yes, we have certainly been working very closely with the ANMF about what has been happening at SAHLN, and about our plans for getting off the Repat site. Obviously they are not jumping for joy at the decision the government has taken, but I think they are satisfied with the process and satisfied with the measures that we have put in place to accommodate the increased patient load at both Noarlunga and Flinders Medical Centre as a result of this.

Mr DULUK: Is it fair to say that the Repat probably works at about 90 per cent capacity?

The Hon. J.J. SNELLING: I would need to check that: 90 per cent is my advice, yes.

Mr DULUK: That means that at any one time there are about 200 inpatient beds being used. We are losing 170 to 125. I would find it difficult that you are probably meeting that requirement or that agreement with the AMA(SA) in terms of the removal of beds?

The Hon. J.J. SNELLING: All I can say is that we have been working through all the relevant industrial bodies as we have made the reconfigurations that have been needed in the capital investments to support our getting off the Repat site. We are very comfortable with where it is at. Certainly, the ANMF has not come to me with any concerns about the process or the measures that we have taken to be able to accommodate that increase in patient load.

Mr DULUK: Has SAHLN made any provisions to deal with ramping and bedding capacity at the Flinders Medical Centre once the Repat closes?

The Hon. J.J. SNELLING: The Repat does not have an emergency department, so there is no issue there with regard to the emergency department—

Mr DULUK: Perhaps going the other way if I could at the same time, when the Flinders Medical Centre is working at full capacity—whether that be through the emergency centre and then out the back door—are patients transferred to the Repat to deal with capacity issues at the Flinders Medical Centre?

The Hon. J.J. SNELLING: We are confident with where it is all at, and we are confident that once we are off the Repat site we will be able to do that safely and effectively. We have increased operating theatre capacity at Noarlunga and we will have increased operating theatre at Flinders Medical Centre. With those measures in place, and with the new rehabilitation services being provided and a new state-of-the-art building, we are comfortable with where it is all at.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, page 58, which is in relation to SA Ambulance. Minister, how many of the additional 72 ambulance officers and support staff promised in February 2015 have been deployed?

The Hon. J.J. SNELLING: We have had difficulty recruiting paramedics, so that has taken much longer than was originally anticipated. Of the 70, I know that we have had a fair bit of success in recruiting a large proportion of that 70. I do not have the exact number who are out on the road, but my understanding is that if they are not already—or a significant proportion of them—they will be very shortly. But we have had difficulty recruiting paramedics.

Mr KNOLL: To be clear, you are saying that some have been recruited and that that cohort will be on the road soon?

The Hon. J.J. SNELLING: If they are not already. I just do not have that information in front of me. I know that we had had success. When I last spoke to the Chief Executive of the SA Ambulance Service, he said that we had had some success in recruiting a significant number of that 70. We might even have some information here. What I can provide are the full-time equivalents for the SA Ambulance Service for 2015-16, which was 1,244, and the number of full-time equivalents as at June 2017 was 1,349. So we have increased the size of the service by about 100.

We expect that figure to grow further as more of that 70 that we had promised come onto the road. We will get the exact number. The chief executive is just advising me that roughly just under half the 70 have so far been recruited. Obviously, there is an induction process and so on that we have to go through. As I say, if that 30 are not on the road, they will be shortly. We have identified a further 35 paramedics to take up those remaining positions, but they are still to be recruited.

Mr KNOLL: Given that the promise was made now 30 months ago, why did recruitment only start nine months ago?

The Hon. J.J. SNELLING: It was always envisaged that the recruitment of the 70 was not going to happen straightaway. It was announced as part of the Transforming Health reforms, but the need for those additional paramedics was to coincide with the reforms playing out, so it actually time lined when those additional 70 would be recruited. It was never the intention of the government to begin the recruitment of the 70 straightaway, so we have done it exactly in the time lines that were originally intended.

Mr KNOLL: Given the fact that, in the minister's and Premier's own statements, Transforming Health has finished, obviously it has not if these extra paramedics have not been recruited yet.

The Hon. J.J. SNELLING: It is shortly to finish. Obviously, we are not off the Repat site and the commissioning of the new Royal Adelaide Hospital is the last part of Transforming Health to be completed. It was always envisaged that we would recruit those additional paramedics as they were needed in line with what the business case modelling suggested as part of the Transforming Health business case. It was never the intention to recruit them straightaway. Indeed, I know the Ambulance Employees Association understood that because they have been lobbying me pretty consistently to have that brought forward.

Mr KNOLL: What commitments did the government recently give to the Ambulance Employees Association in terms of recurrent funding, staffing and capital expenditure?

The Hon. J.J. SNELLING: It was exactly what was publicly announced—that is, that we would set up a working group to work through what the workforce needs would be for the SA Ambulance Service going forward and that they would be represented on that, together with officials from Health. We have also asked a representative of the volunteer ambulance association to be involved in that working group. We expect its work to take between three and six months.

Mr KNOLL: Up until that three to six-month period is finished, you cannot tell us what the financial impact of this is going to be over this financial year in the forward estimates?

The Hon. J.J. SNELLING: No, not until that working group has completed its work.

Mr KNOLL: So there is nothing in the budget for 2017-18 in relation to this?

The Hon. J.J. SNELLING: No, nor would there be because that working group has to complete its work. Budget processes work by identifying what the workforce needs are and then you go through the budget process. You do not do it the other way around.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, page 27. In relation to the vehicle replacement annual program, why has the annual budget for the SA Ambulance Service's vehicle replacement program declined substantially over the past 10 years?

The Hon. J.J. SNELLING: I am aware that the Ambulance Employees Association have concerns about the SA ambulance fleet, in particular that vehicles continue to be in service after an agreed life span of over 250,000 kilometres or five years. We were told that when use for life was first extended in 2010 from three years automatic decommissioning out to five years or 250,000 kilometres, SA Ambulance Service wrote to the Ambulance Employees Association confirming that after such time vehicles would be decommissioned under the ambulance fleet replacement program.

Since 2010, this has been part of routine asset management. In 2017, some exceptions have been made to support the $22 million investment in stretchers. The imminent move to the new RAH plays a role. We have been holding ambulances back. It has been suggested that the Ambulance Service is not conducting all necessary servicing and therefore has unsafe ambulances on the road. This assertion is categorically rejected by the SA Ambulance Service. All SA Ambulance Service vehicles undertake approved engineering services at regular intervals. At every 10,000-kilometre interval, vehicles undergo A, B and C manufacturer recommended servicing.

An additional review, over and above the manufacturer's recommendations, was included when the vehicles were first life extended in 2010, known as a D service, which involved further chassis tests and a visual review by a clinician. This practice ceased in 2014 when it was deemed that this would not add value on a risk basis. Mercedes, the supplier of the vehicle, has confirmed that a chassis check is not part of their recommended service requirements for this type of vehicle, nor is such a check carried out in either Western Australia or Victoria, where the same vehicles are used. In Western Australia, vehicles are sometimes in service until they are 10 years old.

Satisfied that all vehicles being used by the SA Ambulance Service adhere to manufacturer recommended servicing, are fit for purpose and are being properly maintained, by the end of 2017 both NRAH and stretcher demands on the fleet will have been concluded and SAS can return to business as usual asset management. Currently, there are 76 in the SAS fleet exceeding five-year servicing, which includes 34 that have been strategically delayed for decommissioning pending the completion of installation of the new stretchers. We have had to hold some back because we have had ambulances off the road while we have installed the new stretchers in them.

This requires every vehicle to be off the road for a week. Without this move, which poses no risk to patient safety, it would have reduced the total number of ambulances on the road. An additional 41 vehicles over their five-year life have been retained either to support the new Royal Adelaide Hospital move, which will require significant resources, travelling short distances over and above business as usual for South Australia's, or either historical or training fleet not in everyday use. SAS is satisfied that each one of these vehicles has been checked and is fit for service. The budget for service vehicle replacement for this year is $5.9 million.

Mr KNOLL: Just to be clear, 76 vehicles are going to be kept in operation after the normal recommended 250,000-kilometre or five-year—

The Hon. J.J. SNELLING: There are currently 76 there, and they are for two reasons; one is to support the move to the new Royal Adelaide Hospital because we require additional ambulances for that and, if we did not get those ambulances back, then we would have to reduce the number of ambulances we had on the road, which obviously we do not want to do. There are 41 of those, and 34 have been held back for the commissioning of the new stretchers. Those vehicles need to be kept off the road while the new stretchers are installed. Once again, if we did not keep those ambulances back, we would have to reduce the size of the fleet while that work was being done. Once those two bodies of work have been completed, then we will go back to normal replacement rate.

Mr DULUK: I refer you to Budget Paper 4, Volume 3, page 39, SA Pathology. Obviously there is a commitment to reducing staff by about 196 throughout SA Pathology. I am sure that this will see a reduction in skilled staff along the line. How many skilled pathology staff will lose their jobs as part of this—

The Hon. J.J. SNELLING: It is not a commitment: it is a proposal on which we are consulting with the workforce and with the industrial bodies at the moment. A review undertaken by Ernst and Young in 2014 found that the structure of SA Pathology's laboratory services was inefficient. Its operating costs were considerably higher when compared to similar pathology services interstate and the UK's National Health Service.

Currently, SA Pathology is structured so that there is duplication of equipment and laboratory services between public hospitals, whereas the general trend in other services has been to consolidate. With improvements in technology, modern laboratory automation and IT systems it is now possible for pathology services to be provided more quickly, effectively and efficiently while still maintaining a high quality of care.

An efficiency improvement program commenced in May 2016. One initiative of this program was the reconfiguration of SA Pathology services and the creation of an integrated and flexible, high-quality public pathology service for South Australians. In November 2016, consultation papers were released proposing a new configuration with an initial estimated FTE reduction of 278, based on work that had been undertaken by Ernst and Young and Beeston Consulting. This estimated figure was a starting point for consultation with staff and unions. Consultation was held from 9 November to 20 December 2016 and a large amount of feedback was received.

Following this, there has been further extensive consultation and engagement with staff and unions. This included clinical, technical and scientific staff across SA Pathology as well as engagement with local health networks. Based on discussions arising from this process of revised operational configuration, more detailed work on the model has now been designed for consultation having regard to South Australia's unique requirements. On 31 May, a consultation paper was released to staff and unions, providing the revised operational configuration and workforce model for formal consultation, which now proposes a net reduction of 196.6 FTEs.

The efficiencies envisaged would be realised by the state-of-the-art diagnostic laboratory at the new Royal Adelaide Hospital, consolidation of specialised testing, a repurposed advanced diagnostic laboratory at Frome Road and the implementation of modern IT systems, notably EPLIS. These innovations enable improvements in the quality and consistency of care. Feedback about the current proposal is open until 21 July. Feedback is being considered by SA Pathology and a final announcement will be made.

Other areas of the workforce in SA Pathology still to be reviewed as part of this program of work will be subject to a separate consultation process. We will have more to say about this. We are considering the feedback we have received. I have met with Professions Australia and they have concerns. I have listened very carefully to what they and their members are saying and we are giving that consideration. I hope to be in a position to make an announcement about what the government proposes to do shortly.

Mr DULUK: Putting aside consultation and meeting with the professionals, what does the budget expect to save as a result of a reduction of 196 FTEs across the forward estimates?

The Hon. J.J. SNELLING: I do not have the figure, but it is no secret that SA Health has savings requirements on it. If for some reason those savings are not met, then one of two things has to happen: either we have to have additional funding to make up for the savings not being met, or alternatively we need to find the savings elsewhere. However, as I said, we are still considering the feedback we received. There is no doubt that what has been proposed is pretty ambitious, and I know there is a lot of uncertainty. A lot of the savings proposed very much hinge on the implementation of new technology—principally EPLIS, the new operating system—and the automation of the new Royal Adelaide Hospital. We are giving consideration to those things at the moment.

Mr DULUK: Obviously 196 jobs are going, and you would have done some modelling around efficiency and how you can still provide a service that you deem appropriate with 196 fewer FTEs. Surely you would be able to provide us today with roughly what the cost of those 196 FTEs is.

The Hon. J.J. SNELLING: We will achieve $25 million in savings.

Mr DULUK: In FTE savings?

The Hon. J.J. SNELLING: That is everything. That is a global amount but most of it would be FTEs.

Mr DULUK: And over the forward estimates?

The Hon. J.J. SNELLING: It is a four-year impact, so it would be $25 million every year.

Mr DULUK: In terms of the modelling of the impact on wait times and being able to prioritise non-urgent cases and the like, what impact will the staff reductions have?

The Hon. J.J. SNELLING: Obviously, we would be satisfied that it would not have any material impact on any of those things. We would not want to have any material impact on patient care in any way, so I would have to be satisfied, before we made a decision to go ahead with this, that there would not be any material impact on patient care, waiting times or anything like that.

The government has invested a significant amount of money and is in the process of investing a significant amount of money in EPLIS—the new IT system for our pathology services. That has so far successfully been rolled out in the Women's and Children's Hospital. At the moment, work is being done for its implementation in the new Royal Adelaide Hospital, so that has to happen.

The new pathology system at the new Royal Adelaide Hospital involves considerable automation. There is no doubt that, when you invest money in those sorts of new technologies, you should have the opportunity to be able to recover some of that through efficiencies gained from that investment, so that is really what we are looking at. I think there are some concerns about how quickly those sorts of savings can be generated, so we need to have a look at that and that is part of the consultation process we are going through at the moment.

Mr DULUK: Just to confirm, has modelling, a business case or a benefits realisation plan been undertaken to demonstrate that these new technologies will replace the massive loss of staff?

The Hon. J.J. SNELLING: That is part of the EY review.

Mr DULUK: So the modelling you have done is the EY review? The department itself has not done any in addition?

The Hon. J.J. SNELLING: Yes, EY and Beeston Consulting.

Mr DULUK: But no internal verification of that EY report has been undertaken?

The Hon. J.J. SNELLING: Yes, of course. We do not take as gospel what is provided to us. Obviously, we go through it, fact-check it and make sure that it all stacks up. Part of the process is not only Health's internal examination of what is being provided to us, but we also share that information with stakeholders which are, in this case, the various industrial bodies and our employees. We are getting feedback on that.

There is no doubt that the stakeholders and some of our employees have concerns about some of the assumptions made. They believe that there would be a material impact on patient care from the changes. At the moment, we are assessing that, and we will make a decision in the near future about to what extent we will be able to proceed with this.

Mr DULUK: I assume you have read the Ernst and Young report.

The Hon. J.J. SNELLING: I have been briefed on it. I do not read every consulting firm's report from cover to cover but I have certainly been—

Mr DULUK: Read the report where they recommend 196 job losses.

The Hon. J.J. SNELLING: —I have certainly been briefed on it in—

Members interjecting:

The CHAIR: Order!

Ms DIGANCE: Point of order.

Mr Duluk interjecting:

The CHAIR: There is a point of order, member for Davenport. I need you to stop.

Ms DIGANCE: Can the minister be given the chance to answer the question, please?

The CHAIR: Yes, I agree. You need to restrain yourselves.

The Hon. J.J. SNELLING: I have certainly been provided with a comprehensive briefing on the report by my department. We have just closed the consultation period. We are in the process now of assessing feedback from that consultation and will be in a position to make a decision shortly.

Mr KNOLL: I refer to Budget Paper 4, Volume 3, page 39. In relation to the Dental Service, how much commonwealth child dental benefits schedule revenue has the SA school dental service generated in each of the years of its operation?

The Hon. J.J. SNELLING: We will have to get back to you on that, but it would be a significant amount of money.

Mr KNOLL: Thank you; 'significant' is very specific. Can you also take on notice then how much national partnership agreement funding for the treatment of eligible adults SA has received in each of the years of its operation?

The Hon. J.J. SNELLING: As to the national partnership agreement on public dental services for adults, in the 2016-17 Mid-Year Economic and Fiscal Outlook, the federal government announced funding of $242.5 million nationally over 2½ years from 1 January to improve oral health through providing treatment to additional adult patients. Funding under this proposed arrangement is significantly lower than under previous agreements. States and territories continue to negotiate the terms of this agreement in good faith with the commonwealth.

Mr KNOLL: How much of that money is South Australia getting or proposed to get?

The Hon. J.J. SNELLING: The total figure for all national partnership agreements is 58.1. Our proportion of that $242.5 million, I imagine, would be our per capita, but sometimes they adjust it for other factors. It would be roughly our per capita amount, but sometimes the commonwealth do adjust these things based upon our age profile, utilisation of services and so on.

Mr KNOLL: Do you have how many additional eligible adults have been treated under this NPA funding compared with the number treated before the national partnership agreement?

The Hon. J.J. SNELLING: No, I would have to take that on notice.

Mr KNOLL: Can you also take on notice what the average cost was per eligible adult treated before the NPA funding became available?

The Hon. J.J. SNELLING: Sure, we can do that.

Mr KNOLL: If we can move on to Budget Paper 1, page 8, the Budget Overview on page 8 states, 'The Transforming Health program is now completed, having achieved significant reforms.' There is no need to stand with a sign on a battleship. The Premier has claimed that it was always intended that Transforming Health would conclude with the opening of the NRAH. Given that when Transforming Health was announced in February 2015 the new hospital was scheduled to open in April 2016, does the minister think that the Transforming Health program was achievable in 14 months?

The Hon. J.J. SNELLING: Sorry, I do not quite get what you are saying.

Mr KNOLL: You are saying that Transforming Health was supposed to have been completed with the opening of the NRAH. The NRAH was supposed to open in April 2016. Did you actually think you were going to get all the Transforming Health stuff done in 14 months?

The Hon. J.J. SNELLING: Transforming Health has always been about service configuration—which hospitals provide which services—and that work is largely complete. We have seen considerable benefits from realignment of services in the north between the Modbury and Lyell McEwin hospitals. We have also seen an expansion of services, because we have had additional services at the Lyell McEwin Hospital and new services that currently are there were not in the north at all at the Modbury Hospital, so we have seen some significant advances there.

In the south, we have seen the completion of works at Noarlunga Hospital, such as additional operating theatres. We are getting close to the completion of the new rehabilitation building at Flinders Medical Centre, so that will be complete very shortly. Once that is complete, along with the Jamie Larcombe Centre at Glenside, that will enable us to get off the old buildings at the Repat. So, it is largely to be complete. The new Royal Adelaide Hospital will enable the final realignment of services we anticipate happening in the centre.

Mr KNOLL: What is the level of recurrent health expenditure saved in this financial year compared with what was forecast under Transforming Health?

The Hon. J.J. SNELLING: I make no apologies: Transforming Health was never primarily aimed in the first instance at savings. I have always made it very, very clear that Transforming Health is about improving quality of care. We know that health services with poor quality of care are more expensive than health services that provide good quality of care because you have shorter length of stay, you have fewer medical errors requiring re-presentation and you have better outcomes all around. The first aim of Transforming Health was always achieving better outcomes and better quality of services and, from that, we expected that we would be able to harvest savings.

Mr KNOLL: What is the quantum of those savings that have now been harvested?

The Hon. J.J. SNELLING: My advice is $16 million, but that is offset by additional costs. We are having more staff being rostered on seven days, we are employing additional paramedics—

Mr KNOLL: That $16 million is—

The Hon. J.J. SNELLING: It is a gross figure. It is offset by increased expenditure.

Mr KNOLL: But it is per annum?

The Hon. J.J. SNELLING: It would be, yes, but offset, likewise per annum, by additional costs from the implementation of Transforming Health reforms. For example, we are having increased availability particularly of allied health across the roster across seven days a week, we are employing additional paramedics and we have an increase in presentations of about 2 per cent. Really what Transforming Health has enabled us to do is to accommodate those increased presentations largely within our existing beds. If we had not done that, we would have had to add to the number of beds that we have. So we have actually been able to accommodate the additional presentations.

It is not as straightforward as achieving savings. As I say, health is never static; you always have changes, but we have actually been able to keep the budget reasonably stable because of the changes we have made. It does not necessarily mean, and nor was it ever going to mean, that we would spend less money in health. We never envisaged that there would be a time when we would actually reduce the amount of money that we would spend in health. What it has meant is that the efficiencies have meant that we have been able to deal with more patients using roughly the same number of resources.

Mr KNOLL: Just to be clear, Transforming Health was predicted to save current expenditure of about $300 million, so I assume it is about $90 million to $100 million a year—

The Hon. J.J. SNELLING: No, that is not—

Mr KNOLL: —and essentially now you are saying—

The Hon. J.J. SNELLING: I will just correct you there. Transforming Health has never had a savings figure attached to it. Transforming Health has always been an enabler to improve quality of care in our hospitals. From that, we have always expected that our health system would be more efficient and that we would be in a better position to deal with increasing demand for our services in relation to an ageing population and the increasing complexity of patients who are coming to us. That has largely been achieved. We have been able to keep our health budget stable.

If we compare our health budget to requirements and people in the private sector and the sorts of increases we have seen in private health insurance, which has been growing, I think roughly compounding at 5 per cent year in, year out for a very long time, we have been able to keep growth in health expenditure in South Australia far more stable and at affordable levels, and Transforming Health has been a key enabler of that.

It has never been the ambition of Transforming Health to reduce health outlays in South Australia, because that would be impossible and reckless. It has always been about how do we get the best use of the resources that we have and primarily how do we achieve that through getting better outcomes for patients. It has never been a savings target that Transforming Health was expected to achieve because we are never going to get an actual net reduction, or a reduction, in health outlays.

Mr KNOLL: I refer to Budget Paper 5, page 51, health services additional resources, $65 million a year over three years to provide additional hospital services in South Australia. Is this to fund the shortfall created by the fact that Transforming Health has not achieved what originally the budget implications for Transforming Health were?

The Hon. J.J. SNELLING: It is about supplementing the funds Health has available to it to deal with the presentations we get. We get a certain number of presentations. We do not turn people away from our emergency departments. When they present to an emergency department, we treat them and, if they need to be admitted, we admit them, and we have to fund the health service to enable it to do that. Any supplement of any additional funding is to pay for our ability to continue to effectively and safely treat our patients.

Mr KNOLL: You said two minutes ago that Transforming Health has been able to keep the health budget relatively stable.

The Hon. J.J. SNELLING: Yes.

Mr KNOLL: But now we need an extra $200 million injected into the system because we need to fund—

The Hon. J.J. SNELLING: Over four years. We are talking about a budget of almost $6 billion. An increase in that is a relatively small amount in the context of an almost $6 billion budget.

Mr KNOLL: I am just trying to understand the conflict between the two statements.

The Hon. J.J. SNELLING: If the opposition is suggesting that they take a different approach, I would love to hear it.

Mr WHETSTONE: I would like to go to Budget Paper 4, Volume 4, page 83, Health Industries. Employee benefit expenses rose from $1.39 million in 2016-17 to $1.84 million. What was the reason for that, considering there were no extra employees?

The Hon. J.J. SNELLING: I will introduce Marco Baccanti, the Chief Executive of Health Industries SA. I think that Health Industries had a certain budgeted amount for employee expenditure. It has been substantially underspending that amount while it has ramped up, while it has taken on new employees—

Mr WHETSTONE: The same number of employees.

The Hon. J.J. SNELLING: The answer is that they were not in operation for the full year previously and there is an additional FTE in 2017-18. Now they are in operation for the full year, you are seeing a full year.

Mr WHETSTONE: There was more than $1 million of unbudgeted funding from the intragovernment transfer expenses in 2016-17. What was the reasoning behind the unbudgeted expenditure and where was the funding allocated?

The Hon. J.J. SNELLING: Sorry, say that again?

Mr WHETSTONE: There was $1 million of unbudgeted funding from intragovernment transfers.

The Hon. J.J. SNELLING: That would be assistance we provided to companies. We have provided funding to companies to assist them in establishing and investing in South Australia. Prior to last year's Mid-Year Budget Review, Health Industries did not have a fund to enable us to do that. The arrangement was that, where Health Industries believed it had a company that wanted government assistance to establish in South Australia, rather than using additional money and having a budget impact, through the cabinet process we sourced some of that funding from other fund lines within the Department of State Development.

Mr WHETSTONE: Health Industries is being delivered by the Investment Attraction agency. How much of that funding has already been spent and is it solely on grants to attract health industry businesses to South Australia?

The Hon. J.J. SNELLING: I cannot comment on the economic investment fund because that is administered by minister Hamilton-Smith. Health Industries has its own fund of $3 million a year, which is fully committed for last year and this year.

Mr WHETSTONE: What was the cost to establish the Health Industries fund?

The Hon. J.J. SNELLING: Previously, it was done within existing resources. There was no additional funding to enable its establishment. It was able to be done within the existing resources within Health Industries, and they would get some support from the Department of State Development and from SAFA as well; if we are making a loan or something like that to Health Industries, so we get advice from there. There was no additional cost; it would have been sourced from existing resources.

Mr WHETSTONE: Can you provide a breakdown of funding of the $4½ million that was distributed through grants and subsidies?

The Hon. J.J. SNELLING: A breakdown as in?

Mr WHETSTONE: What was the $4½ million used for?

The Hon. J.J. SNELLING: Do you mean in terms of the grant funding that has been provided to companies?

Mr WHETSTONE: Yes.

The Hon. J.J. SNELLING: I can have a look at that. Obviously, some of that would be commercial-in-confidence, but we are happy to get back to you with the information if it is appropriate and possible to provide it.

Mr WHETSTONE: There was a reference to delays in the implementation of marketing and international development activities and recruitment. What were the delays and why were there delays?

The Hon. J.J. SNELLING: In recruiting people, Mr Baccanti has taken care over who he has recruited; indeed, before we were able to recruit Mr Baccanti, before he started in the role, I think Health Industries existed for 12 or so months.

Mr WHETSTONE: How much was spent on promoting companies brought to South Australia by Health Industries SA in their targets for 2017-18?

The Hon. J.J. SNELLING: Do you mean have we spent money on the promotion of private companies?

Mr WHETSTONE: Well, outbound trade missions, inbound trade missions.

The Hon. J.J. SNELLING: You want to know how much we have spent?

Mr WHETSTONE: That would be nice.

The Hon. J.J. SNELLING: We can provide that; we can break that down.

The CHAIR: Member for Chaffey, one more question.

The Hon. J.J. SNELLING: Obviously, the cost would include travel costs for Mr Baccanti and anyone else, but normally I think that it is only Mr Baccanti. Sometimes the chairman of the Health Industries Advisory Board travels with him. There is the cost of brochures, accommodation, and those sorts of things, and we employ people who provide assistance to us overseas.

Mr WHETSTONE: The 2016-17 highlights include the attraction of several health industry-related companies. Given that there was no spend on grants and subsidies in 2016-17, where did the funding for the attraction come from?

The Hon. J.J. SNELLING: I am advised that we make the announcement, but we do not necessarily give the funding in that financial year. The funding could be allocated for future year budgets. Sometimes, the funding is dependent upon the firm reaching certain KPIs—employment milestones and so on—and then the funding would come across to them only on that basis.

The CHAIR: There being no further time for questions, I declare the examination of proposed payments completed.

Sitting suspended from 11:18 to 11:30.