DEPARTMENT OF HEALTH, $2,162,750,000

Witness:

The Hon. J.D. Hill, Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts.

Departmental Advisers:

Dr T. Sherbon, Chief Executive, Department of Health.

Mr J. O'Connor, Executive Director, Finance and Administration, Department of Health.

Mr G. Beltchev, Chief Executive, Country Health SA.

Ms N. Dantalis, Executive Director, Office of the Chief Executive.

The CHAIR: The estimates committees are a relatively informal procedure and, as such, there is no need to stand to ask or answer questions. The committee will determine an approximate time for the consideration of proposed payments to facilitate the changeover of departmental advisers. The minister and the lead speaker for the opposition have agreed on a timetable for today's proceedings and have provided the chair with a copy. Changes to the 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 18 July.

I propose to allow both the minister and the lead speaker for the opposition to make opening statements of about 10 minutes each. 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, at the discretion of the chair, ask a question. Questions must be based on lines of expenditure in the budget papers and must be identifiable and referenced. Members unable to complete their questions during the proceedings may submit them as questions on notice for inclusion on the House of 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 will be 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 will be directed to the minister, not the minister's advisers. I advise that, for the purposes of the committee, television coverage will be allowed from the northern and southern galleries.

I declare the proposed payments open for examination and refer members to the Budget Statement, in particular, pages 2.23 and 2.24, Appendix C, and the Portfolio Statement, Volume 2, Part 7. I call on the minister to introduce his advisers and make an opening statement if he chooses.

The Hon. J.D. HILL: Thank you, Mr Chairman, for the explanations. I acknowledge that the opposition and the government have reached agreement about the time arrangements. I will make an opening statement. Two and a half years ago, when I became Minister for Health, I said that we had a good health system in South Australia and that my ambition was to make it a great one. In the past 2½ years, this government has undertaken an ambitious program of legislative and operational reform to transform the system from good to great and to ensure that it is sustainable into the future. This budget is yet another step in that process.

The Health Care Act comes into force today. This means that for the first time the Department of Health will have direct responsibility and accountability for managing South Australia's public health system. It will be true to say that from this day on the buck truly stops with the minister and the departmental head. Until today the government has been responsible for funding the health system, but each individual board has had operational responsibility for individual hospitals and health units. Today will see the dissolution of the 44 country health boards, the three metropolitan boards, the ambulance (SAAS), IMVS, and the Repatriation General Hospital boards. From today, rather than having 50 different bodies trying to run different aspects of the health system in South Australia, the buck will stop with me, as Minister for Health. This direct line of responsibility and accountability established under the act will accelerate the reform process undertaken by this government. The 2008-09 state budget is yet another step in this government's continuing reform of the South Australian health care system.

When this government came to power in 2002, we inherited a system that was totally ill-prepared to cope with the increased demand created by an ageing population. Much of our state's health infrastructure was over 35 years old and was built to deal with a set of circumstances which had long since passed. Doing nothing and letting the system limp along on its path to collapse was not an option. The first step was the Generational Health Review, which focused on primary health care—that is, keeping South Australians healthy and out of hospital. The second step was modernising our health infrastructure.

South Australia's Health Care Plan is a detailed system-wide strategy that has been developed specifically for the needs of this state. It is a $2.2 billion plan, which is bringing together the metropolitan hospitals to provide a unified health care system. The centrepiece of the plan is the $1.7 billion Marjorie Jackson-Nelson hospital, which will replace the Royal Adelaide Hospital. This is the largest single capital investment ever made in health care in South Australia—and one of the largest ever made in Australia.

The 2008-09 investment program for the health portfolio is $290.8 million, and this will continue the work identified in the health care plan. Some $14.3 million has been allocated this year to commence site works and undertake other planning and consultation processes for the Marjorie Jackson-Nelson hospital. A preliminary master plan has been developed, and work will start on the site later this year. The 2008-09 capital investment program includes a further $112 million to continue redevelopment works at metropolitan hospitals, including $31.8 million towards stages B and C of the upgrade of the Lyell McEwin Hospital as part of the $336 million makeover, which is virtually doubling the number of beds and modernising that hospital; $62 million towards the $153 million Flinders Medical Centre redevelopment, which will include an expanded Emergency Department and new operating theatres; and $18.2 million as part of the $120 million stage 2 redevelopment of the Queen Elizabeth Hospital. Aside from transforming our health infrastructure, this government has also provided the additional operating funds needed to prepare our health system for the future.

This budget allocates $3.246 billion for health units in 2008-09; that is about $1.3 billion or 69 per cent more than what health units spent in 2001 (the last year of the former government). The extra funding allows us to treat more patients and employ more doctors and nurses. Between June 2002 and June 2007, we have employed an extra 2,406 nurses and 699 doctors into our health system. South Australia's Health Care Plan is about modernising our infrastructure and streamlining the system so that money is spent more wisely.

Every metropolitan hospital will have a defined role. Rather than competing with one another and creating unnecessary duplication in an attempt to be all things to all people, each hospital will have a defined role so that each part contributes to the system as a whole. General hospitals will focus on elective surgery, aged care, palliative care and rehabilitation, as well as general medical services and general surgery.

There will be four general hospitals in Adelaide—Modbury, Noarlunga, the Queen Elizabeth Hospital and the Repatriation General Hospital—and four general hospitals in the country—Port Lincoln, Whyalla, Berri and Mount Gambier. The three major hospitals in Adelaide will provide acute and specialist care in the north, south and central metropolitan areas. These hospitals are the Lyell McEwin Hospital, the Flinders Medical Centre, and the new Marjorie Jackson-Nelson hospital in the Adelaide CBD. The Women's and Children's Hospital will continue to be the main provider of maternity and paediatric health care to the patients and children of South Australia.

The Health Care Plan anticipates future demands on the health care system and introduces strategies to reduce the need for patients to access acute and emergency care wherever possible. The first step in preventative health programs is to keep people fit and healthy. Secondly, we are providing better primary health care resources closer to where people live, such as the out-of-hours GP Plus health care centres. These centres will provide additional nursing and allied health services so that GP Plus can offer a greater range of services for their homes to prevent admission to hospital or to enable patients to return home from hospital sooner. These reforms will enable South Australia to deliver Australia's most integrated, efficient health system and its most comprehensive primary health care system.

The needs of country areas are also being addressed through the Country Health Care Plan. The plan provides the way forward for a coordinated and integrated system of care for the residents of country South Australia. By providing a greater range of services in the country, we can, as far as possible, deliver complex health services closer to where people live and reduce the number of visits country patients will need to make to Adelaide hospitals.

Currently, on any given day there is an average of 550 country inpatients in metropolitan hospitals. More than 45 per cent of the public hospital acute inpatient costs spent on country people is spent in city hospitals. We wish to spend money on country patients wherever we can. The key strategies outlined in the plan focus on supporting country residents to take the best care of their health, ensuring primary health care services are locally accessible, optimising the use of the health workforce to ensure a balance between primary and specialised services, consolidating and coordinating specialised services to ensure sustainability, and high-quality care using advanced communication and information technologies.

The state government's annual spending on country health has risen dramatically over the past six years. In 2008-09, $591 million will be spent on public hospitals and health services in country South Australia. This is $210 million (55 per cent) more than in 2001-02. The budget also includes funding to continue or commence projects worth a total value of $92 million at the following country hospitals: $2.7 million in 2008-09 to continue the $36 million redevelopment of the Ceduna Hospital; $1 million in 2008-09 to commence a new $41 million project to redevelop the Berri Hospital; and $7.5 million in 2008-09 to commence a new $15 million project to redevelop the Whyalla Hospital.

The Health Care Act, which comes into effect today, will provide the legislative and operational framework to support our program of reform in both metropolitan and country South Australia by consolidating the governance structure of our health system. This will reduce existing fragmentation and unnecessary duplication within the public health system so that our resources can be used more efficiently. The legislation, like every other health reform put forward by the government, unfortunately has been opposed by our opposition. As the reform process of our health system is an ongoing project, an independent Health Performance Council has been established under the Health Care Act to oversee SA's public health system and advise me and all subsequent health ministers on how to improve it.

The council will be chaired by Ms Anne Dunn. The Health Performance Council will provide an annual report card to parliament on the health system and provide a four-yearly report on the health of our state. The reports will outline statewide trends and changes and show where we need to concentrate our resources to get the best results. Today I am also releasing a report—South Australia: Our Health and Health Services—which has been prepared by the department to provide the council with a starting point. The report shows that 83.2 per cent of South Australians over the age of 16 reported their health status as excellent, and as an ultimate measure of the effectiveness of the health system the average life expectancy at birth has increased steadily over the past 20 years. Particularly pleasing is the fact that South Australia has the lowest infant mortality rate in the country.

In closing, the 2008-09 budget provides the resources necessary to forge ahead with reforming the state's health care service. The 2008-09 budget will see total operating expenditure in the health portfolio reach $3.634 billion, an increase of $267.7 million (8 per cent) compared with the previous budget. We are increasing funding to health to meet the needs of today, and we are reforming the system to ensure that it continues to be sustainable into the future.

Ms CHAPMAN: I refer to Budget Paper 4, Volume 2, page 7.4. Can the minister advise how much provision is in the 2008-09 budget for him to pay out the contract of Dr Tony Sherbon upon his accepting a position with the federal government?

The Hon. J.D. HILL: That is a hypothetical question. There is no money in the budget papers to do such a thing, and it is an outrageous statement for the deputy leader to make as her opening question; however, I must say that it is typical of her style.

Ms CHAPMAN: I refer to Budget Paper 4, Volume 2, page 7.4. There is a reduction in your workforce, minister, from 26,826 to 26,766 full-time equivalents. There is an explanatory note for 2006-07 that relates to domiciliary care and Modbury Hospital staff changes, but this is from last year to the forthcoming year (which we are in currently).

What is the total number of doctors and nurses in the public health system, both full-time and full-time equivalent respectively, as at 30 June 2008? From my records, minister, I am still awaiting the same information for the financial year ending 30 June 2007 in answer to a question I asked on 20 June 2007, to which the minister responded, 'I will get back to you.'

The Hon. J.D. HILL: If I failed to provide information that I said I would, I apologise to the deputy leader and I will have it checked. The only information available at this stage for full-time equivalents is, of course, as at June 2007. It is impossible to say actually what the position was yesterday. It will take us time to get those figures detailed, and they will, of course, be published at the end-of-year reporting for these fields through me, as the minister, and the Auditor-General's Report. That information will not be available until late August or early September.

The estimates 2007-08/2008-09 target of the SA health FTE workforce summary and the Department of Health FTEs are based on an indicative full-time equivalent cap number, which is aligned to the budget in the Department of Health's Finance and Hyperion budget management systems. The cap has not been divided into regions or occupations.

In relation to the reduction in the number of officers in the department, I think the member herself highlights the reason for that, that is, some of the management changes with the transfer of services through Metropolitan Domiciliary Care to my colleague the Minister for Families and Communities.

The full-time equivalent cap for the Health portfolio in 2008-09 is 26,766, and this represents a decrease from the estimated result from 2007-08 of 60 full-time equivalents. The decrease is a result of the reduction in full-time equivalents and relates to the implementation of savings initiatives as part of the 2006-07 and 2007-08 state budgets, which relate to achievements of efficiencies and which support health reform packages. These reductions have not been targeted at front-line health services and will not result in any medical or nursing positions being lost. They have been administrative and back-of-house functions.

It is necessary to note that the reductions in full-time equivalents associated with savings initiatives effectively mask the budget increases associated with a range of initiatives previously announced by the government. So, there are ups and downs that happen at the same time. As I say, the other reductions have been noted in relation to some of the administrative changes.

Essentially, we have been streamlining the way the system works, reducing the number of administrative staff and increasing the number of clinical medical staff. When those figures are available (and my advice is that it will be towards the end of August), we will make sure that they are known publicly.

Ms CHAPMAN: Have I missed this, minister? Did you give me the figures for 2007?

The Hon. J.D. HILL: I cannot recall, but I will check to see whether or not I have.

The CHAIR: Order! Before we go any further, the process of estimates is that you ask a question through me. There will be no discussion between you and the minister resembling a conversation in a bar. You will ask questions, you will reference your questions. If you wish to ask supplementary questions, you will ask for my permission and I will consider it. This is your third question.

Ms CHAPMAN: With reference to Budget Paper 4, Volume 2, pages 7.4 and 7.14, will the minister confirm how much was spent on agency nursing in the financial year to 30 June 2008—and, if available, the amount for each hospital—and the amount budgeted for agency nursing in 2008-09?

The Hon. J.D. HILL: This question is similar to the question that was just asked. The information you are requesting is not in the budget papers. It will not be available until the end of year results are finalised, which is August-September, I understand.

Ms SIMMONS: I refer to Budget Paper 4, Volume 2, page 7.12. Why does the government want to build a new hospital rather than rebuild the existing hospital, and what would be the risks of changing the approach now?

The Hon. J.D. HILL: Just over a year ago the government announced its intention to build a $1.7 billion state-of-the-art hospital to open in 2016, replacing the ageing Royal Adelaide Hospital and incorporating some services from the Queen Elizabeth Hospital. This hospital will be the most advanced in Australia and provide brand new facilities for our doctors, nurses and patients. This major decision was not taken lightly.

As I have said many times, the government's first consideration was to rebuild the Royal Adelaide Hospital. However, as this option was investigated, it became quite clear that it was highly problematic operationally for the patients, staff and families, who would be disrupted by the major construction works on the constrained sites for many years; and, also, because of the time lines involved, rebuilding the hospital would take at least 15 years.

In comparison, we will build a brand new hospital without any disruption to patients at the Royal Adelaide Hospital, and this hospital will combine the best practice and patient care, environmental practice and medical technology and have more beds. It will be far more efficient than the existing hospital or even a redeveloped RAH site. It will also have the capacity for expansion in the future (unlike the existing constrained site); will be located next to rail, tram and road transport options; and will lead to a revitalisation of the west end of the city.

The suggestion that we should rebuild the RAH and use the railway land for a stadium is, of course, being promoted by the other side of politics, but we will look at that closely. When we studied rebuilding the RAH, the option was to begin work in 2007, so that is where we start the planning process. It would have cost $1.4 billion and would have taken at least 15 years if we had decided to rebuild the RAH starting in 2007, and that would have taken us through to 2021 or 2022. However, if we were to lose government and the opposition were to form government and then begin that process, it would not start, of course, until 2010.

These three years (the gap between 2007 and 2010) would have added to the construction time lines, the years of disruption for patients and staff, and the overall cost of the project. The Department of Health advises me that three years of delay for that already very long patch-up job would add approximately $370 million in escalation costs during the construction. This alone would take the cost of the Liberal policy to $1.75 billion (more expensive than the Marjorie Jackson-Nelson option), and it would not be finished until 2024 or 2025, some 15 years after the next election. On the other hand, if the Labor Party is successful, we will be able to open a new hospital in eight years' time. So there is a big difference in time lines.

There are also three other important factors that we need to take into account in relation to the other party's policy, all of which add significantly to cost. First, under Labor, from 2016, this state will have a brand new hospital—one of the most efficient in the world—and this will save at least $50 million a year. This means that, by the time the Liberals could have completed and upgraded their hospital eight or nine years later, they would have forgone at least $400 million in operating savings that they would have had by building the Marjorie Jackson-Nelson Hospital. The savings that could be made were a key factor in the government's decision to build a new hospital. These must be included in the cost of the Liberal Party policy as well.

Secondly, rebuilding the RAH will involve the progressive destruction of the old buildings as new ones are built. This will seriously impact the capacity of the hospital to undertake its day-to-day work. If the Liberals were to start rebuilding the hospital and it was not completed until 2024-25, the lack of capacity, combined with the increased amount for hospital services, would lead to a huge problem.

Most likely, we would have to extend another hospital to create the capacity for the patients who could no longer be served by the RAH over the construction period of some 15 or 16 years. We think at least $100 million in order to supply 150 beds of extra capacity would be required somewhere else. Lastly, by the time of the next election, of course, the PPP process (which we are already undertaking) will have spent money, and we estimate approximately $25 million in government funds would have been spent on the Marjorie Jackson-Nelson project which would be lost if the other option were pursued. Of course, the bidding consortia will have potential costs, as well.

If we combine these factors, the policy to rebuild the RAH starting in 2010 would cost at least $2.2 billion—approximately $500 million more than building a new hospital. These figures are a reality check for anyone proposing that the RAH is a cheaper option. Clearly, it is not. It would take longer—it would take until 2025—and it would cost something like $500 million extra if it were to be done. The cheapest and only realistic option—and the option that would provide the best outcome for the people of this state—is the greenfield development we are proposing on the site.

I will give those figures again. The projected cost of the new hospital when starting in 2010 is $1.677 million—and that is the total cost—and it will be completed by 2016. Rebuilding the RAH: projected costs when starting in 2010, $1.384 million; escalation costs from 2021 to 2025, $370 million; expenditure on the Marjorie Jackson-Nelson project 2007-10, $25 million (which would be lost); and the savings lost from 2016 to 2025, $400 million. That takes to $2.179 billion the cost of rebuilding the RAH.

Membership:

Ms F.E. Bedford substituted for Mrs R.K. Geraghty.

Ms SIMMONS: I refer to Budget Paper 4, Volume 2, sub-program 3.6, Portfolio Statement page 7.35. How will the Country Health Care Plan improve services for people in small country towns?

The Hon. J.D. HILL: The government's Country Health Care Plan will lead to improved services in country hospitals, more funding for country health, improved facilities and fewer people who need to travel to Adelaide for treatment. It will not lead to any hospital closures and will ensure that every hospital has access to emergency services. As I have been saying from the very beginning, this is a 10-year strategy, not a 10-minute strategy.

This plan has been released for consultation with the community. Of course, no matter how much you release for consultation there will always be complaints that there is too much detail or not enough detail. In this case, many people have told me that there is not enough certainty about what will happen for GP Plus emergency hospitals under the plan, even though we have made it clear that this is something on which we wish to consult. Given this uncertainty, I believe that further information needs to be provided to communities about our intentions in relation to these hospitals.

Today I inform the community that, of the 43 GP Plus emergency hospitals, 13 hospitals which have a stable workforce, population and activity will continue into the future with the current services available. I will name those hospitals: Kingston, Port Broughton, Cleve, Coober Pedy, Wudinna, Laura, Maitland, Mannum, Meningie, Penola, Riverton, Minlaton and Tumby Bay. In order to be absolutely clear, no material change is expected in the next 10 years (and that is as far as we are planning) as a sustainable, stable workforce is predicted and an established service profile is present. Medical acute admissions would be maintained. A mix of aged and acute care services will continue in these hospitals. These sites do not currently deliver birthing and/or surgical services.

I also indicate that three hospitals which have a stable workforce, population and activity range of services, including birthing and/or surgical, will continue their current service profile, as well. They are Crystal Book, Jamestown and Bordertown. Material change in the existing service profile, including birthing, surgical and acute medical admissions, is not expected during the 10 years of the plan, unless there is a dramatic change in workforce sustainability or compliance requirements related to safety and quality. So, we are not predicting any change in those three hospitals either.

There are 13 hospitals that undertake birthing and/or surgery that may change over the 10 years, subject to workforce and safety and quality compliance, but will maintain medical acute admissions. They are: Quorn, Peterborough, Streaky Bay, Booleroo Centre, Cummins, Kapunda, Strathalbyn, Balaklava, Renmark, Yorketown, Mount Pleasant, Loxton and Waikerie. Those are where we will keep a watching brief, but we would not expect that there would be much change over the 10 years—and that is, once again, subject to workforce and safety and quality compliance.

There are issues, of course, in relation to the Barossa, where there are two hospitals at the moment, and we will conduct a business case to see whether or not a new hospital should be developed. We are also upgrading the Berri Hospital.

There are 14 hospitals and two remote services where medical acute admissions may change over the 10 years, subject to workforce and safety and quality compliance. Those hospitals are: Elliston, Eudunda, Karoonda, Snowtown, Cowell, Hawker, Kimba, Lameroo, Tailem Bend, Orroroo, Burra, Gumeracha, Pinnaroo, Barmera, Leigh Creek and Woomera. The changes may occur as the services are not sustainable as they are, due to low activity, medical workforce retention issues or for other reasons.

This group needs to develop a service profile in consultation with local HACs, local government, local clinicians and the local Country Health SA executive staff. None of these sites delivers birthing and/or surgery at present. These GP Plus emergency hospitals may have the greatest opportunity to shift to an alternative workforce model than the traditional 2 by 2 by 2 nursing requirements. All services deliver co-located residential aged-care, which requires a minimum workforce.

This list of hospitals, which will also be the subject of ongoing consultation, really reflects that one of the key factors of our plan is to ensure that good quality services are still available in the country even as the workforce changes over the next decade. Most of these changes will happen in any case as the workforce changes. Each hospital has been categorised by the current and likely future workforce, current inpatient activity and safety and quality compliance. However, all categories are dependent on access to sustainable resident medical and nursing workforce and compliance with safety and quality requirements.

In regard to the last two categories of hospitals where changes may happen over the 10 years of the plan, subject to workforce and safety and quality compliance, I am today announcing that I will appoint a GP Plus emergency hospital task force to consult with the communities, doctors and nurses with respect to the future profiles for the GP Plus emergency hospitals—and, in particular, these are those likely to see some changes over the next 10 years. A prominent independent person will chair that group and we will seek representation from doctor groups, nurses and community leaders across country SA. I will also invite the Rural Doctors Association to participate in that task force.

The task force will take into account quality and safety, workforce consideration, local population, health needs, proximity of the hospital to a neighbouring community or general hospital and the duplication of activity in integrating with the work of the statewide clinical networks. The task force will commence this month and will work on these issues over the following six months. As each location is considered, the task group will systematically work through, in consultation with local HACs, local government and local clinicians, the role of each of the GP Plus emergency hospitals and two remote services.

I hope that this further information helps to clarify the situation regarding the GP Plus emergency hospitals and make clear the point that this was a 10-year strategy, not a 10-minute strategy, and that we will be able to work with local communities to get the outcomes that are in their best interests.

I am trying to find for members a statistic that indicates the change of services that has already happened over the last 10 years without any planning, which really highlights the need to have a strategic approach in relation to this, because what we see is ad hoc changes occurring without any kind of backup system in place to look after the communities. We are planning a consolidated approach so that, if individual hospitals lose services because of workforce changes, there is a system in place to ensure that services are still available to them. (I might find it during the course of the day.)

Ms SIMMONS: I refer to Budget Paper 4, Volume 2, page 7.13. The budget papers reflect a commitment to substantial investment in the metropolitan hospitals. How does this fit with the SA Health Care Plan?

The Hon. J.D. HILL: In 2008-09, the government will be investing $126.3 million to continue the development works at metropolitan hospitals in order to ensure we continue to respond to the needs of our community and provide the best possible health care and the best possible hospitals for South Australia. In addition to the $14.3 million to commence site works for the Marjorie Jackson-Nelson hospital, we will be investing $112 million in other metropolitan hospitals, including $18.2 for the Queen Elizabeth Hospital, stage 2 redevelopment; $31.8 for the Lyell McEwen Hospital redevelopment; and $62 million for the Flinders Medical Centre redevelopment.

The $153.68 million redevelopment of Flinders Medical Centre is particularly important for meeting the growing needs of the population in Adelaide's south. The Flinders Medical Centre redevelopment project includes a new three-level south wing to be linked to the existing building. The new south wing will be home to medical consulting clinics; a new labour and delivery ward; an obstetrics and gynaecology ward; and an expanded and redeveloped operating theatre suite will provide 12 new state-of-the-art operating theatres, including a first stage recovery area, staff change room, seminar rooms, offices and a new day surgery unit, including a second stage recovery area. The intensive care unit will be expanded by eight beds, taking the total number of beds to 32.

An expanded and redeveloped emergency department will be provided, including 21 additional treatment cubicles. This expanded service will be further supported through development of a new acute assessment unit. Other key elements of the Flinders Medical Centre redevelopment will include a new cardiac care unit and a major engineering plant and critical engineering services upgrade.

The Lyell McEwen Hospital is undergoing a $336 million makeover, virtually doubling the number of beds and modernising the hospital. Stage A was completed in June 2005 at a cost of $92.4 million and achieved: the improvement of women's and children's health services; enabled increased levels of surgery and ambulatory care; and enhanced the diagnostic services through expanded imaging services. Stage 2 of the redevelopment currently under construction (with a budget of $43.48 million) includes the refurbishment of in-patient and ancillary facilities, the creation of a pharmacy and extended emergency care unit, and an adult and aged acute mental health facility.

Construction of a new radiotherapy services facility using linear accelerated equipment is taking place simultaneously. Stage C, in line with the SA Health Care Plan, will further redevelop the services at Lyell McEwen, with 120 new beds and support facilities, a fit-out of the three vacant operating theatres, and an expansion of research facilities and allied health services. In addition to clinical services, a multideck car park and helipad will be included in the redevelopment.

The $120 million redevelopment of the Queen Elizabeth Hospital is occurring in order to achieve the requirements of the SA Health Care Plan and to meet the needs of the local community. The first component of these works consists of in-patient accommodation, day oncology and dialysis facilities, new car park, child-care centre and new research building, as well as site infrastructure and sustainment works. These works are due for completion by the end of this year. Planning of the second stage is presently being finalised and these works will further support the QEH in meeting the health needs of its local community.

Ms CHAPMAN: Minister, I refer to page 7.23. I will be referring to Budget Paper 4, Volume 2, unless otherwise identified. It relates to employee expenses. Upon the settlement (hopefully one day) of this marathon nightmare doctors' dispute, will the minister release the Reid McKay report for which taxpayers have paid nearly $80,000?

The Hon. J.D. HILL: The doctors' dispute, as the member said, has dragged on longer than I think any of us would have wished. The government has now offered up to 74 per cent increase in salary for certain categories of doctors, including those who have not taken industrial action. The 74 per cent increase would take category 9 consultants, the most senior consultants, from $198,000 (if they do not have access to private practice) to 350 something thousand. We think that we have made a very generous offer. I am very pleased that the emergency doctors and the intensive care doctors have withdrawn their resignations and that those matters have now been resolved in relation to that particular group.

Unfortunately, another group of doctors has said that the offer we have made is not substantial enough for them. That matter is still before the Industrial Relations Commission. It is a very difficult set of issues to resolve. We are trying to keep everyone happy. I feel like a kid playing with one of those toys where you bang down a peg and another peg pops up. We really do need to have a better system. I think the tactic of threatening to resign, which has now been used multiple times, is a little like the boy who cried wolf: eventually, some of these resignations may be accepted, and I think that would not be in the best interests of the doctors or the system.

I think it is a tactic from which the doctors' union should walk away. Certainly, our view is that there should be a longer period before resignations can be accepted. The current arrangements create a vulnerability in our system, which threatens our health services and the care of patients in our hospitals. Nonetheless, we hope that this matter will be resolved. The Reid-McKay report was produced to assist us in the development of our bid, and what happens to that in the future, I guess, is for the future to determine.

Ms CHAPMAN: I have a supplementary question.

The CHAIR: I will not know whether or not it is supplementary until I have heard the question.

Ms CHAPMAN: With reference to accepting the resignations, is that a threat or a promise?

The Hon. J.D. HILL: I just indicate that, eventually, people will resign. Those resignations will not be withdrawn and they will be accepted.

Ms CHAPMAN: I refer to Budget Paper 4, Volume 2, page 7.34 with respect to country health. The minister made a statement in a previous answer about the proposed services for each of the 43 hospitals in certain categories, and I note those. The last 17, of course, are those that are to have their services significantly reduced and, clearly, they are on notice as of today.

Given that the minister has indicated that there is to be consultation about the services (and, in general, the Country Health Plan) until the end of July, and notwithstanding that we are passing the budget bill in two days, have the 2008 and 2009 budgets been prepared for each of the country hospitals and, if not, when will they be provided and, if so, when can the minister provide those budgets together with a copy of the 2007-08 budgets for each of those hospitals or health services?

The Hon. J.D. HILL: The advice I have is that the CE will be issuing the general health budget to the Director of Country Health SA, Mr Beltchev, today. Mr Beltchev will then work on the allocation amongst the individual hospital units over the next month. So, in about a month's time we should have that detailed information.

Ms CHAPMAN: As a supplementary question, is that going to be—

The CHAIR: Be careful, member for Bragg, because this is your fourth question with your last supplementary. If I do not consider this to be a supplementary question, it will be your last question before we go back to the government.

Ms CHAPMAN: Mr Chairman, did you consider my last question to be a supplementary question?

The CHAIR: I did.

Ms CHAPMAN: Thank you. I will ask this question, and if you do not think it to be a supplementary—

The CHAIR: We will move on then.

Ms CHAPMAN: You will let me know?

The CHAIR: We will just move on. It is the exception rather than the rule, Victoria.

Ms CHAPMAN: I remind the Chairman that members of the committee are to be addressed as per their electorate.

The CHAIR: The member for Bragg will not respond to the Chair.

Ms CHAPMAN: I will.

The CHAIR: Ask the question.

Ms CHAPMAN: I will recall parliament if you like.

The CHAIR: Go ahead.

Ms CHAPMAN: It is up to you.

The CHAIR: If the member for Bragg wants to debate with me, we can bring back parliament and she can debate me there.

Ms CHAPMAN: Good-oh! My question, minister, as a supplementary, is that if that information is distributed to the member hospitals as such from country health (which is to be released today) within a month, will they receive that before the consultation period closes at the end of this month?

The Hon. J.D. HILL: The point about the consultation process and the plan for country health, which the deputy leader, perhaps, does not understand, is that this is a 10-year strategy for changes in country health, not a 10-minute strategy. So, clearly, the budgets will need to be allocated before the end of that process. There will be, I expect, some relatively minor changes in the next six months or so in some of the country health areas, but this is something which will evolve over time.

I know it is not in the political interests of the opposition to understand this, but what we are trying to do is to improve country health services so that there is a strategy in place which means that, wherever you are in the country, you have access to better health services. There are some very small health units which do not have a lot of capacity now—and we have seen this in the past—and which have been threatened when workforce changes occur. Sometimes it is impossible to replace individual doctors. We have seen a lot of hospitals which used to perform surgery and obstetrics but which no longer do so because of workforce changes in those communities.

If those changes happen dramatically—that is, overnight—what does that local community do to access health services? At the moment there is no strategy to provide them with any means to get access to those services; they have to do as best they can. What we want to do is to have a strategy in place so that we can plan for the changes which we know are inevitable and ensure that there are better services available closer to where people live.

The CHAIR: The member for Enfield has the call.

Ms CHAPMAN: On a point of order, Mr Chair: I seek that I be given a third question.

The CHAIR: No; it will be your fifth question if I give you another one. The member for Enfield has the call.

Ms CHAPMAN: Mr Chair, on a point of order.

The CHAIR: Order! Do not talk over me. Just sit back—

Ms CHAPMAN: Mr Chair, I am raising a point of order.

The CHAIR: Okay, what is it; what standing order?

Ms CHAPMAN: I am raising a point of order—

The CHAIR: Standing order?

Ms CHAPMAN: —that you indicated that my second question was a supplementary question a moment ago.

The CHAIR: Yes; that is right.

Ms CHAPMAN: So I am not quite sure how this would be my fifth question.

The CHAIR: No; if you ask another one now, it will be your fifth. You have had three questions and a supplementary, and another one would be five. So, no; the member for Enfield has the call.

Mr RAU: I refer to Budget Paper 4, Volume 2, sub-program 3.1: Portfolio Statement, page 7.9. What are the intended benefits of the amalgamation of existing public pathology services into one statewide service, SA Pathology?

The Hon. J.D. HILL: As of today, the new SA Pathology Service has been created. That brings together the services currently provided by the Institute of Medical and Veterinary Science (IMVS) SouthPath and the Women's and Children's Hospital Division of Laboratory Medicine. SA Pathology commenced today and will be incorporated into the Central Northern Adelaide Health Service. The names IMVS and Institute of Medical and Veterinary Science will remain in use for trading purposes. All staff, physical assets, property and liabilities of the three pathology entities will transfer in their entirety into the Central Northern Adelaide Health Service.

That new service, SA Pathology, is headed by an Executive Director who reports to the Department of Health through the Chief Executive Officer of the Central Northern Adelaide Health Service. We are very pleased that Associate Professor Ruth Salom (who comes from Victoria) has been appointed to the role of Executive Director, and is now working full-time in this role.

The SA Pathology project is very much on track. A project team was formed with membership from across the three services. A project director was also brought into the Department of Health from the pathology services to lead the project. Service level agreements have been developed between each of the health regions and SA Pathology, and the service level agreements have been developed based on the services which are currently provided and will be cost neutral.

The organisational structure of SA Pathology has also been finalised, and that will facilitate the delivery of a statewide pathology service. That has been widely accepted, I understand, by the staff of all three services. It has been agreed that directorate managers and clinical directors, in consultation with their staff and management groups, will be determining what particular services will be provided to ensure different services occur across the whole of SA Health.

Directorate management groups of each of the main disciplines of SA Pathology have been created and will ensure the involvement of operational staff in addressing key operational issues such as service coordination, integration, service and clinical protocols, and a range of other services, professional and clinical matters. A thorough due diligence process has been completed as well, and several staff information sessions, followed by staff surveys and so on, have been undertaken.

The need for consolidation of the three existing pathology services has been driven by increasing demand in South Australia for diagnostic services, the shortage of both medical and scientific staff in our state, the demand for new specialised and high-cost diagnostic technology and the need to maximise the use of financial resources.

Therefore, the benefits of bringing pathology services under a single provider include addressing staff shortages and ensuring adequate staff (both medical and scientific) are available across the state by providing an organisational structure that facilitates staff career opportunities which is enhanced by the creation of a statewide service, increasing retention and recruitment opportunities with improved succession planning and by providing access to salary sacrifice to some 1,200 staff at IMVS, and that is a major benefit to them.

An SA pathology teaching and training group is also being established, and that group will also be responsible for establishing the first-time training across all SA pathology. This will respond to increasing demand and address current and future workforce issues, particularly around teaching and training opportunities. The benefits of bringing pathology services under a single provider will also assist in meeting the demand for new specialised and high-cost diagnostic technology and the need to maximise the use of financial resources. There is much more that I could say, but I am very pleased that we have been able to bring this together, and I look forward to working with Professor Salom on its implementation.

Mr RAU: I refer to Budget Paper 4, page 7.3, which states that there are three metropolitan regions with the Repatriation General Hospital as a separately incorporated entity. Can the minister please tell the committee what the plans are for the Repatriation General Hospital, and how the government will ensure that the special health needs pertaining to veterans are met?

The Hon. J.D. HILL: The board of the Repatriation General Hospital met on 25 June this year and formally agreed to its dissolution and the transfer of the Repatriation General Hospital to the Southern Adelaide Health Service as of today. As I stated in parliament, the Repatriation General Hospital would remain separately incorporated until such time as the board chose to become part of the Southern Adelaide Health Service. It has now done so.

Before the board could make such a decision, it had to have the support of the Consultative Council of Ex-Service Organisations and the RSL. The Consultative Council, of course, is an independent body representing a wide range of veterans organisations. That council met with the Premier on 18 June together with me and the Minister for Veterans Affairs, and both the council and the RSL stated their support for the dissolution of the Repatriation General Hospital and for it to become part of the Southern Adelaide Health Service.

It also stated that it believed that this change would lead to the provision of better health services to veterans throughout South Australia, and a proclamation to this effect has now been issued by his Excellency, the Governor, in Executive Council.

There are no plans to change the Repatriation General Hospital other than that which I have just described, and we will ensure that we contribute to improved services for veterans and their families as part of the general Health Care Plan that we have already announced. As part of the assurances given to veterans that their special health needs would continue to be met, I will establish a Veterans' Health Advisory Council under the Health Care Act 2008.

The body, with the majority of members nominated by the RSL, will provide the Minister for Health with advice on health needs and priorities of veterans, advice on the delivery of health services to veterans and advocate on behalf of veterans and veterans' families to the minister. That council is expected to be established some time this month.

Mr RAU: I refer to the Portfolio Statement, page 7.12. Can the minister advise the committee how the Australian government GP super clinics initiative will fit in with the network of GP Plus health care centres that this government is starting to develop across the state?

The Hon. J.D. HILL: The establishment of GP super clinics is an Australian government program targeting 31 sites across Australia, with a total commitment of $220 million. In South Australia, there are three proposed sites for GP super clinics: one at Modbury ($12.5 million has been committed); one at Noarlunga ($12.5 million committed); and Playford North ($7.5 million).

The state government has agreed in principle to match the funding for both the Modbury and Noarlunga sites while the Australian government will fund the Playford North site in its own right completely. These GP super clinics are intended to 'provide infrastructure for general practitioners and other health professionals to work together in the one place, providing a greater range of quality services in local communities'. This is a similar aim to South Australia's GP Plus health care centres and is also consistent with the GP Plus Health Care Strategy of August 2008.

Planning for both the GP super clinics and GP Plus health care centres will be based upon the health needs of the community. Planning for both will also include consideration of the impact on existing practices, and any developments will not create competition with existing local GPs.

Depending on the needs identified in the community, it is expected a range of health services will be available for both the GP super clinics and GP Plus health care centres, including general practice, allied health, mental health, drug and alcohol, dental, nurse practitioner, counselling, diagnostic and some hospital outpatient services. South Australia will be playing a major role in the development of the GP super clinics, and these will be implemented as part of, and complementary to, the GP Plus health care strategy.

Representatives from SA Health, the Central Northern Adelaide and Southern Adelaide Health Services, Adelaide North East and Southern Adelaide Division of General Practices are currently working together on the roll-out of the GP super clinics at Modbury and Noarlunga as part of the overall strategy. Work on the Playford North GP super clinic, which is also to be a satellite of the Elizabeth GP Plus Health Care Centre, will follow at a later date.

The GP Plus Health Care Centre Woodville is an excellent example of government and non-government organisations, in this case SHine SA, joining together to improve primary health care services in areas of need. The building of that centre was completed in April 2007, with SHine SA providing services to the public from that month, and with other agencies commencing services by the end of July 2007. Services provided from the new facility include sexual health medical clinics, counselling, information and pregnancy counselling and related drop-in services, drug and alcohol and child and adolescent mental health counselling, psychological counselling, lifestyle counselling and medical deputising services. The total budget for the project was $5 million.

Provision of a $27 million GP Plus Health Care Centre at Marion has recently been announced as part of a major project, including the State Aquatic Centre, the GP Plus Health Care Centre and other development opportunities as identified by the preferred developer. The GP Plus Health Care Centre will create the opportunity to develop new models of care that respond to the government's health reform agenda, and that centre will provide comprehensive, accessible primary health care services, based on a client and family-centred approach, and will cover the same range of services which I have mentioned in relation to the others.

The GP Plus Health Care Centre at Elizabeth is also under way, and that centre will also provide a broad range of primary health care services, focused on prevention and disease management. The proposal to establish a $12.5 million purpose-built GP Plus Health Care Centre in Port Pirie to provide integrated primary health and allied health services is under way. These services will include Aboriginal health, health promotion, chronic disease prevention, community development, early intervention, mental health services, aged care services, palliative care services, women's health services, child development services, youth and family health and allied health services.

Ms CHAPMAN: I refer to page 7.34; still on country health. With the budget for country health having a gross extra funding for this forthcoming year of only $4.2 million—in fact, a net amount increase of $2.74 million—and the minister's announcement today that a number of hospitals will actually lose services, and a list of 17 particularly, the minister would be aware that notwithstanding the government's claim that better health services will be provided for country people, it is claimed that, in fact, there will be 2,835,000 more kilometres for country people to travel, 311,000 more litres of fuel and not enough beds in the draft plan that is currently out there. It is claimed, in the modelling, that that is actually going to add to the burden, both in cost and in health, to country people.

The Country Health SA: Annual Report 2006-07 states that, over three reports, it has spent $57,900 in preparation of those reports. Doubtless, there have been other reports during the last financial year (ending yesterday) in preparation for the modelling and some explanation as to justify the government's position, claiming better health, better access, etc. Will the minister table the reports prepared by Country Health SA, or his general department, that he says justify the better health outcome for country people, and will he do it this week so that there is some opportunity for country people, before the end of their consultation at the end of this month, to have a look at it?

The Hon. J.D. HILL: That is an extraordinary question from the deputy leader. It starts with an analysis of a statement made by an outside group (politically allied to the Liberal Party of South Australia), it then passes through the budget without much of a reference and then demands the tabling of reports. Let me go through all of those issues.

The Rural Doctors Association, I think, has to make a decision whether it is part of the solution or part of the problem. The exaggerated claims that they have been making—and this most recent set of claims about transport is another example—have been scaring people in the country. They need to decide whether they are going to be part of the solution of developing a better set of health services for people in the country or whether they are running a political campaign on behalf of their friends in the Liberal Party. It seems to me that is the option that they have chosen to date.

Can I say about their analysis of the amount of transport required: they are totally wrong. They have based their analysis on a lot of assumptions which are absolutely untrue, and there is not one skerrick of reasonableness in the claims that they have made. They have criticised me for not providing sufficient information, yet I have written to them and I have offered to go through all of the information and have officers in my department go through that information. They have rejected that offer. They purport to be an objective organisation, yet their putting that particular document out today is absolutely wrong.

In fact, the results will be the reverse of what they are suggesting. There will be less travel for people in the country. Already I am advised that in 2007-08, as a result of some of the changes we have made by increasing services in some of the bigger hospitals, there have been 1,500 fewer case-weighted separations of country people in metropolitan hospitals. In other words, that is 1,500 fewer case-weighted separations—that is the way these things are managed—occurred in the city than otherwise would have, and those people (however many individuals there are involved) will have had services provided to them in the country. So, the evidence is that the approach we are taking is actually working. More work is happening in country South Australia and, under our proposals, more still would occur.

There will be less need for people to travel to the city. Their proposition that people will need to catch ambulances from various locations because somehow or other there will be fewer emergency services, I once again absolutely categorically deny. It is not our intention—and it never was our intention—to reduce the level of emergency services. In country South Australia, people will still be able to attend local hospitals if they have an emergency situation.

Of course, whether or not there are doctors there depends very much on the individual doctors. We have seen many examples over recent years of country communities that have not been able to recruit doctors and, for a couple of years, there have been no doctors although nurses have been available. Those arrangements will still be in place. That will be backed up by a better managed and better integrated SA Retrieval Service which will bring together the resources of Flinders Medical Centre, the Royal Adelaide Hospital, the Flying Doctor Service and the Ambulance Service to support people in country South Australia who have emergencies which are such that they need to be taken to Adelaide. That is precisely what happens now.

We want to build up a different approach to country passenger transport. We have trialled a new approach on Yorke Peninsula with the passenger assisted transport service which has a bus service which collects people from their towns and drives them into Adelaide at a very minimal cost (a contribution of $10) so that people do not have to drive. They are taken to the hospital in Adelaide where they need to go and we would like to see that service rolled out across country South Australia. It is a great saving for people—they do not have to drive, they do not have to pay the petrol costs, so it is a reduction in the burden that is on them.

More people can access it than have been accessing the existing PATS service and, as members would know, under the existing PATS service you get no compensation for the first 100 kilometres of petrol costs. So, under this service, you pay the $10 and you get picked up—not from your front door but from a place in your town—driven to the hospital and then returned home. It is a much better service and they are much better transport arrangements. As we put more services into country South Australia, we will be able to build up those kinds of transport services to link communities to country towns, rather than people having to come to the city.

I absolutely 100 per cent reject the analysis done by the RDA to date as totally fallacious. There will be far less country travel as a result of the plan that we are developing—once again, over 10 years, not over a short period of time.

Ms CHAPMAN: I refer to pages 7.34 and 7.37 and, for the minister's benefit, the latter relates to the SA Ambulance Service. The increase in funding from 2007-08 to 2008-09 is some $3.37 million. Given that the minister has said that he does not think there will be any extra huge demand, I suppose that means he will not put any extra real money into it. What is concerning is a footnote on this page which suggests that someone is making an assessment that services previously defined as urgent are now going to be defined as non-urgent. That is at footnote (a) where it states:

...changes to call assessment procedures for cases linking with the Royal Flying Doctor Service have resulted in the reclassification of a number of cases from urgent to non-urgent.

My question is: who are the people assessing cases previously defined as urgent and redefining them as non-urgent, which is the cheaper option? What qualifications do they have?

The Hon. J.D. HILL: The Royal Flying Doctor Service is a third party, which we fund. As to who has made the decisions in relation to classifications, I will have to take it on notice. This is not something that has been done to reduce the level of service. It is about better providing services to people who need them.

In relation to ambulance services generally, the budget provides an additional $24.8 million over the next four years to assist with service delivery model changes to help meet the anticipated extra demand for ambulance and health services. It also provides an additional $1.8 million for an automated vehicle-location system. That means that the call centre will know where ambulances are and can better direct them to the closest location. It also means extra ambulances.

In this budget, we also fund 96,000 extra callouts for paramedics over the next four years. As we know, as the demand for health services increases, we have to provide more services. We want to not only invest more money in services, but we also want to make sure that we use existing resources as wisely as we can. So, there is a reform component in that system as well.

Ms CHAPMAN: Still on ambulance services, you have at this stage identified that it is expected that the PAT Scheme will be used more. I notice that there is not much more for SA Ambulance in the budget. On the last day of parliament, minister, you were asked to explain how much of this extra $24 million is actually going to be spent in Country Health SA. You could not answer it then, but what is your answer now?

The Hon. J.D. HILL: Work on that is still being determined. As I said, the CE will be providing Country Health SA with its overall budget, and the allocations will be determined over the course of the next month. I hope that, in the next month or so, we can give you a breakdown of all those figures. In relation to the PAT Scheme, we are actually putting more money into PATS every year as growth and demand goes up. What we want to do is use those resources in a better way. The trial in Yorke Peninsula has demonstrated that that can be done. So, within an existing funding envelope, we want to provide better services to more people.

The current PATS arrangement is worked out by giving a petrol allowance for every kilometre over 100 kilometres travelled by a patient. So, they pay the first 100 kilometres themselves and then we give them a subsidy for every kilometre beyond that. It does not apply to people who need allied or dental health services, or some other services, as well. It is limited in scope and it only kicks in after the first 100 kilometres and it does rely on people driving. Of course, many people when they are ill do not want to drive.

The arrangement we are trying to put in place is to have a bus service which picks them up in their own community, charges $10 as a flat fee (or thereabouts), takes them to the door of the hospital and then returns them to their own community. It will cover a broader range of people. Within the same financial envelope we will be able to provide a much better service.

Whether we are in government or you are in government, there is only so much money we are able to put into health. At the moment, as I indicated at the very beginning, we are putting up health funding again by about 8 or 9 per cent. We are doing it every year. Eventually by 2032 the entire state budget will be spent on health. So, as well as putting additional money in, we have to work out how to use the existing resources more wisely. The PATS scheme changes that I referred to is an example of that. In relation to the ambulance services, we will work that out over the next month or so as we develop the country health budget generally.

Ms CHAPMAN: I have a supplementary question, Mr Acting Chairman.

The ACTING CHAIR (Mr Rau): Please, let's not go down that track. Is it genuinely a supplementary question?

Ms CHAPMAN: It is genuinely a supplementary question. We are talking about the ambulance services, and with the minister obtaining these budgets that he is going to fly out over the next month, I just ask that the statewide retrieval service—

The ACTING CHAIR: If it is genuinely a supplementary question, go ahead.

Ms CHAPMAN: I ask the minister to also provide the current budget and the 2008-09 budget for the statewide retrieval service, which is the third arm of the provision of services to get people in and out of the country for their health services. That is at the Royal Adelaide and the Flinders Medical Centre.

The Hon. J.D. HILL: I will ask Dr Sherbon to talk about the statewide retrieval service, which I understand is in its early stages. I am happy to take that on notice and try to find whatever information we have, but I will get Dr Sherbon to comment on that.

Dr SHERBON: The statewide retrieval service is in stage 1 of the three stages of its formation. In this stage 1 process there will be greater coordination between the existing retrieval services, the coordination point within the department (Director of Statewide Retrieval), and its various partner organisations, such as the RFDS and the South Australian Ambulance Service.

There is no distinct entity at this point that is the statewide retrieval service; it is an aggregation of existing retrieval services, so it does not get a defined budget. As we move into stage 2, which will be a much more distinct corporate entity (in the second half of this year), we will be moving to a more distinct corporate entity, with centralised retrieval and operations. By the next financial year we will have a distinct budget for that entity as it is created over the next six months.

Ms BEDFORD: My question relates to Budget Paper 4, Volume 2, page 7.13. What benefits do significant biomedical equipment acquisitions bring to the delivery of health services?

The Hon. J.D. HILL: One of the factors driving costs, of course, in the health system is that there are more technologies available, more people who can access those technologies, and more doctors and others who can use those technologies. It means that people do live longer, and we have seen in South Australia one of the highest life expectancy rates in the world. At the last election the government committed an additional $20 million to buy additional biomedical equipment over four years.

From 2008-09 this funding increases by an additional $5 million per year, which is indexed as an ongoing item: $17 million has been allocated to this over three years. In 2007-08 some of the major equipment acquisitions included: an MRI at $2.4 million; a CT scanner at $1.3 million; an ultrasound scanner at $0.3 million; mobile image intensifiers at $0.5 million for the Flinders Medical Centre; and a gamma camera for the Royal Adelaide Hospital at $0.8 million. Other significant biomedical acquisitions in 2007-08 included: physiological monitoring systems for the Royal Adelaide Hospital and the Queen Elizabeth Hospital; a nuclear SPECT/CT imaging system for the Royal Adelaide Hospital; four ultrasound machines for the Queen Elizabeth Hospital; and radiology equipment for the Riverland Regional Health Service.

In 2008-09 the acquisitions from the additional funding will include: a 64 slide CT scanner for the Lyell McEwin Hospital; a cytology analyser for SA Pathology; and an electron microscope for the Women's and Children's Hospital. In addition to these funds the approved funding for the Marjorie Jackson-Nelson Hospital, the Queen Elizabeth Hospital, the Flinders Medical Centre and the Lyell McEwin Hospital will provide for major expenditure on new biomedical equipment for these sites.

In 2008-09 a linear accelerator is being commissioned at the Lyell McEwin Hospital. This expenditure assists in ensuring that the health system is equipped with the very latest in diagnostic and surgical equipment.

Ms BEDFORD: I refer to Budget Paper 4, Volume 2, page 7.9. Prior to the last federal election, the Australian Health Care Agreement was due to expire on 30 June this year. What does the future hold for the funding of health services in South Australia, and how will the relationship between the state government and the new Australian government improve health outcomes for South Australians?

The Hon. J.D. HILL: This is an important question. The current Australian Health Care Agreement, which provides the majority of the commonwealth's funding of public health services, was due to expire yesterday. As part of the recent meeting of the Council of Australian Governments (COAG), all Australian governments made an historic commitment to a comprehensive new reform agenda for Australia, with particular focus on a number of areas, including health. This reform agenda will be facilitated through reforms to the structure of the commonwealth-state funding arrangements currently being undertaken, which will enable the states to allocate commonwealth funding more effectively, leading to better use of public health resources.

From a health perspective, this will mean that the previously restrictive Australian health care agreement, which dictated the states would spend commonwealth funding on public hospital services only, will be broadened beyond acute care. States will be free to move funding within the Health portfolio to priority areas as clinical practices change preventative health and primary health care initiatives. In developing the new broader health care agreement, all Australian governments agreed that there would be a review of the indexation arrangements and that funding in the future should move to a proper long-term share of commonwealth funding for the public hospital system.

This new health care agreement is due to be signed in December 2008 and commence on 1 July next year. To help these time frames, the commonwealth agreed to roll over the current agreement into 2008-09, and it has put an extra $1 billion into the system. This decision, which provides SA with approximately an additional $79.5 million of funding over two years, can be seen as a first step towards a reversal of the declining share of public hospital funding by the commonwealth, which we witnessed over recent years. It is interesting to note that, if the previous Australian government had been as committed to increasing the funding of SA public health/hospital services as is this government, it would have been required to provide an extra $677 million over a four-year period from 2003-04 to 2006-07.

The new platform for cooperative reforms and investments will deliver real benefits for this state for our families and communities into the future. With the new spirit of cooperation that exists and a commitment to genuine partnership in governments and funding arrangements, we will be able to get real reform. We have already had breakthrough agreements in areas unresolved between the states and territories for too long. It will move on from a blame game to, hopefully, cooperation between the various levels.

We would hope to see clarification of roles and responsibilities, a reduction in duplication and waste, and enhanced accountability to the community. As evidence of the cooperative nature which exists between the two governments, South Australia is to receive additional funding to support essential health services such as elective surgery and dental health, and it is also expected that South Australia will receive around $15.2 million in 2008-09 for these two initiatives alone.

Ms BEDFORD: My final question refers again to Budget Paper 4, Volume 2, page 7.9. How will the Health Care Act 2008 improve governance arrangements for South Australia's public health system?

The Hon. J.D. HILL: The Health Care Act 2008, which generally comes into force today, introduces a range of governance reforms aimed at creating an integrated health system for South Australia, with improved statewide coordination and integration of public health services. The act will address the fragmentation and complex governance arrangements in the current health system, reforming them to create a system with streamlined governance and greater accountability.

Following the implementation of the act, the CE of SA Health will have direct responsibility and accountability for managing our health system. The regional boards will be dissolved, and regional chief executive officers will report directly to the chief executive of the Department of Health. The South Australian Ambulance Service will be transferred to the Department of Health also, with its own chief executive officer reporting directly to the Department of Health's chief executive. Then, of course, the chief executive is responsible to me, and I am responsible to the parliament; therefore, clearer accountability lines have been put in place.

In country areas from 1 July, Country Health SA will become an incorporated hospital, and all incorporated hospitals in country areas existing before that date will become sites of the Country Health SA Incorporated Hospital. Streamlining the governance structure of Country Health, the boards of the incorporated hospitals will be dissolved and the CE of Country Health will report to the CE of the Department of Health.

We have also set up Health Advisory Councils for those local communities to make sure that their voice is heard. The Country Health SA Board Health Advisory Council has also been created, and it will play an important role in overseeing the Country Health Advisory Councils and providing advice to me across a whole range of country issues.

Health Advisory Councils will also be created to represent a range of other communities, including the SA Ambulance Service, particularly the volunteers in relation to the SA Ambulance Service, and the Vets. HACs will ensure that the needs of particular communities from time to time can be communicated to me and to others.

We are also developing the Health Performance Council, which will come into effect today. It will provide independent advice to me, to the CE and to the parliament about the effectiveness of the health system and community engagement. In addition, the Health Performance Council will be required to provide four-yearly reports through me to the parliament, which will give us a good state of health in our state on a four-yearly basis.

Ms CHAPMAN: I refer to page 7.34: Country Health. In relation to consultation on the Health Care Plan, you indicated, minister, that there is an opportunity for feedback and, in fact, feedback forms have been made available for the community to tell you what they think about this proposal. As was highlighted at a meeting in Peterborough the other night, there is no address on the bottom of the form to send it to. When one of the attendees asked what the address was, the officer from your department did not know and suggested that they look on the website. My question is in relation to general consultation. Has any regional impact statement been done on the plan itself and, if so, by whom? Will you make it available?

The Hon. J.D. HILL: The Deputy Leader of the Opposition of course starts with a trivial matter and tries to suggest that somehow or other it is indicative—

Ms Chapman interjecting:

The CHAIR: Order! When the member asks questions with debate contained within them, the minister will respond in a like manner. If the member wishes to make a grievance, the house offers plenty of opportunity for her to do so. Rather than having this crossfire going on between the member and the minister, the committee would be better served if she allowed the minister to answer the question she has asked.

The Hon. J.D. HILL: I was making the point that it is unfortunate if an address was left off the form. These things happen from time to time, and it is always regrettable. However, I would have thought that the public of South Australia know how to contact the health minister. I was asked about this in a radio interview a week or so ago, and I made an apology at the time and said that people could send the form to me at Parliament House.

I can assure the Deputy Leader of the Opposition that plenty of people have worked out how to contact me as Minister for Health, so I do not think that it has in any way reduced the capacity of individuals to communicate or make contact with me. Obviously, we will take all those views on board.

As I say, we are still consulting on this, so it is impossible to say at this stage what the impact will be anywhere because it is out for consultation. The document has been published and, as you would know, one of the issues (and this is always the case when you go through consultation) is that if you go out broadly to the community and say, 'We are going to consult you over something,' they ask, 'What is it you plan?' So, you tell them roughly what it is you plan and then they say, 'You haven't consulted us.' You can never win with these things.

We have now said that we have come up with our plan, that this is it in broad terms and that it contains a whole range of options and things we want to talk to the community about. We have now come up with more specific information to try to provide clarity, certainty and confidence in the community, but we will not have a totally clear idea until after the consultation process and we have considered all the things people have had to say—because we do listen to what they have to say. At that point, we will be able to determine precisely what the impact will be particularly in the community.

Once again, this is a 10-year strategy and not something that will be dealt with in a very short period of time. Things will evolve. The point I make now and have made many times is that this is precisely what has been happening in country South Australia: over time, services in country towns have diminished in various ways. Smaller country communities have been losing doctors, birthing and obstetrics. For example, in the South-East, in Bordertown, over the past 10 years that community has lost two specialist general surgical services, local GP surgical and anaesthetist services, obstetrics, and two longstanding general practitioners. That is just in one country hospital. That is not as a result of any—

Ms Chapman interjecting:

The Hon. J.D. HILL: The smart comments do not assist. They are just a demonstration of your own personality. They do not help in any way whatsoever.

Ms Chapman interjecting:

The CHAIR: Order!

The Hon. J.D. HILL: The point I am making is: without any planning, without any thinking, and without any kind of effort, these quite significant services have disappeared from Bordertown, largely driven by workforce issues. At Kingston, for example, in the past 10 years, obstetrics and minor surgery have gone. At the Penola—

Ms CHAPMAN: I have a point of order, Mr Chairman. My question was specifically: has the government done a regional impact statement on this plan?

The CHAIR: Order! Thank you. Before I rule on your point of order, you can hardly expect a minister to sit there and listen to your interjections and your jibes and expect him not to respond to those. If you wish to just ask a question and sit back and listen to the answer, I will rule in your favour but, when you continually interject, interrupt the minister and try to debate the minister across the table, what do you expect him to do? He is responding to attacks from you. The minister was trying to answer your question and you began to interject. I do not uphold your point of order.

The Hon. J.D. HILL: To bring it to a conclusion, the question was: are there regional impact statements? I was demonstrating that changes have been occurring in country health over time as a result of workforce changes that have been unplanned. They have had big impacts on local communities. For example, as I indicated, obstetrics has gone from Kingston hospital. Who has planned that and what arrangements were put in place to deal with those situations? In the past, we have had individual hospital boards that have dealt with the services in their particular region. What we want to do is put in place a general system so we can anticipate these changes and make allowances in a positive way so that there are extra services provided in perhaps fewer centres, but at least those services are provided.

The regional impacts of all the changes that I have just described (and I could go through every hospital and tell you what is happening) have never been assessed, and no allowances have been made. It has just been allowed to drift on. We are planning to have a process in place so we can manage change in a sensible way and, at the end of this consultation process, we will give greater clarity to the community about what is intended and the rate at which the changes may occur. As I have indicated, in the vast majority of what we are calling GP Plus emergency hospitals, there will be no change, or very little change at all.

Ms CHAPMAN: My next question is: having not done a regional impact statement on the Health Care Plan, when will you be doing one, because it is government policy to do that on any change of services in the regions; and will you make it available?

The Hon. J.D. HILL: I have just said to the deputy leader that we are going through the process of developing in detail how this strategy will pan out over a period of time. There is an implication that I am obliged to do some particular kind of report in relation to this. This is something that will evolve over a period of time. It has been worked out in collaboration, I would hope, with the community. I have given clarity about how this will work in relation to individual hospitals. I have set up a task force, and I am sure it will give me advice about the implications of the proposed changes on the communities.

The point is that change is happening, anyway, without any consideration of the consequences on any of those communities. We want to develop a strategy which takes into account potential changes and maximises the services that we can continue to deliver. The Country Health Care Plan document which I presented a month or so ago gives a very good account, I think, of the impact on country South Australia of the arrangements that we currently have in place and the health outcomes for people in country South Australia, which are less good than for people in the city, and our goal will be to ensure that, over time, we can improve on that.

Ms CHAPMAN: I will ask my final question on country health and the plan. The plan is out for consultation. We will pass the budget for it in two days in this parliament, so the funding will be allocated. The plan will issue today to the head of Country Health SA, and over the next month he will distribute budgets to each of the health/hospital units; and the minister has identified today with some more specificity the services they will provide in the future.

At this stage there has been no environmental impact statement, other than as the minister indicates. There has been a general impact on the regions—I think that is obvious—some of which has not been documented. Government policy is that a regional impact statement must be done in relation to these plans. I ask again: minister, are you going to do one or are you going to get permission from the Premier not to do one?

The Hon. J.D. HILL: The deputy leader thinks she has found some sort of an Achilles heel in our approach here. I say again: this is a 10-year strategy.

Ms CHAPMAN: Do you want to debate it?

The Hon. J.D. HILL: You can debate it with me at any time, deputy leader. This is a 10-year strategy. We will be building up services in a range of communities and there will be positive impacts on those communities. In relation to the communities which are already losing services, obviously there are negative impacts on them directly because those services are going as a result of doctors' retiring or resigning, or for whatever reason not delivering the services they used to. For those people there is no back up. When the doctor who delivers those services (which might include birthing and surgical services) goes there is nothing in place for those people now. They have to make do with whatever arrangements to which they currently can get access.

Under our strategy they will have a place within 90 minutes for 96 per cent of them which will have better health care services and better hospital services than they currently have. I am happy to have a regional impact statement in the sense of being able to demonstrate where improvements are and what employment arrangements will be effected over the course of this plan. Largely, they will be positive. The deputy leader will be very disappointed when she sees the plan.

Ms SIMMONS: I refer to Budget Paper 4, Volume 2, sub-program 1.1, Portfolio Statement, page 7.15. The 2008-09 budget papers talk about funding for the blood, organ and tissue unit. Could the minister advise the committee of South Australia's organ donation performances?

The Hon. J.D. HILL: This is an issue of great interest to me as health minister. Recently, I had an opportunity to look very closely at this matter in another jurisdiction when I went to Spain last year. The Spanish government, of course, has probably the best organ donation system of anywhere in the world. The person who runs that program is coming to Adelaide later this month to attend a conference–and I will get into the detail of that.

During the 2007 calendar year, there were 27 organ donors in South Australia. Obviously, we are grateful to those donors for the gift of life they have given to so many transplant recipients. South Australia's donation rate of 17 donors per million population continues to be almost double that of the Australian rate of nine donors, but it is still below international standards. In order to help address that issue, we are having a National Organ Donation Summit on 8 and 9 July this year, and key speakers will be invited from two global leaders in organ donation—Spain and the United States. These countries have rates of 34 and 25 donors per million respectively.

This summit is supported by the Australian government and endorsed by my fellow health ministers across Australia. I expect the event to make a significant contribution towards helping us understand how we can improve rates both in South Australia and across the nation. Discussions will be centred on the issues of national governance, consent and family refusal, whether legislative changes are required and whether we can amend the clinical requirements for organ donation to occur after death.

While in Adelaide, Professor Matesanz, who is the director of the Spanish organ donation agency, will be reviewing our local hospital arrangements and providing advice and possible system improvements.

Strategies are already being adopted in South Australia to optimise organ donation rates by ensuring a coordinated statewide uptake of any proposed improvements and ensuring the engagement of all hospitals in this state. One such strategy is the appointment of a statewide medical adviser on organ donation, which will happen later this year.

South Australia has also become one of the few states in Australia to offer state funding to private hospitals to assist with the costs associated with organ donation. I know that South Australians are incredibly generous people, and many have indicated a wish to be organ donors upon their death. I want to make this as easy for them as possible, whether or not the death occurs in the public or the private hospital system.

I invite parliamentary colleagues to attend the free interactive public lecture following the summit to hear our international summit speakers discuss developments in organ donation and hear reports and summit outcomes. That lecture will take place on Wednesday 9 July at the Hyatt Regency, Adelaide, on North Terrace at 5.30pm.

Ms SIMMONS: I refer to Budget Paper 4, Volume 2, page 7.9. One of the 2007-08 health highlights is reducing waiting times for people requiring restorative dental care to 18 months at June 2008. What will be the impact in South Australia of the Australian government's decision to reintroduce the commonwealth dental health program from July 2008—from today?

The Hon. J.D. HILL: The waiting time for restorative dental care reached a peak of 49 months in mid-2002. Since that time, we have provided an additional $56 million for public dental services, which has resulted in waiting times being reduced to 18 months by June 2008. So, 49 months to 18 months is a pretty significant turnaround. The number of people on the restorative dentistry waiting list has also been reduced from 82,000 in mid-2002 to 33,000 in April this year. That is a 60 per cent reduction and represents the lowest number of people waiting for dental health care since the loss of the commonwealth dental health program in 1996.

The reintroduction of the Commonwealth Dental Health Program from July this year (today) will provide an additional $7 million approximately for public dental services each year and will result in a major improvement in access to public dental care. Waiting lists for public dental care will rapidly reduce from approximately 19 months in June this year to, we expect, about 11 months by June next year and are expected to fall further in subsequent years. As the program is further extended, adult concession card holders will be able to enrol for regular check-ups and preventative dental care—and that is the situation we would like to get to; we are not just dealing with emergency work.

In addition, the Commonwealth Dental Health Program will enable adult concession card holders with oral health conditions that affect their medical conditions, or whose oral health is affected by poor general health, to receive enhanced access to public dental services. This component of the Commonwealth Dental Health Program replaces the previous federal government's Medicare dental program for people with chronic medical conditions.

In addition, from July this year the Australian government is introducing the Teen Dental Plan, which is funded at $490.7 million over five years. Under this program, Medicare will issue an annual $150 voucher to children aged from 12 to 17 to cover the cost of a preventative dental check-up every year. This program was initially limited to private dentists, but the Australian government has recently decided that teenagers will also be able to redeem the dental plan voucher in the school dental service, which is a good thing. To be eligible for the plan, the teenager must be eligible for Abstudy, the youth allowance or be from a family that is eligible for Family Tax Benefit A (and this, indeed, covers most children). No co-payment will be charged for children in this group.

Ms SIMMONS: I refer to Budget Paper 4, Volume 2, page 7.5. The 2008-09 budget papers identify SA Health as the lead agency to achieve the South Australian Strategic Plan target (T2.2) in relation to the proportion of South Australians at a healthy weight. Can the minister please explain what EPODE is and how it will assist South Australians to eat a healthy diet for good health and obesity prevention?

The Hon. J.D. HILL: On the last day of March this year, I was delighted to announce the government's proposal to import a healthy living program, which was pioneered in France, to fight childhood obesity. The EPODE program (Ensemble, prevenons l'obesite des enfants—or Together, let's prevent obesity in children) is helping French children maintain a healthy weight and get fit, and will be introduced across the state to help South Australian children.

Up to 20 sites across the state will be chosen over the next four years, with almost $2 million allocated over the next 12 months to establish the first five sites. Up to 200 schools across the state will be recruited over the next four years to spearhead the program across the 20 sites, offering intensive support for healthy eating and physical activity for children. That is on top of a $14 million investment in fighting childhood obesity that we announced last year.

EPODE is a successful program run across more than 160 communities in France, with proven results in helping combat obesity in kids. The program has now been adopted in Belgium and Spain, and is now expanding to Greece and Canada, with interest from many other locations as well. Results from the initial trial of 10 towns show that not only had the children acquired a better knowledge of nutrition but they had also significantly modified their eating habits. For example, the number of families who ate chips once a week fell from 56 per cent to less than 40 per cent. Obesity in children did not increase during 1992 to 2000, while in other regions it doubled.

The initiative will involve the whole community, with leadership from local government, active participation of health services, businesses, shops, workplaces and community organisations. The EPODE approach works closely and intensively with communities—we know this is what makes a difference. Schools are an important focus and up to 200 schools will be involved in 20 different geographic locations. Intensive support for healthy eating and physical activity is provided to students, teachers and parents. Working through both schools and communities at the same time offers the best chance for success in childhood obesity, so we need to expand gradually and maximise our efforts in areas of need.

It should be noted that EPODE is not the only program for schools. Other programs are being run right across the state, including the Premier's Be Active Challenge, the Right Bite healthy school canteens and training of DECS workers to better support healthy eating and physical activity. According to SA data, one in five four year olds is overweight or obese. South Australian adults are 21.3 per cent obese compared to 9.8 per cent in 1992, with almost a quarter million people in our state regarded as being obese. As a community, the cost is enormous. It has been estimated around $21 billion a year for obesity in Australia, or around $1.6 billion for South Australia this year. We are already addressing the issue, but we need to do more, and this program will be an important part of that.

Mr PISONI: I refer to the same budget line. On the EPODE program, minister, you spoke at the NOBLE conference on 5 November last year and stated that there were methodological issues with the EPODE program. I also draw to your attention the editorial in the European Journal of Obesity written by Manfred Müller who is an authority on nutrition and childhood obesity and who makes the following comments reflecting the concerns that you raised in your speech. He states:

However, the results of the program have not become available to the international scientific community. Thus we are not aware of peer-reviewed scientific publications in English pertaining to the processes or the results of EPODE or the prior intervention programs in Fleurbaix and Laventie; a PubMed research revealed no results for the term EPODE.

Also Sandrine Raffin, who is a co-designer of the EPODE program, addressed a meeting of the German Platform of Nutrition and Physical Activity in the summer of 2007 in Berlin. In her talk she stated that, with exception of Fleurbaix, obesity prevention rates had not decreased as a result of intervention in other French communities. What were the methodological issues with the EPODE program that you spoke about at the NOBLE conference?

The Hon. J.D. HILL: I cannot recall exactly what I said at that conference. In relation to EPODE, they have done a whole lot of evaluation. I think that they are working across 100-plus sites with thousands of kids, parents and teachers—so tens of thousands of people, effectively. They have done an evaluation which demonstrates the outcomes to which I have just referred.

They attempted to have that published, I think, in Lancet. The editors of Lancet did not publish the results because there was no control group. Essentially, if you are working in a community with 5,000 or 10,000 people, what do you use as a control group other than the sort of broader stats that you have across the nation? Those kinds of methodological or scientific issues at that standard make it difficult for someone doing an evaluation and research on this program. However, I understand that EPODE is doing other bits of work in order to demonstrate its effectiveness.

The point is that we know that we have a problem. We have looked around the world at programs that are having a positive impact, and the only two of which I am aware (and there may be others) is the EPODE-style program, which is essentially working with communities to try to get a change in behaviour. We have seen these kinds of programs in Australia change the social norms. We have seen these programs effective in Australia over time, for example, in relation to smoking. I think it is absolutely clear that, over the past 34 years, the social norm in relation to smoking has changed. What was an acceptable activity pretty well anywhere—in the house, the workplace, restaurants, wherever—has now become a socially unacceptable activity.

We have seen the decline in smoking from 60 per cent amongst males some years ago to less than 20 per cent now. We have seen the social norm change in relation to waste management. As I say often, when I was a child the social norm was to throw whatever rubbish you had in the car out the window because that would keep the car clean. We now, obviously, understand the consequences of when we throw that out the window and it lands on the pavement or in the bush. Programs such as Keep South Australia Beautiful, Put It In The Bin and Bin It—all those kinds of programs—have changed the social norms. Fewer people now behave in the way they may have found acceptable years ago.

We know that programs focused on changing social norms worked. The only other program of which I am aware and which has worked in terms of reducing childhood obesity is a program in Singapore. As I understand it, children there are weighed at school and those who are obese or overweight are made to go to a special room for their lunches, and they are separated from the rest of their peers. After school they are enrolled in a particular set of physical activities which are special to them. That kind of segregation and identification of weight issues in that context I just do not think would work in Australia. It may work in a more authoritarian society but I just do not believe it would work in Australia.

I think we must go along the path of changing the social norms and changing the social values. We have seen lots of examples of that working in the past. I am happy to provide whatever research material we have in relation to the effectiveness of EPODE, but essentially it is about working with communities to try to change their behaviours in relation to children's eating and bringing all the partners together, so it would be the local doctors, schools, councils and businesses—everyone would be focused on one outcome, which is to make kids healthier. I am very confident that that approach will work in our context.

Mr PISONI: I do have some of the results here. The program started in 1991. Of the children measured in 1991, the obesity rate for girls was 14.1 per cent and the rate for boys was 9 per cent, with an average between boys and girls of 11.4 per cent. When the measurements were taken in 2000 in those same communities we saw obesity rise to 13.3 per cent. What is interesting about the research on the EPODE program is that the same students were not measured. It was simply a point in time. The same students were not measured.

The best research I could come up with on the EPODE program was the cross-sectional survey which, in the scale of methodology from 1 to 8, comes in at about number 5—which is a survey or interview of a sample of the population of interest at one point in time. I have been told by those in the scientific community that that is a very low form of reference. As a matter of fact, it is only three up from the lowest point—anecdotal; which is something a bloke told you in a pub after a meeting.

I have some additional questions on the cost of the trips to France. This relates to the same line. Will the minister advise of the cost of overseas travel by staff of the Health Promotions Branch in the 2007-08 financial year? Will the minister advise of the cost for himself and his staff to travel to France to meet Dr Jean-Michel Borys?

The Hon. J.D. HILL: I will address the preliminary parts of your question. Jean-Michel Borys (the person who came here) made it plain when he gave a briefing that—and I think you were in attendance at one of the briefings when he went through the research data—in the early days of this program, it was not having an outstanding success. I think his reason for that was that they were focusing only on the school. It was when they broadened the program in the most recent years to include the community, local government and doctors (and all the rest of the power figures in the community that make up the village that you need to raise a child) and brought in all those other factors, the obesity rates improved quite dramatically.

That, I think, is the significant thing: it is working with all of the influences on a child to create an environment where a better understanding of nutrition is created; better focus on exercise—it is a whole lot of little things. It is a multifactorial response, including families eating together rather than sitting on the couch watching television; having limits on how much television people watch or how much internet time people have; focusing on exercise and doing things together as a family. All those little things are very hard to tabulate and then say, 'Well, this created that impact,' or, 'That created this impact.' I think the overall evaluation demonstrates that there is an improvement in levels of obesity and the number of children who are overweight in the communities in which this work is done.

Clearly, it is at a very early stage, and our intention is to adapt that approach to children in South Australia. We already run a whole range of programs, all of which have budget lines, which do good things. However, of themselves, they probably do not have a breakthrough kind of capacity; whereas I think that working with schools, doctors and families using this integrated approach will.

We have seen the success of this approach across a whole range of areas, for example, sexual health, where literacy levels, understandings and behaviours have changed in the community as a result of the HIV AIDS scare of 15 to 20 years ago. Behaviours do change when people are confronted with the facts, where information is provided from a range of sources, people are supported and so on. In relation to travel, I am happy to provide the information required. I do not have it with me now.

Mr PISONI: What credibility checks were conducted into the work of Dr Jean-Michel Borys before introducing his program? In the context of that question I would like to raise some points that my research has uncovered. In the French EPODE program 50 per cent of the total money from private sponsors goes to the Proteines agency. Dr Borys is a director of the Proteines agency. It is a PR and advertising company that, in short, helps companies to put a healthy spin on their products.

This is all on the Proteines website, minister. Clients include EPODE; Danone—`the nutritional benefits of ultra-fresh dairy products are on the increase; in order to convince experts and consumers, Proteines develops strategies aimed at privileged ambassadors for these target groups'; and Ferraro—Kinder, which makes Nutella of course—treat...or trick? Proteines has been responsible for its advertising campaign that 'revisits the concept of pleasure and gives you the keys to sensible indulgence'.

There is Kellogg's: a guide to Kellogg's corporate healthy eating way; and, of course, McDonald's is a client of Proteines, the same company of which Dr Borys is a director. It boasts: `From allegedly being responsible for the increase in obesity to having the profile of a corporation committed to transparency and healthy lifestyles, McDonald's has clearly shifted its focus on health by optimising its product range and providing more information on nutrition.' Other clients include: Nestlé, Unilever, Coca-Cola and Bayer.

I draw the minister's attention to a brochure (of which Dr Borys was a co-author in 1999) entitled, 'The benefits of moderate beer consumption'. I put it to you, minister, that Dr Borys is a hired gun for the junk food and alcohol industry. Some of the claims that this brochure (co-written by Dr Borys) makes, according to my understanding of the Food Labelling Act in Australia, would be illegal. It states:

Three glasses of beer a day should reduce the risk of heart attack by 25 per cent.

It also goes on to state that it is the alcohol that—

The CHAIR: Order! And your question is?

Mr PISONI: I will get to that in a moment.

The CHAIR: Get to it now.

Mr PISONI: There is a disclaimer, of course, at the back of this brochure after all these claims—

The CHAIR: Order! I have given you a directive, member for Unley. What is the question?

Mr PISONI: I know it is difficult to hear that the—

The CHAIR: No, it is difficult to hear your voice. What is the question?

Mr PISONI: I know it is difficult to accept that the minister has been conned on this EPODE program. What checks did you make, minister, about Dr Borys?

The Hon. J.D. HILL: I made one check that you obviously have not made. I went over there and had a look on the ground. I talked to doctors, I talked to parents, I talked to teachers, I talked to academics, and I met the people who are the beneficiaries of the program. I would suggest that, rather than doing internet research, you actually use some of your travel allowance and go and have a look yourself. I went and had a look on the ground and talked to the people who are the beneficiaries. I also met—

Mr Pisoni interjecting:

The Hon. J.D. HILL: I think it is outrageous, Mr Chairman, that the member for Unley who clearly has decided for whatever political advantage he thinks it brings him to attack our attempts to reduce obesity in the community, to malign a significant—

Mr Pisoni interjecting:

The CHAIR: Member for Unley, this is your last warning. I am happy to bring the house back; it does not bother me. You asked a quite detailed question and you gave a detailed explanation. The minister has been answering for about 30 seconds and you pop in like a child. How about sitting quietly and letting him answer?

Mr PISONI: Thank you, Mr Chair.

The CHAIR: You are welcome.

The Hon. J.D. HILL: The other person I was going to say I met with was the head of the International Obesity Taskforce who works with the World Health Organisation, and I went through the two programs—the Singapore program and the French program—with him. We went through the methodological problems that I described, and I think his view was that the French program was worth considering.

He drew my attention to the Singapore program and we, of course, both agreed that that would not work in an Australian context. Jean-Michel Borys is a medical doctor. I think he is a cardiologist from memory, so it would not be surprising if he were writing papers about issues to do with cardiology. He is, I think, a very sincere and focused person who has a very clear understanding about what he is attempting to achieve. His organisation, EPODE, is a not-for-profit, non-government organisation. It relies on sponsorship, and he has certainly not hidden that in any way. All of the communities understand that there is private sponsorship for the activities.

Ms Chapman interjecting:

The CHAIR: The member for Bragg is warned. Unfortunately, minister, the time has expired. Do you wish to continue answering or do you wish to come back to finish your answer?

The Hon. J.D. HILL: I would like to continue answering it if I may. I will not take much longer. The gentleman in question has very high ethical standards, I believe. He has made it very clear that the organisation which he runs has private sponsorship. There are very clear rules about how they are involved. There is no advertising whatsoever at a local level in terms of the programs that affect children. I think it is a reasonable approach that he is taking because it is not a government-sponsored organisation.

Our introduction of it in South Australia would be different, of course. We would be the first government to adopt this approach. The overall approach, which is to work with communities to get good positive outcomes, is, to me, the most sensible possible thing you can do in relation to changing social behaviours, and one of the social behaviours that we need to change is the dietary and exercise habits of our children.

Ms BEDFORD: I refer to Budget Paper 4, Volume 2, page 7.13. This page of the Portfolio Statement shows an allocation of $750,000 in 2008-09 for the Health and Medical Research Fund. What is the fund used for and what else is the government doing to strengthen health and medical research in this state?

The Hon. J.D. HILL: Before I answer the question, I will deal with a couple of things that were raised earlier. When I went through the list of hospitals earlier, I mentioned 14 hospitals that we would be looking at. I then read out 16 names, including Leigh Creek and Woomera, which are remote-service category hospitals and should not be included in that list; but they will be looked at as well.

In relation to employment figures, the deputy leader asked me about the number of nurses and medical officers, full-time and head count. I advise that, as at April this year—and, of course, these figures will be confirmed in September—there were 10,721 full-time equivalent nurses and 2,266 medical officers. On a head-count basis, there were 14,045 nurses and 2,604 medical officers. In relation to the International Obesity TaskForce, I spoke to Professor Philip James, who is the chair of that task force. I also understand that Professor Boyd Swinburn, who is the Professor of Population Health at Deakin University, is also involved in the evaluation of the French program.

In relation to health and medical research, the Health and Medical Research Fund is unique to South Australia. The fund provides a valuable opportunity to grow health and medical research capacity. The fund brings with it opportunities to invest strategically in health and medical research in South Australia, to build capacity and to leverage funding received from other services.

This year, the Health and Medical Research Fund is contributing to the purchase of medical and research equipment in eight facilities. The new equipment will be used to aid study in areas such as stem cell research, osteoporosis and cancer treatments. The eight facilities that have received funding to date are: the Royal Adelaide Hospital, the Queen Elizabeth Hospital, the Lyell McEwin Hospital, IMVS, Country Health SA, the Women's and Children's Hospital, the Repatriation General Hospital, and the Flinders Medical Centre.

All of the equipment provided through the fund has been identified as addressing a vital and specific medical research need and is not readily available to researchers elsewhere within the state. The new equipment will increase the capacity of the state's research facilities and will support the conduct of high quality health and medical research throughout South Australia's hospitals and universities.

South Australia has a proud tradition of world-class health and medical research. South Australian researchers are of the highest calibre and their research is internationally renowned. In addition to the Health and Medical Research Fund, SA Health is currently supporting a number of initiatives and collaborations with the university and NGO sectors to support and further progress health and medical research in our state.

We have, of course, gone through the Shine and Young review. Professor John Shine and Mr Alan Young were commissioned to undertake a review of health and medical research in South Australia with the aim of making recommendations to provide strategic directions for health and medical research, build on the state's research effort and collaboration and increase the state's capacity to attract and effectively use research funds.

Following that review, it was recommended that an independent flagship health and medical research institute be established to bring together top researchers to work in related fields. This would provide a focus for health and medical research activity in South Australia, recruit and retain leading research teams, attract increasing levels of national and international funding and enhance collaborative activity. Shine and Young outlined three key recommendations to establish that institute, which included housing the health and medical research institute in a new flagship research facility and then build the Health and Medical Research Fund.

While the health and medical research institute would be independent from hospitals and universities, it would work in close collaboration and partnership with both sectors. That would be particularly evident through the 'nodes' of the institute, which would be fostered and developed at each of the universities and teaching hospitals to focus on research areas of particular strength.

Both minister Caica and I are supportive of the recommendations. Officers from my department and the Department of Further Education, Employment, Science and Technology are working to progress the recommendations. We are also working on the Centre for Intergenerational Health, which is a research collaboration promoted under Constellation SA. The aim of this centre is to provide a unique interdisciplinary capability for research into factors that are crucial for sustaining good health across the life span within and between generations, particularly in later life.

It is a collaborative initiative between SA Health and the Department of Further Education, Employment, Science and Technology and the three universities. Professor Shine and Mr Young, in their review of health and medical research, recognise the Centre for Intergenerational Health as a key niche area for SA and as an important starting point for building a collaborative research capacity. A Centre for Intergenerational Health program director has been appointed to develop a clear business plan for the centre, and will work on enhancing collaboration between the parties.

We are also building a $19 million research facility at the Queen Elizabeth Hospital, which is almost complete. We are also working on a data linkage unit, which will be a fantastic benefit for researchers in South Australia. A consortium has been formed to develop this data linkage system, and includes the three universities, the Health Department, the Department of Education and Children's Services, The Department for Families and Communities, Further Education, Employment, Science and Technology, the justice portfolio and Trauma Injury Recovery SA, and, potentially, the Northern Territory and the Cancer Council. Funding will total $2.3 million over four years. This, of course, will provide a fantastic database which will allow a whole lot of research. There is much more as well, including a joint project with the Cancer Council.

Ms BEDFORD: I again refer to Budget Paper 4, Volume 2, page 7.13. In the 2008-09 budget, $14.286 million has been allocated to the Marjorie Jackson-Nelson hospital on top of an estimated result of just over $4 million in 2007-08. What health care benefits will South Australians see in the future from this investment, and why will it be different?

The Hon. J.D. HILL: The Marjorie Jackson-Nelson hospital will open to receive its first patients in 2016. It is, of course, the centrepiece of our reform agenda. It will be the most technologically advanced hospital in Australia—a custom-designed and built state-of-the-art facility. In addition, a critical component of planning the hospital is the development work around clinical services and the model of care that will operate in the new hospital.

This work is led by the Clinical Planning Team which will produce a clinical services document by the middle of this year. The document will incorporate a summary of the model of care, broad service descriptions, and high-level concept functional relationships. The work will feed into the project brief that will go out to expressions of interest in 2009.

Clinical consultation will be required through the public-private partnership process, and appropriate strategies will be developed to support the various stages. It will be overseen by the Clinical Steering Committee, which includes representatives from a range of organisations—the Central Northern Adelaide Health Service; the Divisions of General Practice, Medicine and Surgery; SA Pathology; general managers of the Royal Adelaide Hospital and the Queen Elizabeth Hospital, directors of nursing and allied health directors from those two hospitals; the Faculty of Health Sciences at the University of Adelaide; the School of Health Science at the University of South Australia; and the Department of Health through its Operations Division and Statewide Service Strategy Division of the Major Projects Office.

The current consultation process commenced in February this year to work through the draft model of care and to inform the work around the clinical functional brief. During this time, more than 150 clinicians, as well as a range of other people, have been involved and invited to participate at some level. The process has evolved somewhat as the work has progressed and has incorporated the following levels of consultation and communication:

Focus groups, which have concentrated largely on specific stages of the patient journey. They include: access/diagnosis; operating theatres; procedures; inpatient model of care; ward design; exit/discharge; and ambulatory care.

Consultation meetings with sub-specialty groups or 'service lines', which have incorporated individual consultation meetings with heads of units, clinical leaders, as well as groups of clinicians. These meetings have included discussions on the concept model of care, the patient journey as it applies to the specialty service, and issues specific to the specialty service.

Consultation meetings with individuals and groups in the Department of Health and the Central Northern Adelaide Health Service to review the model of care development, links and consistencies with a range of related planning and reform activities; and

Consultation meetings with the clinical networks to establish an iterative process ensuring links with the statewide network plans, and communication meetings incorporating presentations and updates for staff groups, senior management meetings and meetings with key groups, including the Consumer Advisory Council and staff associations.

A lot of work is being done to make sure that a whole lot of points of view are brought into this planning process. It is anticipated that acute care providers within the hospitals will link with a range of chronic disease pathways, primary, secondary and community services to provide comprehensive health care to the community.

The hospital will be designed and built with the comfort of these patients in mind and with guidance and input from clinical staff to ensure that it is practical and functional. It will have the patient-centred model of care, incorporating four key aspects—the healing environment, treating the patient as a whole, safe care, and the patient journey. The consultation process is focused on the patient's perspective to identify and avoid delays, duplication, and wasted and excessive processes.

Ms BEDFORD: I again refer to Budget Paper 4, Volume 2, page 7.12: new funding for the redevelopment at the Berri and Whyalla hospitals. How does this fit in with the reform of Country Health Care in country South Australia?

The Hon. J.D. HILL: As the member would know, we are planning to increase the capacity in country health South Australia, in particular build capacity in four general hospitals at Berri, Whyalla, Mount Gambier and Port Lincoln. This is a 10-year strategy and, of course, we want to make sure that a broader range of services is available in the country. Country general hospitals will be the main centres of their surrounding areas and will deliver acute services across an identified catchment, meeting their majority of acute in-hospital treatment needs of the residents in the local community and the surrounding districts.

These centres will be developed to retain as much secondary level acute activity as possible so that only people requiring very highly specialised or complex care will be required to travel to Adelaide. The country general hospitals will offer services, including inpatient and day rehab, gerontology, urology, an enhanced range of orthopaedic services, specialised palliative care, in-hospital services, renal dialysis, paediatric specialists, early intervention services in mental health, chemotherapy, intermediate mental health care, acute care beds, short stay options, and a range of other services in the community for people experiencing mental health problems.

I have already gone through the figures. We are spending $41 million at Berri and $15 million at Whyalla, and the works will commence in Whyalla this year and be completed in 2010-11. The Berri works will commence in 2009-10 and are due for completion in 2011-12. The planned redevelopment at Whyalla includes: the provision of an integrated theatre suite, including day of surgery admission facilities and day surgery unit; upgraded high dependency unit; additional in-patient beds to enhance palliative care and mental health services; expanded rehabilitation services; and the provision of facilities to support day oncology services.

In the Riverland, at the Berri hospital, it includes: provision of an expanded accident and emergency service; additional operating theatres; establishment of a renal dialysis unit; additional in-patient beds to enhance obstetric care; palliative care; mental health services; expanded rehabilitation services; and the provision of facilities to support day oncology services.

Ms CHAPMAN: I refer to Budget Paper 4, Volume 2, page 7.1, and these questions will be about the government's Marjorie Jackson-Nelson hospital proposal. Also, page 37 in Budget Paper 5 refers to this project. It was described in the 2007-08 budget last year as a $1.677 billion project, and I note that the minister repeated that amount today. I also note at page 37 in the footnote it explains the fact that the total cost of the project is now N/A (not available) by stating:

The 2007-08 Capital Investment Statement included an estimated total project cost of $1,677 million. The government has decided to procure the hospital through a public private partnership, and the total cost depends on future procurement processes and accounting treatments.

So now it is an unknown, according to these budget papers. When the minister told us today that $25 million of this project is going to be wasted if there is a change of office in March 2010, I can only assume that he is taking what has been spent—which I understand is, up to yesterday, about $4 million, the $14 million plus that is proposed in this year's budget and something for the 2009-10 budget, which adds up to that $25 million. My question is: what has been the total cost of the project so far against the health budget, including the advertising campaign, the preparation of tender documents, the consultancy reports, etc.?

The Hon. J.D. HILL: We will get the detail for the member, but I will comment on her initial observations, seeing she was so kind to make them. Perhaps I should have clarified for the member what a PPP process involves. Through a PPP process of procurement the government does not spend the capital upfront and, in fact, the costs associated with delivering this project for the government upfront are those that we will expend in the development and evaluation of the detailed tender process documents, and the advice that we have from experts to give us ideas about how we should proceed—all of those kinds of things. The estimation of that is about $25 million by 2010.

The cost, of course, for the overall project is still, we anticipate, just slightly below $1.7 billion, but that of course will be provided by the private sector. The amounts to pay for that will not be seen in our budget papers until the building is completed, and that is around 2016, so I guess four years before then you would start to see in the budget papers and the forward estimates the projected costs of that way of procuring it.

That is one of the great advantages of a PPP. Under the standard means of procuring a hospital the government would have to obtain, either by borrowing or from other sources, the capital that is required and start spending that money as the building proceeds—and we are seeing that, of course, in relation to the Lyell McEwin and the Flinders Medical Centre and the like. But, through a PPP process, of course, we do not pay anything until the hospital is built, other than the costs associated with our own work in relation to the planning of the tender process, and the evaluation of it.

I am advised that the expenditure in 2007-08 was $4.017 million and the advertising expenditure in 2007-08 was $679,000. That is generally for the health care plan, so that would cover the Marjorie Jackson-Nelson hospital and other things such as the Country Health Care Plan public presentation.

Ms CHAPMAN: In relation to the PPP for the Marjorie Jackson-Nelson hospital, has the government secured monoline insurance, as required for PPP projects, now that you have changed to this new format?

The Hon. J.D. HILL: I will ask Dr Sherbon to respond to that.

Dr SHERBON: The Department of Treasury and Finance is chairing an executive steering committee overseeing the PPP. There will be opportunities for consortia that procure finance to deliver the PPP to reinsure their finance through the bond reinsurance market, to which you refer. The advice that I have received recently from DTF is that, given that this is a government project delivered by a major sovereign government with a AAA credit rating, they see bond reinsurance risk as a low risk to the project at this point in time.

They are obviously watching the bond reinsurance market and other insurance markets. Should those markets deteriorate further and the price of finance increase, naturally, when we come to procurement we will be comparing any bids with a public sector comparator. That comparator may well prevail if the cost of finance is too high for the consortia. However, at this stage, the DTF view when I last asked (which was a month ago) was that it was a low risk.

Ms CHAPMAN: As the proposed hospital will result in a change of use of the land from railyards to a hospital, and section 23 of the Adelaide Park Lands Act requires a report on the future use and status of the land to be laid before both houses of parliament and to be furnished to the Adelaide City Council, my question is: has this report been prepared and, if not, when is it likely to be prepared and provided, as required by law, and tabled in this parliament?

The Hon. J.D. HILL: Any amendment to the change of land use for parklands under the care and control of the government will be undertaken in accordance with the statutory provisions of the Adelaide Park Lands Act. The land is currently owned in fee simple by the Minister for Transport and operated by TransAdelaide, which we know. This land will be transferred to me as Minister for Health.

A rezoning exercise will take the form of a ministerial development plan amendment pursuant to section 26 of the Development Act (I released documentation for that some months ago, and that process is proceeding). The government master plan acts as a vehicle to consider a range of relevant West Adelaide precinct interface issues. I would assume that any reporting that is required to parliament would occur after those processes are completed, but I will happily take advice on that to better inform my answer.

Mr RAU: I refer to Budget Paper 4, Volume 2, Portfolio Statement page 7.10. Can the minister please update the committee on the progress and impact of the statewide information line for maternity services, the Pregnancy SA Info Line and the recently established health call centre, HealthDirect Australia?

The Hon. J.D. HILL: Both of those projects are going very well. A new statewide telephone service for women seeking their first antenatal appointment in a public maternity hospital unit was launched on 3 December 2007 (I am pleased to say, my birthday). This new initiative was proposed by the South Australia Maternal and Neonatal Clinical Network to facilitate a coordinated approach to antenatal bookings. The Pregnancy SA Info Line is a single point of telephone contact for the public and health professionals and is already providing valuable support, with up to 250 referrals for antenatal appointments every week.

We are experiencing our highest fertility rate in a decade: 2006 data from the Pregnancy Outcome Unit published in November 2007 reports that the total fertility rate was 1.82 births per woman. This compares to a rate of 1.73 births per woman in 2002. The increasing number of antenatal appointments and subsequent births required a new approach. Pregnant women have historically had the choice of visiting a GP or a public antenatal clinic for the management of their pregnancy. The info line does not change that arrangement. Importantly, GPs can still refer pregnant women to a public hospital for the management of a clinical condition without having to contact the info line.

Public hospitals will continue to support and promote the General Practitioner Obstetric Shared Care program, and a media campaign about the info line commenced on Sunday 10 February this year. All GPs were sent a letter in November last year giving them information about it and an invitation was sent to them to attend an information session that was conducted by the SA Maternal and Neonatal Clinical Network.

The health call centre, HealthDirect Australia, is a free line call. It was launched in South Australia in January this year to provide better access for South Australians wishing to manage their own health and wellbeing. It has taken about 46,000 calls from people seeking health and medical advice or assistance from a registered nurse over the phone. It provides South Australians with access to high quality health advice and information 24 hours a day, 365 days a year.

Calls are answered, on average, within 18 seconds and last eight minutes, and callers always speak directly to a registered nurse. About 25,000 callers to date have phoned, expecting to have to take immediate emergency action, such as calling an ambulance, visiting an emergency department and getting to a GP straight away. However, after speaking with a nurse, about 10,000 of these callers were reassured that they did not have to take such urgent action regarding their health.

The service has already taken about 30,000 phone calls that would otherwise be made to hospital emergency departments seeking health advice from a nurse, and this has allowed busy emergency department staff to better concentrate on face-to-face calls. So, it has reduced by 10,000 the number of people who might otherwise have gone to an emergency service or called an ambulance, and reduced by 30,000 the number of phone calls that would otherwise have gone to an emergency department. Some 1,300 calls have been made by people from Aboriginal and Torres Strait Islander backgrounds, and we expect the service to receive about 180,000 calls annually from South Australians, with about 50,000 of these coming from rural and remote areas. So, it is a great new service.

Mr HANNA: I refer to page 7.9. One of the targets for the coming year is the development of the GP Plus Health Care Centre at Marion. Given the recent announcement that the swimming pool will finally go ahead, can the minister give details of what the GP Plus centre will look like, the extent of interaction with the pool to be built adjacent and also the list of services to be provided?

The Hon. J.D. HILL: As to how it will look, I cannot answer that yet: I do not believe it has been designed. My understanding is that an office building will be part of the development, and the GP Plus centre will exist in a number of the floors of that building. How big the building will be and those kinds of issues I cannot answer, but it will be a user-friendly building, which will be adjacent to the aquatic centre.

We think that developing the centre in this way is a good opportunity to develop those links between fitness and health. The GP Plus Health Care Centre will create an opportunity to develop new models of care that respond to the government's health reform agenda. The centre will provide comprehensive accessible primary health care services that are based on a client and family-centred approach. The services will cover youth health services, community health clinics and dental services as well as a medical and specialist clinic with a focus on chronic disease management, health promotion, disease prevention and post-acute outpatient services. I know from the development of the GP Plus Health Care Centre at Aldinga (which is in my electorate) that these services will develop over time.

In terms of the Aldinga one (and I am sure the process will be the same at Marion), an extensive process of discussion and consultation will take place with the local community and also local service providers—particularly GPs but also other service providers—about what is currently there, what the gaps are and how the service can assist the existing primary health care providers deliver services. For example, in Aldinga (which is a different model but the same sort of approach will take place), GPs identified after-hours services for GPs as one of the things they found difficult to deliver, so we now have after-hours GP services.

In Marion, of course, that would be a different outcome, I assume, because it is a 24 hour GP clinic. The GPs would want to send their patients to classes which might assist them manage their diabetes or lung disease—all those kinds of things. There must be support groups for those kinds of people, so we will develop those kinds of services as well. It will be an evolving set of services that will very much relate to the particular needs of the community. It will be a very large centre. I do not have the details in front of me, but I am more than happy, as it is in his electorate, to provide the honourable member with a more detailed face-to-face briefing with officers if he would like to go through that process—perhaps not now but at some future stage.

Mr HANNA: The only other aspect I would like to ask about now is: what is the time frame for consultation processes and the actual opening of the GP Plus centre?

The Hon. J.D. HILL: It is anticipated that construction will happen this financial year (2008-09), with completion in early 2010.

Mr HANNA: That date rings a bell for me.

The Hon. J.D. HILL: Yes, strange about that, but it will happen. Make sure you are there. I will certainly make sure the honourable member is there for that important event. A development process will apply, of course, to the building, but in terms of the service arrangements that process has already begun, as I understand it. Certainly, there has been close cooperation with the Divisions of General Practice in the southern area (I know that from having talked to them) and through the GP Plus network. I am happy to provide a detailed briefing to the honourable member about what the thinking is at this stage in terms of what should be there.

Ms CHAPMAN: I will return to the Marj but, with respect to the GP Plus centres, last year a significant project was announced in the budget (and the Treasurer referred to it in his speech), that is, that there be a new GP Plus centre at Port Pirie, and it was highlighted in the regional statement. Of course, it is completely absent in this year's budget having not been started last year. When will Port Pirie get its GP Plus project? Will it start in 2010? I would like some idea about when that will get going, because it is completely omitted.

The Hon. J.D. HILL: I am happy to provide that information. The proposal which we announced last year as part of the Health Care Plan and which is a 10-year plan for the development of infrastructure in South Australia and the change of services identified Port Pire as a town which required extra capital works. We identified $12.5 million to provide a new centre for the provision of integrated primary health and allied health services in Port Pirie. These services include Aboriginal health, health promotion, chronic disease prevention, community development, early intervention, mental health services, aged-care services, palliative care services, women's health services, child development services, youth and family health and allied health services.

The current community and allied health services building (previously the nurses' accommodation) is and was considered to be inadequate due to the building's structure, poor disability access and safety issues. The new GP Plus Port Pirie health care facility will result in:

a high quality and better coordinated service;

primary health care services delivered more efficiently and effectively;

increased capability to attract and retain health professionals in the Mid North region;

facility and service models that have a flexible capacity to respond to and meet the changing health and wellbeing needs of the population; and

culturally appropriate services for Aboriginal people, which enhances the mainstreaming of Aboriginal health.

Planning for the building will commence in mid 2009, with construction forecast to commence in mid 2010 and completion in mid 2012.

Ms CHAPMAN: I return to the Marjorie Jackson-Nelson hospital, and I refer to page 7.13. The minister indicated that he is proceeding with a ministerial PAR pursuant to the Development Act, and I note that. Previously, I had raised the question of the minister's obligations under the Park Lands Act. Even in the published material on the Marjorie Jackson-Nelson hospital at page 27 this is acknowledged as a process that must be undertaken. Is the minister even going to prepare this report and, if so, when?

The Hon. J.D. HILL: I think I answered that question last time; I am happy to go through it again. The government is going through a PAR process. I think I said in answer to my last question that I assumed that the development of any report that is required under the legislation will occur after that process has been completed, but I would seek advice as to whether or not I am correct in that assessment. The health department, through its CE, has already had discussions with both the council and the Parklands Authority. I have met with the mayor and discussed this in general terms. I understand that other departmental officers also met with the council.

We are working closely with the bodies we need to work with and we are developing the proposals in, I think, a pretty good integrated way with the other ambitions that the Parklands Authority and the council would have for their areas. They raised a number of questions. The Hon. Ralph Clarke, I understand, is a member of the Parklands Authority and he was particularly keen to make sure that the new hospital had a focus on art. I was able to assure him personally that that would be the case. We would ensure that good design was a feature of the development. As to the statutory requirements, we will comply with them. I will get further advice about it, but I would have thought that would most likely be after we had gone through the final planning process.

The CHAIR: I remind the committee that Ralph Clarke has not earned the title 'honourable'.

The Hon. J.D. HILL: I do beg your pardon. I am sorry.

An honourable member interjecting:

Ms CHAPMAN: I think it is something to do with court proceedings. The Adelaide Park Lands Act provides that if land within the Adelaide Parklands, occupied by the crown or a state authority, is no longer required for any of its existing uses, the minister must ensure that a report concerning the state government's position on the future use and status of the land is prepared within the prescribed period. It then goes on to require, as I have indicated, that the report be laid before the houses of parliament and given to the Adelaide City Council, which has certain entitlements, and it provides for reference to the parliament's Environment, Resources and Development Committee.

I am a bit concerned to hear the minister say that he is going to get advice about what he needs to do with this, when we have already spent over $4 million on this project (and another $14 million to be approved in this year's budget) without having obtained that advice or attended to the preparation of this report or tabled it in the parliament. If all of this is aborted under the requirements of this act or needs to be debated by any government amendment proposed to this act, then we surely need to deal with that before any other money is spent.

The Hon. J.D. HILL: The deputy leader likes to make assertions and say what one should or should not do, but I prefer to act on the basis of advice rather than use the ad hoc approach that she obviously prefers. I will get advice and we will prepare any statutory reports that are required. The advice I have is that it is required after the PAR process. I assure the member (and anybody else who happens to be listening who thinks that somehow or other she has discovered some secret flaw in the proposition that would stop this project proceeding) that there is nothing in the Parklands legislation which would stop us building a hospital on that site. This land is owned by the government. It is not land, as in the case of the Victoria Park development, which is owned by the council. This is our land; we own it—it is owned by the Minister for Transport.

We are creating a DPA (development and planning amendment) which is out for a process of discussion. It will create a hospital zone on that site and then we will be complying with the planning arrangements to build a hospital. There is nothing in the legislation which will stop that. There is a provision in the act which requires us to lay before the parliament certain documents and to consult with the Parklands Authority and the council—and we will do that. I repeat, for the third time, that we will do that in the appropriate way. As I suggested in my answer to the previous two questions, the most likely time I believe that would occur is after the planning amendment has been completed. I am now advised that that is, in fact, the case.

Ms CHAPMAN: What is the time frame that you anticipate for the completion of the ministerial plan?

The Hon. J.D. HILL: Overall, it was about a nine to 12-month process. It is within the control of the planning agency and the Minister for Planning has the carriage of it. The advice I have is that it should be within a 12-month time frame and I think we have had three or four months possibly now. I beg your pardon: the clock has not started ticking yet. The advice I have been given is that it will be within 12 months.

Ms CHAPMAN: Is it the government's plan that it will proceed to prepare the report required under the Park Lands Act after the ministerial plan has been determined?

The Hon. J.D. HILL: That is the advice I have just provided, yes.

Ms CHAPMAN: You indicate that nothing is going to stop the government from proceeding with this. However, as you would be aware, there are processes by which this matter can come back before the Environment, Resources and Development Committee. Pursuant to section 23(6), the Environment, Resources and Development Committee may, on referral under subsection (5) (which is either by the Adelaide City Council or if a dispute arises between you and the Adelaide City Council), inquire into the matter as it thinks fit; make any determination or recommendation that it thinks appropriate with a view to resolving the matter; or make any report to parliament that it thinks appropriate in the circumstances of the particular case.

Clearly, it is a project which, under these processes, could end up back here in the parliament, not only in terms of the report that you provide, but with recommendations from the ERD Committee. That is a lawful process. Why are you not getting on with the preparation of this report so that it can be examined and, if there is a necessity to follow any of these matters through with the ERD Committee, so that it can be attended to before any more money is spent?

The Hon. J.D. HILL: The assumption that I think the deputy leader is making is that any of these processes could stop the project proceeding—that is not the case. The plan amendment process will create a zone on the site which will allow us to build a hospital there. We own the land; we will proceed. We will comply with all the other requirements of legislation but they will not, in any way, stop us from doing what we want. I know that the opposition does not like this plan. It wants to build a stadium on the site—that is fine—but we will build a hospital. There is nothing in the legislative process that anybody can point to which will stop us doing that.

Ms CHAPMAN: At page 7.13, also on BP 5, at page 37 (still referring to the Marjorie Jackson-Nelson hospital), the proposal advertises that the hospital will have 800 beds. This will be 700 multi-day beds and 100 same-day beds. Will the minister confirm whether the 100 same-day beds will be available for extension overnight and for multiple days, if required?

The Hon. J.D. HILL: The advice I have is that that would only occur in extraordinary circumstances, like a major disaster—an outbreak of bird flu or something like that. We are building the hospital taking into account what we believe are the future health care needs of the state. We are creating extra capacity at the new hospital; we are creating extra capacity at the Lyell McEwin; creating extra capacity at Flinders; and, of course, with the Country Health Care Plan we expect to see more patients using country health services rather than city health services.

In addition to that, we are giving a much greater emphasis to what we are calling our GP Plus Health Care strategy, that is, focusing on prevention and primary health care so that fewer people need to go into hospital. Of course, there is a great investment in ambulatory care out of health care services generally, and all of those elements are part of the one plan. The number of beds that are proposed for the Marjorie Jackson-Nelson hospital is the number that we believe we will need in the time frame this hospital is being created in, but bear in mind that on that site there is capacity for expansion if required. The number of beds we are creating there is what our experts tell us we will need when that hospital opens.

Ms CHAPMAN: On the question of the 700 beds, at present the Royal Adelaide Hospital has 650 operational beds, as I understand it. That is, they are available for overnight stay. They have various allocations: some are in general and some are in surgical, etc. The material that has been published by the government about this new project indicates that it will go from 650 beds to 800 beds. Also, at the Royal Adelaide Hospital chairs are available for the recovery of day patients; people go in for day surgery and sit in a lounge chair and recover. In addition to these 100 same-day beds, will there be further day surgery recovery suites and, if so, how many?

The Hon. J.D. HILL: As to the number, I cannot say, but I assure the honourable member that we will not make patients stand up in their recovery; we will have chairs for them and all the things you would normally expect to find in a hospital. We are creating extra capacity in the hospital, and we are taking to 800 the total number of beds, some of which are for day surgery. As the honourable member would know, the number of items that can now be done by way of day surgery has grown astronomically. I remember talking to an ophthalmologist about the procedures they use now for cataract removal or glaucoma—one of those ailments. In days gone by a patient would spend two weeks in hospital with sandbags beside their head to keep their head still while they recovered. Now, of course it is done within an hour or so. There are great developments in procedures, so the need for day beds is growing. All the recovery arrangements will still be in place. I am not sure we know precisely how many chairs will be used for recovery, but I will certainly find out for the deputy leader.

Ms CHAPMAN: Among the 650 current beds at the Royal Adelaide Hospital, how many are designated as same-day beds?

The Hon. J.D. HILL: I will have to take that on notice. This is really not going to the budget: it is going to the existing hospital arrangements. I am happy to find out for the honourable member what the disposition of beds currently is at the hospital, how many recovery chairs there may be and what the plans are for the new hospital but, in terms of the detail of the recovery chairs and so on, we are going through an extensive process of consultation with the clinicians in relation to what is required. We are trying to build a hospital for the future, taking into account what we believe the situation will be when it is completed, not as it is now, so a lot of future-proofing (to use a pretty bad term) is going on at the moment to think through the needs for the future.

Ms CHAPMAN: On the same subject, will the minister confirm who registered an expression of interest for the Marjorie Jackson-Nelson hospital project management and commercial, financial and security risk assessment advisory services, which were advertised to close on 28 March 2008; and when does tender close for these projects?

The Hon. J.D. HILL: I will ask Mr O'Connor, Finance Director, to answer that.

Mr O'CONNOR: The tender processes you referred to are three separate tender arrangements: one for the commercial and financial advisers, one for project management and the third one for security risk. The commercial and financial and the project management tenders have been awarded, but the risk management one is still under consideration. The commercial and financial advisory services will be provided by Ernst and Young, and the project management services will be provided by Arup.

The Hon. J.D. HILL: I think you can appreciate that we cannot say who did not win.

Ms CHAPMAN: I understand. With the risk management, did you receive any expression of interest?

The Hon. J.D. HILL: I think the question has to go through me.

The CHAIR: I should make clear that all questions are directed through the minister, for the protection of the advisers.

The Hon. J.D. HILL: I am advised that, yes, we have had a number, but I cannot tell you exactly how many.

Ms CHAPMAN: Is there any particular reason why there has been a delay in the acceptance of a tender for that?

The Hon. J.D. HILL: There has been a range of tenders, and they have been prioritised in a particular way. I would not think it was fair to say there had been a delay.

Ms CHAPMAN: When do you expect that process to be completed for the risk management advisory services?

The Hon. J.D. HILL: It is a matter of days or weeks; it is imminent.

Ms CHAPMAN: That being concluded, will that be made available?

The Hon. J.D. HILL: Yes; it is not a private process.

Ms CHAPMAN: I will take that on notice. In Budget Paper 3, page 2.43 and also Budget Paper 4, Volume 2, page 7.49 there is reference to a budget blow-out. What is the breakdown of the $70.3 million of what are called the 'additional resources' that are required in the five months from the 2007-08 mid-year budget review to the 2008-09 budget?

The Hon. J.D. HILL: Would you mind giving that reference again?

Ms CHAPMAN: Budget Paper 3, page 2.43, and, in more detail, Budget Paper 4, Volume 2, page 7.49. It is the explanatory material to the commentary on the financial accounts.

The Hon. J.D. HILL: I will ask Dr Sherbon to provide that answer.

Dr SHERBON: The figure was an adjustment made by the Treasurer on advice from the Department of Treasury and Finance. It reflected an increased demand in metropolitan public hospitals to the order of $54 million (we are checking that figure as we speak), and a recognition that non-wage cost pressures increased greater than what was first expected when the budget was laid down in June 2007. The non-wage cost pressures were $17 million, and the activity figure is $53 million.

The Hon. J.D. HILL: I think this reflects two things—that the inflation rate in health is greater than in the community generally, and that the demand pressures on our hospital services are growing at a phenomenal rate. I think there was something like 14.5 per cent, or thereabouts, growth in demand for emergency services over the last three years. It just keeps growing at a faster rate than we ever anticipated.

Ms CHAPMAN: Has the medical inflation factor been taken into account in the negotiations for the commonwealth-state agreement to which you referred earlier?

The Hon. J.D. HILL: There are three elements in terms of the Australian Health Care Agreement. One is the base funding; under the former government the proportion of funding coming to the states to run the hospitals declined from about 50 per cent to 40 per cent and our state component had to go up, so we would like to re-establish a proper base for funding. The second element is the indexation of the base; under the former arrangement the commonwealth inflated it 4.5 per cent—that covered all growth, I think, including inflation—and that was roughly half what the growth really was. So that is the second area of discussion with the commonwealth. The third area is the growth in demand. So, we are negotiating around three factors: the base; the medical inflation rate; and the growth in demand.

Ms CHAPMAN: While we are on the commonwealth agreement, I am happy to ask my questions on that area. You mentioned earlier that an extra, I think, $1 billion has been allocated, pending its final conclusion, to be effective 1 July 2009 rather than today. My question relates to an answer you recently gave the parliament regarding the increased demand that may arise out of the federal government's announcement on insurance.

My understanding of your answer was that you did not expect there to be any immediate impact on the state budget because you expected that, if anyone were to drop out, it would be the young, healthy people; but in the longer term, with those left in private health insurance perhaps facing higher premiums and therefore possibly more of them dropping out, that may be the implication. So you would be expecting the commonwealth government to pick up that extra cost that would be imposed on the state.

My question on that—particularly as it may enhance this third demand factor to which you have referred—is: have you been given any assurance by the federal minister, in the ministerial meetings, that that will be provided?

The Hon. J.D. HILL: Since the commonwealth government made its announcements—during what was, I think, part of its budget process—we have not yet had a ministerial council meeting. Another one is lined up within the next couple of weeks. However, South Australian officials have been working with officials of the commonwealth, and a number of these issues are being resolved through the COAG process as well. So, all those factors have been put on the table.

However, if we could get agreement from the commonwealth to share the growth on a fair basis then it really would not matter what policy decisions it made, because all those decisions would ultimately be picked up in the health care agreement. It is when the commonwealth artificially limits the growth factors to a level below real growth, taking into account inflation and demand for services, that enormous pressure is placed on the state budget. So, whether it is a Liberal or Labor government, the position I put is the same: we want a fair growth figure.

To be fair, the commonwealth has an unlimited budget when it comes to Medicare presentations; people go to GPs and it has to fund that regardless of how many people turn up. We have a similar situation when it comes to hospital attendances; we have to fund that regardless of how many turn up. What we are looking for is the same kind of sharing of that burden with us that the commonwealth now has on its own in relation to Medicare payments.

Ms CHAPMAN: Is there any budget allocation in either the current year or in forward estimates to measure that growth— particularly if the growth in demand is identified as a result of federal government policy—so that you may recover that entitlement (under whatever formula is finally struck) from the government? If so, what budget allocation has been made for that monitoring or process?

The Hon. J.D. HILL: There are three parts to my answer. First, there is growth funding in the budget, and I will get Dr Sherbon or Mr O'Connor to give you an outline of what that is. It takes into account previous growth in South Australia and what we think may occur in the future. Secondly—

Ms CHAPMAN: I do not mean to interrupt, but I think we are at cross-purposes. I have asked about growth as a result of the federal government initiative and whether there is any monitoring or funding for that.

The Hon. J.D. HILL: I think your summary of my answer to parliament was reasonably accurate: that we believe it is unlikely to have much impact on demand in the short term as a result of commonwealth changes, but who is to say what it might be in the long-run? We have not anticipated in any budgetary sense what that might be because, plainly, we just do not know. We will monitor it closely. We will certainly argue with the commonwealth that whatever growth occurs as a result of its policy changes should be picked up by the formula. But, as I say, if we had a fair formula based on a 50-50 arrangement and a fair inflater in relation to the CPI in health, and also a fair growth factor taking into account the real growth in demand for hospital services, all those factors would cover that matter.

Ms CHAPMAN: I think you have made it fairly clear that you expect the base funding to be restored to a 50-50 arrangement. I think your statement to date—since the commencement of the new federal government—is that you would not have expected that in the first year but that, in the long term, you want that brought back to a 50-50 arrangement. Can I have an indication about what the government thinks is reasonable—from South Australia's point of view—as regards the inflation factor and the formula for demand?

The Hon. J.D. HILL: Can you repeat that?

Ms CHAPMAN: Of the three factors, you have made fairly public that you expect the base funding should be 50-50, as it used to be. You are obviously critical of the previous Liberal government for reducing that to 40 per cent. You made that comment again today. I understand what you are seeking on behalf of the state but, in relation to indexation and demand, what do you think are fair formulas to be applied for the purposes of the commonwealth agreement referred to?

The Hon. J.D. HILL: The officials are working through the details of that. In general terms, I would like to see an open-ended commitment to growth. So, if growth in South Australia is 5 per cent in terms of presentations, that should be reflected in the formula—so, an open ended formula rather than a fixed formula. The commonwealth, I guess, will not want to do that, so we will work through it together.

What we would like to see is a fixed figure that more accurately reflects real estimations of growth, but these things form a matrix. There are three factors there. As long as we get a fair deal—and it can be seen to be a fair deal—we will be happy, regardless of which elements are advanced and in which order. As I say, this is a matter for ongoing discussion between officials from the various states, the commonwealth, and by treasurers and premiers with the Prime Minister. I am advised that the security risk assessment adviser was awarded just last week to Sinclair Knight Merz.

Ms CHAPMAN: I will just go back to the commonwealth agreement. I think I understood you to say that you may not get all three things that you want but, if you were to get the base funding right, possibly some movement from the commonwealth, and one or two of the others, you would consider that to be a fair deal. Is that what you said?

The Hon. J.D. HILL: In general terms, the commonwealth is changing the way it is funding, so it will have fewer special-purpose funds, a broader approach to funding and a limited number of special-purpose funds, but it is also looking at reform arrangements. For example, one of the possibilities that has been floated is that the commonwealth would fund all of the non-patient admissions. So, all GP services would be covered by Medicare, and everybody who turns up to an emergency department might be covered by the commonwealth. That would be a totally different structure in the way of funding health. It might mean that we get less money, but the outcome would be better for our budget, because the commonwealth would then be paying for all non-admission services.

I think we need to take a reasonably flexible approach to this to work through a set of arrangements which create reform and which stop the buck-passing that goes on between the two levels of government. It will make the system work better. How well that will pan out is impossible to tell. I do not want to be constrained by a set of narrow parameters. What we are looking for is a good health outcome, which will mean that the commonwealth will better fund the health services to be closer to the original Medibank and Medicare arrangements, which were on a 50-50 basis.

In the past as I understand it, hospitals, as independent entities, would provide services and would charge patients, which acted as a disincentive for people to go to a hospital. So, part of the Medibank, and then Medicare, reforms were that patient services would be absolutely free and that the commonwealth would compensate the states for the provision of those services. That is what we are looking for. I do not really mind how it is done, as long as it is fair.

Ms CHAPMAN: I refer to Budget Paper 3, page 4.2. Is it still your expectation that this health care agreement to commence on 1 July 2009 will be signed by December this year?

The Hon. J.D. HILL: I am advised that the aim is for it to be signed by the premiers—not the health ministers—at the October COAG meeting.

Ms CHAPMAN: I refer to page 4.2, as follows:

COAG agreed that the new health care agreement would be signed in December 2008 with a commencement date—

And it goes on.

The Hon. J.D. HILL: The advice I have is that it is currently planned for a bit earlier—in October.

Ms CHAPMAN: I refer to Budget Paper 3, page 7.7, as follows:

The government is implementing policies to manage the increase in expenditure on goods and services. However, if these policies are unsuccessful, it may result in significant future costs.

Will the minister identify what policies are being used to manage increased expenditure on hospital goods and services?

Dr SHERBON: We are working on a procurement strategy to restrict the growth of non-wage costs, that is, goods and services and other non-wage items. That strategy is designed to procure more smartly than in the past by strengthening our bargaining power with suppliers and reducing costs. There is a risk in that there is a very significant growth in costs in the sector not so much from existing goods and services but for new products that come on the market, which are often in demand by clinicians. There is a risk, and we have highlighted it. We are attempting to reduce the growth in the cost of goods and services but, as highlighted in the budget papers by the Treasurer, we will have to deal with the risk should it arise. At this point in time, we have confidence that we can ameliorate growth in the cost of goods and services.

Ms CHAPMAN: Can the minister give an example of the new products mentioned, or what new services we will change to produce the management of any increase in expenditure?

The Hon. J.D. HILL: I know that one of the issues in country health, for example, is that, until the country health arrangements changed, every hospital in the country (40-odd) went through its own procurement process. Clearly, there are real advantages if you can procure across a bigger system. That is one example that I can think of.

Dr SHERBON: There are also some increments in goods and services and new drugs. Every week a new drug comes onto the market, inevitably more expensive—or, in rare cases, cheaper, but usually more expensive—than previous drugs. Naturally, clinicians request the latest available drug to treat the condition from which their patient is suffering. There are also new prostheses for orthopaedic implantation and cardiac implantation (a recent source of growth), in particular, and technological advancements in things such as radiotherapy and diagnostic imaging. We have just had a request for a range of new diagnostic products on the market as technology advances. They are the sorts of examples that creep into new products that are available.

Ms CHAPMAN: I would have thought that new drugs, as was pointed out, are more expensive. New prostheses, high demand for diagnostic imaging, etc., are all the expected increases in expenditure, but this commentary refers to keeping a lid on it. What are the policies other than perhaps either cutting the number of some of these services that you will approve or getting cheaper equipment? Can you give some examples of how you will keep the lid on these costs other than to instruct your hospitals, with 26,500 staff, all of whom you now employ between the two of you? As you said, minister, the buck stops with you. What will you do to achieve this?

The Hon. J.D. HILL: I will give one example that was put to me by a former member of this place, Michael Armitage (former health minister and now the chief executive of a private insurance group), who came to see me about issues dealing with prostheses. There is a whole range of prosthetic devices in the marketplace which can be used to perform, for example, a hip replacement. These products come onto the market, and doctors like to try different ones, and different doctors have different preferences, and so on. Research has established that certain devices have fewer failures than others. Mr Armitage advocates (certainly, when he came to see me) that we have a limited list of preferred products that can be used—those which have the best outcomes for the patients—so that you have fewer redo lists, for example, and so that you do not use expensive options when you can have a more affordable option which has a better or equivalent health outcome.

That always struck me as a very sensible thing to do. Through the development of our clinical networks, different groups of doctors are looking at the best ways of delivering services. I hope that one of the things that they would ultimately do is look at the equipment and the goods and services that they require to deliver their services so that cost and effectiveness can also be brought into play. Dr Sherbon will probably give more practical examples than those I have given.

Dr SHERBON: To continue with the minister's example of orthopaedic prostheses, under this organisation's previous system of governance there were many different purchasing and contractual points throughout the organisation. Now, under the streamlined governance structure, we can organise our bargaining power with suppliers a lot more effectively and bargain as a large purchaser, and drive down unit cost. We will be doing that with a range of products. Orthopaedics prostheses is probably a little more complicated than other products, such as sutures, needles, etc., because it involves lot of clinician preference. The strategy of procuring more smartly is a key plank of our measures to control cost escalation of goods and services.

Ms CHAPMAN: Obtaining the best price and limiting the product may all sound like sensible initiatives but, largely, they result in often excluding the clinician from consultation, because they are the ones who want the more expensive equipment or the new drug, or whatever. I ask this question because it is my understanding that, for example, recently there was the acquisition of an aircraft for retrieval services in country South Australia and a subsequent complaint that there had been no consultation about what sort of aircraft would be suitable for the retrieval of people.

The Hon. J.D. HILL: I make the general observation that one would not want to impose any prosthetic device on clinicians without having consulted with them, and I am sure, as I said, through the clinical networks we would want to do that. Equally, in the use of sutures and all the rest of it, we go through a process to ensure we can maximise the value while minimising the impact on clinical decision making. In relation to the aircraft, I will ask Dr Sherbon to respond.

Dr SHERBON: Continuing the orthopaedic prostheses argument, as the minister confirmed, we will consult clinicians. There is actually a wider range of choice of prostheses available in the public sector at no cost than there is in the private sector. The previous federal government instituted a restricted regime where, if orthopaedic surgeons chose a prosthesis outside of a list that minister Abbott established, the patient wore a much greater cost. That does not happen in the public sector. We are concentrating on reducing the unit cost of prostheses, not necessarily imposing unfair obligations on orthopaedic surgeons—although, as the minister says, we are working to get a coherent guideline for the use of prostheses from the medical clinical network.

In regard to the aircraft, SA Health does not purchase aircraft. It may well be the RFDS. We will have to check on that.

The Hon. J.D. HILL: We will get an answer on that.

Ms CHAPMAN: In relation to the networks, because they are the new groups that will be consulted, I think they have been operating for the past couple of years. What procurements or goods or services have they given the minister advice on so far in relation to what would ultimately provide some saving to this budget?

The Hon. J.D. HILL: I think we have eight clinical networks. I will have to get advice on whether there are particular goods and services that have been identified. I know there has been advice from the cardiology network, for example, on the application of equipment and where it should be placed—that is, very big items. The obstetrics network, for example, suggested the telephone help line as a device to provide better services to people in a better coordinated way. So they have been developing broad strategies. In regard to where we are in relation to particular items, I cannot answer that now but I am happy to get some advice for the member.

Ms CHAPMAN: I appreciate you will take that on notice, minister, but I am specifically looking for projects they have given you advice on which will help manage the increase in expenditure on goods and services rather than ideas such as the telephone line. Obviously that is a new initiative, and it may be a very good one, but you have referred to it today and it does not necessarily reflect as a cost initiative.

The Hon. J.D. HILL: I understand.

Ms CHAPMAN: I will go back to the IMVS, and you have answered some questions at page 7.26 about the new SA Pathology, which is effective today. Last year it was announced that there would be a $2 million-plus saving as a result of establishing SA Pathology and amalgamating the IMVS with other services. Has that saving been achieved?

The Hon. J.D. HILL: I am checking the detail of that. As I understand, it was programmed for the financial year we are just entering, not the one we have just left, so there are some administrative savings from doing that.

In relation to the savings target of $1.1 million—not $2 million, as the member said—from 2008-09, we are confident that that will be achieved.

Ms CHAPMAN: To achieve that, what positions will be no longer paid for?

The Hon. J.D. HILL: Essentially we now have three sets of management running three services. We will have one management structure in place and we will make administrative savings as a result of that.

Ms CHAPMAN: So this is at the executive level of the other two? There are currently three, and you say there will be—

The Hon. J.D. HILL: We are not absorbing the two smaller ones into a larger one—we are creating a new unit—so the administrative savings will be across all three of the existing services.

Ms CHAPMAN: I did not mean to suggest that it was all going two into one, because we have had that argument already. There will be now one chief executive and, presumably, a reduction in the need for second level executive positions. Is that really what we are seeing?

The Hon. J.D. HILL: That is right, yes.

Ms CHAPMAN: And that has already been achieved, as of today, presumably? It has started?

The Hon. J.D. HILL: This financial year. There are obviously some transitional arrangements that will need to take place and, if people have contracts or are permanent, other work will have to be found for them or arrangements put in place to make those arrangements, but we are confident that that will occur.

Ms CHAPMAN: In this year's budget I note there are another 230,000 pathology tests anticipated for the 2008-09 year. That is quite a significant increase relative to the amount that was done last year. This is all at page 7.26. What extra revenue will that generate from the commonwealth?

The Hon. J.D. HILL: There are two sources, of course. Our own growth is increasing demands but, of course, we are optimistic about the IMVS's capacity to compete with the private sector in the broader health system. We will have to take the second part of your question on notice. I do not have that detail.

Ms CHAPMAN: Is it proposed that any other staff will be taken on to do all these extra tests?

The Hon. J.D. HILL: No. The advice I have is that we expect, through the consolidation, to be able to achieve more throughput.

Ms CHAPMAN: Budget Paper 4, Volume 2, page 7.20 relates to public health. In February this year, and I think again in April, I asked the minister about the chromium contaminated water under the General Motors-Holden's Woodville site in the context of public warnings (or the absence thereof) to residents in that area. This came shortly after a public warning had been issued in relation to the consumption of bore water in the Beverley and Woodville South area. I have not yet received any responses to those questions as to what will be done about it. Is there any provision in this year's public health budget to clean up that water?

The Hon. J.D. HILL: Let me give the member the information that I have. Residents of Allenby Gardens, Beverley, Woodville South, the north-eastern portion of Findon and the south-eastern portion of Woodville West have been warned not to use groundwater from residential bores for drinking, cooking or other domestic purposes. All residents in the affected area have been advised in writing, and media releases were issued on 18 December 2007, 16 January 2008 and 19 March 2008.

These warnings were issued following the detection of trichloroethylene (TCE) from bores in the areas. Concentrations were well above drinking water guidelines. TCE is an industrial chemical widely used as a metal cleaner and degreaser, but long-term exposure may lead to cancer. The source of the contamination is unknown. Contamination of shallow groundwater by industrial chemicals such as TCE is a widespread problem in urban centres around the world.

Ms CHAPMAN: I think we are at cross-purposes here. I have not asked about the trichloroethylene problem; that was a previous matter. I am asking about the chromium in water under the General Motors-Holden's site, which is in the Woodville area. That is a different matter.

The Hon. J.D. HILL: My apologies. I will seek a report for the member on that topic.

Ms CHAPMAN: And, in particular, whether there is any funding in this budget to clean that up. I will move to my next question. Is there any funding in this budget—and I note that in the Premier and Cabinet portfolio, 'New works', there is a purchase of land for the safe storage and destruction of explosives—

The ACTING CHAIR: (Ms Simmons): Does the member have a budget paper page number?

Ms CHAPMAN: I am referring to 'Capital works', Budget Paper 5. It is not there; that is what I am asking.

The Hon. J.D. HILL: What is not there?

Ms CHAPMAN: I note that, in the Premier's portfolio of investment programs, he is to purchase land for the safe storage and destruction of explosives at a cost of $5 million. For the last three years I have been asking regularly in the parliament (as the minister would know) about what has happened with respect to the radioactive waste site that the government had announced. Is there any funding in this year's budget for the radioactive waste site to be established so that the radioactive waste stored in the basement of the Royal Adelaide Hospital can be transported, along with that from other sites in Adelaide?

The Hon. J.D. HILL: Of course, the responsibility for this is not within the Health portfolio: I understand it is within the Department of Transport, Energy and Infrastructure. I am happy to pass on the member's request for information to the minister responsible.

Ms CHAPMAN: If that site has not been built before the commencement of the Marjorie Jackson-Nelson hospital, is it proposed that there will be a radioactive waste storage unit in the new hospital?

The Hon. J.D. HILL: These are issues that we will have to explore and consider. My hope is that there would be a central state store that could house these collections. They are relatively small, as the member would know; they do not take up a lot of space. There would be the capacity, I think, in other centres in Adelaide if we had to transfer from one hospital to the other. This is too hypothetical for me to really give any elaborate answer. I am happy to pass on the request to both my officials and minister Conlon's officials to see if we can give the member something more succinct.

Ms CHAPMAN: The minister may wish to take my next question on notice. What was the cost of security guards in public hospitals during the 2007-08 year, and what is budgeted for in the 2008-09 year?

The Hon. J.D. HILL: We will see if we can get some particular information, but there is no budget line as such. The hospitals have budgets to work within, and if they need to hire security guards that is what they do. It is regrettable that these days we have to have security guards to basically protect patients and staff from some other patients, but that is the nature of the world in which we live.

Ms CHAPMAN: I appreciate that may take some time. I will now read the omnibus questions, as follows:

1. Will the minister provide a detailed breakdown of the baseline data that was provided to the Shared Services Reform Office by each department or agency reporting to the minister: including the current total cost of the provision of payroll, finance, human resources, procurement, records management and information technology services in each department or agency reporting to the minister, as well as the full-time equivalent staffing numbers involved?

2. Will the minister provide a detailed breakdown of expenditure on consultants and contractors in 2007-08 for all departments and agencies reporting to the minister, listing the name of the consultant and contractor, cost, work undertaken and method of appointment?

3. For each department or agency reporting to the minister how many surplus employees will there be at 30 June 2008, and for each surplus employee what is the title or classification of the employee and the total employment cost (TEC) of the employee?

4. In the financial year 2006-07 for all departments and agencies reporting to the minister what underspending on projects and programs was not approved by cabinet for carryover expenditure in 2007-08?

5. For all departments and agencies reporting to the minister what is the estimated level of under expenditure for 2007-08, and has cabinet already approved any carryover expenditure into 2008-09? If so, how much?

6. (i) What was the total number of employees with a total employment cost of $100,000 or more per employee, and also as a sub-category the total number of employees with a total employment cost of $200,000 or more per employee, for all departments and agencies reporting to the minister as at 30 June 2008; and

(ii) Between 30 June 2007 and 30 June 2008, will the minister list job title and total employment cost of each position (with a total estimated cost of $100,000 or more):

(a) which has been abolished; and

(b) which has been created?

7. For the years 2006-07 and 2007-08 will the minister provide a breakdown of expenditure on all grants administered by all departments and agencies reporting to the minister, listing the name of the grant recipient, the amount of the grant and the purpose of the grant and whether the grant was subject to a grant agreement as required by Treasurer's Instruction No 15?

8. For all capital works projects listed in Budget Paper 5 that are the responsibility of the minister, will he list the total amounts spent to date on each project?

The Hon. J.D. HILL: I have received further advice around the Parklands legislation, which was the subject of a number of questions. I am advised that section 23 of the Adelaide Park Lands Act requires a report to be tabled in both houses of parliament and a copy furnished with the ACC describing the proposed change in use and the condition of the site. This must be done within 18 months of the decision to change use. I am advised that we plan to table this report before the end of this calendar year.

The ACTING CHAIR: There being no further questions for the Minister for Health, I declare the examination of the proposed payment for the Department of Health adjourned until tomorrow.

The Hon. J.D. HILL: Thank you, Madam Acting Chair. I take this opportunity to thank the officers from my department and from my own ministerial staff for the assistance given to me in the preparation for today's estimates. I thank members of the committee for their help, as well as you and other chairs here today.