DEPARTMENT FOR HEALTH AND AGEING, $3,010,707,000

Membership:

Mr Hamilton Smith substituted for Ms Chapman.

Mr Griffiths substituted for Mr Gardner.

Mr Venning substituted for Ms Sanderson.

Witness:

Hon. J.D. Hill, Minister for Health and Ageing, Minister for Mental Health and Substance Abuse.

Departmental Advisers:

Mr D. Swan, Chief Executive, SA Health.

Mr J. Woolcock, Chief Finance Officer, SA Health.

Ms J. Richter, Executive Director, Health System Performance, SA Health.

Ms N. Dantalis, Director, Corporate Governance and Policy, SA Health.

The CHAIR: I need to go through the preliminaries so that people are familiar. 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 consideration of the proposed payments to facilitate changeover of departmental advisers. Changes to committee membership will be notified as they occur. If the minister undertakes to supply information at a later date, it must be submitted to the committee by no later than Friday 21 September. I propose to allow both the minister and the lead speaker of the opposition to make brief opening statements if they so wish.

There will be a flexible approach to giving the call for asking questions, based on about three questions per member. 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. Members unable to complete their questions during the proceedings may submit them as questions on notice for inclusion in 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. All questions are to be directed to the minister, not to the minister's advisers. The minister may refer questions to advisers for a response. I also advise that for the purposes of the committees, television coverage will be allowed for filming from the areas clearly marked on the floor of the room.

I declare the proposed payments open for examination and refer members to the Portfolio Statements Volume 3. Minister, do you wish to make an opening statement?

The Hon. J.D. HILL: Thank you very much, chair, and members of the committee. Providing the best possible health care to all South Australians is a core and enduring priority of the Labor government. That is why this government has invested heavily in health services and in the construction of new health facilities. In 2012-13, $4.927 billion will be spent on health services and functions across government, a massive 129 per cent more, or $2.8 billion extra, than in 2001-02 when we came in government.

This increased investment has seen over 4,500 additional nurses working within the system and well over 1,000 extra doctors and 1,000 extra allied health workers. In addition to massively increasing the workforce, the government has systematically gone about rebuilding the state's hospitals which were the oldest on mainland Australia. SA Health's 2012-13 capital expenditure will be $489.3 million. This is the second year in a row that our capital expenditure will reach this unprecedented level of almost half a billion dollars.

In the north, $50 million will be spent on the $201.7 million stage C redevelopment of the Lyell McEwin Hospital which will add 96 new beds, improve emergency department access and flow through, the creation of an acute medical unit, as well as create a cancer centre increasing chemotherapy and radiotherapy services.

The Elizabeth GP Plus centre has opened and a GP Super Clinic has been built in close proximity to the Modbury Hospital. In the south, the $162.7 million redevelopment of the Flinders Medical Centre is now substantially complete and the Marion GP Plus centre has opened, as has the Noarlunga GP Super Clinic.

The budget also provides $15 million towards a $64.4 million upgrade of the Women's and Children's Hospital. In the country we are investing $20.8 million towards the $36 million redevelopment of the Berri Hospital and $8.5 million towards the construction of the Port Pirie GP Plus Health Care Centre. In conjunction with the commonwealth government we are also providing $12.7 million towards the $39.2 million Port Lincoln Health Service redevelopment, $8 million towards the $26.7 million redevelopment of the Mount Gambier Health Service, and $38.4 million towards the $69.3 million redevelopment of the Whyalla Hospital.

Capital projects worth $3 billion have been completed, are underway or have been funded across the health portfolio by the government. Of course, the centrepiece of our knew hospital infrastructure is the new Royal Adelaide Hospital, where site works are nearing completion and construction is underway.

As well as increasing the number of staff and rebuilding the state's health and hospital infrastructure, we are also providing our doctors and nurses with the tools they require to provide the best possible care to patients. The 2012-13 budget includes a $191.7 million investment in three major e-health initiatives that will move SA Health into the digital age of health care. These are EPAS (Enterprise Patient Administration System), EPLIS (Enterprise Pathology Laboratory Information System) and ESMI (Enterprise System for Medical Imaging).

Patient diagnostic information cannot currently be easily shared electronically between hospitals, making it difficult and time consuming for the results of pathology tests or scanning taken at one hospital to be shared with another hospital on a subsequent admission. These new systems will create one patient, one record, one system. This will give doctors faster access to the patient information they need to make life-saving decisions. It will transform health care in South Australia, improving the quality of care and saving time and money.

The government's mission has been to rebuild the health system. This has been a hard road and the task continues, but the investment in health is starting to reap results, as South Australia has steadily improved in all the key service and timeliness indicators over the past few years. In emergency departments the median wait time to service delivery was 20 minutes in 2010-11. That is down from 29 minutes four years earlier and means that on the latest available figures South Australia was second best performing in the nation in 2010-11 for this category.

The result for the year to date to April 2011-12 is 16 minutes, a figure which for the first time includes large country hospitals. Ninety per cent of people were seen by a doctor or nurse within 104 minutes in South Australia in 2010-11, making South Australia the best performing jurisdiction for this category in 2010-11. Seventy-one per cent of our patients were seen on time, according to clinical categories in SA emergency departments in 2010-11, making SA the equal second best in the country. This is up from 61 per cent four years ago. The year to date to April 2010-11, including seven country hospitals, is 76 per cent of patients seen, according to clinical categories.

It has been historically harder for small states to perform well in ED timeliness categories, making our performance even more meritorious. Doctors and nurses within our EDs should be proud of these results. These improvements in emergency department waiting times are partially a result of the success we have had in reducing the growth in presentations to EDs. SA had the best (or lowest) growth in ED presentations in the nation in 2010-11. The year-to-date figures to April 2011-12 show a very marginal acute reduction in ED presentations of 0.1 per cent. This is an incredible difference from the annual 4-5 per cent growth we were experiencing before the introduction of the health care plan in 2007.

At the last election the government committed $111 million to back the introduction of a new ED target for 90 per cent of all patients to be seen, treated and discharged or admitted to a ward bed within four hours by June 2013. The most recent national comparative data for this was done in 2009-10 and showed that just under 60 per cent of patients met the target. This has improved to 64 per cent in the year to date to April 2011-12, including seven country hospitals. The government has recently focused its attention on the particular target and, for the actual month of April 2012, 68 per cent of patients were seen, treated and discharged or admitted within four hours. This is below the state target of 75 per cent by June 201 but is ahead of the national target of 67 per cent by the end of the 2012 calendar year.

Remarkably, improvements in emergency department performance have occurred while unprecedented levels of elective surgery performances have been undertaken. On average, from 2006-07 to 2010-11 SA recorded the second highest growth in elective surgery in Australia. In metropolitan hospitals alone, we undertook over 5,500 more procedures in 2010-11 than we did in 2006-07.

The direct result of these additional procedures has been to dramatically reduce the number of overdue patients. As at 30 June 2011, there were only five patients overdue for their elective surgery in South Australia in metropolitan hospitals, which was the third year in a row we finished with virtually no overdue patients. We anticipate a similar result this year.

The median wait time for elective surgery across South Australia for the year to date April 2012 was 33 days. This is down from 42 days in 2007-08. We have been improving while the national trend has been in the opposite direction. In 2010-11, 90 per cent of all patients in South Australia were admitted for elective surgery within 208 days, which is 17½ per cent better than the national average of 252 days. Waiting times for this measure have further improved to 187 days in the period to April 2012.

What these figures show is that South Australia has a world-class healthcare system. It is an excellent and improving system. Whilst there are always improvements to be made, it is worth reflecting on these achievements. The doctors, nurses and other clinical and support staff, as well as health managers, should be pleased with their achievements, and I thank them sincerely for their efforts.

Many of these improvements have been helped by our efforts to increase transparency of our health system, giving South Australians unprecedented access to internal dashboards that show the number of patients being treated in our metropolitan hospital wards and emergency departments at any one time. We are now taking this transparency even further, and I can announce today that more dashboard information will go live from this Friday. This includes a new ambulance dashboard to help further improve the flow of patients through hospital emergency departments.

When particular hospitals are busy, the ambulance service will be able to make a real-time decision about where to take patients, rather than hospitals going on ambulance diversion. The dashboard provides updates every five minutes of activity in emergency departments, bed occupancy and other useful information to assist ambulance staff to make decisions about where to best take the patient. The change will enable a faster response and better spread the demand across emergency departments.

In addition, people can now see the number of patients being treated at hospitals in Port Lincoln, Port Pirie, Whyalla and the Riverland. These hospitals join Port Augusta and Mount Gambier hospitals, which both went live last year. Residents can see information updated every 30 minutes about the bed occupancy, average length of stay and patient admissions and discharges at their local hospitals. There is also information about elective surgery, including waiting times, cancellations and the types and numbers of procedures.

The health system is the largest single part of government. During 2010-11, there were approximately 1.62 million hospital bed days throughout the public hospital system. In the 2011-13 financial year, we anticipate that SA Health will perform over 65,000 elective surgery procedures, make over 300,000 GP Plus appointments and undertake 83,000 breast and 154,000 cervical cancer screenings. The Ambulance Service will respond to over 335,000 callouts, and the Dental Service will undertake over 100,000 hours of dental services on children.

By any measure, this is a large system that interacts with many, many South Australians, each and every year. Often at times, and it is obvious to say, the health system interacts with people at times of great stress and these interactions do not always go as well as people might hope. The health system is always striving to perform better and learn from mistakes that do occur; however, it is wrong to draw universal conclusions about the system from these individual cases.

Over recent years, SA Health's performance has improved in key measurable categories. Our next challenge is to maintain this improvement while stabilising the growth in expenditure and services. This is a challenge that all other states and, indeed, all other Western jurisdictions are facing. I and the government look forward to this challenge.

The CHAIR: Does the shadow minister have an opening statement?

Mr HAMILTON-SMITH: Not really, Mr Chair, except to thank all the staff for the effort they have put into today; I know it is considerable. I will go straight into questions.

Minister, you have talked about and given selective examples of how our health system is working well in certain categories. The opposition appreciates and welcomes that, but I am interested in asking you some questions about where it is not working quite so well, particularly at the Lyell McEwin, since that is topical today. In doing so, I am referring to the Northern Adelaide Local Health Network in Budget Paper 4, Volume 3, starting on page 44. Doctors are meeting out there today to talk about the problems of overcrowding and the emergency department not coping very well. One of the measures that the minister did not mention in his opening remarks was the four-hour rule, which is the—

The Hon. J.D. HILL: Yes, I did mention it.

Mr HAMILTON-SMITH: —measure used by the commonwealth, which has been nationally agreed to, to assess the time taken from the moment a patient enters the ED until discharge either to home or to the hospital proper. My understanding is that our performance is at about 59 per cent. Perhaps the minister could clarify that for the committee across the hospital system, but my specific question is: how is the Lyell McEwin Hospital performing on the four-hour rule? What percentage of patients are meeting the requirement?

The Hon. J.D. HILL: I thank the member for the question. I did actually say that during my opening remarks, although I did not answer the question in relation to the four-hour rule generally. I think I said that we were at about 60 per cent earlier this year and the most recent figures show that we are now at about 64 per cent. In April 2012, 68 per cent of patients were seen, treated and discharged or admitted within four hours. To requote myself, the government has recently focused its attention on this particular target and for the actual month of April 2012 68 per cent of patients were seen, treated and discharged or admitted within four hours. So, there have been huge improvements.

The four-hour target was an election promise that we made at the last election. The data that the member is referring to, the 59 per cent or thereabouts, relates to the period before or at the time of that target being set, so it was not a target that we had at the time. Subsequent to our undertaking to move towards that target, the commonwealth picked up a similar measure, so we have morphed our target into their target because it just makes sense to have only one target. Whereas we had 95 per cent, the national target is 90 per cent, so we have agreed to that change; the doctors were supportive of that as well. Western Australia has had a target of 90 per cent for four hours for a couple of years longer than us and they are the best performing in Australia.

I think what that demonstrates to me—and it is true generally of health—when you set a target, you publish it, you work towards it and you will make improvements. We did not have it as a target. It is not something we measured, it is not something we knew about, particularly. We have now set it as a target, so we have moved from 59 per cent whenever it was and in April this year we were at 68 per cent. From memory—and I saw a stat today from Lyell McEwin—I think Lyell McEwin is at about 50 per cent, so it is fair to say that the hospitals which deal with the more complex cases and the hospitals which are the busiest—Flinders, Lyell and RAH—are not performing as well as some of the other hospitals. The Women's and Children's, Noarlunga and TQEH are performing better. The focus is quite rightly on the biggest and most complex hospital systems, and they are the three acute hospitals which form the spine of our system.

Mr HAMILTON-SMITH: I thank the minister for his answer. Of course, April is a warmer month, and I imagine what happens with these measures is that in warmer months and low demand months our performance is better than in colder months or high demand months. I wanted to confirm what I think I just heard. Lyell McEwin is meeting on an aggregate over the year about an average of 50 per cent of people seen within the four hours. I think I heard the minister say that. Could you confirm for the last complete full year of recording, rather than month by month—and I think Mr Swan confirmed this at the Budget and Finance Committee—is it about 59 per cent or 59.3 per cent or something for the last complete year of measuring the four-hour rule?

The Hon. J.D. HILL: I think I gave that. I think it was 64 per cent, the figure I gave.

Mr HAMILTON-SMITH: That was for April; that was for one month, I think.

The Hon. J.D. HILL: No, it was 68 per cent for April. I will confirm it if I have got it wrong, but I think it was around 64 per cent for last calendar year.

Mr HAMILTON-SMITH: The commonwealth publication says 59.2 per cent.

The Hon. J.D. HILL: Yes, but I think you have an older publication. I am talking about the—

Mr HAMILTON-SMITH: Sorry?

The Hon. J.D. HILL: You may well have an older publication. I think the commonwealth figures, as I said, were based on the 2009-10 calendar year, but I will get that confirmed. We should be able to do it by the end of today.

Mr HAMILTON-SMITH: All right. Where does the last four full year of recording rank South Australia compared to other states on the four-hour rule system?

The Hon. J.D. HILL: The only figures we have are the 2009-10 figures, which you have already referred to. What we do not have are the most recent—and we have improved—so I cannot answer that question because those figures have yet to be published.

Mr HAMILTON-SMITH: Where does the 2009-10 ranking place us?

The Hon. J.D. HILL: As you know, the ACT was performing less well than us. We were at 59.4 per cent; New South Wales was at 61.8 per cent and the others were in the 60s, so we were the second performing at that time. However, as I said, this was before we set the target. We have now set the target and if we took the most recent figure we would be performing about fourth, I think, around Australia.

Mr HAMILTON-SMITH: So it is correct to say that we were, according to those figures, the worst performing of the states and you hope that we would be performing better but you do not know whether the other states have improved, do you?

The Hon. J.D. HILL: All I can tell you is what has happened in our state. We were at 59.4 per cent and we are now (in April) 68 per cent, so that is quite a considerable improvement. That is not a yearly figure; that is a monthly figure. The point I made is that once you identify an area and you put resources and effort behind it you get improvements. This was not an area which we had focused on in the past.

Mr HAMILTON-SMITH: At Lyell McEwin it is 50 per cent, so that is significantly below the rest in terms of performance to the four-hour rule, as you have just mentioned, and that should ring an alarm bell. I am now moving to page 46 of the same budget paper that I referred to earlier, where the performance indicators show that in the Northern Adelaide Local Health Network, we are achieving only 79 per cent of emergency patients being seen within the required 10 minutes and only 59 per cent of urgent emergency casualties being seen within the required 30 minutes. I note the target there is 75 per cent. That, read the other way around, means that 41 per cent of urgent casualties are not being seen on time. Does that figure give the minister some cause for concern, and is that one of the issues that doctors are discussing right now?

The Hon. J.D. HILL: I cannot tell you what the doctors are discussing right now, but I can tell you that we are committed to improving the performance of our emergency departments, and the figures I gave in my opening statement indicated that we have a higher percentage of patients seen in time in South Australia compared to the national average. That obviously varies from site to site.

The member raised the issue of the Lyell McEwin, so I will perhaps give a general overview: the Lyell McEwin, which services the northern suburbs had, I believe, been neglected for many years by government. The services provided at the Lyell McEwin were not much better than you would expect in a small country community, even though it was perhaps the most rapidly growing part of our metropolitan area.

Over recent years we have committed hundreds of millions of dollars to expand and rebuild the Lyell McEwin Hospital to make it a modern, acute service. There is still $200 million worth of building works going through at the moment. By the middle of next year, we will have an extra 48 beds available at the Lyell McEwin Hospital and then, six to 12 months later, we will have another 48 beds, which will give it extra capacity.

The emergency department at the Lyell McEwin has 41 bays and the hospital in year 2010-11 had approximately 57,706 presentations at the emergency department, which works out at around about 150 to 160 patients a day, so 40 cubicles ought to be enough to deal with that number of patients if the flow through the hospital is working as well as it should. The issue I imagine the doctors are working on today with my departmental officers is to make sure that the flow from the emergency department of patients who need to be admitted works purposefully.

There is a bit of a handicap at Lyell McEwin because the beds they require have yet to be opened, and you just cannot speed up those capital works any faster. There is a range of things that we can do to improve that flow, and the report that Stephen Christley prepared, which I tabled in parliament last week, highlighted a number of those issues. I imagine that is the subject of the discussion today, how to achieve those things. I will ask Mr Swan to just give some details of the kinds of measures that are being looked at to improve the flow.

Mr SWAN: There was a meeting this morning between all the clinicians and management, where they talked about access to beds and access to services, which was very productive. The clinical community out at Lyell McEwin and Modbury for the northern network is very committed to improving access to services. They discussed a range of initiatives that they will be moving forward with over the next few weeks, particularly the development of an acute medical unit for Lyell McEwin Hospital, which will fast-track acute medical patients into beds, improving access to diagnostic services early, both from the emergency department and inpatient units, which it will assist with, again, early admission.

Event-led discharge is really nurses having protocols prescribed by the doctors that allow them to discharge patients when they are ready to go home, which means that it fast-tracks people moving back to their own community. All those things are committed to by the clinical community and hospital management, and they will be undertaking them over the next few weeks.

Mr HAMILTON-SMITH: I thank the minister and the CEO for their answer. It is interesting that after such a long period in government, though, we are still facing a situation where, as a casualty, you have a 50 per cent chance at Lyell McEwin that you will not be out of there within four hours, to meet the four-hour rule, and if you are an urgent casualty there is a 41 per cent chance that you will not be seen on time. I appreciate the measures that are being taken to try to fix that, but it is an alarming figure for the people of the northern suburbs.

Since the minister has raised the issue of the report that was recently commissioned into Lyell McEwin Hospital, conducted by Dr Stephen Christley, could I just ask a question about that? I have read the statements made by SASMOA's Dr David Pope when he first raised this issue. He seems to use the language of doctors having been asked to see and assess patients on the floor, not claiming that they were laid out physically on the floor and seen on the floor, but they were asked to see patients on the floor. I note on page 5 the report itself gives a commentary of a nurse saying to a doctor that if he wished to examine this patient now he would need to do so on the floor because the hospital had run out of barouches.

Can I just check the minister's understanding of what Dr Pope from SASMOA actually said. I note the minister's comments claim that Dr Pope and SASMOA said doctors did see patients on the floor, when, looking at the letter of what was actually said, it appears he only said that they were asked to see patients on the floor. Perhaps you could clarify that for us.

The Hon. J.D. HILL: I will certainly do that. I read all of this into the Hansard last week. I quoted a number of claims that were made, and I will just find the quote from Dr Pope. It is worth pursuing. Dr Pope, on Friday the 18^th, said:

On Tuesday evening, the Lyell McEwin ran out of hospital beds and barouches, and the doctors were asked to see and assess patients on the floor because there didn't seem to be any other option available.

Then, he said, again on the 19^th, on Channel 9:

Medical staff were asked to see people on the floor because they needed to lie down for their conditions, and there was nothing to lie down on.

Then, on the 23^rd, he said:

We were expecting to find that the overcrowding is severe. The hospital regularly comes close to running out of barouches, and on last Tuesday evening actually did run out of barouches and beds, and it is that overcrowded patients, if there is no bed or barouche and they are still arriving, there is no other place but on the floor.

There are lots and lots of similar quotes to that, but there is one particular quote I am looking for; that is, on Wednesday 23^rd May on ABC 891, he said:

What happened was that the hospital emergency department ran out of beds and barouches. There were patients needing to lie down to be assessed for their condition. There was no option but for the people to use the floor, so medical staff were seriously asked if they would see, examine and treat people on the floor. Nobody was on the floor for any length of time, but that was the situation that was faced by medical staff at that time.

I read that to mean that they were seen on the floor but not for very long. The reality is that nobody was seen on the floor. There was one reference that the report found where a doctor said to a nurse, 'Where is the bed?' and the nurse said something along the lines of (and it could well have been a joke, that was the reference in the report), 'Well, you'll have to see them on the floor because there's no bed available.' Of course, that did not happen. A bed was found, and the patient was looked after properly.

So, what was hearsay was exaggerated by SASMOA in the media, and the impression was clearly given, and was reported repeatedly, that patients were seen on the floor. I was asked a number of times in the media, 'Isn't it outrageous that patients were seen on the floor, as alleged by the doctors' union?' and I said, 'This is yet to be proved.'

I organised a review, which the health department organised, and that has demonstrated that no patient was seen on the floor on the day that the allegation was made. I do not want to quibble about this; it was a very busy day. It was probably one of the busiest days we ever had. But it is simply not true what was reported repeatedly in the media in relation to the Lyell McEwin.

Mr HAMILTON-SMITH: But, minister, you have been unable to give a quote—

The Hon. J.D. HILL: Yes, I did. I just gave one.

Mr HAMILTON-SMITH: If I listened to you, you can listen to me. You have been unable to give a quote from Dr Pope that unequivocally states that patients were seen on the floor. In fact, you have supported the point I am making by giving numerous quotes from David Pope that doctors were asked to consider seeing patients on the floor, etc.

The only quote which you have been able to provide from Dr Pope which might suggest that patients were seen on the floor is one remark in an interview where it said, 'nobody was on the floor', and then he says, 'for any length time,' which you interpret as an unequivocal statement from him that they were seen on the floor.

The first point I am making is that you may have had questions put to you by the media, and you may have assumed that Dr Pope had said that, but when you check what SASMOA and Dr Pope actually said, and I think this comes out in the report that has been done by Dr Christley, it seems that just about every point that Dr Pope raised has been vindicated: the hospital ran out of barouches. The report says that they were unable to put on enough nurses that evening. In fact, I think the exact quote, on page 2 of the report, was:

It was not possible to fill all of the nursing shifts in the ED on the evening...'

He also says in his report that a nurse told a senior doctor that if he needed to examine a patient now he would need to do so on the floor. He also confirms that patients were seen in chairs on the floor, raising questions as to what 'on the floor' means. I am wondering whether we are having a semantic argument here. If you are seen in the waiting area on the floor in a chair when you should be on a barouche in a waiting bay, what is 'on the floor'?

The point that Dr Pope, SASMOA and the doctors seem to be making is that this was an overcrowded, difficult and awkward situation and people were being seen in the waiting areas on the floor, whether some of them were sitting or not, and that nurses were seriously proposing to doctors that they might need to consider seeing them on the floor. I have your Hansard here. I wonder, when you said about 'this department', 'The investigation did not find any cases that matched the statements made by Dr Pope,' whether that was a completely accurate remark, because I think the investigation found a lot of what Dr Pope said to have been completely truthful and accurate.

The Hon. J.D. HILL: You can try to interpret it that way if you like, member for Waite, but I will read again from the transcript of the interview Dr Pope had with David Bevan on ABC radio from 8.00 to 9.00 am on Wednesday, 23 May. Bevan said this to Dr David Pope:

...can you confirm, you don't have any doubts, that this incident did occur...a patient or patients plural were forced to lie on the floor at the Lyell McEwin in the last week or so and that's where they were being treated?

David Pope in response:

...that's right. What happened was that the hospital and the Emergency Department ran out of beds and barouches. There were patients who needed to lie down to be assessed for their conditions and there was no option but for the people to use the floor. So medical staff were seriously asked if they would see and examine and treat people on the floor...nobody was on the floor for any length of time but that was the situation that was faced by medical staff at the time.

I think that is pretty unequivocal. He was asked: were people lying on the floor? He answered: that's right.

Mr HAMILTON-SMITH: I think you will find that doctors have a different view of that. The other thing I find surprising is that the report you are holding up as something to be proud of, claiming that it completely vindicates or somehow or other supports the argument that all is well there, is, in fact, quite damning when you read the detail of it. I gather you are looking at taking actions. What actions are you intending to take to fix the problems identified by Dr Christley in his report, because some of them are quite striking?

The Hon. J.D. HILL: I have not made any of the claims that the member just suggested that I made in relation to this report. I have said that Lyell McEwin had a very difficult day. It is true that there was a shortage of beds, barouches and the like. None of those things we have glossed over; they have all been printed and published in this report and the report goes through a number of recommendations to improve the situation. As Mr Swan said, they are being worked through.

The point is that a claim was made by a senior representative, the president of the doctors' union, that patients were being treated on the floor. He also said that the emergency department had run out of oxygen. Both those claims were reported in the media, which brought into disrepute the way that emergency department was running; both those claims are untrue. Steven Christley, who did the review very thoroughly without fear or favour, came to that conclusion.

It is absolutely proper that we have discussions in here and in the community about the level of resources and the issues around emergency departments, but those discussions have to be made on the basis of truth about claims. You cannot just make things up and use that to support your arguments. Particularly, I think, given the high regard that doctors have in our community, there is a special duty on them to make whatever claims they are making based on an accurate assessment of the issues.

To simply say that there were patients being treated on the floor, as he clearly does in that interview with David Bevan on 23 May, has subsequently found to be unsupported. There is nobody who has supported that claim—nobody. The best that can be drawn is that there was something said by a nurse to a doctor, which was possibly a joke, about how busy it was, but no patient was treated on the floor.

Mr HAMILTON-SMITH: Yes, but you do accept that they were treated out of the waiting area in chairs in the corridors? Do you accept that or not? The report says that happened, so is that right?

The Hon. J.D. HILL: The claim was—and that is the point you put to me—whether I was inaccurate when I reported to the parliament that Dr Pope was wrong when he said that there were patients treated on the floor. I said exactly what I should have said in the parliament, that that claim was incorrect. It was a busy time. A lot of patients who came in had to be dealt with.

As I said in the parliament at that time, and I have said in the media on multiple times, and I have said out at Lyell McEwin, I have great sympathy for Lyell McEwin because it is a hospital which is under enormous pressure while we are building the infrastructure that will support additional beds. Once we have that in place, it will take a lot of the pressure off, but there are other things that we can do in the meantime, which David Swan has outlined.

Mr HAMILTON-SMITH: We will not waste any more time of estimates on this point, but my view is that you have used a bit of licence as well in interpreting Dr Pope's remarks.

The Hon. J.D. HILL: Point of order, Mr Chairman: I am not sure if it is appropriate for the leader to make commentary like that and leave it hanging in the air, and I ask him to withdraw. I object to that completely.

Mr HAMILTON-SMITH: I do not think it is unparliamentary; I am just expressing a view. I think you have used a bit of licence in the interpretation you have put on Dr Pope's remarks, and you have made a political point.

The Hon. J.D. HILL: If that is what you feel, member for Waite, I will go through the remarks again. Dr Pope was asked:

Can you confirm you don't have any doubts that the incident did occur: a patient or patients, plural, were forced to lie on the floor at Lyell McEwin in the last week or so, and that's where they were being treated?

He said, 'That's right.' If you think there is licence in my interpretation of that, I will leave it to others to judge who is correct.

Mr HAMILTON-SMITH: You said on radio this morning words to the effect that you completely refuted the doctor's views and positions on the situation at Lyell McEwin. I think you used that terminology. You were critical of Dr Pope on radio this morning, and then I think you said (I was taking notes at the time) something along the lines that you completely disputed the claims of the doctors in regard to concerns about Lyell McEwin, or words to that effect. I would have to get the transcript to be precise.

Are you in some sort of cold war with the doctors at Lyell McEwin, and why are you not talking to the doctors at Lyell McEwin instead of sitting here criticising Dr Pope and engaging in insults back and forward between the doctors and the minister? Is there a breakdown in the relationship between you and the doctors?

The Hon. J.D. HILL: There is lots of argument in that question. The reason I am sitting here is because it is estimates, and the reason we are talking about these issues is that you have raised them. I am not at war with any of the doctors. What I am trying to do is make sure that whatever discussion we have about the way our health system operates is based on the truth and on facts and not on exaggerated claims, whether they are made by politicians or by representatives of unions, doctors or other unions. The health system is hard enough to manage and to get right; to do it on the basis of claims which are made which are incorrect I just think is something I have a responsibility to challenge.

The interview I had on the radio this morning raised a number of issues. The particular issue being talked about, which I seem to recall the remarks I made related to, was the claim that the closure of some acute mental health beds was responsible for some of the pressures at Lyell McEwin. I simply made the point that those beds have yet to close so they could hardly be responsible for any pressures that might currently be felt at Lyell McEwin.

I did not go on to make this point because the interview did not go in that direction, but the beds which are to be closed in the southern suburbs, and a number at Glenside, I feel are unlikely to put very much pressure on Lyell McEwin. In any event, the number of mental health patients who were at Lyell McEwin on at least one of the days in question I have some figures on was about 4 per cent, so a relatively small number of the patients are mental health patients.

There is an issue around mental health beds, and I am happy to go through that with the member when we get to that part of the discussion later on this afternoon, or I can do it now if he wishes. We have opened up considerably more places for mental health patients in our state. Currently, I think around 74 additional places have been made, so there are more places for mental patients to be treated in South Australia.

The Stepping Up report, which made a series of recommendations to government and which were adopted, said that we had too many acute mental health beds and recommended that we transfer the resources from those acute beds into sub-acute and other services, which is exactly what we said we would do and we are now doing it. It is true that sometimes mental health patients do end up in emergency departments and stay there for a very long period of time, and that is one of the issues the CE is working on at the moment with Lyell McEwin and other hospitals.

I meet with doctors frequently. I met just recently with the head of Lyell McEwin emergency department and went through a number of the issues with her. The CE and I went out to the hospital about six weeks ago and addressed a meeting. We invited all the doctors and staff to attend and we talked about these issues. Dr Pope was in the audience and raised some issues in relation to mental health beds, which we addressed.

There is no war at all between doctors and me. I have enjoyed extremely good relations with the medical fraternity in the years I have been health minister, but during enterprise bargaining times—and that is what we are going through at the moment (there are enterprise bargaining discussions on the table at the moment between SASMOA (the doctors union), the health department and the government)—you get these kind of claims being made. We have to challenge some of those claims. It would be totally wrong for government to just swallow everything said. We have to go into a robust discussion with representatives of the union, but that is not to say we do not have good relations with them.

Mr HAMILTON-SMITH: Have I just heard the minister correctly that he is asserting that the concerns raised by SASMOA and the doctors about overcrowding and problems in emergency departments are being raised as a bargaining tool in industrial negotiations about remuneration, because that is just what you inferred? You inferred that the doctors are making false claims about emergency departments just to argue for more money. I find that quite offensive, and I think they will as well. I ask you to clarify the remarks.

The Hon. J.D. HILL: Certainly. It is interesting that you are inferring something from my remarks. When I tried to do that with you last week in question time, when I said that I thought you were implying something, you took exception and said that it was unparliamentary. I am saying that what is good for the goose is good for the gander.

I was saying that an enterprise bargaining discussion is going on at the moment, and sometimes some of the claims get a bit heated. One of the things we want to do in particular, which would take pressure off the emergency departments, is to have the capacity to have senior doctors rostered on duty 24 hours a day in parts of the hospital other than the emergency department and the ICU. Currently we have senior doctors rostered in the emergency department and the ICU around the clock, and that means that senior people can make critical decisions when patients need assistance, but we do not have the capacity to have rostered on physicians and radiologists in particular.

We would like to have those specialties rostered so that they are available to discharge more quickly, available to diagnose and to move patients through the hospital system. The doctors union has taken a particularly hard line against that, and this is an area of dispute. There are areas of dispute between the parties in relation to how to resolve issues which affect the emergency departments. That is a fact of life. I think doctors have some genuine concerns about a range of issues about patient flow through emergency into the rest of the hospital. We take them extremely seriously. They are not part of the enterprise bargaining arrangements. They are management issues and are about professional responsibilities that are taken on by various elements within the system.

So, it is not correct to draw the conclusion that the member did. All I am merely saying is that there are enterprise bargaining discussions occurring at the moment and, whenever those discussions occur, there is often a little heat around because the parties are wanting certain things out of the discussions.

Mr HAMILTON-SMITH: You have just repeated it. You have just virtually repeated it. You have said these issues arise when there are industrial negotiations going around. I just find that remarkable but, anyway, as you would have it.

The CHAIR: If you have finished that line of questioning, I want to go to the government. They have some questions and then I will come back to you.

Mr HAMILTON-SMITH: Thank you.

Ms THOMPSON: My question relates to Budget Paper 4, Volume 3, pages 37, 48 and 50. I doubt it will be a surprise to the minister, but I would like further information on the improvements and clinical service enhancements that have been completed at the Flinders Medical Centre.

The Hon. J.D. HILL: I am more than happy to report that the $162.7 million investment in the Flinders Medical Centre was virtually completed in May this year. It was within budget and four months ahead of schedule. In 2005, as part of our then election commitments, a major capital funding commitment was given to enable the redevelopment of the Flinders Medical Centre's critical clinical facilities, central engineering plant and hospital facilities. The project and associated funding commitments were subsequently confirmed by the government, with a total capital funding commitment of $162.7 million being approved for the project, which enabled construction works to begin in early 2008. That redevelopment has included:

a new purpose-built 20-bed cardiac care unit on level 6;

a new 30-bed acute medical unit, located adjacent to the emergency department and the intensive and critical care unit, which will assist clinicians to rapidly assess, plan and implement care for approximately 5,000 acutely unwell medical patients each year;

expansion of the intensive and critical care unit from 24 to 32 beds, which will enable care to be provided to more than 2,100 patients each year;

expansion and complete redevelopment of the emergency department in accordance with the latest models of care;

expanding the facilities from 31 to 50 treatment cubicles;

upgrade to the operating theatre suite, which includes 10 new operating theatres and space for two future theatres to be developed;

an integrated recovery facility accommodating 22 stage 1 and 14 stage 2 recovery bays;

a new centralised sterile store and a holding bay for patients waiting for surgery;

a $50 million major upgrade of the central engineering plant and systems infrastructure;

the new South Wing, which is a new three-level building accommodating new maternity and gynaecology inpatient services;

a new berthing and assessment suite; and

new medical clinics and administration areas.

It should also be noted that the new South Wing building has been awarded a 5 Star Green Star rating in the categories of design and also as built. These are the first such ratings to be awarded by the Green Building Council of Australia, since the introduction of its new hospital rating tool. This demonstrated the government's commitment to achieving high quality service delivery, while making sure we maintain excellence in the application of ecologically sustainable development principles. Some notable environmental features include:

a 286-panel solar hot water system;

a displacement air conditioning system that allows individual temperature control in patient rooms;

the use of low volatile organic compound paints, adhesives and floor coverings; and

highly efficient energy consumption, reducing energy costs by $400,000 each year, CO₂ emissions site wide by 4,160 tonnes and a water consumption reduction of 20 per cent.

The redevelopment of FMC is being facilitated by using Baulderstone as a building contractor and a design team led by Woodhead Architects. This has been a significant redevelopment for the southern metropolitan area and will certainly assist in meeting its ongoing growing needs. I just pay tribute to the people who managed that project. They have done a superb job, in my view.

Mr ODENWALDER: Minister, my question refers to the 2012-13 Agency Statements, Volume 13, Sub-program 1.3. I wonder if the minister can just provide some further information on the key dates for the design and construction of the new RAH and when it will be open to the community?

The Hon. J.D. HILL: I am happy to do that and I thank the member for his question. In December 2007, the government approved the construction of the new Royal Adelaide to be delivered under a public-private partnership procurement arrangement. We signed the contract on 20 May 2011. We reached financial close on 6 June that year with SA Health Partnership to design, build, finance, maintain and provide non-clinical support services for South Australia's new Royal Adelaide Hospital over a 35-year contract. All clinical services at the new RAH will continue to be provided by SA Health.

SA Health Partnership has subcontracted the design and construction responsibilities for the project to Hansen Yuncken and Leighton Contractors as a joint venture. The design and construction phase of the hospital project involves two key activities. The first activity is design development. This process commenced on 22 June 2011 and will be completed over an 18-month period. During this activity the builder is developing, refining and finalising the design documentation from the bid design documents to construction documents. This is a consultative process between the state, SA Health Partnership, the builder, the designers, the facility management subcontractor (Spotless) and planning groups. Planning groups are made up of clinical representatives from the existing Royal Adelaide Hospital and SA Health as well as other stakeholders. It is anticipated the design development process will conclude by the end of 2012.

The second activity is construction during which the builder undertakes construction procurement activities, coordination of infrastructure enabling works and construction of the new RAH in accordance with the construction documents. Works commenced in 2011 to prepare the site for construction. This included the removal of old railway sleepers and ballast, remediation of the site and removal of over 200,000 cubic metres of material. In addition, piling for the retaining wall along North Terrace was carried out with the piles being bored to minimise disruption to neighbouring properties. Building platforms and access roads around the site for construction traffic were also formed, and sewer and stormwater pipes that traverse the site around the footprint of the new building were diverted.

Construction for the main building has now started with the piling/laying of the foundation commencing in June this year. It is anticipated that the building works will be completed by late 2015. During the construction period, the state will also undertake works to ensure the hospital is ready for use, and they include selection, procurement and installation of clinical equipment; development and installation of clinical ICT systems; training of staff in new work practices in the hospital.

At construction completion, extensive testing will be undertaken to make sure the hospital has been built in accordance with the construction documentation and performs in accordance with the technical expectations. It is anticipated that successful completion of the testing regime will mean that the hospital will achieve technical completion in January 2016 and, after technical completion, the state will undertake state operational commissioning work. Further testing will be undertaken to ensure that the hospital is capable of supporting clinical activity in accordance with the functional brief. It is anticipated that successful completion of this testing will mean that the hospital will achieve commercial acceptance in April 2016. At this point transition from the existing RAH can occur, and services will be transferred to the new facility. We expect it to be fully commissioned and operational in April 2016.

In June 2046, the contract with SA Health Partnership will end and the hospital will revert to the state at no additional cost. The hospital is required to meet strict handback condition requirements to make sure it will continue to deliver quality healthcare outcomes for the state for many years after the contract ends.

Dr CLOSE: Further to that answer, minister, could you provide some further information about the benefits of the new RAH, in particular the advantages associated with single rooms and how that will improve the health and wellbeing of patients?

The Hon. J.D. HILL: I thank the member for Port Adelaide for her question. Clinical planning for the new RAH has occurred in the context of our state's healthcare plan. The healthcare plan will be achieved through the development of new models of care. It will enhance current care provided within the hospital system and facilitate new ways of working. Our healthcare plan determined that 800 beds needed to be provided at the new RAH—a combination of 700 overnight and 100 same-day beds compared to the 680 at the existing hospital. The new RAH design comprises 100 per cent single inpatient bedrooms, each with ensuite, and facilities to allow a family member to stay overnight as appropriate.

Evidence suggests that in order to deliver the fundamental elements of the new models of care, there is a direct and critical relationship between the size of the space around the bed and direct adjacent access to the ensuite from the patient's bed. The new RAH's use of single rooms will offer numerous benefits. For example, maximum flexibility and efficiency will be achieved as there will be no restriction in bed availability and no need to regularly move patients to manage clinical issues such as gender mix, isolation requirements due to infection status, disruptive patients and dying patients. Patient falls will be reduced through a direct line of sight to the ensuite from each patient bed. Infection control measures will be supported through the appropriate separation of patients, individual patient ensuite access and improved hand washing provisions through the increased number of basins.

Single rooms would help create an environment that is much more supporting of a dignified, compassionate death. Improved communication between clinical staff and the patient will be facilitated and give patients greater opportunity for involvement in their own care. Patients will have greater control over their environment, including lighting, music, temperature control and fresh air. The provision of adequately sized bedrooms will allow treatment and therapy to be undertaken in the patient's bedroom, thereby minimising the need for patient movement around the hospital. Patient privacy and dignity will also be maximised. Noise and exposure to treatments of other patients will be reduced, improving rest and recovery. All inpatient bedrooms will have access to views and natural light, and family and carers will be able to have greater involvement, including staying overnight where that is necessary.

Inevitably, there will be instances of surges in demand for services in the emergency department which is why the new hospital design provides for additional treatment cubicle capacity from 63 at the existing RAH to 78 at the new site, just on 25 per cent increase. This includes an increase in the current four resuscitation rooms to eight in the new hospital (doubling). One of the most significant impediments to managing emergency patient throughput is access to diagnostic imaging, therefore direct access to imaging has been designed into the emergency through the incorporation of two CTs, one MRI, two digital x-rays and two ultrasound rooms dedicated for emergency patient use.

Furthermore, the new RAH will have sophisticated and intuitive ICT systems and infrastructure to support patient identification and registration. In addition, it will have automated ordering systems for imaging and medications, as well as decision support systems that reduce patient queueing time and improve overall service efficiency and patient throughput across the hospital. The new RAH will be seen within the context of SA Health whole-of-system responses which will include transfer of appropriately lower complex patients to other hospitals to cope with any large surges in demand for inpatient services.

Mr PEGLER: When going through this, I noticed that all the local health networks have the performance indicators for percentage of patients attending emergency departments who were treated within accepted times, and also the percentage of visit times in emergency departments within four hours, yet the Country Health SA local network information does not seem to be in these statements. I apologise if I am wrong but I went right through it and I could not find them.

The Hon. J.D. HILL: I will see whether we can find them for you. It is true that we have only recently started measuring performance in country hospitals. I have just been advised that we do not have it in the reports but we do have some of that information available and I will happily obtain it for the member. In fact, by and large, it is very good. I might have some of the information here. ED presentations seen on time, for example, in country (month of April 2012) is 92.1 per cent, compared to metropolitan which was 76.6 per cent; year to date, April 2012 for country EDs was 91.9 per cent, compared to 72.8 per cent. That includes the seven large country hospitals from September 2011.

ED visits completed within four hours in the country (this is the seven largest country hospitals) was 91.1 per cent in April 2012, and the same percentage year to date. So the performance in country hospitals is very good. I guess that is, in part, due to the relatively small numbers; the crush of demand in the country is not as it is in the city. We do not have every country hospital included because there would be some country hospitals where they would be likely to see one patient a day. However, the ones which are the busiest are included, as I understand it. If you wanted particular information about the Mount Gambier Hospital, I can happily provide what we have to you.

Mr PEGLER: I think my point was that if we have those performance indicators for other areas—

The Hon. J.D. HILL: It should be in there, as well, I agree. We will make sure we fix that for next time.

Mr HAMILTON-SMITH: Getting back to the question of the emergency departments, we saw Dr Di King leave her post at Flinders after a meeting with hospital officials about ramping. We have had a number of doctors now come out and speak up publicly at Flinders and at the Royal Adelaide Hospital through their faculties and through SASMOA. That has met with a response from the government that has sometimes, in the view of doctors, been hostile.

Doctors have raised with me concerns about bullying and intimidation of doctors where they speak out, causing doctors to be cautious to use their associations. Are you aware of any incidents, complaints or concerns raised by doctors about bullying or intimidation following public remarks, and can you give us an assurance that doctors are free to speak up without fear of retribution, which is the concern they have raised with me?

The Hon. J.D. HILL: I am not sure who is talking with you, but I can assure you that there is no censorship on the medical fraternity. In fact, my experience in 6½ years of being health minister is that they have never been shy about expressing their opinion, either directly to me or publicly, or in any other forum. I think the suggestion that somehow doctors are intimidated about speaking their minds is an absurd one.

I meet with doctors all the time and I have never, I think, in the time that I have been minister, knocked back a request by a group of doctors to come and see me, whatever hat they happen to be wearing. Recently I have met with representatives of the College of Emergency Department Doctors, all of whom, I think, had spoken out publicly at one stage or another. We had a couple of meetings. We have had very friendly chats and we are working on trying to make improvements. I think the feeling from that meeting was very positive. The CEO was there with me and can confirm that if he wishes.

Doctors speak their minds. If they get it wrong, I reserve the right to express my opinion too. If a doctor wants to put their hand up and say something publicly, I reserve the right to say something if I disagree with them, and I will, but I would have thought that it is drawing a long bow to say that is bullying. Nobody has ever been told not to speak what they believe. That is their right, as it is any citizen's right, to say how they view things. Obviously, we want to have constructive relationships with our employees, and I think by and large we do.

There are issues around emergency departments in the three largest hospitals. That is essentially where the issues are, at Lyell, Flinders and RAH. There are different issues in each of the hospitals. We have increased the capacity at Flinders Medical Centre. I think it was 35 and it is now up to around 50 cubicles. There are issues around ramping, so we have conducted a review into that. The review is yet to be finalised, but I am anticipating that will have some positive suggestions about how we can help that.

I made some announcements today about Ambulance Dashboard, which will give the ambulance service better capacity to know which hospitals are busy so that patients can be sent to less busy hospitals. That would help there. I have released a report into issues at Lyell McEwin. That has some positive suggestions which were being worked through, and the CEO talked about meetings today which went through that. I am optimistic about improvements there. We have had a similar discussion at Adelaide with the doctors there and a whole range of suggestions about improvements there. My understanding is that the doctors are pretty happy. If they have views they can come to me directly or use one of the various bodies they are members of—colleges, the AMA, SASMOA or, indeed, staff associations—to put points forward.

Mr HAMILTON-SMITH: I thank the minister for that. Just getting on to the question of ambulances, the doctors at Lyell McEwin have threatened to ramp if they feel arrangements at the emergency department are unprofessional. We have had ramping Flinders. Would you just confirm to the committee what it costs the government each day that the ambulance services impose no revenue industrial action as a result of ramping? What is the cost to the budget each day?

The Hon. J.D. HILL: The advice I have is that, if the ambos do not collect revenue from the customers, it is about $200,000 a day. A substantial amount of that, of course, is money that the insurance companies would be saving, so the insurance companies are probably the ones that do best out of that. Let me just talk about the issue of ramping. Ramping is not a policy that we have in this state. It is, in other states: Western Australia, New South Wales, Queensland and, I think, Victoria all have policies about ramping, where ramping is an approved health service policy. It is a legitimate policy, I suppose, in those jurisdictions, but it is not one that we want to have in our state. The legitimacy is based on the idea that the ambulance paramedics hold the patient and look after them until the emergency department has capacity. The problems with doing it, I think, relate to the ambulance service's capacity then to go out to look after other patients. That is the issue.

If you want to have ramping, you have to increase the number of paramedics you have so that you do not reduce the capacity of the paramedics to do their job and, if you are going to increase the number of paramedics, you may as well put the resources into the emergency department or into the back of hospital to create flow. I just do not see the benefit. It is a possible policy, but it is not one we would want here.

From time to time, and on occasions, the transfer of patients from an ambulance to the emergency department takes longer than the benchmark times. We generally try to do it within 30 minutes, although I understand that with more complex cases it can take up to about 40 minutes, and both sides of the service seem to accept that as being reasonable. When it gets beyond that, it becomes problematic.

It is a relatively rare event, but we will resist any attempt to introduce it as a policy. The health system develops policies. We cannot have individual bits of the health system developing their own policies. You cannot run a system which has dissonance between the policy makers. I am always happy to talk to people, always happy to listen, and always happy to try to resolve problems, but we cannot have individual units making up their own policy lines.

Mr HAMILTON-SMITH: Moving on to the question of code black incidents of violent behaviour in hospitals. Can you tell us what is the most recent full year of reporting on code blacks, including Lyell McEwin?

The Hon. J.D. HILL: Are you referring to a particular budget line there that I can check?

Mr HAMILTON-SMITH: I am referring to the northern area health service. I know you have a contract which you pay out for security services which has to do with protecting hospitals from violence. I am happy to use the same one I used before, which is sub-program 2—

The Hon. J.D. HILL: I am not trying to be cute, but I was going to see whether there is any reference in there to code black because I do not think the budget papers refer to code black. Do you have a reference—

Mr HAMILTON-SMITH: No, but the budget papers refer extensively—

The Hon. J.D. HILL: I am happy to get the information for you if I can, but I was just hoping that you could point to the section which might assist us. We will have to take that on notice; it is not in the budget papers. I am happy to find out the information for the member.

Mr HAMILTON-SMITH: Well, hang on. You have come here today supposedly prepared to answer questions, minister. Budget Paper 4, Volume 3, page 64, Expenses.

The Hon. J.D. HILL: What is the question?

Mr HAMILTON-SMITH: Page 64 deals with payments made by you for a range of things. 'Other expenses' alone is $93,539,000. Buried in your expenses somewhere is a security contract.

The Hon. J.D. HILL: Okay. I am happy to get the answer for you.

Mr HAMILTON-SMITH: I am just asking you. You have come here today. Don't you know how much you are spending on security services because I understand that you have put that tender out?

The Hon. J.D. HILL: The member can get excited, but I am happy to find out the information. I was not trying to be cute. I was actually trying to find out what the member was referring so that I could get the information for him. I do not have the information here; I am happy to try to provide it. If I can get it by the end of today, I will.

Mr HAMILTON-SMITH: I would like to ask some questions about Jacqui Davies. I do not know whether you need your mental health people here for that, but I would like to know what is the current status of Jacqui Davies' position at Yatala in regard to her mental health care and whether she is likely to be readmitted to James Nash House and whether the minister is considering sending the patient to Victoria for treatment.

The Hon. J.D. HILL: In relation to the second matter, any decision about whether or not Ms Davies goes to Victoria would be a matter for her initially to request and for the Minister for Correctional Services to agree to and for the Victorian government to agree to. I do not control any of those elements, so I cannot answer that.

In relation to where we are at, it is fair to say that the Department for Health and Corrections have met on a number of occasions to try to provide a more co-ordinated approach to this person, and there has now been agreement between the two agencies to provide clinical support and modified accommodation to make sure that she is safely looked after. The care plan will also ensure the safety of the nurses and corrections staff who are responsible for her care.

She is currently being managed in D wing of the Adelaide Women's Prison, where her condition is regularly reviewed by a visiting consultant psychiatrist. The most recent clinical review was on Friday 15 June. Health SA and the Department for Correctional Services continue to work together to provide the best possible care regime for her, with admissions to forensic mental health services when necessary for treatment and respite.

I understand that DCS will undertake modifications to the small women's unit at Port Augusta Prison. This will provide flexibility to relax her current regime but maintaining a safe environment which reduces the opportunity for self-harm. I am advised that modifications to the common and outdoor areas near her cell in Port Augusta will also be undertaken. This prison accommodation will be more conducive to her ongoing management. While the work is taking place, clinical support will be provided at James Nash House to try to make sure of a successful transition to her new placement.

It is expected that the transfer to James Nash will take place within the next fortnight, with the exact date to be determined by her clinicians. Next year, when upgrading works are completed on the Adelaide Women's Prison, including single rooms for inmates, the prisoner will likely return to Adelaide to complete her sentence. Of course, I understand there is a parole hearing which may change all of these matters. Throughout her sentence, regular reviews of her mental and physical health will continue, with episodic admissions to forensic mental health services provided whenever they are clinically indicated. Staff at Port Augusta Prison, I understand, will be extensively consulted prior to the prison transfer.

Mr HAMILTON-SMITH: I thank the minister for that. Does the minister agree with the Public Advocate that if Jacqui Davies had been given better mental health care earlier she may have been able to better present at the parole hearing yesterday, given that she is obviously going to be released at some point in the future?

The Hon. J.D. HILL: I am not aware of the Public Advocate's comments along those lines and I do not really want to comment on matters which are clinical; I am not a clinician. I accept that he may well have said that but I cannot respond, really, to that question.

Mr HAMILTON-SMITH: Are there any other patients in the prison system that the minister is aware of, or upon whom he has been briefed, with serious mental health issues, about whom he has concerns?

The Hon. J.D. HILL: I cannot recall any similar patients in the mental health system. It is true that there are a number of prisoners with mental illness. You would have to say that there is a high correlation between being in prison and mental illness: a number of people who are in prison are obviously depressed as result of the circumstances they are in. We have quite a large mental health service that supports prisoners in our institutions in South Australia but I am not aware of any other patient who is in a situation similar to the prisoner we are talking about.

Mr HAMILTON-SMITH: Is it a critique of our mental health capabilities that we might have to send—or that it is even being discussed that we might have to send—Jacqui Davies to Victoria for treatment? Why can't our mental health system meet her needs?

The Hon. J.D. HILL: This is an interesting question and I think it is worth exploring a little. As I understand it—I am no expert on this—borderline personality disorder (I am not talking about this particular person but just generally) is an issue that Corrections has to deal with frequently; a lot of prisoners are in that category. This particular prisoner seems to be at the more extreme end of it, I am advised. There are mental health issues associated with it and, as I have tried to explain on previous occasions, there is argument about whether it is a mental illness or not.

Putting all that to one side, it means that people who have extreme versions of borderline personality disorder are very difficult to manage. Not reflecting on the particular person, but somebody with borderline personality disorder is capable of doing extreme things and knowingly doing those extreme things. They have, to a certain degree, as I understand it, very strong control over what they do, so I guess a person who is willing to do extreme things can get outcomes for themselves that somebody who is more conservative in their behaviours would not get. So, that is an issue for a prison system. How do you manage somebody who is prepared to self harm in order to achieve certain outcomes?

The system in Victoria that the member refers to, as I understand it, is a unit that is part of the gaol system rather than the health system. I guess in a bigger jurisdiction you can probably justify creating such an institution. It may be something that prisons here could look after, for example, if the prison system here had a wing which was designed for prisoners who had borderline personality disorder or other behaviour issues and they could put into that wing prisoners who were difficult to manage from a behaviour point of view, and then treat them in a way which optimised the way that they were looked after, then mental health and other services could be put in to support them.

I think that that is the arrangement that they have in Victoria. That is not an arrangement we have here. We have a distinction between corrections and mental health. James Nash is a mental health facility; it is not a prisons facility. If a unit were created at Yatala, for example, which specialised in that kind of disorder, it might help the prison system better manage prisoners with those issues and I think that that is what they have done in Victoria. I am not 100 per cent certain, but I think that is the way it is managed. So, it is an issue for us how we manage prisoners who have these conditions.

The interesting thing is that this particular prisoner was brought before the courts on three occasions and found fit to plead, so there was no defence of unfit to plead, which would have meant that she would have gone into James Nash on any of those occasions. So, she was found fit to plead and convicted and a court found that she should serve time in a prison. That is what the court found. All of us now are being put into the situation of second guessing whether or not that was the right decision but that is what the court found: she should be imprisoned. The prison system is now going to adapt some of its cells in Port Augusta to better manage her, and mental health will help in the transition to that and then of course help once she is there.

Mr HAMILTON-SMITH: Just moving on to Budget Paper 4, Volume 3, page 38, The Queen Elizabeth Hospital, will the government rule out closing the intensive care unit at The Queen Elizabeth Hospital.

The Hon. J.D. HILL: I advise that since 2009-10, SA Health, through the provision of state and commonwealth funds, has invested in the emergency department to develop a short stay unit for the emergency department, increase medical and nursing staff, implement a 'see and treat' clinic and develop a medical assessment unit to make sure that appropriate and effective care is provided in the ED at QEH. The redefinition of hospital-based service at TQEH which includes closure of the intensive care unit, reflects the vision outlined in the South Australian Healthcare Plan 2007-16. That is what we announced back then. Intensive care services will continue to be provided up until 2016.

As a general hospital, which is how we envisage The Queen Elizabeth Hospital, it will be a leader in the provision of specialist rehabilitation for older people, including stroke and orthopaedic focused care, expansion of aged care assessment and palliative care services as well as continuing to provide elective surgery, general medicine, mental health, medical education, training and research. In 2016, as a general hospital, patients will still have surgery at The Queen Elizabeth Hospital, with high dependency beds available at the hospital. There is some further discussion, I understand, at an area level, about something which I guess you could describe as between high dependency and intensive care. I think intensive care units can be ascribed in a category system, the same as a lot of other things in health, category one, two or three or thereabouts.

I think they are talking about high dependency plus, intensive care or whatever is the lowest of the categories (I am not sure what that category is called); three is the highest, so one would be the lowest. There may well be intensive care beds at level 1. That is still being talked through.

The overall plan, which was announced six years ago now, was that we would transfer the intensive care services to the three spine acute hospitals—Lyell McEwin in the north, Adelaide in the centre, Flinders in the south—and the other hospitals, which provide other services, would link in with them. Intensive care in the central Adelaide area would generally be done at Royal Adelaide. There is a question mark about whether the lower level intensive care would still continue, but generally we would expect there to be a high dependency service there.

Mr HAMILTON-SMITH: I thank the minister for that. If I am hearing correctly, 2016 is the key date. Are you suggesting that beyond that there will not be an ICU as we know it now but some sort of degraded, downgraded or lower categorised capacity?

The Hon. J.D. HILL: I am suggesting that we will have a level of service there that is appropriate to the kinds of patients we would expect the hospital to be treating. One of the things we have to do—and it really does not matter who is in government, it has to be done—is to ensure that we do not have overlap and duplication and that we use the resources in the best way we possibly can. We have had our strategy out on the table now for five years, namely, that Royal Adelaide, Lyell McEwin and Flinders are the hospitals which have the tertiary care (quaternary in the case of Royal Adelaide), and the other hospitals will look after less complex patients.

A lot of elective surgery you would want to have at QEH, but not for those who are likely to require intensive care—that would be the very sick, those with a whole lot of complex comorbidities, those who are grossly overweight and so on. That is the rationale behind it, and I think we have been pretty clear about it.

Mr HAMILTON-SMITH: There is a concern for stakeholders in the west that that will basically make the emergency department at Queen Elizabeth a triage centre for the Royal Adelaide Hospital because, without an ICU and the capacity to respond to more serious cases, there is this concern that this downgrading will seriously degrade the capabilities of the hospital. Noting that the government has decided to postpone stage 3A, which included an upgrade of the emergency department, as per Budget Paper 6, page 66, how can there been any guarantee, since that is after the next election, that that stage 3A will proceed at all?

I suppose I am asking: what is your vision? You began the answer earlier, but what is the vision for the hospital? Will stage 3A ever proceed, or is there a risk that it may not proceed? If you are not going to have an ICU, why would you spend the $125 million upgrading the emergency department, extending the emergency care unit, imaging and nuclear medicine outpatient clinics and operating theatres, with their associated support services, if there will not be a full ICU function?

The Hon. J.D. HILL: You are leading with your chin there a bit. The only risk to its not proceeding would be a change of government because we are absolutely committed to going ahead with that plan. If it were not for the financial circumstances we are in currently, we would be continuing with the plans as in the budget papers from last year. Unfortunately, something has to give, but we are absolutely committed to continuing the upgrade of that hospital and to seeing a broad range of services provided for the western suburbs.

The vast majority of the emergency patients who would be seen there would continue to be seen there. I am not sure what percentage goes into ICU, but it would be a relatively small percentage. The relationship between QEH and RAH will be similar to the relationship between Modbury and Lyell McEwin, and the relationship between Repat and Noarlunga and Flinders. It is a cluster arrangement, which is part of the LHNs we have set up, where these hospitals will more and more be run as one hospital over two sites. So, the staff management and staff arrangements will be collective across those sites.

I think that, more and more in the future, you will see the Central Northern Adelaide Health Service and the Southern Adelaide Health Service operating as one hospital over multiple sites. The planning will appropriately distribute resources where they are needed.

Mr HAMILTON-SMITH: That is fine, minister, but, on that same budget line, if you are planning to upgrade operating theatres with associated support services without an ICU—because, as you have said, that is going to be degraded—does that not raise questions about what sort of operations might be possible in that stage 3A: the developed hospital?

Are we only going to see really basic, elementary, low-level grades of surgery at the hospital, and what implications might that have for the stroke unit or for other types of surgery going on there? Will those functions move off to Adelaide without an ICU? It all seems to hinge around an ICU.

The Hon. J.D. HILL: We certainly want to have the hospital focusing on rehabilitation and services for the elderly—for palliative care services. As a general hospital, TQEH will be a leader in the provision of a specialist rehabilitation role to people, including stroke and orthopaedic focused care, expansion of aged care assessment and, as I said, palliative care, as well as continuing to provide elective surgery, general medicine, mental health and medical education training and research.

All of those things will continue in the same way that we have a whole range of services at Modbury. In fact, what we want is there to be a lot more elective surgery at the Repat, Modbury and at TQEH. One of the difficulties around Lyell McEwin, Flinders and the Royal Adelaide is that they have a huge number of emergency department patients and, sometimes, when emergencies come in, it means elective surgery lists are cancelled.

You have this competition for resources between the emergency departments and the elective surgery. To the extent that you can separate those kinds of pressures, the system will work better. We would want to see a lot more elective surgical work done at TQEH, Modbury and the Repat, while still maintaining, in the case of Modbury and TQEH especially, the emergency services.

A broad range of quite complex elective surgery can continue but, where there is a higher likelihood of risk or comorbidities are great, then you would see those patients going to the tertiary hospitals—that is what I would want. If I needed something complex done, I would go to the hospital which had the greatest degree of complexity, but if you had something simple to be done—orthopaedic work or something—you would go to a hospital like that and you would get it done pretty quickly because of the other pressures not being there.

Mr HAMILTON-SMITH: It has been put to me at Modbury and Lyell McEwin that the closure of the ICU at Modbury has resulted in the need to retrieve patients by ambulance to Lyell McEwin, sometimes at short notice. As one doctor put it to me, it is only a matter of time before someone dies en route because Modbury could not deal with the crisis because of a lack of an ICU. Are we not putting other lives at risk at TQEH by downgrading or degrading their ICU, such that they have to be removed to Royal Adelaide, and how do we save those lives? Say, with suspected heart attacks, aren't ambulances just going to have to keep driving to Royal Adelaide—if in doubt, keep driving—and bypass TQEH because there is no ICU?

The Hon. J.D. HILL: The beginning of that question was talking about the Modbury ICU closing down. I am not sure if the member is aware, but the ICU at Modbury, I think had, from memory, one or two beds. It had only a part-time ICU doctor. It was not a fully operating ICU. It just made no sense to have a very small amount of resources there. If you only have a doctor on duty for half of the day, it is not really an ICU. So it was a very sensible decision to concentrate those resources at Lyell McEwin, and that will be the same with the other hospitals. Noarlunga Hospital does not have an ICU. I do not think the Repat does. The Repat is similar to TQEH.

These are the decisions you have to make when you are health minister. How do you ensure that we have a system in place that properly provides the services that people need? You cannot do everything in every hospital—you just cannot. It is not feasible. Five or six years ago we put out a plan which said what we would do and we are now moving to doing it. It is a rational plan. It is, I think, working extremely well. We have reduced the growth of and demand on our healthcare services. Performances are improving right across the board.

We have the longest living people in Australia in South Australia, so something must be going right. It is always possible to point to something and say that somebody is going to die if you do this, and that is a regular claim made around the health system, but the reality is that we have a very good health system which saves lives every day.

Mr HAMILTON-SMITH: I will move on to some financial questions. I refer to Budget Paper 2, page 5, which is about how health spending accounts for 31 per cent of the state budget. What is the current growth rate that the minister is working on per annum in health spending as a percentage of health spending? What is that growth rate as a percentage of total government outlays?

The Hon. J.D. HILL: The rate of acceleration in the health budget, is that what you are saying?

Mr HAMILTON-SMITH: Yes, both the health budget and its percentage of government outlays as a whole.

The Hon. J.D. HILL: From memory, and I will get my officers to correct me, health is currently about 31 per cent of the state budget. When I first became minister I think it was about 27 per cent or 28 per cent. The budget allocation this year increases by 5.6 per cent. When I first became minister it was growing at about 9 per cent per year, and the state revenue base was growing at about half that at 4.5 per cent which enabled me to calculate that by 2032 the entire state budget would be spent on health. So, one of the things we have been working on very hard is to reduce demand by making sure people get services before they end up in an acute hospital, which is the most expensive part of the hospital system.

So, getting that growth below 6 per cent in terms of budget is a remarkable achievement, in my opinion. I am pleased that we were able to do that and, if we could get it below that, that would be good too. In relation to code black, I am advised that at the end of February 2012 (the 2011-12 year), there have been 3,902 code blacks across all clinical areas in metropolitan hospitals. Lyell McEwin to February had 1,224. To improve the system, SA Health has a new SA Health protective security policy mandating and reporting on the Healthwatch database, and that will be implemented from the beginning of the next financial year.

Mr HAMILTON-SMITH: On that code black question, minister, were you able to get advice on what the total cost of the contracts are for security services?

The Hon. J.D. HILL: No, sorry. We will chase that up.

Mr HAMILTON-SMITH: Just going back to that question of growth in health spending, when talking about growth, how do you deal with the issue of borrowings or debt related to capital works? In particular, what impact will the commencement of payments for the new RAH have on the percentage of health spending? How is that going to be incorporated into the statistics and into the growth, or will that be put off to the side?

The Hon. J.D. HILL: You would probably need to ask Treasury how they will manage that. The Lyell McEwin, for example, is spending a couple of hundred million dollars to build the Lyell McEwin. The way that is managed through government is that Treasury grants a capital sum to health which is outside of the operating budget, so when I mentioned that 5.6 per cent growth I was talking about operating expenses not capital expenses, so Treasury will give us money over a period of time to do a particular capital work and then they manage how that is paid for. They either borrow it, which government does from time to time, and then pay that off over a period of time. That is a matter for Treasury. We just get to spend the money which has been allocated to us.

In the case of the PPP arrangement, there is a figure, which is an annual figure, which we will pay over the course of the PPP which includes the debt aspect of the project and the interest and repayment of the capital, and there is a component which relates to the provision of non-clinical services. I am not sure how Treasury will manage this but, if it was consistent with how we do things in relation to any other project, the debt aspects would become something which would be a central issue, and other services like electricity, water and so on, which you would expect to pay for in any hospital, would be a provision that would go to Health.

Treasury may determine that all of that will become an allocation to Health or they may separate the two elements. I do not know, but I can certainly seek advice from Treasury. They may well have not thought through the policy and no doubt there is a policy question there. Essentially, government will have to pay it, just as it pays the cost of the interest and the capital associated with the Lyell McEwin.

Mr HAMILTON-SMITH: On Budget Paper 3, page 107, you talk about a 1 per cent growth in hospital expenditure above the level incorporated in the 2012-13 budget increasing expenditure by approximately $40 million per annum. What core data did you use to assemble that figure?

The Hon. J.D. HILL: Just give me the page reference again, sorry?

Mr HAMILTON-SMITH: It is page 107, Budget Paper 3. It is a 1 per cent growth in hospital expenditure, rather than health budget expenditure. It means a $40 million increase per annum in the health budget.

The Hon. J.D. HILL: This is an example of what 1 per cent means. What they are really saying here is that if there is a growth in hospital expenditure of 1 per cent it equals $40 million a year. That is all it means. It is not saying that there has been a 1 per cent growth; it is just a—

Mr HAMILTON-SMITH: No, but if you follow that through it is deducing that it costs you $4 billion a year to run the hospitals alone. How have you assembled that?

The Hon. J.D. HILL: What is the statistical basis of it?

Mr HAMILTON-SMITH: How have you based that figure?

The Hon. J.D. HILL: Yes, I understand. We will get that checked, but I think you are right. We have a budget of $4.9 billion; I am not sure precisely what proportion of that is spent on hospitals. We do have out-of-hospital expenditure, and we do prevention and primary health care and a whole range of things.

If I refer you to page 37 of Volume 3, the health services figure shows that the 2011-12 budget is $4,096,841,000 so 1 per cent of that is $40 million. That is to cover health services, and the sub-programs are: Central Adelaide, Central Northern, Southern Adelaide, Women's and Children's, Country Health and SA Ambulance—essentially, the health services as distinct from the head office and all the other services we provide.

Ms THOMPSON: My question relates to Budget Paper 4, Volume 3, pages 37, 48 and 50. I am interested in the new developments at the Repatriation General Hospital in conjunction with aged care and health group. Minister, can you advise of the benefits of this new development, please?

The Hon. J.D. HILL: Thank you, member for Reynell. As you would know, and I am sure the member for Waite knows, the Repatriation General Hospital was established in the middle of the war in 1942 and has developed into a 280-bed acute care public hospital, specialising in the care and rehabilitation of veterans and also older people generally. It has forged a very strong set of affiliations with a number of research facilities and teaching and education institutions, including and especially the Flinders University. The Repat is acknowledged in South Australia's healthcare plan as a specialist general hospital, and this government is currently contributing $32.3 million to ensure it retains its specialist services and strengthens its focus on being a centre of excellence for rehabilitation.

In addition, it is working with the private sector, and particularly the Aged Care and Health group (the ACH group as it is known), to collaboratively expand existing facilities at the hospital. ACH is a significant and well-established non-government provider of aged-care services throughout South Australia and it is undertaking a collaborative venture with the government to develop a teaching, aged-care and rehab facility at the Repat that combines teaching, research in aged care, and rehabilitation services on that site.

The facility will provide the physical infrastructure and capacity to support the future role of the hospital and provide enhanced access to aged-care beds for the southern metropolitan community. It will enable Southern Adelaide Local Health Network and the Aged Care and Health group to better manage aged patients and their transition from acute care to the home or residential care in an environment consistent with the commonwealth aged care reforms.

The facility will provide a new 120-bed integrated teaching, aged-care and rehabilitation facility, with 60 commonwealth licensed residential aged-care beds, 24 transition care beds, 16 flexible care beds, 20 rehabilitation beds, and the establishment of an aged-care teaching facility. While the government will be contributing $20.3 million for its component of the facility, ACH will be contributing about $15 million, and Flinders University another $2 million. Together, we will jointly deliver the teaching, aged-care and rehab facility.

It really shows our desire to maximise the benefits to the community by working together with the private sector and the university sector. Construction is expected to start in the second half of this year and be completed by the end of the following year. In addition to the facility, we are also investing $6.2 million in the construction of a new ambulatory rehab facility to be completed early next year as well, $2.8 million in infrastructure works and the relocation of car parks completed in May 2012, and $3 million to refurbish the ward 20 rehabilitation building as the last part of this project, which will be completed in May 2014.

Mr ODENWALDER: Some of these issues have been touched on in response to earlier questions from the member for Waite. Can the minister provide further information on the improvements that have been completed and those planned for the Lyell McEwin?

The Hon. J.D. HILL: The Lyell McEwin hospital provides a comprehensive range of specialist and diagnostic treatment services to a population of about 196,000 people living in the northern suburbs. As you know, as the local member, it is a population that is growing and likely to grow quite dramatically. In May 2005, our then premier, Mike Rann, opened the $92.4 million Lyell McEwin Hospital redevelopment stage A, announcing at the time the ongoing commitment to the $43.5 million stage B development.

Stage A works replace much of the core clinical and support infrastructure, with the provision of two new wards, new emergency medical imaging, intensive care, high dependency, coronary care, operating theatres and women's healthcare centre, as well as administrative, education and other support services. Stage B includes the establishment of an emergency extended care unit, significant upgrades to ward 1A, palliative care and medical care beds, enhanced day surgery and oncology facilities, the extension of SA pathology and hospital pharmacy, delivery of a 50-bed mental health facility, and the creation of administrative and research space. The final component of stage B, being the mental health facility, was completed in November 2009.

To enable work to be undertaken under stage C redevelopment, the government brought forward the construction of a multideck car park which was completed in February 2010 at a cost of $25 million. We have now undertaken the initiative to commit a further investment of $201.6 million, which includes the money for the car park for stage C of the continued redevelopment of Lyell. This stage C is well underway to provide for a new inpatient building, with a helipad on the upper level to support the expansion of clinical services, construction of a new support services building to accommodate expanded women's health centre facilities, a maternal assessment unit, fit-out of two operating theatres and administration, research, education and clinical offices, relocated and expanded back of house services and a range of internal reconfigurations which will generate efficiencies to suit the expanded functional requirement.

In addition, an new ambulatory care building is being constructed to accommodate the expansion of outpatient and allied health functions. Of the stage C redevelopment, the refurbishment at Muna Paiendi Aboriginal health building was completed in October last year and the 98-bed inpatient building, which I have referred to, with an elevated helipad, is currently under construction and is due to be completed in June next year. A women's health centre facility is also under construction, and it is expected to be completed in October next year. The work currently occurring to create further space for medical imaging and theatre stores will be completed, we hope, by the end of this year.

In addition to that amount of money ($201.6 million), the government has also initiated a development to provide a second linear accelerator, an integrated 12-chair oncology service and associated areas, including a CT simulator room. This is being delivered as part of the improvements being made across the state to the state cancer services, and it will be completed by September 2013. This significant initiative, I think, demonstrates our commitment to both the northern suburbs and this hospital. It is not that we have not done anything at the hospital over the last 10 years. There has been a hell of lot done, and there is more to be done to build this hospital up so that it can take its place as one of the three leading acute health services in our state.

Dr CLOSE: My question relates to new COAG initiatives, and the reference is Portfolio Statement, page 9. Can the minister provide further information about South Australia's success in securing commonwealth funding for new COAG initiatives?

The Hon. J.D. HILL: South Australia signed the National Health Reform Agreement in August 2011, and funding for the first two years of the agreement will reflect existing base funding under the National Health Agreement. However, over the period 2014-15 to 2019-20, states and territories are guaranteed an additional $16.4 billion nationally ($1.1 billion for South Australia).

In addition to the National Health Reform Agreement, SA Health has successfully negotiated 13 COAG national partnership agreements, project agreements and implementation plans over the 2011-12 financial year, bringing around $388 million into South Australia over the next five years. New agreements over this period include two project agreements which were successfully negotiated under round three of the commonwealth's Health and Hospital Fund.

These will bring $72.7 million into South Australia to enable significant redevelopment of the Port Lincoln and Mount Gambier health services, construction of a new ambulance station in Mount Gambier and a community dental clinic in Wallaroo. In addition, South Australia will receive $47 million over three years under a new national partnership agreement on financial assistance for long-stay older patients.

South Australia will receive a further $20.3 million, through a range of other new COAG agreements, which will provide essential health services across the state. Many of these initiatives will benefit people living in rural, regional and remote areas, and the renegotiation of both the National Partnership Agreement and improving public hospital services and the Whyalla Regional Cancer Centre implementation plan, will bring $202.1 million and $60.26 million respectively into South Australia.

SA Health has a clear strategic framework in place for negotiating these agreements with the commonwealth and monitoring progress towards the objectives, outputs and performance measures of each agreement. South Australia has overall performed well nationally with existing COAG agreements. Most notably, South Australia's performance has improved significantly against both elective surgery and emergency department targets.

In relation to elective surgery, South Australia was the only jurisdiction to achieve all components of the National Partnership Agreement on elective surgery and therefore be deemed eligible for the maximum reward funding. In relation to emergency departments, the proportion of South Australian patients seen with the national benchmarks, as I have said before, has increased to 71 per cent over the period 2007 to 2010, and we are regarded as one of the best performing jurisdictions in the nation.

Mr HAMILTON-SMITH: Sticking to financial questions at present, I refer to Budget Paper 6, page 63. In the Budget and Finance Committee on 7 May, Mr Swan, when asked a question by the chairman about a potential $410 million savings task, said the following:

We are talking about $125 million plus $86 million of increasing growth. We are talking around $210 million, $215 million. About $74 million of savings that have not been realised are in train for 2010-11 and previous years...

Has the budget changed these figures, and what is the cumulative savings task as of this budget for 2012-13?

The Hon. J.D. HILL: The savings targets, as I understand it, for 2012-13 (and I will just get them corrected) are exactly $116.79 million. That is the amount we need to save next year out of the budget—just under $117 million.

Mr HAMILTON-SMITH: That is the savings task set for that year?

The Hon. J.D. HILL: Yes, 2012-13.

Mr HAMILTON-SMITH: The point I am getting at (and I think this relates to the questions asked in Budget and Finance) is that you are $125 million under budget this year, that carries over and there are some further carryovers from previous years where savings targets have not been achieved, and this was explored in some detail in Budget and Finance.

There is a cumulative carryover of savings targets. Mr Swan talked about the $125 million plus $86 million of increasing growth, and then he talked about $74 million of savings that have not yet been realised, etc., offsetting that. This new savings target you just mentioned of $117 million for next year, as I understand it, needs to be taken in the context of the carryover.

The Hon. J.D. HILL: The $125 million the member referred to has been provided in the budget for 2012-13, so our savings target is $116.79 million for 2012-13. That increases for the following years, but I think I might get the CFO to go through these figures.

Mr WOOLCOCK: In relation to the question of the cumulative impact of all savings for the 2012-13 year (that includes savings that we have already implemented and achieved), the total number is $324.5 million, which is consistent with the number that was discussed in the Budget and Finance Committee. The growth component in 2012-13, above 2011-12, is in total around $117 million, as the minister said, that we need to identify and implement strategies to achieve.

The Hon. J.D. HILL: To clarify that, in other words the other savings have already been made, but we have to continue making them.

Mr HAMILTON-SMITH: Are you telling the committee that the $125 million overspend this year has now been provided for in the budget; it has been paid out, so we have written off that $125 million? Is that what you are saying?

The Hon. J.D. HILL: Yes.

Mr HAMILTON-SMITH: And you are starting with a blank sheet of paper, if you like, on 1 July?

The Hon. J.D. HILL: I might get the CFO to explain that again. That is true: the $125 million has been provided. It has been provided on the basis that we pay it back over the next few years, so it is managed over a period of time. I will ask the CFO to explain how that is to work.

Mr WOOLCOCK: In relation to the budget page reference you identified, cost pressure on funding of additional resources is identified that shows a contribution in 2012-13 that decreases in 2013-14, so Health has a requirement to implement strategies to manage those as that funding reduces over the forward estimates.

The Hon. J.D. HILL: While the member is finding his place I can advise that, in relation to the security contract, it is currently out for tender, it is being evaluated at the moment and the pricing has already been fixed as submitted, so until it has been accepted I will have to take it on notice. We obviously do not want to give away our commercial position at this stage until the tender has been completed, but when it is I will provide the information to the member.

Mr HAMILTON-SMITH: The $125 million has been carried forward and will be, if you like, required of you; is that right?

The Hon. J.D. HILL: Let me explain it as I understand it, and if I am wrong I will get these guys to explain it. I am a simple man, the son of an accountant, but I did not take on too many of his genes. The $125 million has been provided in the 2012-13 budget, so you were right when you said we start with a blank sheet; it is $117 million we have to find next year. Then, in subsequent years, if we achieve all of that $117 million next year, the amount we have to achieve the following year includes the component of the $125 million, plus other forward savings that we have, and I will tell you what that is. The $125 million is in this year's budget, we have a savings target of $160 million. We finish next year with $117 million saved and no further pressures. Then, in the subsequent year, 2013-14, if nothing else has changed, we would have a component of that $125 million that we would have to find, plus some other savings. I will get the CFO to tell you what that amount is.

Mr WOOLCOCK: In 2013-14, the requirement would be around $90 million in terms of managing the $125 million that is being referred to; and there is growth in savings in the 2013-14 year of around another $79 million. So $79 million plus $90 million. So it is around $160 million.

Mr HAMILTON-SMITH: What is the savings target then for each year going through until 2015-16? Could you just run—

The Hon. J.D. HILL: What I find a bit complex about this is whether you are talking about the savings targets that are added each year, or the cumulative effect of the savings targets. Once we have actually found the savings, they are ongoing savings, so in one sense they slip off the page because once they are found, they are found. If you stop doing something, you have stopped doing it, so there is an additional amount of money for each year. I think the CFO has just said that in 2012-13 we have to find just under $117 million. Then, on top of that, we have to find the difference between $117 million and $165 million. Then, the next year (2014-15), we have to find the difference between $181 million and $165 million. Then in 2015-16 it is the difference between $188.9 million and $181.8 million; plus then we would have to find new savings that have come in which is $29.25 million, $60.81 million, $93.67 million, plus a couple of other million below the line.

Mr HAMILTON-SMITH: What page were you reading off then?

The Hon. J.D. HILL: I am reading off my notes. It is a mixture of things. It is the new saving initiatives, the $125 million paid back over time, and any other initiatives which have yet to be sorted. The key target for us for this year is $117 million and that is all we can focus on.

Mr HAMILTON-SMITH: I will read the Hansard and try to reconcile those figures with what Mr Swan said.

The Hon. J.D. HILL: We will read it too and if we have some clarification, we will get that for you.

Mr HAMILTON-SMITH: If I could explain the issue because, in October 2011, the Budget and Finance Committee was advised that the savings target in 2012-13 was around $330 million and that was raised again—

The Hon. J.D. HILL: Yes, but that is cumulative—

Mr HAMILTON-SMITH: That is the point.

The Hon. J.D. HILL: That includes savings that have already been made.

Mr HAMILTON-SMITH: Made and achieved?

The Hon. J.D. HILL: Yes, made and achieved. The point is that we have to find $117 million worth of savings—

Mr HAMILTON-SMITH: Of additional savings.

The Hon. J.D. HILL: —in this budget, yes. We will have a look. I agree, I find it as complex as you. If I can find a simple way of expressing it, I will get it for you.

Mr HAMILTON-SMITH: You were set certain savings targets. What did you achieve, what did you not achieve, and what happened with the shortfall? With the savings that were not achieved, for example, in 2011-12, what was the target and what did you achieve? In fact, you went over $125 million, so just clarify that for the committee.

The Hon. J.D. HILL: As of March 2012 we are projecting to achieve $67 million in savings growth associated with the following initiatives: public sector long service leave arrangements, $9.1 million; corporate service reform, $6.8 million; private hospital subsidies, $1.2 million; and SA Ambulance Service administrative efficiencies, $288,000. Partly achieved targets for 2011-12 included: efficiencies in prior savings, $17.9 million; service efficiencies, $15.6 million; 2008-09 mid-year budget review FTE reductions, $4.6 million; efficient price reform, $6.3 million; medical imaging, $1.7 million; pharmacy services, $1.3 million; hospital car parks—revised arrangements, $1 million; fleet savings, $676,000; advertising savings initiatives $501,000; and supply chain reforms, $274,000.

The following outlines the underachievement of savings initiatives of $74.3 million, which had been allocated as part of the prior state budget: outpatient service reforms, $21.7 million (a lot of work has been done on that, but we will not achieve those savings in this current financial year); hospital car park (as you know, there were industrial issues and changes to create two-hour free parking; we were hoping to raise more; Mid-Year Budget Review full-time reductions: we had a target of $10.7 million, and we have not achieved that. There is an expected achievement of $4.6 million against that, so it was a shortfall of $6.1 million.

Service efficiencies of $20.5 million were part of the target. We underachieved there by about $4.9 million. For pharmacy services we had a target of $2.7 million, which was partly achieved ($1.3 million) and $1.4 million not achieved. For medical imaging we had a target of $6.1 million; we achieved only $1.7 million. With efficient price reform we had a target of $17.1 million and we achieved $6.3 million. With fleet savings we had a target of $1 million, but we underachieved that by $335,000.

For subleasing of office accommodation we had a target of $1.7 million, which was not achieved. For advertising we had an under achievement of $604,000. For supply chain we had a target of $1 million and we achieved about a quarter of that. Efficiencies of price savings had a target of $39.1 million, and we achieved about $18 million of that, and that covers most of them.

Mr HAMILTON-SMITH: It is all a little bit muddy. On this budget line there is a provision of $132 million in additional spending in 2012-13 and another $35 million in 2013 to provide for the department to develop what it calls 'a more even annual build-up of savings'. How will that figure impact on the 2014-15 and 2015-16 budgets, because it looks as though the government is putting in an injection of extra funding to ease your efficiency and savings targets in the lead-up to the election. Will there not be a carry forward after the election of those imposed savings requirements that will bob up again in 2015-16?

The Hon. J.D. HILL: I think that is a political interpretation of it but, since we have been in government, when health is overspent or there are underachieved savings, the government has put in the resources necessary to balance the books. I am not sure what happened under previous Labor governments, but certainly under the previous Liberal government that was then carried as a debt on the books of the individual hospital. That was an artifice to make the Treasury figures look better, and then the hospitals were suppose to somehow or other pay back that money. Of course it never happened, so it was just hanging there. We got rid of that approach. Treasury I think has recognised that it sets targets; some of them are very ambitious. I have said repeatedly that just about every single one of these savings initiatives is contested, often in the Industrial Relations Commission, which slows down the ability to achieve.

Sometimes the ambitions are so great that they are unable to be achieved in the time frame which is set for them, so Treasury has made the adjustments as they have. It is not trying to get them past any election date; that is consistently what they have done, I think, in the past.

Mr HAMILTON-SMITH: What effect will the increased efficiency dividend spelt out in the budget line and the FTE reductions have on your annual savings target? They have come in in this budget as additional measures, haven't they? In dollar terms, how does that alter the figure?

The Hon. J.D. HILL: Are you talking about beyond the forward estimates?

Mr HAMILTON-SMITH: Yes.

The Hon. J.D. HILL: I was just trying to clarify that. We obviously have to work through how we can do that. There is enormous pressure to find ways of doing things more efficiently, and that involves work practices, how you procure, management of the fleet, temporary staff and contract staff—right across the board. That is why we have had some outside consultants come in to have a really close look at how we do things at a hospital level.

Through the new national arrangements, the independent pricing authority will benchmark our performance against other states and that will help us see which elements are more expensive than other states. It is very difficult, I have to say, but it is the challenge that we have, and we have set up some mechanisms to try to do it.

Mr HAMILTON-SMITH: Just to summarise, if we can, with the savings task for each of the years in the estimates period, could you just go over for me what you expect that to be in each year between now and 2015-16? Could you recap on what you expect it to be and the cumulative savings target each year?

The Hon. J.D. HILL: The difficulty I have is I that can give it to you on a cumulative basis, but that includes savings that have already been made, or I can give you the new targets for each—

Mr HAMILTON-SMITH: I would appreciate your giving me both.

The Hon. J.D. HILL: I will try to give you everything I can. In 2012-13, which is the next financial year, we have some savings targets growth, which is 85.99, and some savings targets from 2010-11 of 30.8, which are carried forward—that comes to 116.79. We have some savings from CHRIS, which is the payroll system, of 0.88, so it is nothing terribly much, and then we have the cost pressure of the $125 million, which over time we have to manage.

In 2013-14, we have 134.24, which is the costing savings target growth, and 30.8, which is the forward savings from 2010-11, but if we are successful in achieving the 116.79 in 2012-13 that, of course, comes off the 165.04 we have to save in 2013-14, so the 2013-14 of 165 is cumulative. In addition to that, the 2012-13 budget decisions give us another 29.25 for 2013-14 and 1.95 through the savings associated with the payroll service, and we still have that underlying cost pressure clawback of 128 in that year.

In 2014-15, we have 151.06, which is the costing savings target growth and the 30.8, again, from the 2010-11 savings targets. That gives us 181.86 but, if we have achieved everything in the previous two years, the net there is about $26 million. We have budget decisions from 2012-13 of 60.81 we have to add, then 3.109 from the CHRIS savings and, on top of that, we have the underlying cost pressures, which accumulate to be about 131 I suppose, with inflation added to it.

For the 2015-16 year, we have 158 in costing savings target growth, and 30.8 again, which is the 2010-11 savings targets, which gives us 188.89, but if we have achieved everything from the previous three years the net savings there are about $7 million. We have the 2012-13 budget decisions, which will give us $93.67 million for 2015-16 in addition, and then 3.17, which are the payroll savings. We still have the underlying cost pressure from the 125 which, at that stage, will be 134.67.

That is a mixture of additional savings and ongoing savings that have to be accounted for. The 125, in fact, in 2011-12 is 122 because $3 million was for activity growth, and that 122 has to be managed somehow or other over the forward estimates. We have some savings targets from 2010-11 which have to be managed, and then we have got individual savings targets for each of the four years, which come from the current budget allocations, and some savings targets which have come from the past. If we manage all of those, there is relatively little extra that we have to do each year. There is still a lot, but there is relatively little.

The CHAIR: Thank you. We can now break and come back at 4.15, please.

[Sitting suspended from 16:01 to 16:16]

Departmental Advisers:

Mr D. Swan, Chief Executive, SA Health.

Mr J. Woolcock, Chief Finance Officer, SA Health.

Ms J. Richter, Executive Director, Health System Performance, SA Health.

Ms N. Dantalis, Director, Corporate Governance and Policy, SA Health.

Dr P. Tyllis, Chief Psychiatrist, Acting Executive Director, Mental Health and Substance Abuse.

The CHAIR: I will put forward what my understanding is so that the minister is reasonably happy with this. We are going to Mental Health and Substance Abuse but we still have Health and Ageing open, so there may be questions on either. If the minister would like to make any statement in regard to Mental Health and Substance Abuse, now is the time.

The Hon. J.D. HILL: Yes, I would. The state government recognised in 2005 that significant reform was necessary to improve services to South Australians with mental illness and we elevated it as a top priority. The work started with the 2007 release of the Social Inclusion Board's 'Stepping up' report which gave us a roadmap to rebuild the mental health system in this state. Today, five years on, I am very pleased to say that we have made quite significant progress.

The government has invested more than $300 million to rebuild Glenside Hospital, as well as build new steps of mental health care in locations across the state. In addition, the commonwealth has provided $79.4 million over four years, along with $14.2 million over five years, to fund extra mental health services in this state, and we thank them for that.

I can announce today that these investments will deliver 251 extra mental health beds and places in South Australia by late 2014. By early July this year, 74 of those extra beds and places will have been delivered as part of the massive building program that is underway and continues in the 2012-13 state budget. Back in 2006-07 South Australia had a system of inpatient mental health care available at Glenside and metropolitan hospitals but very little else. The new steps being introduced will better care for people when they are becoming unwell and as they are recovering. These new steps include intermediate care, community rehabilitation centres, supported accommodation, secure care, crisis respite, and youth subacute care.

The upgrade of existing acute care beds and wards in numerous metropolitan hospitals has also been supported through this investment and, while some acute care beds will close to make way for these new services, in total there is a net gain of 251 beds and places, increasing from 513 in 2006-07 to 764 in 2014-15, which is almost a 50 per cent increase. This means people with a mental illness can be appropriately placed with the right service rather than an acute care bed when they may not be acutely unwell.

In addition, 262 social houses with NGO support packages are being developed across the state for people with a mental illness, with federal economic stimulus funds. To date, 243 have been built and tenanted. We are also building six community mental health centres and, with federal funds, establishing a seven day walk-in mental health service in northern Adelaide.

From 2012-13 the Assessment and Crisis Intervention Service (ACIS) will be expanded to operate 24 hours a day, seven days a week, and these services will help take pressure off busy emergency departments. The first time, dedicated mental health services are being introduced into country South Australia so that people can access services closer to their homes. The needs in forensic mental health care have been highlighted in the media in recent months. The need to increase the number of forensic mental health beds is acknowledged.

South Australia, like other Australian states, has experienced considerable growth in the number of prisoners and, hence, the growth in offenders with mental health disorders. In addition, pursuant to the Criminal Law Consolidation Act 1935, people found to be mentally impaired at the time they committed an offence can be released on licence and if they breach their licence conditions, they can be sent back into forensic mental health care even if they are no longer mentally unwell.

The state government has allocated $19 million to consolidate 10 beds from Glenside to the James Nash House site. The department is exploring whether there is an alternative way to create 20 beds rather than the 10 within the existing budget framework. With $6.1 million in commonwealth funds for 10 extra forensic step-down beds adjacent to James Nash, if we could achieve this it would increase the number of available forensic and forensic step-down beds from 40 to 60, an increase of 50 per cent.

Further to this major building program, South Australia reviewed its investment in NGO services and developed new models of care and contractual arrangements. South Australia's investment in NGO services has increased by a staggering 900 per cent since 2002-03. The new Mental Health Act 2009 is now in place, and a campaign is running to raise awareness and reduce the stigma faced by those with a mental illness. A draft suicide prevention strategy has been developed and is now being finalised following community feedback for lease this year.

In Drug and Alcohol Services the new inpatient unit at Glenside is due to be operational in mid-2013, and a new day centre opened at Ceduna in May providing a culturally appropriate service to minimise harm to Aboriginal people from substance abuse issues. A total of $6.3 million, excluding enforcement costs, is estimated to be spent in 2011-12 on tobacco control activities.

I have been delighted with figures that show a significant decline in smoking prevalence among South Australians following concerted campaigns to cut tobacco use. Data shows that 17.6 per cent of South Australians aged 15 or over smoke, down from 20.5 per cent in 2010; and 15.2 per cent smoke daily compared to 17.2 per cent in 2010. I would like to thank all of the departmental officers for the dedicated work in the area of mental health reform and drug and alcohol abuse reform, as well.

Mr HAMILTON-SMITH: This is a really important area, and I have quite a few questions on mental health, the aged and alcohol and substance abuse, but I still have broader questions that affect all of those portfolios, if I may. I see we still have two and a quarter hours. I would not want to give up the valuable time with the minister and his staff, being a great fan of budget estimates that I am. I will go to the question of the Office for Business Review which I know is—

The Hon. J.D. HILL: Sorry?

Mr HAMILTON-SMITH: The Office for Business Review, addressed in Budget Paper 6, page 65. I know this cuts across all parts of the health portfolio in looking for efficiencies. This budget line says the new Office for Business Review and Implementation will be funded from within the additional resources, from the $389 million of health services and additional resources that are funded on this page. Could the minister outline what the current exact cost of that unit is over the estimates period? I think the figure we were working to previously, from media reports, was $10 million over four years.

The Hon. J.D. HILL: That is roughly correct; $9.8 million over four years.

Mr HAMILTON-SMITH: That is still correct; $10 million over four years?

The Hon. J.D. HILL: Yes, approximately.

Mr HAMILTON-SMITH: There is, I think, a figure given on page 18 of Budget Paper 4, Volume 3, for an additional $0.7 million of new funding. That raised concerns with me as to whether this had identified an additional amount.

The Hon. J.D. HILL: Which year was that?

Mr HAMILTON-SMITH: It is in Budget Paper 4, Volume 3, page 18. The budget says there will be $0.07 million of additional funding.

The Hon. J.D. HILL: Are you talking about the Nationally Funded Centres Program, the $0.7 million? I am not sure what you are referring to. It is on page 18 of Volume 3?

Mr HAMILTON-SMITH: The Mid-Year Budget Review mentions the $10 million over four years figure.

The Hon. J.D. HILL: The line where it says 'partially offset by additional expenditure in 2012-13'. Sorry, we got the wrong line.

Mr HAMILTON-SMITH: You will see it there just above, under Estimated Result.

The Hon. J.D. HILL: I will ask the CFO to explain it.

Mr WOOLCOCK: That line is referring to explaining the movement in expenditure between the years, between the 2011-12 estimated result and the 2012-13 budget. What it is highlighting is that there is a difference between those two years because it would have been a part-year impact in 2011-12, and the group just started halfway through the year; you will see a full-year impact in 2012-13.

Mr HAMILTON-SMITH: So there is no net increase there?

Mr WOOLCOCK: No.

Mr HAMILTON-SMITH: Has the number of people in the unit and remuneration levels changed at all? I think Mr Archer is running that unit. Can we just clarify whether that unit and Mr Archer are reporting to the Treasurer, to the health minister or to both? Who in fact has control over that unit and its functions?

The Hon. J.D. HILL: I think I have said this before: the unit reports to the CE of Health, Mr Swan, who reports to me, and of course Mr Swan also reports ultimately to the Premier, if the Premier chooses to have him do that. We have also set up a mechanism, a cross-agency body, which Mr Swan chairs, that goes through the work; that is a joint Health and Treasury body. On a regular basis, the unit, through the CE and through me, reports to the sustainable budget committee of cabinet. There is a range of mechanisms, but the administrative arrangements are that the unit is a responsibility of the CE of Health. The reporting arrangements are traditional, I guess you would say.

Mr VENNING: Where is David Davies in all that? Where does he fit in?

The Hon. J.D. HILL: David Davies, are you talking about the new head of the mental health directorate? He certainly does not fit in to the financial unit. He takes the place of Derek Wright, who has recently returned to New Zealand. David Davies will be the Director of the Mental Health and Substance Abuse Division.

Mr VENNING: Has he commenced in the job?

The Hon. J.D. HILL: On 16 July.

Mr HAMILTON-SMITH: Just moving on to the health transition, Budget Paper 6, page 66, I see $4.9 million is allocated over two years for this transition to the national e-health. I also note that doctors nationally have expressed some concern about this e-health initiative from the commonwealth. Could you update the house on how that money is going to be spent? I assume it is the PCEHR program that picks up most of this money, so could you tell us how that investment is going to unfold?

The Hon. J.D. HILL: When the decision was made on a cooperative basis, I guess through COAG, some years ago, all the jurisdictions agreed to contribute to the administrative arrangements that were being put in place, and so that is our share of the costs of running NEHTA, that is the authority. It is not for the development or rollout of the e-health processes, as I understand it, but I might ask the chief executive to amplify on that.

Mr SWAN: The funding over the next two years of $4.9 million is South Australia's contribution to running the authority, the National E-Health Transition Authority. All jurisdictions, including the commonwealth, make a contribution to that authority to actually set up the body that governs the development of e-health. The person who controls the electronic healthcare record is probably what you are referring to. The comments back from the clinicians is the initiative that is really being run by the commonwealth, through NEHTA, to move towards a personally controlled electronic healthcare record. So, it is a commonwealth initiative, but we are running the office because of the need for integration with healthcare systems we want to run. Obviously, it is the interests of all jurisdictions to try to move to a digital age of clinical information and to make sure that the patients have access to information.

Mr HAMILTON-SMITH: Is it foreseen that NEHTA will manage not only PCEHR but other e-health initiatives as they roll out, or is it there principally to manage PCEHR?

The Hon. J.D. HILL: I will ask Mr Swan to answer that again.

Mr SWAN: No. It is mainly to roll out the personally controlled electronic healthcare record. Obviously, we have responsibility for our ICT systems, particularly moving to the ones the minister's raised about moving to enterprise-wide clinical information systems, but there needs to be close collaboration about setting standards and protocols about the interface of systems, the standards that industry needs to comply with to make sure that there are integrated clinical systems that do move between primary health care, the acute care sector and other aspects of other healthcare needs.

Mr HAMILTON-SMITH: I will now move on to Budget Paper 5, page 28, which talks about the enterprise patient administration system (EPAS). Will NEHTA, this national entity, have any role in coordinating the rollout of state-based initiatives, such as EPAS, to make sure that one state can talk to the other and that the systems are compatible across jurisdictions, or is PCEHR going to be the only program or initiative within the ambit of NEHTA?

The Hon. J.D. HILL: That is a good question, I think. This whole issue of e-health is something that all jurisdictions are working through. We have seen some disasters in other countries. I think Britain went through an attempt to create one system which was going to apply to everyone everywhere. Fortunately, they did it before we started looking at ours, and we have learnt from their experience. They had to junk what I think may have been even billions of dollars worth of work, and it completely fell to pieces, and it took years to do it.

I might be using language incorrectly but, as I understand it, the approach that is taken here is that the national scheme will create an individual health record, which every citizen will be able to voluntarily take up, and that system will then be able to be accessed by the individual state systems. The EPAS system we are creating will be a hospital-based system, which will allow every patient who has contact in the public health system over time will have all their data accumulated to one site and updated and have a protocol-driven delivery system particular to them.

There will be trials later this year. In fact, I had a meeting yesterday with Allscripts, which is the body responsible for providing the software to us. There will be a trial this year to make sure that we can link GP systems in with the hospital system. That will be, I understand, if not the first, one of the very first, such trials in the world and certainly in Australia. It is a pretty remarkable thing they are doing.

Then, once that kind of connectivity happens and the commonwealth then brings in its personalised individually-controlled health record system, all of those elements should be able to talk to each, with the appropriate safeguards for the individuals. I assume that cloud technology comes into all of this. The various elements are created, and then in the cloud, they talk to each other. I am not an IT expert, but that is as I understand it.

Mr VENNING: I refer to the same line in Budget Paper 5, page 28, in relation to EPAS. I have been around for a while and I am very concerned, because we had XLCare, then we had CPS and now we have EPAS. I understand that, at the moment, you are training people in both CPS and EPAS at the same time and that is causing a fair bit of confusion. Look at the amount of money we have invested here: $408 million until 2031. Minister, I ask you, is it necessary to keep changing and are you confident that EPAS is the answer until 2021?

The Hon. J.D. HILL: They are different systems. XLCare is a system that has been around for a very long time.

Mr VENNING: Is it still in use?

The Hon. J.D. HILL: Yes, it is. It is a system that has been used to work out how many nurses are used to provide clinical care to patients on a ward; that is, effectively, what it does. EPAS will have the clinical information which will feed into the nursing requirements, but EPAS does something quite substantially different.

Mr VENNING: Do you understand it?

The Hon. J.D. HILL: Yes, I do. Without confusing both of us, I am trying to find ways to explain it. There will be a screen next to every bed which will be like an iPad, so it will be touch screen technology, which will allow every clinician who deals with a patient—say, if you are in bed at some time in the future in the new Barossa Hospital—

Mr VENNING: I will be a much older person.

The Hon. J.D. HILL: —and you are an elderly person who needs a whole range of complex care, your records will come up on that screen and they might know, for example, that you are allergic to peanuts; that is one simple example. When you go to order your breakfast cereal and you type in what you want for breakfast, if you order something that has peanuts in it, it will not let you have it.

Equally, if you come into the emergency department unconscious and they can work out that it is you, they will look on the screen and they might find you are allergic to penicillin so they will not give you penicillin. They will also know that you have particular conditions which require certain medication, so they will have your whole history which will allow immediate treatment to be much more responsive.

As they go through the treatment protocols when you are in hospital, say, for the first time, the doctor will put in whatever they think you require and the screen will make sure that the medication doses and the timing of those doses are properly monitored. If a nurse tries to give you an overdose (not deliberately but by accident), the protocols in the screen will tell the clinician what is going on.

We have been working with hundreds of people over recent months to train them up, and the clinicians have been very much engaged in developing the protocols for each of the clinical areas that is being used, so this is something far different from the XLCare system, which was really about measuring units of labour in a particular ward setting. The other system you mentioned—the CPS—I think we were trialling that at a couple of sites.

Mr VENNING: Apparently you still are.

The Hon. J.D. HILL: Lyell McEwin and Port Augusta; yes.

Ms THOMPSON: My question relates to mental health infrastructure and the improvements that are currently underway. How will these improvements provide people with the services to manage their illness closer to where they live in the community? This is Policy, Clinical Services and Administration, Budget Paper 4, Volume 3, page 17, 1.6 'Mental Health and Substance Abuse', Portfolio Statement page 32.

The Hon. J.D. HILL: Would you mind repeating the first part of the question?

Ms THOMPSON: Could you outline the mental health infrastructure improvements that will provide people with services to manage their illness closer to where they live in the community?

The Hon. J.D. HILL: I am happy to do that. As I said in my opening remarks, we are undergoing major reform to modernise and improve our mental health services. Historically, in South Australia and internationally, the solution to mental illness before sophisticated drugs and treatment measures came into place—institutionalisation was the name of the game. If somebody had a mental illness, they were locked away. Even people without mental illness who got pregnant or were a bit odd were locked away, and institutionalisation was what we used to do to people. There was a reaction to that, I guess, once new psychotic drugs were developed and new techniques were developed to look after people with mental illness and the civil liberties campaigning happened.

In the seventies and eighties, we went through a deinstitutionalised phase, and we opened the doors and put a lot of people out. I think what we are now going through could be described as the new institutionalised phase—new and appropriate contemporary institutions which best meet the needs of people so that every hospital in the metropolitan area has a mental health ward. In the past, there used to be two great big institutions where people had to go.

Mental illness is something you should be able to go to your local hospital to get help for if you need an acute bed, not to some great big institution which is scary and away from ordinary citizens. It also means that we need a variety of other subacute places where patients who are beginning to feel unwell, or who coming out of a critical episode, can go and be supported, and that is largely what the Stepping Up report is about.

In terms of our facilities, we have built and operate three 20-bed community rehabilitation centres. I think there is one community rehabilitation centre in the southern area, although I know it is not in your electorate, as well as commencing services at three new 15-bed intermediate care centres, one at Glenside, one at Noarlunga and one at Queenstown. The rehabilitation centres are places where people go for relatively long periods of time to help them rehabilitate and become used to using transport systems, shopping systems, getting jobs, looking after themselves, washing and doing all the things that are a part of everyday life, but once you have been institutionalised for a while, if you have had an acute mental illness, it is often difficult to get back into those norms of society, so that is what they are about.

The intermediate care centres are places where people can go when they are starting to feel unwell, where they can get some intensive help that may help them avoid an acute hospital setting, or it may be a place they go after they have left an acute setting such as Glenside but they are not quite ready to go home, so they can get extra help.

We also have plans to open six new community mental health services which bring together a whole range of services in the metropolitan area. The most recent one was in Tranmere in May this year—and I think the member for Waite was there at the opening by the Premier—and planning and construction is underway for two centres, both in the west and the north. We hope we will have all of them up by 2014.

There was also a gap in supported accommodation identified by the Social Inclusion Board, and that has been addressed with the construction of 59 supported accommodation dwellings across the metropolitan area. These have been developed and constructed by NGO community houses. In addition, 20 supported accommodation units were constructed and opened in Glenside in August 2011.

These are units for people who have been institutionalised for, often, very long periods of time, and for the first time they have a street address, they have their own bathroom, their own laundry, their own kitchen, and they have their own porch they can sit on in the afternoon sun and read a book or a magazine. I think it is extraordinary to see the change in the circumstances of some of these people who were treated in this highly institutionalised way, where their personality and their capacity to make decisions were considerably diminished.

Furthermore, we have completed and tenanted 243 new homes out of 262 social houses funded by the commonwealth government through the Economic Stimulus Package. When that stimulus package came up, mental health put up its hand and said, 'Let's have some of those,' and we got a lot of them. All of those consumers now have a package of support in their own homes which is transformative for them.

This is not institutionalised care: this is de-institutionalised care, but it is not just saying, 'Go out and live in the community.' It is giving support for these people so that they can do that. There is a lot more I could say about new beds in all our hospitals and a whole range of other services, including an aged care unit at The Queen Elizabeth Hospital which will be opened late this year and a whole range of services for other patients as well.

Dr CLOSE: I refer to Budget Paper 4, Volume 3, pages 48-52, on the subject of tobacco reforms. What are the latest tobacco reforms announced by the government and can you provide information minister?

The Hon. J.D. HILL: I thank the member for Port Adelaide and also the member for Waite, who has offered pretty strong bipartisan support on behalf of his party for these reforms. We know that three South Australians die every day from tobacco-related illness, and an estimated $2.39 billion is lost to our economy each year in health costs and lost productivity relating to smoking. So everyone who gives up potentially saves years of their own life as well as the cost to our community.

The prevalence of smoking in our state has reduced significantly over the past year. The smoking rate in 2011 for people aged 15 years and older is now 17.6 per cent, which is down from 20.5 per cent in 2010, and for daily smoking the rate is now 15.2 per cent. Young people, that is 15 to 29 year olds, have also registered a significant downward trend, going from to 22.9 per cent in 2010 to 17.6 per cent in 2011, and their daily smoking rate is now 13.6 per cent, down from 17.3 per cent in 2010. That is a huge reduction.

A lot of people are giving up and a lot of people are not taking up smoking. The social norms are now very much against taking up smoking amongst young people, and that is something about which we should be very pleased. The reduction in the number of smokers aged 15 years and over is approximately 40,000 people over that period of time. This is the largest reduction observed in the past 10 years. The reduction in young smokers between 15 and 29 years is approximately 18,000, and that is the biggest reduction in the past six years.

As members would know, a range of factors contribute to this: the increase in the excise tax has made cigarettes more expensive, and we know that has a positive effect on smoking. We have also introduced new regulations under the Tobacco Products Regulation Act 1997, and this restricts smoking in a range of areas, including near children's playgrounds and in covered public transport areas. Now local councils and other incorporated bodies can apply to have areas or events smoke free. I understand the Royal Show will do that this year, which I think is a great thing.

Of course we have also banned the display of tobacco products from general retailers from the beginning of this year. Specialists will have the same applied from the end of December 2014, and we have increased the amount of government advertising. We will increase advertising in 2012-13 with a budget of $1.9 million. There are three things you can really do to reduce tobacco use, I am advised: first, put up the price; secondly, make it as unglamorous as you can (which is where all those restrictions come into place); and, thirdly, advertise like crazy to get the message across to people that smoking is not a cool thing to do.

Mr ODENWALDER: I refer to the same budget line as referred to by the member for Reynell (sub-program 1.6, Budget Paper 4, Volume 3, page 32). Will the minister expand on recent cooperative initiatives with the commonwealth to implement new infrastructure and services to address the needs of people in South Australia with a mental illness?

The Hon. J.D. HILL: I am pleased to do that and I thank the member for his question. I outlined a range of things we have done. I am very pleased that the commonwealth has allocated I think $94 million over the next five years for service improvements. I will tell the committee what that is providing to us. It is providing $79.4 million over four years to develop six service projects that will deliver an additional 159 beds and bed equivalents by the middle of next year, and that is on top of the 92 adult beds and places we are generating.

The provision of supported accommodation services is still a gap, and the new 80 support packages under the sub-acute care initiative will provide much needed support to our metro and country consumers after they leave acute care. The commonwealth will fund 24 beds in three centres that will be developed across the metro area. These will provide early intervention care and ease pressure on families caring for a person with a mental illness, and they will be supported by 10 bed equivalents across the community to provide in-reach service to people's homes.

The commonwealth funding allows South Australia to develop two new 10-bed community rehab centres in country South Australia—one at Whyalla and one at Mount Gambier. The commonwealth funding will also enable the establishment of a 15-bed youth sub-acute facility for adolescents and young adults aged 16 to 24 years. This, together with the already operating Early Psychosis Intervention Service, will form the foundation for a new service response to mental illness needs of young people. The commonwealth is also funding a new 10-bed subacute facility near James Nash House, which will be open by mid-2013. So, we are very grateful to the commonwealth and it is good to see the two levels of government working together.

Mr HAMILTON-SMITH: Just on EPAS, before we leave that—Budget Paper 5, page 28—my understanding is it is $408 million until 2020-21. Could the minister just confirm the split of that funding between state and federal, and could he just tell us how exactly is the $42.5 million of state money scheduled to be spent in 2012-13?

The Hon. J.D. HILL: Sorry, Martin, what was that last part?

Mr HAMILTON-SMITH: There is $42.5 million of state money being spent in 2012-13. It is listed on that budget line. So, I just really want to know what the split is between state and federal. How is the $42 million we are spending going to be deployed but, most importantly, can you tell me: are you confident you can keep this project on budget? Given the problems we had with the Oracle system, there are always dangers and risks with new IT systems.

The Hon. J.D. HILL: The commonwealth has given us $90 million towards this project, so the remainder is a state program. I get a briefing on, I think, a monthly basis on how this project is going. I have got to say it is going according to the planning and is on target to get to where we need to be.

I am advised that the planning phase of the program was completed on 31 December last year with a favourable variance of $241,000. This phase resulted in a business case and a fully costed total cost of ownership developed and presented to cabinet. The design and build phase of the program has now commenced and is projecting a spend total of $28.4 million during 2011-12. The activities undertaken during 2011-12 include:

procurement of the once-off vendor licence and annual support charges for the year—approximately $19.6 million;

procurement of the infrastructure required to host and support the enterprise patient admin system—approximately $4.7 million; and

engagement of a number of SA Health staff and contractors to design, build and support the enterprise patient admin system—approximately $4.1 million.

During 2012-13, the EPAS implementation phase will commence with an estimated investing expenditure of $42.6 million, which is the figure you have referred to, noting that an additional $0.5 million of contingency is required to be reclassified from operating expenditure for authority to invest in new expenditure authority in 2012-13. I guess that is just a financial technical matter. This phase will involve training and site preparation, rolling out the EPAS into the Mount Gambier and Port Augusta hospitals, the Noarlunga Health Service, the Repat General Hospital, the Lyell McEwin Hospital and The Queen Elizabeth Hospital.

It is an ambitious project, but there is huge enthusiasm in the health system for it. The clinicians are very much engaged. I have been to a couple of meetings where there have been hundreds of people present who voluntarily turned up to be there. There is a network of training that is going on in anticipation of the rollout to the various sites. A whole range of clinicians is involved in planning the clinical aspects of the trial, as well as all of the technical work that is going on, under very strong leadership from the Chief Medical Officer, Paddy Phillips, and Pam Zervas, who is the project director, both of whom are very committed and are providing, I think, outstanding leadership.

Mr HAMILTON-SMITH: So, you are fairly confident that it is on time and on budget?

The Hon. J.D. HILL: Yes, indeed.

Mr HAMILTON-SMITH: Just moving to Budget Paper 4, Volume 3, page 38: Shared Services, that budget line talks about Health's participation in Shared Services and signals $6.8 million in regard to an expenditure increase. What is the arrangement at present between Health and Shared Services? I know there has been a level of participation but not full involvement, as I understand it, so can you just clarify how it is all going with Shared Services?

The Hon. J.D. HILL: Can I just clarify, are you talking about the working relationship or the nature of the services that Shared Services provide?

Mr HAMILTON-SMITH: What functions have been handed over to Shared Services and what functions have been retained? Of those functions that have been handed over to Shared Services—I know we had some issues with payroll recently—how effective has that handover of functions been and how was this $6.8 million of additional expenditure incurred?

The Hon. J.D. HILL: The $6.8 million, I am advised, is really centralising into the department the cost of providing the services. Shared Services is a government service but it is kind of an outsourcing from the department, if you like, so we have to pay for it; that is what we pay. I think in the past those figures were spread across the local health networks of the hospitals. They are now being brought together in one sum, so Health allocates that sum as a central line.

There have been no additional services provided by Shared Services in the past 12 months, so it is the payroll services essentially—accounts receivable and accounts payable. There obviously have been some issues around the delivery of those services according to the expectations that we have had. The member for Waite highlighted the issue around ambulance payroll. That was particularly complex. It was probably the worst time for Shared Services to take over the responsibility because the enterprise bargaining arrangements with the ambulance service included the decision to recalibrate the pay rates for a whole range of paramedic qualifications and then back pay that over a very long period of time.

We are talking about people who work shift work and who have taken leave and so you could not think of a more complex and more difficult task to do. A new agency was asked to do it, and I guess that was frustratingly difficult for them. However, I think those issues have pretty well been resolved. My colleague minister O'Brien, who is responsible for it, jumped in to try to make all that work, and I understand that it is working okay now. I certainly haven't heard anything too contrary. I understand that some administrative changes have been made with Shared Services to give it a sharper focus. We have regular meetings with them, as I understand it. Whatever issues there were, I think they are being addressed.

Mr HAMILTON-SMITH: So this $6.8 million is a contribution you have made to Shared Services—

The Hon. J.D. HILL: That is our charge.

Mr HAMILTON-SMITH: Right. But have there been corresponding savings within Health as you have offloaded those functions, or have you had to develop new systems to interact with Shared Services that have negated against the savings measures? In other words, has it been a productive exercise or a counterproductive exercise?

The Hon. J.D. HILL: No, I am advised we have not duplicated any service or created a new service. We obviously kept working with Shared Services to get it right, but over time as they take on these functions the amount of the participation by Health will decline. As to the savings in relation to Shared Services, those savings are in their budget. Our charge covers the cost that we have to pay them for doing whatever it is they are doing, so whatever the savings are they are allocated at that level. I guess minister O'Brien could give a better indication of what those savings are.

Mr HAMILTON-SMITH: While we are on that subject of financial management, I will move to Budget Paper 4, Volume 3, page 33 on the Oracle Corporate System (OCS). What is the present status of the OCS rollout, because we have had all of those issues? In particular, can you clarify for us the exact situation today in regard to unreconciled accounts and double payment of bills and any other corresponding problem which resulted from the introduction of the Oracle Corporate System over Legacy systems?

The Hon. J.D. HILL: These are issues which flow from the Auditor-General's Report. I will ask Mr Swan and Mr Woolcock to perhaps add. I will get them to go through those issues.

Mr SWAN: SA Health is the first South Australian government entity to fully implement Oracle financial systems across the enterprise. It is in many other health systems across Australia. We are trying to move from what are currently 18 separate and outdated legacy systems into an enterprise-wide financial and procurement system—which is the Oracle system—and trying to get compatibility across our system.

We have implemented the financial module across the enterprise, right across SA Health. We started with the procurement arm of it. We have actually completed about four or five sites, including the department, Modbury Hospital, the ambulance service and Mount Barker. We are now working through phase 2, which will be the balance of the rollout of the procurement arm of the software. Importantly, we are developing the business plan to facilitate that which will include not only the rollout of the procurement but also the training, education and change management that is really required to make sure that success in implementation is quite effective. That is where we are at, at the moment.

Mr HAMILTON-SMITH: I might have missed this, but what is the situation with unreconciled accounts?

Mr SWAN: As at 19 June 2012 all outstanding amounts have now been recovered.

Mr HAMILTON-SMITH: The double payment of bills?

Mr SWAN: That is correct.

Mr HAMILTON-SMITH: What about unreconciled accounts? Did you mention that in your—

Mr SWAN: Yes. The specific area of concern raised by the Auditor-General related to bank reconciliations. SA Health started the consolidation of bank accounts in 2010, following the implementation of the Oracle corporate system. From October 2011, all payroll and accounts payable runs were transitioned across the integrated bank account structure. It is no longer being paid within site-based accounts. However, as at March 2012 there still remained about 100 transaction and investment accounts across the metropolitan hospitals with financial institutions that SA Health is progressing to close. Around 20 metropolitan accounts have now been closed.

The issues relating to reconciliation of bank accounts are accounting and process related. The reconciliation issues arose following the transition of financial function from legacy financial systems to the new Oracle corporate system. The project team led by SA Health executive, principally staffed by SA Health staff, including additional contract support was put in place to deal with the specific issues that arose out of the implementation of the system and the integration of the financial function.

The residual reconciliation items that relate to the 2010-11 financial year have been addressed and cleared and the finalisation of the 2011-12 reconciliations are continuing. It is worth noting that throughout this process SA Health has identified no inappropriate transactions; the bank accounts for SA Health entities are being reconciled monthly and in a timely manner for 2011-12.

Mr HAMILTON-SMITH: Is there a dollar value of unreconciled accounts that you can give us?

The Hon. J.D. HILL: Which year are you referring to? Sorry, I will just go back. There were issues around the reconciliation in 2010-11 which the Auditor-General referred to, and the reconciliation process had not completed by the time the Auditor-General reports came through. However, in terms of 2011-12, the reconciliation process is now going according to standard processes on a monthly basis, so I guess in the middle of any month there will be some unreconciled amounts but the 2010-11 accounts have now been settled.

Mr HAMILTON-SMITH: Fully dealt with, okay. Before we leave that subject, can you tell the committee, at the end of the process what was the total amount we had to spend on consultants of one form or another to help sort through the problems? I know there were a number of different consultancies with a number of different accounting companies. Can you give us how much we spent on each consultancy linked to that problem?

The Hon. J.D. HILL: We may have to take that on notice. I think some of the information I have already provided to the committee but I am not sure. In fact, I am pretty certain that I have given most of it but, if we have not, we will check and get you a consolidated statement.

Mr HAMILTON-SMITH: You just mentioned—and I guess it relates to the accounts generally on Budget Paper 4, Volume 3—the issue that no incidence of fraud was detected in this respect. Have there been any reports of theft or fraud within the health portfolio more broadly in 2011-12 and, if so, what are the details?

The Hon. J.D. HILL: Obviously, there are the issues around the toner cartridges and the food laundering programs which the member would be aware of, and there might be one other case in relation to the management of what is called an SPF fund, which is a trust account managed by medicos. There is an investigation I understand that might be occurring, but my offices are not aware of any other issue. If we become aware of it, we will certainly provide some further advice.

Mr HAMILTON-SMITH: Did you say a trust account run by medicos, or medical officers?

The Hon. J.D. HILL: Yes. I might just ask David to explain.

Mr SWAN: These trust accounts are called special purpose funds that every hospital has that deal with a range of non-operating funds. They could be research funds, they could be university funds, they could be donation funds that are there for a specific purpose and hence the name of the type of trust. Each hospital would have many of these funds. In fact, each specialty would have their own funds for a range of purposes. They may have commonwealth grants, they may have grants or donations from third parties that may be undertaking research in certain areas, so they are used to keep out of the main operating budget list there for services. Of course, that is what we are really referring to, one of these accounts where there is something that we are working through.

Mr HAMILTON-SMITH: Are you able to tell us which hospital that matter relates to?

The Hon. J.D. HILL: Under investigation we do not give too much more detail.

Mr HAMILTON-SMITH: So apart from the cartridgegate issues, there have been no matters that have required a referral to police at this stage?

The Hon. J.D. HILL: I will have to take that on notice. It is a big organisation with lots of people working in it. I personally am not aware of any matters that have been reported to the police, but I cannot say with my hand on my heart that at every hospital site somebody has not referred somebody to the police. It certainly has not come to our attention.

Mr HAMILTON-SMITH: Just moving to the Royal Adelaide Hospital, if I may, for a moment, and hospitals more generally, but particularly that one. Are you able to say what the total costs are for running the existing Royal Adelaide Hospital, and therefore are you able to say once we close this hospital we will save that amount of money per year, which can offset the expense of the new hospital? Are you able to put a figure on what it costs you each year to run the Royal Adelaide Hospital as it stands? That is Budget Paper 4, Volume 3, page 38.

The Hon. J.D. HILL: I will just give you some rough figures and perhaps ask the department to provide some extra figures. The non-clinical service at the existing RAH in 2010-11 is estimated to be about $171,000 per day, which is less than 10 per cent of the total running cost of the hospital. If you index that to 2016-17, it is about $212,000 each day. The existing Royal Adelaide Hospital was to be scaled up to the capacity of the new Royal Adelaide Hospital.

If we scale it up to the capacity of the existing hospital, it works out about $0.25 million a day for the non-clinical services. Under the new Royal Adelaide Hospital contract, the actual figure to be paid to SA Health Partnership consortia in the first year of operation as part of the service payment for non-clinical services is $198,000 a day. If you compare like with like, it is cheaper to run the non-clinical services at the new RAH than it is at the existing RAH.

Based upon the figures above, the annual savings in non-clinical services is approximately $21 million each year, including approximately $2.5 million saving in gas and electricity costs. That is because the new hospital will have about 30 per cent more capacity. That is why you have to inflate those figures. Then, of course, we have the costs of paying off the capital, and as I have said, we are yet to know how Treasury wants to allocate those costs. If you build a new hospital, you have to pay the capital and the interest on that capital. The running costs, as I have said, work out at about a quarter of a million dollars a day at the existing hospital, using 2016-17 figures, based on an increase to the same capacity, and about $198 per day at the new hospital.

Mr HAMILTON-SMITH: Minister, I think you mentioned that the new hospital would be about 30 per cent more capacity than the existing hospital; is that right?

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

Mr HAMILTON-SMITH: Were you talking about the total number of beds and ED capacity there, and can you elaborate on that? One of the issues I will ask you to explain is whether we have built enough capacity in the new RAH to cater for growth over its life, because we are talking about 30 to 40 years from now.

The Hon. J.D. HILL: It is 30 per cent more capacity. I do not have the chart with me, but I have certainly seen it. There is a chart that goes through and compares all of the spaces in the hospital, and that creates 30 per cent more capacity.

Mr HAMILTON-SMITH: Is that beds or space?

The Hon. J.D. HILL: No. It is emergency department spaces, recovery spaces. One of the pressures in the current hospital is that there are not a lot of recovery spaces, so it stops the amount of surgery you can do, for example. All of those things, if you put them together, create 30 per cent more capacity. Also, there will be better throughput in the hospital as a result of the design changes. Staff will not have to walk long distances to get from one place to another or to take patients around.

One figure that sticks in my head is that the average patient at the current RAH would spend six or seven days in the hospital and, during that time, they would probably be moved from their bed to another place for a service, on average, somewhere between eight and nine times. At the new hospital, that will be reduced to two and a bit times because we will bring the services to the patients. They will be in their own rooms, there is more privacy and there is more space, and that creates efficiencies.

All the planning we did was based on forward growth. We know that in South Australia the demand for health services will continue to grow until about 2040, and then after that it will taper off; in fact, the demand for health services will decline. The key issue for us, from a clinical management and financial management point of view, is getting us and our children through to 2040 when, sadly, our generation, the baby boomer generation, will cease to form part of the—

Mr HAMILTON-SMITH: See you in the old folks home, John.

The Hon. J.D. HILL: Well, we would have shuffled off this mortal coil. Increasingly large numbers of us—

Mr HAMILTON-SMITH: We will probably be in adjacent wards.

The Hon. J.D. HILL: Yes, that is right. The baby boomer generation, which is the huge pressure in the health system, as it was in the 1960s and 1970s on the education system, will come to an end, and it will start coming to an end in about 2040. The predictions are that it will peak at around about that time, it will taper and then start to decline. Our planning is based on making sure that we have sufficient capacity in our system and that we can afford to pay for it; that is the other aspect.

The solution which is offered up often, I think simplistically, is that the answer to every problem is to create more hospital beds. If we were to take that as the only way of dealing with these pressures, we would have a gigantic number of beds and no staff to look after patients. Reform really has to be about keeping people out of hospitals by keeping them well and by reducing the length of stay in hospitals by a whole lot of reforms and managing the process. We are pretty confident that the healthcare plan of 2007, which is a 10-year plan, of which we are now halfway through the development, will provide capacity through to that period.

The advantage we have on the new RAH site is that there is capacity there to increase the size of that hospital by another 30 per cent. It is essentially being built in three pods, which are stacked against each other, and we would be able to build relatively easily a fourth pod adjacent to the three existing pods. If we get to 2020 or 2025 and something has changed in the modelling or the growth of our population, or some wonder drug means that people will live for another 20 years or something—let's hope—and we need more hospital beds, we have capacity there to do that. I am pretty confident that the best modelling we can do has been applied to this service.

Mr VENNING: You referred earlier to a question of mine about how Dr Derek White of New Zealand has gone back to New Zealand and now another New Zealander has taken his place. I am reliably informed that the last seven senior appointments in this mental health unit are all from the same New Zealand facility at Waitemata. Are these appointments jobs for the boys or girls? Do we not have Australians who are qualified?

The Hon. J.D. HILL: I am not too sure who has been informing you. Dr Peter Tyllis, I can assure you, is not from New Zealand. He has been living in South Australia for quite a number of years, so I do not know who is doing the informing. Can I say that we are very lucky to be an attractive place for New Zealanders to come and work because I think they have probably one of the best worked-out mental health systems in the world and we have learnt a lot from New Zealand.

To go back to an earlier remark I made, in South Australia we had a tendency until the fifties and sixties to put everybody in a big institution, then we de-institutionalised and we thought we were doing pretty well. In the eighties we were considered to be the best-performing mental health service in Australia, and then we did not really do much for another 20 or 30 years. We are now starting to make the reforms that jurisdictions like New Zealand made a number of years ago. Before you make these criticisms, I would invite you, on one of your parliamentary trips, to visit New Zealand, and I would certainly help arrange for you to go and have a look at what they—

Mr Venning interjecting:

The Hon. J.D. HILL: We have certainly had a number of New Zealanders but I am not aware of the—

Mr VENNING: It looks like jobs for the boys, doesn't it?

The Hon. J.D. HILL: It doesn't, to me, at all. It looks like we are getting the very best people to run our health service.

Mr VENNING: Derek White was a New Zealander and he did most of the appointments.

The Hon. J.D. HILL: Derek Wright is his name; he is actually a Scot and he went to New Zealand a number of years ago. He was an outstanding leader and I was very disappointed that he left; he went back to New Zealand for family reasons. I am not too sure who is informing you—it may be people who have been unsuccessful in obtaining a job, I do not know—but we are lucky to be able to attract New Zealanders to our state. In fact, I would like to create a stronger partnership with New Zealand because I think the way they have delivered mental health services provides a very good indicator of where we need to go in South Australia.

Mr VENNING: Shouldn't we be training some of our own, though, minister? These people go home and leave us without anybody.

The Hon. J.D. HILL: I am not sure that they have left us without anybody; we have some very—

Mr VENNING: They all go home, eventually.

The Hon. J.D. HILL: Some people go and some people stay; that is the nature of the international job market. We have people from England, Africa, India and from all over the world working in our healthcare system and we are lucky to have them. I think this narrow-minded, parochial kind of view that South Australians are the only people who should ever do anything is something that we really need to challenge. Where would the Barossa be now if not for migration from Germany over decades in the 19^th century? It would not be growing grapes, that is for sure.

If I may continue, I advise the member for Waite that, in the past 12 months, we have not referred any employee to the police, I am advised. Secondly, in relation to a matter he raised about the intensive care unit at The Queen Elizabeth Hospital, only 2 per cent of total admissions who go through the emergency department need intensive care beds, so the claims that we would somehow downgrade it into a triage centre are incorrect. For comparison, I am advised that at Flinders and Royal Adelaide it is about double that, 4 per cent.

Mr HAMILTON-SMITH: I would love to go on about the ICU requirement, because I suspect there might only be 2 per cent admissions but there would be another percentage who could have been in the ICU and would not have been at The Queen Elizabeth Hospital had there not been one, arguably, but that is another point. Getting back to the Royal Adelaide, has the government decided what it will do with the old RAH site? What options are on the table?

The Hon. J.D. HILL: No, the government is yet to decide. I have certainly made public my views and the matter is now something which the Deputy Premier as Minister for Planning is responsible for managing. There are certain parts of the site which Health will hold onto, at least in the short term. The IMVS services, or SA Pathology as it is now called, will continue at the site. We are going through a business case to look at what we need to do there—upgrade the site, move it elsewhere—so that is being thought through.

The dental hospital continues to be there and we are obviously thinking through that with the university. I think that there is the option to say, broadly, without committing anybody to anything, that the sixties and seventies Playford buildings which were constructed, and modernised the Royal Adelaide Hospital in his term, by and large have fulfilled their useful purposes and will be pulled down. That will create a capacity to create extra open space; whether it is used by the Botanic Gardens or some other purpose is yet to be determined.

The heritage style buildings—though not necessarily heritage listed at this stage, and I am thinking particularly of the McEwin Building, the Bice Building on North Terrace and the buildings on Frome Road, including the old nurses' quarters, the Margaret Graham Building and so on—all have the capacity to be used for a range of purposes. The universities are certainly interested. We have some arts facilities which we could put in there which would be consistent with the North Terrace arts cultural precinct and there may well be other administrative functions that could be placed in there by Health if it was so inclined.

Then you have the buildings which go from the medical school right through to where SA Pathology is. It seems to me that there is a bold opportunity there to redevelop that entire section—relatively old buildings, not particularly functional—and the university and the government, or the university by itself, or several universities together might be able to do something really dramatic on that site if we were just to get rid of the buildings that are there.

All of those things need to be thought through and, certainly, we have no specific plans at this stage, just a selection of ideas. One thing I will say, though: I certainly will oppose the proposal by the National Trust to keep as a heritage listed building the aptly named East Wing of the hospital which shadows over the Botanic Gardens, and I was very pleased to see your leader agree with me at least in relation to that particular aspect of that development.

Mr HAMILTON-SMITH: Well, you could make Parliament House 'West Wing', couldn't you? Just a joke. Arguably, it probably already is. Still on the RAH issue, because I know this will be important not only for mental health but also for health more broadly, the $397 million payment per annum that we are going to be up for: can you explain to the house whether that is a fixed amount or whether it is variable each year, and what proportion of that annual payment is for capital, and what proportion of that annual payment is for the operating costs at the hospital that you talked about earlier in your answer?

The Hon. J.D. HILL: For the first full budget year 2016-17, the annual service payment is anticipated to be $395 million and, of course, that will be offset by whatever we are currently paying for non-clinical services at the RAH. The average full year service payment is anticipated to be $397 million in nominal terms. This is made up of both the cost to build and finance the hospital and also to maintain it and provide non-clinical services to be delivered by SA Health partnership. Total annual payments are fairly constant, again, in nominal terms over the life of the project, varying slightly with life cycle payments for significant asset maintenance and replacement works.

There is a cycle of extra activity that occurs when certain things need to be replaced. The anticipated annual service payment will only be above $400 million in eight financial years out of 30, and only once right at the end will it be above $440 million. It is anticipated that in the last year it will be $479 million. Over time, the real value of the payments, taking into consideration the impact of inflation, will reduce significantly over the course of the project, so it will halve, assuming an inflation rate of 2.5 per cent.

In terms of the proportion that goes to interest, the proportion that goes to capital and the proportion that goes to services, that will obviously vary over time. A bit like a house mortgage, you pay more interest at the beginning and, as the contract comes to a conclusion, you are paying more capital; I understand that is the way it works: there is a schedule over time, and some adjustments can occur in the course of it.

Essentially, at the beginning it is the most burdensome and at the end it is relatively low impact. Of course the service payments will have to inflate according to cost pressures, and they are the costs of cleaning and all those kinds of things—non-clinical services that would rise in the existing RAH. Those elements will go up and the other elements are fixed and will go down.

Mr HAMILTON-SMITH: Minister, did I hear correctly: did you mention a figure of $497 million?

The Hon. J.D. HILL: You asked whether it changed, and I said that is roughly around $397 million on average each year.

Mr HAMILTON-SMITH: On average over the 30 years?

The Hon. J.D. HILL: The average full-year service payment is anticipated to be $397 million in nominal terms. There are eight years when it will go over that, and they are the years when there is a peak in capital works that need to be done. There is a schedule I suppose when the carpets need to be replaced.

Mr HAMILTON-SMITH: Will they be the first eight years generally?

The Hon. J.D. HILL: No. If you imagine a 30-year cycle (I have no idea whether this is the case), the air conditioning might need to have a major upgrade in the 15^th year, so there is a spike in capital works. Soft furnishings will have to be replaced probably after 10 years. That is all considered in the contract. That is part of the average of $397 million, but sometimes it is above that and sometimes it is below.

Mr HAMILTON-SMITH: So in other years it will be well below $397 million?

The Hon. J.D. HILL: That's right.

Mr HAMILTON-SMITH: In terms of how you are going to pay for that, I notice that the budget line, page 71 of Budget Paper 3, talks about $70.6 million being spent in 2015-16. How will the cost transfer of this liability be managed between Health and Treasury? Will that money be allocated to Health and paid to the consortia by Health, either through Treasury or directly, or will Treasury manage that outside Health's budget purview?

The Hon. J.D. HILL: That was the question you asked earlier, and I think I said that as far as I am aware that is yet to be determined. My sense of it is that the service arrangements—the cost of cleaning and all those elements, I assume—would be health-style budgets, whereas the capital costs and the interest payments could be something Treasury will deal with directly, or they may decide just to make a provision to Health.

One of the options, I am just advised, is that the asset would be placed on our books—that would probably be the logical and most straightforward way for them to do it. It is similar, but different. When we get money from Treasury to build a new hospital or to extend a hospital, such as Lyell McEwin or Flinders, we get money appropriated from Treasury for that, and it just comes in in a lump. This is less lumpy, I guess—that is the way you would have to describe it. Treasury will have to give money to us to do it, whatever way it works.

Mr HAMILTON-SMITH: It is more than likely that the transparency with regard to all of these movements will be through the health component.

The Hon. J.D. HILL: I cannot answer that. Treasury will have to make that determination. I am just rethinking aloud now, but it does seem logical to me that they will do it that way. They may have a better way or a different way of doing it. There may be some financial benefits from doing it a different way. I am just not aware of that.

Mr HAMILTON-SMITH: No worries. Budget Paper 4, Volume 3, page 17—just the program 1 in general, which must pick up the IMVS. Has there been a change of senior management at IMVS recently and, in particular, is Professor Ruth Salom to remain in the position? Has there been a budget blowout in the IMVS recently?

The Hon. J.D. HILL: Unfortunately, Ruth Salom, who is not a New Zealander but a Victorian, has returned to Victoria to be with her family.

Mr VENNING: Not from New Zealand?

The Hon. J.D. HILL: No, she is not from New Zealand. She was a great loss actually, and I know the CE of Health tried to persuade her not to go, but she had been here with us, I think, for about five years which was, essentially, her contract. She did a great job bringing the elements to create SA Health. The business has grown dramatically in that time. The amount of commercial work that the business does is phenomenal, so she did an extraordinary job. I think the recruiting process has been completed and we are about to offer somebody the job.

Mr HAMILTON-SMITH: Has there been a budget blowout in IMVS and is there any concern about IMVS having overpaid for a computer program or some related issue?

The Hon. J.D. HILL: There is no budget blowout that I am aware of. They have spent some money planning for a new computing system called EPLIS, which is referred to in the budget papers. If the member has any information, I am happy to get it checked out.

Mr HAMILTON-SMITH: Okay. The minister has no concerns about management or the conduct of business in IMVS at all at present?

The Hon. J.D. HILL: I am not aware of any reasons to be concerned. There were issues in the past which caused some concern but that is going back several years now.

Mr HAMILTON-SMITH: Just before we get onto mental health, the GP Plus system is dealt with in Budget Paper 4, Volume 3, page 45. Can you just give us an update on progress with the GP Plus clinics? There was an issue with at least one of them with regard to GP services. Are we on budget and on target with what we wanted to achieve from the GP Plus network?

The Hon. J.D. HILL: Yes. As I understand it, it is going well. There were issues around the GP Plus Super Clinic at Modbury. The service provider that was contracted to provide the service decided they no longer wanted to provide the service, so we put in some locum doctors. The amount of patients they have been seeing is growing.

We put in a locum service to support the GP Plus while the recruiting was going forward. I understand there are a number of groups of doctors who are wanting to take on the role and I think we are pretty close to finalising that. Just for the benefit of the members, a key indicator of the effectiveness of GP Plus programs and services overall is the trend in the number of hospital admissions that are considered to be preventable, given adequate community-based care. The number of these types of admissions to acute hospitals is continuing to decrease with 1 per cent fewer compared with the same period last year. The hospital avoidance program for residential aged care facilities has achieved a 14 per cent reduction in the number of ambulance transfers from participating facilities to hospital emergency departments.

We, in fact, had the lowest number in the most recent stats of the GP-type presentations going to the emergency departments. It is still high—it is 30-something per cent—but it is lower than any of the other states. Our GP Plus strategy, which is not just about the centres but about a whole range of other things, has worked. Prior to the strategy, the average number of separations in the metropolitan hospitals was 4.6. In the 2010-11 year the metro growth was 1.1, despite increasing numbers of older citizens and also the growth in lifestyle illnesses and the increases in elective surgery. This is a very good strategy. Some of the teething issues, I guess we will sort through, but the overall strategy is working very well.

Mr VENNING: I refer to Budget Paper 5, the Capital Investment Statement, page 28. Don't look because it is not there, under a heading of 'new projects'; I note that the Barossa hospital is not there. Minister, what do I tell the people of the Barossa in relation to the current facility we have there? Would you agree in the short term to do some minor works to at least get the facility so that we deal with the serious shortfalls that are there because of the ageing facility? Are you suggesting that the facility becomes unworkable and that the Barossa people will then seek their medical care at the Lyell McEwin and further then overload that system?

The Hon. J.D. HILL: I would have thought that the Gawler hospital was closer than the Lyell McEwin to them.

Mr VENNING: It's just not big enough to cater for it all.

The Hon. J.D. HILL: I am just saying that I would have thought Gawler hospital was closer. Application was made to the commonwealth Health and Hospitals Fund in the last round of funding for a new Barossa hospital, so we have kept it on the agenda, I can assure the member for Schubert. I should not make jokes about it. We understand that it is an important initiative for his community and, if we could get the funds for it, we would love to rebuild a new hospital in the Barossa.

We were advised in May this year unfortunately that the application had been unsuccessful. The Department for Health and Ageing, in conjunction with Country Health SA Local Health Network, is preparing a strategic asset infrastructure plan to complement its strategic healthcare plan, so we will have a look at the key infrastructure issues in relation to those hospitals amongst all the others. We are also looking at the requirements for upgrading at Angaston and Tanunda as part of the minor works program. I do not want to create too great a sense of expectation because there are a lot of other priorities that fall under funding in that category. It will be looked at and, if it has needs which are greater than the needs of other hospitals, it will get some attention but it will not be specially favoured.

Mr VENNING: That's a given.

The Hon. J.D. HILL: Nor will it be ignored.

Mr HAMILTON-SMITH: I will move on to the patient assisted transport scheme (PATS) which is dealt with in Budget Paper 4, Volume 3, page 61. What complaints has the government received about the PATS scheme? By way of explanation, a number of country members—the members for Flinders, Schubert, Chaffey and Goyder, for instance—have raised with me concerns. I note on this budget line that the number of claimants fell short from 22,300 to 19,400 in 2011-12 and that the number of payments reduced from 50,000 to 43,000. On the budget line, the budget claims that that was done without reducing service delivery, but the feedback I am getting from country members is that that is not the case. What complaints are you getting about the PATS scheme, and have we got a problem with underfunding of that scheme?

The Hon. J.D. HILL: The problem is really the reverse. It is the overfunding of the scheme which has occurred over recent years. This is a scheme which was established initially by the commonwealth government and then it was transferred to the state without growth funding. I am not sure when it was transferred over. It was in the 1990s, I think—a long time ago. The call on that scheme has continued to grow, so we have had to manage it. I will get to the issue of complaints in a second.

The way of managing it is essentially twofold: one is to make sure that we have more services available to country residents, so we have dramatically increased the amount of elective surgery in country South Australia so fewer people have to travel to the city. We have increased the amount of renal dialysis that happens in country locations so that fewer people have to travel to the city for that; and we are in the process of increasing the amount of chemotherapy. I think that is the biggest thing we can do.

It is appalling that people had to travel to the city when they could quite easily have had services in country areas for chemotherapy. We are talking about people who feel absolutely sick and they have to come back and repeat a level. We have a network of 10 or 12 country hospitals which will be linked to Whyalla, the Lyell McEwin and the Royal Adelaide Hospital where a lot of chemotherapy can be given in the city. Port Pirie has been doing it for a long time very well.

Putting more services on so that fewer people have to travel is one strategy. I think some people feel a bit aggrieved, and I had one complaint from somebody at Port Lincoln who objected because we were not funding them to come to the city because we had provided a doctor in their town. I think it was at Port Lincoln. They objected because they could no longer travel to the city. Sometimes we are not allowing everybody to take somebody with them unless they absolutely need to have somebody travelling with them.

We are just making sure that the rules are followed appropriately and that we are not lax about them, and that has perhaps reduced the number of trips and the cost. That is part of having to manage a budget. It is just one of the lines in a very big budget that we are trying to manage appropriately. However, I am absolutely certain that those who need services and who need to travel are getting support. There are a few complaints about whether or not people get services (and I have just given an example), but most people would like to see a huge increase in the subsidy that is available.

I would love to be able to increase the subsidy that is available, but I just do not have the budget allocation that will allow me to do it. As I say to people, if I had an extra million dollars, $2 million, $5 million, $10 million, or whatever it would be to increase dramatically the PAT scheme, and if the choice were that or putting extra services in the country, I would rather put the extra services in the country, as tough as that might appear.

Mr Venning: Hear, hear!

The Hon. J.D. HILL: The member for Schubert says. 'Hear, hear!' and I thank him for that.

Mr HAMILTON-SMITH: I will move on to the issue of mental health and ask a few questions about beds, but that does not necessarily mean I will not have some more questions for Mr Swan. The Public Works Committee was recently advised that at any one time there were around 30 people needing a forensic bed who could not find one, and it was further advised that around 10 people needing forensic beds were in acute beds either in closed wards or elsewhere, where rightly they should have been in a forensic bed. Is that information correct, or can the minister clarify the actual situation?

The Hon. J.D. HILL: I think that is roughly correct. The Stepping Up report, which I have referred to, did many good things, but one thing it did not do was address the issues around forensic mental health beds: it simply allocated resources from the Glenside site to the James Nash site but did not increase the number of beds. There were 10 at Glenside and 30 at James Nash, and the idea was to put another 10 at James Nash and close down Glenside, so there would be 40 beds in all.

We do need more forensic mental health beds, in my view, and the best advice I have had around the place is that we probably need about 60 to cover the demand. There are three kinds of people who end up in a forensic mental health facility. There are those who are not fit to plead, and they are determined to go there by the courts for a term usually equivalent to the term they would have been convicted had they been fit to plead. If it was murder, it would be a fairly long time and if it was a less serious matter it would be a shorter period of time. After they have served that term, or during that term, they can be released on licence and that is supervised through the staff at James Nash.

The second class of patients, or clients, I suppose you would call them, are those who are in a correction facility and who develop a mental illness, or whose mental illness becomes so acute that they need to be placed in a mental health bed. They are the second class who go to James Nash. The third class are those who have an intellectual disability which renders them incapable of pleading. They are not mentally ill, they are just not competent. This is a difficult group. I guess you would call them disability clients, really. They go to James Nash and there are usually half a dozen or so or thereabouts of that group.

Then there is a fourth group. They are the ones whom I referred to in an earlier remark who are released on licence and who commit an offence while on licence. They are taken to court, and even though they are no longer suffering a mental illness, the court returns them, as it is obliged to do, to James Nash. That is an area that we need to reform. It seems to me that if a person is no longer mentally ill and commits an offence, then the safe haven, if you call it that, of James Nash should no longer be available to them. They should suffer the consequences of anybody else who commits an offence. The ongoing use of a mental health facility for somebody who no longer has a mental illness is somewhat strange. That would take some of the pressure off if we could do that.

So what we are doing is that we want to create extra capacity. As I mentioned before in an earlier remark, the commonwealth government has granted us some money which has allowed us to create 10 sub-acute beds on the James Nash site. These are for people who are in James Nash who are not quite ready to be out on licence. This will create a halfway house; that will take some of the pressure off.

As I have also said on previous occasions, we have $19 million to build 10 extra beds at James Nash. What we are doing is looking to see whether those $19 million can be used to create 20 beds rather than 10 beds. That would require a few changes to the way we are thinking about how we deliver those beds, but I am confident that we can do that. If we were able to do those things, that would give us 60 beds, so a 50 per cent increase. That would go a long way to redressing the backlog or the waiting list, and if we can change the rules about the readmission to James Nash of people who breach licence that would, I think, probably make it disappear completely.

We are working through all those things and I hope I shall be able to make some announcements about how we have progressed that shortly. I do agree that there is insufficient capacity in our forensic mental health facilities, and as a result of that a number of acute beds in the non-forensic area are being used to hold forensic style patients—or consumers or whatever language you use—and that creates pressures elsewhere.

Mr HAMILTON-SMITH: I did hear you on the 7.30 Report talking about the production of 20 beds from funding for 10, which I note has been through the Public Works Committee, and I was thinking that the only other occasion I have seen that happen was a gentleman standing on a mountain turning loaves and fishes into multiples of loaves and fishes.

The Hon. J.D. HILL: I will accept the comparison; that is all I can say.

Mr HAMILTON-SMITH: There were some stark contrasts, I might add, between the two, but I am just trying to work out, since this has already been through Public Works, how you are going to get 20 beds out of 10. I am familiar with the project; I have had the briefing and have been out and had a look at the site. It does seem to me to be a wistful claim, unless we are talking about an ATCO hut style new prison.

The Hon. J.D. HILL: No, I am not talking about that.

Mr HAMILTON-SMITH: You are not going to get the shipping containers in?

The Hon. J.D. HILL: No. We are thinking it through and after we have thought it through, which we hope to do pretty shortly, in the next few weeks, I will certainly make public announcements. I am putting a bit of pressure on the department. I mean, it seems to me that $19 million is a hell of a lot of money to build 10 beds. There are other ways that we can approach this and that is what we are looking at. Some of that money needs to rehabilitate parts of the existing James Nash, too, so it is not just for the building of beds, to be fair.

The CHAIR: I remind the committee that, technically, we are now into the time for the Office for the Ageing. I do not know whether you have any other advisers you want to bring down for that.

The Hon. J.D. HILL: It depends whether—

The CHAIR: I think the shadow will get to it at some stage, so as long as they are ready.

The Hon. J.D. HILL: Can I say that we will be joined at some stage shortly by Mr Greg Mackie, who is the Executive Director of the Office for the Ageing within the Department for Health and Ageing.

Mr HAMILTON-SMITH: Minister, I refer to Budget Paper 4, Volume 3, page 15. Getting back to the Stepping Up report, which the minister has referred to on a number of occasions, I have seen in the report a discussion about the number of acute mental health beds we have in South Australia compared with other states, and I have a copy of the report here. Can you point out to me the page and the recommendation that says in that report that we should cut the number of acute beds we have in South Australia and redirect the funding from that cut to other beds? Where is the specific recommendation that we should cut? You have made that claim on a number of occasions.

The Hon. J.D. HILL: I do not have the report in front of me, but I remember that at the time when we received this report, the government's response was that we recognised that the resources we were putting into acute mental health were far greater than the national average and that we needed to create additional steps, and the way we would fund those would be by transferring some of the resources from the acute sector to the sub-acute sector.

Mr HAMILTON-SMITH: While recognising that is what you have done, I will check the Hansard both of today and your other statements to see whether that is exactly what you have said, because I think the language you have used is that the Stepping Up report recommended that we cut the number of acute beds and redirect the funding into other beds.

The Hon. J.D. HILL: If I have made an error, I will correct the record myself. Can I say that it was the government's response to the Stepping Up report which adopted that approach. I have considered the report and our response really to be part of the same process.

Mr HAMILTON-SMITH: I just think this is an important thing to clarify. My reading of the report—and correct me if I am wrong—is that there is no such recommendation in the report. There may be reasons we have more acute beds in South Australia than in other states, and you mentioned one of them a moment ago, and that is that we have some forensic patients occupying acute beds.

There may be a greater demand here, there may be certain local circumstances that necessitate that we have more acute beds. I am questioning the very fundamental proposition that you have put publicly and to the parliament that the reason we are cutting the acute beds—and I note that the doctors and the ambulance service have raised this as a concern—is because the Stepping Up report said that we should do so, and I cannot see in the Stepping Up report any claim that we should do so. So, it seems rather to be a conclusion the government has reached.

The Hon. J.D. HILL: If I have incorrectly stated the report, I will apologise. The point I make, which is the key point, is that the report recommended a number of steps and, if it did not say explicitly, it certainly said it implicitly that we had put all of our eggs in the one basket and that basket was acute mental health beds, and what the report was recommending is that we create a series of steps so that patients had places to go other than acute services.

The way in which we have gone about doing it, as I have said repeatedly, is to transfer some of the budget from acute beds into sub-acute beds, and that is what we said at the time the Stepping Up report was put up. If it does not explicitly say it in the Stepping Up report, I can assure you that it was implicit in the thinking behind the Stepping Up report, and it was certainly part of the government's response to that report. I am not sure what you are really saying about our citizens to say that we need more acute mental health beds than other states. The reality is that we have more acute mental health beds than in other states, and I think that, even with the changes we are making, that would still largely be the case.

We also now have 72 or 74 additional places over and above the number of places we had when the report was produced, so we have created greater capacity to help people who have mental illness including (which I have not included in that 72) another 240-odd supported accommodation units where people who have mental illness can live; those units did not exist in the past.

The end result will be that by 2014 we will have created another 250-plus beds or bed equivalents for mental health patients. If you add the supported accommodation and the extra beds, there are about 500 new places in South Australia for people with mental illness. When we started we had 512, so we will have almost doubled the number of places where people who are mentally ill can get care, and I think that is a huge achievement.

We do not need all the acute beds to be maintained when we have that growth in non-acute provision. The issue around forensic is an issue, but it is not the only issue. The capacity has increased quite dramatically in the provision of services through subacute, and we do not need to keep all the existing beds just because of the forensic issue.

Mr HAMILTON-SMITH: Your decision is to cut 10 mental health beds at Margaret Tobin and another eight at Glenside; is that correct? Is it 18?

The Hon. J.D. HILL: The word 'cut' is kind of—

Mr HAMILTON-SMITH: Well, 'close'.

The Hon. J.D. HILL: I have just been given figure 13, which I refer you to, of the Stepping Up report, which has the—

Mr HAMILTON-SMITH: Recommendation 13, or figure 13?

The Hon. J.D. HILL: Figure 13, and it has the steps. It has 24-hour supported accommodation as the bottom step: current is 49 and proposed is 120 to 150; community rehabilitation centres, current zero, proposed 60 to 80; intermediate care, current zero, proposed 80 to 92; acute inpatient beds, current 252, proposed 190 to 220; and secure rehabilitation, zero proposed 30 to 40. I think that is pretty explicit: it is suggesting that we should close somewhere between 30 and 60 acute inpatient beds, so it is very much in the report. That is what we are doing—we are transitioning those beds from acute services into subacute services because that is where the growth is.

Patients do not want to wait until they get really ill. I have seen lots of parents who have come to see me in my electorate over the years who have adult children who are mentally unwell. They get so frustrated that the only sort of service for them has been an acute service. What we now have is a range of services, which is what Stepping Up said, and that figure that has just been brought to my attention demonstrates that that was foreseen in that report.

Mr HAMILTON-SMITH: You say the acute inpatient beds are the beds to which we are referring at Margaret Tobin and Glenside?

The Hon. J.D. HILL: Yes.

Mr HAMILTON-SMITH: How many acute beds do we have as of today? How many acute inpatient beds do we have right now?

The Hon. J.D. HILL: Total adult acute beds, 2011-12, estimated 220.

Mr HAMILTON-SMITH: That is 220?

The Hon. J.D. HILL: Yes.

Mr HAMILTON-SMITH: Right now?

The Hon. J.D. HILL: Yes, right now.

Mr HAMILTON-SMITH: What that very table you have just pointed out to me says is that we should have 220.

The Hon. J.D. HILL: It says 190 to 220.

Mr HAMILTON-SMITH: Well, 190—

The Hon. J.D. HILL: That is what it says: 190 to 220, and expected—

Mr HAMILTON-SMITH: What does it say? Which—190 or 220?

The Hon. J.D. HILL: It is in that range, and it is expected that by late 2014 it will be 214, so that is the maximum.

Mr HAMILTON-SMITH: So you are tending to take it down to $190 million?

The Hon. J.D. HILL: No, $214 million.

Mr HAMILTON-SMITH: But the $18 million that you are cutting—the $10 million at Margaret Tobin and the $8 million at Glenside—presumably, will come off the $220 million and make it $204 million, is that right?

The Hon. J.D. HILL: No, I am saying that in the 2011-12 year we have estimated $220 million and the adult acute beds are expected to be 214 because we are growing some others in the country, for example.

Mr HAMILTON-SMITH: We will have 214 at the end of the process, is that right?

The Hon. J.D. HILL: So, 214, which is absolutely in line, at the upper end, in fact, of the recommendations of the Stepping Up report.

Mr HAMILTON-SMITH: With respect, I do not think that that table is a recommendation.

The Hon. J.D. HILL: Okay. Let us just agree to differ.

Mr HAMILTON-SMITH: I think it is part of a discussion.

The Hon. J.D. HILL: Let us just agree to differ but that is what that report suggested we should have, and that is what we will have. In addition to that, we have all these other facilities. With total state and COAG funded places, excluding aged extended care which is a different category, we had 513 in 2006-07 and, by the end of 2014, we will have 764 places right across the board for people with mental illness. That is a huge increase—251 extra places—and a minor reduction in the number of adult acute beds.

Mr HAMILTON-SMITH: On the same budget line, how much do we save with each acute inpatient bed that we cut and, therefore, how much will we save by closing the 10 at Margaret Tobin and the eight at Glenside combined?

The Hon. J.D. HILL: It is not for saving, it is so that we can transfer the resources to the other facilities which we have already—

Mr HAMILTON-SMITH: Yes, but you must have measured that in dollar terms and know how much you can transfer, so I am wondering what that figure would be?

The Hon. J.D. HILL: This is a model of care which we have been working on. It is about creating the right number of beds in the right kind of categories, so we are in the process of doing that. As to the average cost of an acute bed, I can find out, I imagine, and I will happily let the member know.

Mr HAMILTON-SMITH: But would you not know that for today's purposes, in the sense that the saving you hope to make from cutting those 18 beds is obviously—

The Hon. J.D. HILL: Your word is 'savings', it is not mine.

Mr HAMILTON-SMITH: You are looking to transfer resources from one area of care, acute beds, to another area of care. Surely you have measured that in dollar terms.

The Hon. J.D. HILL: I have not got the information here. I will get it for you.

Mr HAMILTON-SMITH: Just on beds. You might have already said this in your answer to an earlier question. If you have, please excuse me and do not bother repeating it, but in each of the categories mentioned on page 32 of the Stepping Up report, can you tell us what the current number of beds is? Just to be clear, we have forensic beds, we have acute inpatient beds, then we have the other various beds that are mentioned on page 32 of the Stepping Up report. Can you just update the information on that? How many have we got? For example, 24-hour supported accommodation, community rehab, intermediate care—acute inpatient you have given us—and secure rehab, which I assume means forensic.

The Hon. J.D. HILL: Yes, well the forensic ones are included within the acute adult bed target.

Mr HAMILTON-SMITH: So, the forensic beds are included in the acute inpatient bed figure?

The Hon. J.D. HILL: Yes, and that has always been the case so we are comparing apples with apples there. Women's and Children's Hospital had 12 beds in 2006-07, we now have 12 beds at Women's and Children's Hospital; intermediate adult beds in 2006-07, we had zero, we now have 65 in 2011-12 and expect it to be 90 by the end of 2014-15 when the program is rolled out; community rehabilitation centre beds, we had zero in 2006-07, we now have 60, which is the total number planned; secure care, we had zero at Glenside in 2006-07, we will have 40 at Glenside; supported accommodation at Glenside in the metropolitan area, we had zero in 2006-07, we have 79 now and that is the figure we will get to. I am sorry the forensic beds are not included, my apologies; that is an addition.

The forensic beds were 40 in 2006-07, they are 40 now and, unless I find these extra 10, they will still be 40. The COAG sub-acute places, which include supported accommodation places, are 80; forensic step-down, 10; crisis respite facility, 24; crisis respite non-facility, 10; community rehabilitation centres, country, 20; and, youth inpatient, 15. That totals 159. There were none of those in any of the years, but they will all be in place by 2014-15. If we go across the board: there were 513 in 2006-07, it is 587 total places now and, by 2014-15, there will be 764 places, a growth of 251 across all those sectors in that period of time. I have further information (somebody did know): the cost of 10 acute beds is roughly equivalent to the cost of 15 intermediate care beds.

Mr HAMILTON-SMITH: It would be nice to know the dollar amount at a later time.

The Hon. J.D. HILL: I will get that.

Mr HAMILTON-SMITH: The Eating Disorders Unit, Budget Paper 4, Volume 3, pages 14 to 16: how many beds, if any, do we have that might be dedicated to eating disorders, and what is the cost per bed of providing those services?

The Hon. J.D. HILL: I will ask Dr Tyllis to come to the table.

Dr TYLLIS: Can I have the question again?

Mr HAMILTON-SMITH: How many beds do we have that might be dedicated to eating disorders? We had, I think, Ward 4G.

Dr TYLLIS: There are six beds currently in Ward 4G that are dedicated to eating disorders.

Mr HAMILTON-SMITH: And there are still six dedicated to that?

Dr TYLLIS: Yes.

Mr HAMILTON-SMITH: Do you have a cost per bed of providing that?

The Hon. J.D. HILL: I am not sure that we have an individual ward cost system in place. We know roughly the cost of providing an in-hospital bed: it is about $1,000 or $1,200 on average—it would vary a little. One of the benefits of the Oracle system eventually is that we will know all that.

Mr HAMILTON-SMITH: Regarding the involvement of NGOs in mental health, I refer to Budget Paper 4, Volume 3, page 43, which touches on this. To take the Central Adelaide Local Health Network, there seems to have been lower than anticipated revenue and associated expenditure from non-government sources—I think it is about $20 million. Are we fully optimising the capacity of the NGO sector in the mental health area? I note that you have opened a lot of beds in some of the categories you mentioned earlier. Would it have been more cost effective to have engaged more fully with the NGO sector with regard to the provision of some of those services, or have we fully reached out in that regard and brought NGOs into the network?

The Hon. J.D. HILL: It is a bit hard to answer that, because you are asking to make a value judgment. The NGOs would always say they could do more and some would say that the government should do everything. The principal approach is that government really should provide the clinical services and that is our responsibility, but there are other services that can be provided by not-for-profit NGOs. For example, NGOs are funded to provide rehabilitation support, accommodation, respite, education and counselling and information services to people with mental illness and their carers and families.

The Social Inclusion Board's Stepping Up report included recommendations regarding the review of investments in non-government services, and the 2007-08 budget allocated new funding of $36.8 million to the NGO sector over four years. The Social Inclusion Board in 2007 included recommendations to build the capacity of the non-government sector to deliver psycho-social rehabilitation and support services using a partnership approach and to reassess the investment in non-government service provision to implement a more rigorous contracting process that builds on the stepped system of care. Funding to non-government providers has increased from $3.43 million in 2002-03 to $44.5 million in 2011-12, which I think in anybody's book is a substantial increase. The majority of the funding provided to the NGO sector is allocated through detailed procurement processes.

During 2012, over 1,000 South Australians were receiving support services from the non-government sector in partnership with the government mental health services. These are 2011-12 outcomes. Funding for mental health services provided through NGOs during the 2011-12 original budget was 44.5. Services delivered through NGO partnerships are aligned with the State Strategic Plan target 2.7, improved psychological wellbeing, and the SA Health Strategic Plan, strategic direction 3, reform mental health care.

The mental health division of the department introduced an activity reporting and monitoring system in 2008 that requires non-government organisations to regularly provide aggregated data on program activities, duration of contact and the nature of services to allow compliance with requirements of the service agreement to be monitored. This allows us to be satisfied with what they are doing. So, there are a lot of things.

The 2012-13 target might be of interest. In addition to the 2011-12 funding to non-government programs, new service programs arising from recent COAG funding for subacute care, the degree of services to be provided by the NGO sector is currently being assessed, but the funding will be significant, so this will be extra funding. These services will be provided across the following programs:

80 places across the state for intensive home-based community support. I think we find the NGO sector generally is better at doing that kind of work;

support for consumers of forensic mental health services who are returning to the community—once again;

in-homes psychosocial crisis respite services in the metro area; and

community transition support services for young people going home after inpatient treatment.

A range of issues there can be addressed through good cooperation with the NGOs. For example, I know that on the Glenside campus we opened up 20 supported accommodation units, which I think are run by Mind, a not-for-profit organisation which manages that set of units for us, provides support to the people who live there and makes sure their wellbeing is looked after. I guess they are better at doing that than government instrumentalities.

Mr HAMILTON-SMITH: Could I ask a couple of questions on the related issue of drug and alcohol abuse because, as we all know, the two are very closely connected. Looking at Budget Paper 4, Volume 3, page 30, sub-program 1.6, there does not seem to be much detail there about how the money is being spent. It is two lines: income and expenses. For example, how much of that is being spent by Drug and Alcohol Services SA (DASSA), and how does DASSA spend its funding? It is just very short on detail.

The Hon. J.D. HILL: I am advised that Drug and Alcohol Services operates a statewide service. It is managed through the Southern Adelaide Local Health Network for a whole range of reasons. The net budget allocation for Drug and Alcohol Services in 2011-12 is $32.6 million and will be fully expended. It provides a range of effective prevention and intervention treatment programs, including:

detoxification for safe withdrawal processes, estimated result 4.5;

psychological counselling and social support rehabilitation interventions, including substitution treatment for opioid dependence, estimated expenditure 7.7;

the residential rehab program, the Woolshed, about 950;

an outreach service in the APY lands, 380;

targeted alcohol and other drug intervention programs for Aboriginal people, the Aboriginal Connection Program at the Port Augusta and Ceduna day centres, estimated at 1.4;

specific population of the programs, such as the Clean Needle program and the police drug diversion initiative, about $3 million; and

a 24-hour, seven day a week confidential alcohol and drug information service, about $910,000. In 2012-13 expenditure will increase for the prevention and intervention program at Ceduna day centre with the completion of the facility and increase in staff, including the running of the facility. The increase in the projected budget is 660 which increases from 445 this year. It is anticipated that the transition of Drug and Alcohol Services' withdrawal services to the new Glenside Health Service will occur within the 2012-13 financial year as well.

Mr HAMILTON-SMITH: Does DASSA produce an annual report of some kind? If not, what form of openness and accountability is there in regard to oversight of what DASSA is doing? Is it just regarded as a section within Health, for example? It seems to be an outriding organisation but it does not seem to report very openly.

The Hon. J.D. HILL: It is subject to the same reporting processes as any other element within the health sector. As I said, it is run through the Southern Adelaide Local Health Network. There will be a section in their annual report which is in effect DASSA's annual report, so that will go through their achievements and targets and so on.

Mr HAMILTON-SMITH: How many people work at DASSA and what are the top five positions by salary per annum?

The Hon. J.D. HILL: Just give us a minute. The director of DASSA is there busily writing it out.

Mr HAMILTON-SMITH: While we are getting an answer for that one, I wonder whether the minister could explain why it looks as though drug and alcohol day centres received $1.27 million in 2011-12 that was not originally budgeted for. It is the same budget line.

The Hon. J.D. HILL: Say that again.

Mr HAMILTON-SMITH: Drug and alcohol day centres apparently received $1.27 million in 2011-12 that did not appear to have been budgeted for. I wondered what that money was spent on.

The Hon. J.D. HILL: We will get that answer. The information in relation to the number of people who work in DASSA is 220 full-time equivalent staff. I am not sure what you want to know in terms of the salaries, what the salaries are?

Mr HAMILTON-SMITH: Yes, what the salaries are and what the titles of the positions are.

The Hon. J.D. HILL: I can take that on notice. I imagine most of the high salaries paid are doctors' salaries. I will get that information for you.

Mr HAMILTON-SMITH: You may have mentioned this a moment ago, but I believe there is a family wellbeing centre in Amata in the APY lands. I am referring to Budget Paper 4, Volume 3, page 14. You may have given us in that list a budget for that project. If not, could you give us the budget for the project? Is the budget achieving its goals?

The Hon. J.D. HILL: I can give a general overview. The former federal government, when Tony Abbott was the health minister, provided funds to set up a substance misuse facility at Amata. It was contrary to the wishes of the community, but nonetheless it was set up there. Shortly thereafter, Opal petrol was introduced and the principal substance misuse problem, which was petrol sniffing, virtually disappeared on the lands. In fact, on a recent trip up there, I saw only one case and I remember when I first went up there 25 or 30 years ago virtually every youth had a petrol can around their neck. It is an extraordinary change in social behaviour in a relatively short period of time. There are other substance abuses, and it is obviously dealing with the long-term effects of petrol sniffing, so there are disability issues that need to be maintained.

The commonwealth government's plans and our plans are to use that facility now as a wellbeing centre. There will be investment by the commonwealth—and I think some of that investment has already occurred—and a whole range of services as well as drug and alcohol services that will be provided for them. When I was up there recently there was a disability service that was being run from there. I think there is a healthy living and healthy eating project that has been running from there. I might have to take that on notice; I am sorry. I do not have any particular details of that.

Mr HAMILTON-SMITH: I thank the minister for that. I will move on to some issues to do with ageing, because I see the clock is moving on.

The Hon. J.D. HILL: I might invite Mr Mackie to join me and make his way down here.

Departmental Adviser:

Mr G. Mackie, Executive Director, Office for the Ageing.

Mr HAMILTON-SMITH: I am interested in the relationship between the state government and the federal government over the aged in regard to who does what. In particular, I noticed today public reports about an Adelaide nursing home that had been put on notice to better feed its residents after an audit found it was not providing enough nourishment to prevent weight loss, and another facility was found to be inappropriately restraining residents in chairs. Sixteen of the 266 SA homes are listed as being noncompliant in one or more of the 44 standards that are being monitored, presumably by the commonwealth regulator. What role, if any, does the state government play or is it playing in the regulatory regime which is designed to ensure higher standards in our aged care facilities?

The Hon. J.D. HILL: The advice I have is that the state government has no role in relation to the licensing, regulation or inspection of nursing home facilities. We obviously try to work cooperatively with them to ensure that residents do not unnecessarily get sent to hospitals in the middle of the night for matters which could be dealt with, and should be dealt with, at the home. However, we have no legal responsibilities under legislation; it is completely commonwealth.

Mr HAMILTON-SMITH: Would local councils not have planning responsibilities and, through the planning legislative regime, would we not be influencing the design, for example, and kitchen and food criteria, and health and safety standards? Are the aged care centres not picked up by the same food safety legislation that affects restaurants and hotels and so on and so forth? For example, if you have a salmonella outbreak in an aged care home (as we have seen in previous examples elsewhere), does not the state regulatory regime kick in then?

The Hon. J.D. HILL: Sure, and it is the same for people who commit murder and light fires and burn places down—the general state laws apply. I am sorry; I did not mean to suggest that there was no state control but, in terms of licensing, regulation and inspection of the facilities once established, it is really up to the authority. However, if there is an outbreak of respiratory illness, as there is from time to time, then obviously we would issue instructions about certain elements.

We do not regulate the business, as such. I guess the normal kind of operations of state law would apply. They are not on separate territory but they, as nursing homes, are subject to commonwealth legislation. Clearly, planning laws would need to be observed, industrial relations law would need to be followed—all of those state-based laws. I apologise if you took what I was saying to suggest that those things do not apply.

Clearly, if a salmonella outbreak or the like occurred (as the member mentioned) obviously the state health officials and local government officials would have a role. Whether or not they are properly feeding people the right amount of food, whether the cleaning is being done or whether the patients are being tethered to beds and so on may well be a police matter if state law was broken if somebody was being held against their will or something along those lines perhaps.

Mr HAMILTON-SMITH: They are obviously criminal matters. I was more concerned about food safety, health standards and I suppose planning safety in making sure that essentially that these aged homes are not dumps that do not meet planning laws.

The Hon. J.D. HILL: Sorry; I misunderstood the original question. Sure, I imagine—although I am not an expert in planning laws—that they would have to comply with whatever the state laws are in terms of fire and so on.

Mr HAMILTON-SMITH: Yes. That gets me to the next question in Budget Paper 5, page 27. Nationally there have been some fairly tragic examples of fires in these sorts of facilities that have resulted in considerable loss of life. I noticed the New South Wales government is getting involved in the business of investing in improved fire safety arrangements with sprinklers and so on and so forth. Do we have any obligation or responsibility there that we need to attend to?

The Hon. J.D. HILL: I am not sure what New South Wales is doing. I did see something in the media about what the member is suggesting. The obligation is on the provider to comply with whatever regulatory framework the commonwealth sets. I am not aware of those issues in particular in South Australia. The health department certainly would not have a role in that. Some other agency of government may be interested in how many fire alarms and so on there are, but it is certainly not part of our operations.

Mr HAMILTON-SMITH: Isn't it? I am just questioning that, because surely—

The Hon. J.D. HILL: I am talking about Health; I am not talking about the state.

Mr HAMILTON-SMITH: Okay. I guess, to the extent that Health has a responsibility for the aged, as an organ of government, I am just wondering whether Health makes sure everyone else is doing their bit. For example, on fire safety, the state government imposes certain requirements on people with regard to fire alarms. There is an active advertising program about having them installed. I gather there are fire hose requirements and fire safety criteria that need to be met. I do not know whether this is set out in local government regulations or state.

The Hon. J.D. HILL: I understand it is the commonwealth that inspects and regulates those functions and I think prescribes the standards as well. We are obviously interested in them being well operated and well run and we want to have a cooperative arrangement with them, particularly in relation to health management, so that the people who live in those homes are well supported. One of the tragedies I think, if you talk to any intensive care doctor or any emergency doctor, is the number of nursing home residents who are sent to emergency departments, essentially to die.

They want to die in their own bed, but they come to the end of their life and they are bundled up and sent off to an emergency department and then spend three or four days in an intensive care unit before they die. It is not what people want. It is certainly not what the doctors want. We would really like to see better protocols put in place, better understanding about how that part of a person's life can be managed.

I toured with my own GP, who does some locum services, a few years ago. He said, 'Come and have a look at what happens.' We went to a nursing home, in my electorate in fact, and he told me that he is often called to nursing homes to assist with the death of residents. The family turns up; they have never met him and he is the one who tells them what is in fact happening. He said that it comes as a shock to many of them that the mum or grandmother they have loved so much is now dying. There has been very little preparation made.

Part of the problem is a kind of interesting management dilemma, because when people go into nursing homes they generally want to keep the doctor they have had all their lives. Of course, if you are in a nursing home with 80 or 100 other patients, that could easily mean 20, 30 or 40 GPs who are responsible for providing services. It is difficult for them to get in. The nursing home cannot get the doctors to visit in the daytime because they are in the clinic, so what they tend to do if they get a GP is wait until the locum service is on, so they get a doctor they do not know. Alternatively, they stick them in an ambulance and send them off to an emergency department.

I think this is an area where we can do a lot more work. It is one of the reasons I was very keen to have ageing come into the health portfolio, so that we can develop better protocols for managing people in these circumstances, which should be done. They should be in some ways joyful experiences, strange as that might sound, rather than really frenetic and institutionalised experiences. I think most people want to die at home. A peaceful death in your own bed is the preference most of us have, and that could be better managed, I think.

I have just been advised the top five positions by terms of salary in DASSA are, as I predicted, clinicians, medical doctors.

Mr HAMILTON-SMITH: This issue of geriatric patients occupying beds in hospitals, which you have touched on, and therefore clogging those beds up, if you like, for emergency patients to be put in, and this broader question of better managing the geriatric population, are clearly real issues that need addressing. Do you have specific programs you are working on and investing in to address some of these issues because, unless we do, we are not going to ease the problem in acute beds? Are you going to spend more in that area?

The Hon. J.D. HILL: There are a number of things we are doing, and one of them is to try to keep elderly people out of hospital. We have invested in out-of-hospital care programs, and we identified a number of elderly people, usually elderly frail people, who are in and out of hospital quite frequently because they fall off their medication or they just fall over. We have the Royal District Nursing Service provision to assist those people, and that has reduced quite a lot the incidence of re-admission.

Bringing ageing into the health portfolio has meant that the health department now looks after the ACAT, which is the aged care assessment teams, and I think there are 160 people who deliver those services. We are reviewing those processes to try to get a better integration between that ACAT assessment team and the movement of patients who are ready to go into a nursing home-style accommodation, and in the past, that has been a bit problematic.

In 2011-12, the funding was $8.5 million provided by the commonwealth under the Aged Care Assessment Program implementation plan. An amount of $4.6 million was allocated to the Adelaide Aged Care Assessment Team and $2.6 million to country to administer the aged-care assessment teams.

The number of people who participated and received an aged-care assessment in 2011-12 is 14,500, and we have a funding agreement negotiated with the commonwealth to continue the operational management in the 2012-14 period. South Australia will receive $8.4 million in commonwealth funding for 2012-13.

The targets for 2012-13 include undertake an external evaluation of the aged-care assessment program, which I have just referred to, including the efficiency, governance and structures of the teams in South Australia; to establish recommendations for the SA Health executive to guide the implementation of best practice and integrated approach to delivering the comprehensive assessment function with the health and community system, with improved services for older people; implementing new EB business initiatives to streamline aged-care referral, assessment, administrative services and so on.

What we are doing is integrating better that aged-care assessment with the health portfolio so that we can speed up the process. Sometimes people were waiting in hospital for one or two weeks just waiting for an ACAT. So, it would be good to get that ACAT assessment happening more quickly. It is not necessarily that there are not nursing home beds available for them, it is just that the assessment has not occurred in a timely manner.

Mr HAMILTON-SMITH: I refer to Budget Paper 6, page 124. I want to move to the personal alarm systems rebate scheme. I see for 2010-11 that $2.9 million was budgeted over four years to provide people over 75 with personal alarm systems, and then there is a break-up of how much was spent in each year. But the same budget line does not seem to appear in the 2012-13 budget papers.

The Hon. J.D. HILL: It will appear in the Minister for Communities and Social Inclusion's budget papers. The subsidies programs were kept together in that program. More the policy and the health issues came across to our portfolio.

Mr HAMILTON-SMITH: They are running that. You are not able to tell us whether or not that program is working effectively?

The Hon. J.D. HILL: My understanding is that it is working effectively, but I am not in a position to really reflect on it.

Mr HAMILTON-SMITH: I refer to Budget Paper 4, Volume 3, page 44, Queen Elizabeth Hospital, stage 2B. There is discussion there about acute mental health beds for older persons at TQEH. The SA Health website states that there is a new 20-bed acute ward at The Queen Elizabeth Hospital, scheduled to open in 2012. Is that project on budget and on time, and is it going to deliver the results intended?

The Hon. J.D. HILL: I think I referred to it in an earlier question, but my advice is that it is on target. My advice is that construction is also well underway on a 20-bed aged/acute mental health unit to be completed in 2012-13, so there are no issues that I am aware of about its delivery.

Mr HAMILTON-SMITH: Going back to Budget Paper 4, Volume 3, page 35, the Seniors Card that incorporates the Metrocard technology: could you tell us what was eventually spent on this program, and did it achieve the results it intended?

The Hon. J.D. HILL: I will ask Mr Mackie to amplify that.

Mr MACKIE: The Seniors Card with the Metrocard incorporated was approved by cabinet in 2010-11; that is my understanding. Funds were allocated for 2011-12, some of which have been expended. I think the overall package was in the vicinity of $2.5 million; I will confirm that in a moment. It is expected that the rollout of the integrated Seniors Card/Metrocard to Seniors Card holders will occur in the coming financial year, 2012-13.

Mr HAMILTON-SMITH: In relation to the Repat General Hospital—Budget Paper 4, Volume 3, page 16, 'Sub-acute Care Beds'—$19.55 million was budgeted for 2011-12 but only $3 million was spent. Quite a bit seems to have been budgeted but that amount was not spent in 2011-12. I see that $18.5 million is budgeted for 2012-13 and that might partly explain what has occurred, but could you tell the committee about that and also the role, going forward, that you see for the Repat in dealing with problems with ageing and geriatrics?

The Hon. J.D. HILL: I think the issue with that hospital (I will get it confirmed) is that that development took a long time to negotiate. There was a range of issues with the ACH and ourselves; they have now been signed. I think it has all been resolved and it is proceeding, so it is just reprofiling the project. We expect the Repat—this was a decision they initiated some time ago—will continue to have a very strong focus on the health of veterans. Of course, many veterans who need medical services are older-aged so the hospital will become very much focused on geriatric medicine: aged care medicine for elder citizens.

The facility we are building with ACH will create a leading centre nationally (and, probably, internationally), because the proposition is to have an aged care facility/nursing home on-site which is also used for training in a variety of disciplines and for research purposes about what are the best therapies and the best strategies for looking after elderly people. It is taking geriatric medicine to a new level, so I think it has a very strong future in that area. As you know, there is also the palliative care centre at the hospital, so palliative care (which is an associated discipline) will continue to be strong at the centre. Mr Mackie wants to add something.

Mr MACKIE: I just want to correct the figure I gave you: in 2012-13 it is estimated that $2.162 million will be expended in relation to incorporating the Metrocard, and about $54,000 per annum in recurrent costs thereafter.

Mr HAMILTON-SMITH: Minister, I have some questions in overview of the things we have raised and discussed today. Clearly, the big issue going forward with this budget and future budgets, not only in this estimates period but also in the rolling estimates period, is simply the cost of health and how we contain it, as both a percentage of budget outlays and simple growth from year to year in health spending.

Obviously, there are some choices. If you were starting with a blank sheet of paper, you might have a different hospital network. There are some issues to do with technology. What do you see as the opportunities and the threats going forward in managing the health budget for any government, for your government, and for any subsequent government? What are the opportunities to save money, and what are the major threats to cost blowouts that need to be contained and dealt with in your opinion?

The Hon. J.D. HILL: I thank the member for this question. This issue was dealt with, principally, through the SA Health Care Plan 2007-2016 that flowed on from the John Menadue inquiry, the Generational Health Review. It made the assessment, which is similar to the assessment made in Stepping Up, that we were putting too much effort into acute care and not enough into prevention and primary health care, that we had far too much duplication, that we had far too much competition between services, that we had areas where there was a lack of service provision; and that we had fractured governance arrangements with too many boards doing too many things at too many sites.

It is really those issues that I have spent the last 6½ years trying to deal with, and the real threat is that we do not have the bravery to continue to do those things. It really means greater focus on out of hospital care. Our GP Plus strategy is about that and, as I mentioned before, the anticipated growth in separations from hospital was 4 or 5 per cent when we started, it is now 1 per cent or so, so we have had a real reduction in growth and demand, and that is a major achievement. In fact, we are the only state that has had that turnaround, and the CE informs me that the other departments have asked us to make a presentation in the next health minister's meeting on how and what we have done because we put more resources into that area. That is one area.

We have to maintain that focus on our GP Plus healthcare strategy, putting more services out in the community. We have to maintain the discipline around the consolidation of services on sites—some of the hard decisions about where you have intensive care, where you have acute medical services. We made the decision to have them in three of our tertiary hospitals, but there is always pressure to water that down and allow more things to happen on more sites. Every time you do that you create a cost burden.

We have gone through some of the hard decisions in terms of governance, so we have clear governance arrangements now where the department is in charge of all the services. They have local advisory bodies, but they are responsible through to the CE, who is responsible through to me, so we can do central planning, central coordination, central procurement, central recruitment, central clinical planning, and financial management. There are problems with Oracle, sure, but if we do not proceed down those tracks, we are just perpetuating really inefficient systems ongoing.

All those things are opportunities, but if we do not proceed with them they are threats. Whichever side is in government in South Australia, we have very problematic years between now and about 2040, so we have about 30 years of expected growth in the demand for hospital services. For example, we know in about 2016 the average growth rate of our population aged over 75, will be about 9 or 10 per cent a year.

The population that is under the age of 15 is only growing at about 1 per cent a year, and we know that if you are over the age of 65 you are twice as likely to end up in a hospital bed in the course of a year; if you are over the age of 85, you are five times as likely to end up in a hospital bed in the course of the year. So, we have this ageing population with the inherent associations with extra hospitalisations.

We have to manage that by keeping people healthy and reducing the length of time they spend in hospitals and making sure that the services we provide are really targeted and quite rational. We just cannot allow whoever is in charge (and both sides of politics will be in charge over the next 30 or 40 years—there is nothing more certain than that) to give into special pleading. That is really the job we have to do: to be disciplined about it, and the way we have attempted to do that is by putting out a healthcare plan that has been debated and discussed, and we continue to talk about how we can improve things.

There are a lot of risks there, but strong opportunities to get it right. We are doing better than any of other states at the moment in relation to these matters and our performance continues to improve, which is the other aspect of what we are trying to do: continue to reduce the demand and reduce the costs, but also improve the service. We are doing pretty well on all those fronts, so I thank the member for his question.

Mr HAMILTON-SMITH: One final question, which is really a proposition. I thank all the staff for all their effort today, which is very much appreciated. Estimates are a very worthwhile process for governments, oppositions and the public, which is good. I wonder whether part of the solution going forward is to reduce competition between the government and the private sector. You gave the example of the GP Plus clinics and whether we are duplicating services to the GP network or whether the private sector of health could adapt to that. I suppose I am putting it as a proposition rather than a question, but the real question is: when do you think you will be promulgating the new healthcare plan that I know you are working on at the moment? When will we see that?

The Hon. J.D. HILL: To answer the first part first, I think we have very good relations with the private sector. GPs are the bulk of people in the private sector and the Medicare Locals the commonwealth is setting up will help improve not so much the relationship but the workings between that part of the private sector and the public sector. For example, one of the things we did a number of years ago was employ 50 practice nurses to go and work with GPs. We paid them to go and work with GPs to help improve the way they are able to manage people with chronic disease. There has been a huge uptake and a very successful program.

We have a strong commitment to working with the private sector. We have programs to work with local pharmacies and other health providers to integrate our messages, campaigns and so on. We also use private hospitals to provide services when our own services are stretched, with the potential to do elective surgery. I do not know whether we have actually done much yet, but we have done a little bit and are certainly open to all of that.

Flinders Private is adjacent to us, and we use it a lot for surgery and there is a sharing of resources. I am not ideological about this at all. If there is a better way of doing it, involving the private sector, I am for it. We are just reviewing our healthcare plan at the moment to make sure it is still on target. We are halfway through the plan. It is a 2007-16 plan, so we are making sure that the assumptions in it are still current. Once we have gone through that process, I guess we will make some sort of public announcement about it.

The CHAIR: There being no further questions, I declare the examination of the proposed payments completed. I thank the minister, his advisers and members of the committee.

At 18:49 the committee adjourned until Thursday 21 June 2012 at 09:00.