Department for Health and Wellbeing, $4,046,725,000

South Australian Mental Health Commission, $2,058,000

Membership:

Mr Picton substituted for Hon. J.R. Rau.

Mr Boyer substituted for Hon. Z.L. Bettison.

Minister:

Hon. S.G. Wade, Minister for Health and Wellbeing.

Departmental Advisers:

Dr C. McGowan, Chief Executive, SA Health.

Mr D. De Cesare, Acting Chief Finance Officer, SA Health.

Mr D. Frater, Deputy Chief Executive, SA Health.

Ms L. Cowan, Deputy Chief Executive, SA Health.

Mr B. Hewitt, Executive Director, Infrastructure, SA Health.

Mr A. Knez, Manager, Executive Services and Projects, SA Health.

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

The Hon. S.G. WADE: Yes, I can.

Mr PICTON: Yes.

The CHAIR: Changes to committee membership will be notified as they occur. Members should ensure the Chair is provided with a completed request to be discharged form. If the minister undertakes to supply information at a later date, it must be submitted to the committee secretary no later than Friday 26 October 2018. I propose to allow both the minister and the lead speaker of the opposition to make opening statements of about 10 minutes each, should they wish.

There will be a flexible approach to giving the call for asking questions, based on about three questions per member, alternating each side. Supplementary questions will be the exception rather than the rule. A member who is not part of the committee may ask a question at the discretion of the Chair. Questions must be based on lines of expenditure in the budget papers and must be identifiable and referenced, and I will ensure that this one is enforced at all times.

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. The incorporation of material in Hansard is permitted on the same basis as applies in the house; that is, that it is of a purely statistical nature and limited to one page in length. All questions are to be directed to the minister and not the minister's advisers. The minister may refer questions to advisers for a response.

The committee's examination will be broadcast in the same manner as sittings of the house are broadcast, and that is through the IPTV system within Parliament House and via the web stream link to the internet.

I will now proceed to open the following lines of examination: SA Health, Minister for Health and Wellbeing, Department for Health and Wellbeing. I declare the proposed payments open for examination and refer members to the Agency Statements, Volume 3. I call on the minister to make a brief statement if he wishes, and perhaps to first introduce his advisers to the committee.

The Hon. S.G. WADE: I would like to introduce Dr Chris McGowan, Chief Executive of SA Health on my left; and Mr Don Frater on my right, who is the Deputy Chief Executive of SA Health. Behind me is Ms Lynne Cowan, Deputy Chief Executive of SA Health; Mr Brendan Hewitt, Executive Director, Infrastructure, SA Health; Mr Danny De Cesare, Acting Chief Finance Officer, SA Health; and Mr Andrej Knez, Manager, Executive Services and Projects, SA Health.

I will now proceed to the opening statement. The Marshall Liberal government is refocusing health in this state with a progressive vision for the health and wellbeing of all South Australians. The budget is focused on delivering on the promises the government made to the people of South Australia at the election. The government is committed to refocusing health expenditure, not only in the care and treatment of illness but also in the wellness of our community. The SA health system is centred on delivering high-quality and safe medical care and treatment to those in need, either in a hospital, community or home environment.

Health is a large and complex portfolio and this budget will deliver better health and preventive services for all South Australians. In the government's view, the former government's savings targets were not realistic or achievable and placed a considerable burden on the system. For this reason, the budget has included significant savings relief for health by providing additional funding to reset the savings program for SA Health. The budget provided $70 million in 2017 and an extra $730 million over four years to deliver hospital and health services to our community. Allowing for additional savings of $181.9 million over four years, the government will be providing net additional funding of $548 million over four years, from 2018-19 to 2021-22.

The budget recognises that South Australian hospital services are not operating as efficiently as other systems and that sensible reform should be pursued to ensure SA Health delivers more services at the national efficient price in the future. As the Treasurer advised as part of the budget address, even with all the money invested in our health system to date, South Australia continues to have the worst performance of any state in terms of the percentage of ED visits completed within four hours, with 64 per cent of patients seen in this time.

A number of statewide system reforms will be pursued by this government to drive efficiencies and service improvements at the local health network and agency levels. The health budget also provides funding for a range of new initiatives over the forward estimates, consistent with our election promises. These include the following:

$40 million over two years to reduce elective surgery waiting lists in South Australia's public hospitals to provide timely and equitable access to elective surgery for all South Australians, with treatment prioritised based on clinical need;

$56 million to provide improved Country Health facilities and to address the backlog of sustainment works and significantly improve the amenity of our regional hospitals and infrastructure;

$30.7 million to introduce a fully funded meningococcal B vaccination program for South Australian babies and young people;

$23 million to support the establishment of a four-bed high dependency unit at Modbury Hospital to care for patients with complex needs;

$20 million for a rural health workforce strategy to address the shortage of health practitioners in rural areas. This strategy will provide for the recruitment and development of health professionals required to deliver regional health services into the future;

$16 million for increased palliative care support for people in the final stages of life;

$5.2 million for the planning and design of a new women's and children's hospital, with a view to the new build by 2024; and

$10 million to strengthen cardiac services and develop The QEH as a key cardiac centre, with a focus on common acute chronic cardiac conditions for an ageing population.

On 28 June, 24/7 cardiac services recommenced at The Queen Elizabeth Hospital, delivering on this government's commitment—

Mr PICTON: How long this is going for, Stephen?

The CHAIR: Sorry, member for Kaurna! Quite clearly in my opening remarks it says, as was agreed to in the schedule that you agreed to, that a minister is allowed a 10-minute opening statement—as you are allowed to as well. I will continue to allow that, as I have for all ministers in these estimates and in previous estimates. Minister, please continue.

The Hon. S.G. WADE: On 28 June, 24/7 cardiac services recommenced at The Queen Elizabeth Hospital, delivering on this government's commitment to restore these vital services in the western suburbs. $22.1 million was allocated to expand regional dialysis services at the Mount Gambier hospital. The government will continue other major health-related infrastructure spending over the forward estimates, including a $91.6 million Modbury Hospital upgrade, a $277 million redevelopment of The Queen Elizabeth Hospital stage 3 and $58 million for the Lyell McEwin emergency department expansion.

A key commitment of the government was to board governance. Fundamentally, we trust people with their health. We are devolving health management through board governance. This will ensure strong community and clinician engagement in how health services are run to ensure that they meet the needs of local communities. Devolution is being implemented through a staged approach. The first stage of these reforms is complete with the passage of legislation for the establishment of governing boards. Board chairs have recently been appointed in eight of the 10 local health network chair roles, with the recruitment of board members to follow shortly. Boards will not only empower the community and clinicians but I believe they will also empower local management to be part of the decision-making process and deliver better outcomes.

A second stage of work has commenced that will consider a wider range of issues, such as the government framework to support a devolved system and a functional review to consider the devolution of functions to the local health networks, as appropriate. A key part of the reform process will be the engagement with clinicians and the community in delivering these reforms, along with other key health stakeholders. Another priority for SA Health will be to improve preventive health care measures through empowering individuals to make better and more informed choices about their own personal health and wellbeing. This will range from the primary through to the continuing, to assist people to remain well and out of the hospital system.

I acknowledge there will be challenges ahead for SA Health. The key challenge will be to ensure the health system is sustainable without compromising the provision of high-quality services to the community. I conclude my opening remarks by acknowledging our doctors, nurses, midwives, paramedics, allied health professionals and other SA Health staff across our health system for their support, hard work and dedication to delivering quality and safe care.

The CHAIR: Thank you, minister. Member for Kaurna, do you have an opening statement to make?

Mr PICTON: Thank you, Chairman. I welcome the minister and the advisers, but I will just briefly say that I think it is a disgrace that the minister took the full 10 minutes to give an opening statement for what is a two-hour block for $6 billion worth of expenditure. The opposition has a limited time for questions.

The CHAIR: So do not waste any of your questions, member Kaurna.

Mr PICTON: Exactly.

The CHAIR: Perhaps we could have your first question for the day?

Mr PICTON: We have many questions for him to answer and the minister is, I hope, not going to spend his time with Dorothy Dixers to take up even more time of this limited period that we have to ask and answer questions.

The CHAIR: Member for Kaurna, question please, sir.

Mr PICTON: Thank you. I refer to Budget Paper 5, page 77, which refers to the KordaMentha review of the Central Adelaide Local Health Network. I am wondering if the minister can outline what the cost of the report is to taxpayers for both sets of reports, and also the supporting officers and project office that is referred to in the budget papers.

The Hon. S.G. WADE: In terms of the contract with KordaMentha itself, the contracted cost for phase 1 and phase 2 is $880,000. If the honourable member, by talking about support, is referring to the steering committee within SA Health, the engagement of clinicians and the like, that has not been separately costed and I am happy to take that on notice, but the contract with KordaMentha itself for the first two phases is $880,000.

Mr PICTON: The budget paper refers to the formation of a dedicated project office, so how much does that cost? It is in the last paragraph of page 77, on the last line. If the minister does not know he can perhaps take it on notice.

The Hon. S.G. WADE: I am happy to take that on notice.

Mr PICTON: On what date did you first receive the diagnostic report from KordaMentha?

The Hon. S.G. WADE: I will take that on notice.

Mr PICTON: You do not know on what date you received your report?

The Hon. S.G. WADE: I will take that on notice, Mr Chair.

Mr PICTON: So you cannot tell this committee when you received your report in the last few weeks?

The Hon. S.G. WADE: I have taken that question on notice.

Mr PICTON: On what date is the second report due to the government?

The Hon. S.G. WADE: My expectation is that I will receive the second report, the implementation plan, by the end of October.

Mr PICTON: How is it consistent with cabinet confidentiality for a cabinet-in-confidence document, which supposedly this is, to be quoted from the Treasurer in excerpts that he likes to have published, but for the rest of the report to remain private?

The Hon. S.G. WADE: That is a question that you will need to put to the Treasurer.

Mr PICTON: You yourself have quoted from this report as well, so how is it consistent with cabinet confidentiality for you to quote from a cabinet-in-confidence document?

The Hon. S.G. WADE: I think the key information that the Treasurer conveyed to the estimates committee was key information that the people of South Australia have a right to know.

Mr PICTON: They had the right to see the whole report.

The Hon. S.G. WADE: As I have indicated publicly, it is the intention of the government that the diagnostics and the implementation plan will be released together in the not-too-distant future.

Mr PICTON: Will they be released in full?

The Hon. S.G. WADE: I expect they will be but I will need to consult my officers as to whether any redaction is required.

Mr PICTON: What could possibly be the redactions that would be required?

The Hon. S.G. WADE: It depends on what is in the report.

Mr PICTON: How was KordaMentha appointed; what was the process that led up to that?

The Hon. S.G. WADE: I will ask the deputy chief executive officer to answer that question.

Mr FRATER: Arising out of the budget papers, the Central Adelaide Local Health Network support for service improvements funding issues which you raised before, CALHN sought to engage a number of people in executive roles to undertake a way forward and to implement a sustainability program. In terms of the turnaround role for the executive position, it was apparently not attractive to potential candidates due to a number of issues and the salary offered was considered to be low in regard to the responsibilities and accountabilities for the role. CALHN had used a number of other big four consulting companies in the past. The option was investigated to look at KordaMentha to undertake expertise in forensic investigation. It was a direct appointment undertaken by the CE in accordance with the standard procurement process.

Mr PICTON: The CE of SA Health or the CEO of the local health network?

The Hon. S.G. WADE: Sorry, Mr Chair, can I ask that questions be—

The CHAIR: Yes, and I was about to intervene.

Mr PICTON: Yes, it was a question to you, minister.

The CHAIR: I will be strict on that.

Mr PICTON: Was it the CE of SA Health or was it the CEO of the local health network?

The Hon. S.G. WADE: It was the chief executive of SA Health.

Mr PICTON: So nobody else was asked to apply for this; only KordaMentha was asked to apply for a contract worth almost a million dollars.

The Hon. S.G. WADE: I think the deputy chief executive has explained the context in which that procurement was decided upon.

Mr PICTON: Is that consistent with the state procurement guidelines?

The Hon. S.G. WADE: Yes, I am advised.

Mr PICTON: Was advice sought from the Procurement Board about that?

The Hon. S.G. WADE: We will take that on notice.

Mr PICTON: Does KordaMentha have any experience in providing similar reviews of public health services?

The Hon. S.G. WADE: The company has worked closely with both the former SA government and the federal government on a number of high-profile projects including the Arrium steelworks in Whyalla.

Mr PICTON: That is a bit different.

The Hon. S.G. WADE: Sorry, Mr Chair, could I have the opportunity to answer the question?

The CHAIR: You certainly can.

The Hon. S.G. WADE: Thank you. The company has worked closely with both the former SA government and the federal government on a number of high-profile projects, including the Arrium steelworks in Whyalla and also the NBN Co, Australia Post and Defence Housing.

Mr PICTON: Have any reports been done by KordaMentha into public hospital services?

The Hon. S.G. WADE: I will just make the point that the projects I have mentioned that KordaMentha has been involved in are very different from each other. This project is different, too.

Mr PICTON: Do I take it from the minister's answer that there has never been a project of this type done by KordaMentha into public hospital services?

The Hon. S.G. WADE: I will take that on notice.

Mr PICTON: Does KordaMentha have any health experience whatsoever?

The Hon. S.G. WADE: I am advised that they do have health industry experience and, as I said, I will take that on notice.

Mr PICTON: Does the diagnostic report that you have received from KordaMentha say that there are too many nurses employed in the Central Adelaide Local Health Network?

The Hon. S.G. WADE: I am not going to, shall we say, provide the shadow minister with a jigsaw of the diagnostic report piece by piece.

Mr PICTON: You have already put some pieces out there; why not the rest?

The CHAIR: I appreciate this is a very important portfolio, as all portfolios of government are. But this one is particularly important, and I think we all want appropriately to have answers provided by the government and questions asked. If we can just be respectful and allow the minister to complete his questions—and he is proving to answer his questions in a timely fashion as well—and if we continue in this format, I think we will have a very pleasant, enjoyable afternoon.

The Hon. S.G. WADE: Thank you, Chair. In terms of the KordaMentha report, I have already assured the committee that the full diagnostics and the implementation plan will be released publicly in the next month or so.

Mr PICTON: Minister, I refer to Budget Paper 4, Volume 3, page 56, that refers to Central Adelaide Local Health Network and a reduction in FTEs over the next financial year of 850 staff, which is a very large number of staff members in a local health network to drop. How many of those 850 staff will be nurses?

The Hon. S.G. WADE: I would just make the point to the committee that the figures that the honourable member refers to are not a target. They are indicative. CALHN, having been informed by the KordaMentha reports, will be able to settle on strategies. The impact that that will have on particular groups of FTEs is yet to be seen, but I would just reiterate what the Treasurer advised to the estimates committee on Friday, that there would be no nurses or doctors sacked as a result of this budget.

Mr PICTON: With respect, minister, how does that magic pudding work in that you are going to reduce by 850 staff at CALHN? This is in your own budget papers; presumably the numbers in the budget are predicated on the basis of that reduction. How can you possibly do that without sacking any doctors, nurses or other health staff?

The Hon. S.G. WADE: There is an element of déjà vu in these questions, because these same questions were put by previous oppositions, and your fellow—

Mr PICTON: You are the minister now, so you can answer them.

The Hon. S.G. WADE: I give the same answer that minister Snelling gave before me, which is it is up to the individual LHNs to identify strategies. These figures are indicative. Also I would make it clear that they include agency staff, and one of the things that was highlighted in the KordaMentha report is that there has been a significant increase in the use of agency staff in CALHN. Part of the figure the honourable member refers to will be refocusing on using SA Health nursing and doctors.

Mr PICTON: Minister, how can you have it both ways, on the one hand saying that there will be no sackings of nurses and doctors under this government and on the other hand saying, 'These targets of 850 staff that are going to be cut, that's just up to the LHN to work out how they are going to do it, and we are not quite sure how they're going to reduce those staff numbers?' Surely, if there is a government mandate as to how these staff should be reduced, apparently including no sackings whatsoever, then that should be a directive down to the LHNs.

The Hon. S.G. WADE: Again, I would reiterate these are not targets. These are not mandates on the LHN—

Mr PICTON: Your budget is predicated on them.

The Hon. S.G. WADE: I would reiterate that these figures are not targets; they are not mandates down to the LHNs. In terms of how LHNs manage their workforce, clearly attrition is a natural part of the life cycle of a workforce within an LHN. We expect all the LHNs to operate within our mandate, which is that there shall be no sackings of doctors and nurses as a result of this budget.

Mr PICTON: Given that, is the minister saying that all savings that are going to be identified—and the budget quite clearly says for CALHN that there is going to be a $130 million reduction in expenditure from the previous financial year to this financial year—all of that reduction will not come from any salaries whatsoever, and it will only be from agency nurses and other suppliers, which is a pretty small percentage of the CALHN budget considering that two-thirds of everything that is spent in the health budget is spent on staff?

The Hon. S.G. WADE: The honourable member invites me to reflect on the ways that LHNs will be able to save money without reducing staff. One example that I would give would be the—

Mr PICTON: That was not my question.

The Hon. S.G. WADE: The question I understood I will answer. In relation to public sector costs of providing clinicians rights of private practice, the SA government is looking to increase the contribution that clinicians make in relation to treating private patients in the public system—

Mr Picton interjecting:

The CHAIR: Order!

The Hon. S.G. WADE: —beyond the cost of providing the necessary insurance cover and administrative support. They currently pay 9 per cent compared with other jurisdictions where it can be as high as 68 and 90 per cent. So that is one of the ways in which we will be looking to help our health system become more efficient.

Mr PICTON: Can the minister confirm what the overspend was for CALHN between the 2017-18 budget and the 2017-18 estimated result?

The Hon. S.G. WADE: Budget Paper 3 shows that the Central Adelaide Local Health Network was projected at 30 April to have a $255 million budget overspend.

Mr PICTON: That is not what the budget papers say.

The Hon. S.G. WADE: That figure does not include statewide clinical and support services, which is a part of CALHN. Including the statewide clinical and support services, the estimated CALHN overspend for 2017-18, as at 30 April 2018, was projected to be $281 million. SA Health advises that the final unfavourable variation to budget for CALHN for the 2017-18 year, including statewide clinical and support services, is expected to be $298 million.

Mr PICTON: So why in Budget Paper 4, Volume 3, page 56, does it show an overspend of $98 million?

The Hon. S.G. WADE: The budget figures in the program summary report that the Central Adelaide Local Health Network is estimated, as at 30 June 2018, to have a $98 million budget overspend for 2017-18. This figure does include statewide clinical and support services, which is a part of CALHN. The budget overspend of networks in Budget Paper 4 is offset by three factors: firstly, funds held centrally by the department; secondly, part of the $132 million budget allocation to Health as part of the 2017-18 Mid-Year Budget Review; and, thirdly, part of the $70 million budget allocation to Health as part of the 2018-19 budget but applied to the 2017-18 financial year. I am advised that both the $255 million and the $98 million figure are unfavourable variance to budget figures and that they are consistent.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 72, SA Ambulance Service. On what basis has the minister decided to privatise the NALHN patient transfer ambulances?

The Hon. S.G. WADE: No decision has been made to privatise the NALHN patient transport services.

Mr PICTON: You have said in your press release for the budget that you are putting this out for contract, so was the press release that you put out wrong?

The Hon. S.G. WADE: The government has decided to approach the market to ensure that we have the most cost-effective means of providing a dedicated transport service. In terms of maximising the impact of each dollar spent on health, we believe it makes sense to see if another provider can provide the service we need at a lower cost.

The service would be focused on patients not requiring a full ambulance service. If a patient going between the hospitals needs the level of care provided by an ambulance, they will get it. SA Health already uses private providers to transport patients in at least four of its entities—SALHN, NALHN, Country and SAAS—and NALHN will be looking at opportunities to go to a contestable model for non-acute patient transfers between Modbury and Lyell McEwin.

Mr PICTON: Has the minister spoken to paramedics on the ground who advise that over 80 per cent of the patients to be transferred between these hospitals require medical supervision from ambulance paramedic staff?

The Hon. S.G. WADE: I have heard that suggestion, and I would just say that if 80 per cent of patients need a full ambulance service, 80 per cent of patients will get a full ambulance service.

Mr PICTON: What will happen to the staff of the four rotating crews dedicated to the ambulance when the service is privatised?

The Hon. S.G. WADE: The shadow minister persists in misrepresenting the government's decision. The government has only decided to test the market.

Mr PICTON: You are not going to do it?

The Hon. S.G. WADE: The government has only decided to test the market. NALHN intends to employ a consultant to advise on the most suitable option for patients and the network. A number of options will be explored as part of this process, including but not limited to: (1) NALHN purchasing vehicles and operating the services internally; (2) working with SAAS in a different way; and (3) outsourcing non-acute patient transfers.

In terms of two of those options, I would remind the honourable member, knowing that he was a former assistant minister for health in a previous government, that in three years of the last term of the Labor government more than 1,200 patient transports were provided by external services contracted by SAAS.

In relation to the first option that NALHN will be looking at, which is an internal service, that sounds to me remarkably like the service that already operates in the south. The Southern Adelaide Local Health Network operates a transporter service for non-urgent patients who require transfer between SALHN hospital sites by barouche. It can be used for elective cases, to transfer patients to appointments, to transfer discharges to a residential care facility or for interhospital ward-to-ward transfers.

That service is operated Monday to Friday on two shifts. It is provided by a South Australian local health network employed driver. The fact of the matter is, if a service such as this is safe in the south, we have no reason to think that NALHN cannot develop a model that can be safe for the north.

The CHAIR: The member for Narungga.

Mr PICTON: Ah, a Dixer.

Mr ELLIS: Thank you, Mr Chair. A very important part of the budget. In fact, I suspect the previous minister for health would have been fumbling for words upon this question.

The CHAIR: Member for Narungga, can you please just ask the question.

Mr ELLIS: How much funding has the government provided—

Mr Picton interjecting:

The CHAIR: Thank you, member for Kaurna. I do not need any assistance in how to chair estimates, but I thank you as well. Member for Narungga.

Mr ELLIS: I am particularly interested in regional health. I refer to Budget Paper 5, pages 82 to 89. How much funding has the government provided for regional health in this budget over the forward estimates, and how will it impact the people living within the electorate of Narungga?

The Hon. S.G. WADE: I thank the honourable member for his question. The government has committed significant resources over the forward estimates to improve rural health services. For example, $56 million will be provided over the next four years to address the backlog of sustainment and infrastructure upgrade works in country hospitals. This includes $1.8 million to upgrade the Whyalla renal dialysis unit. In addition, in relation to Narungga specifically, over four years there will be $605,000 to upgrade surgical facilities at Yorketown and employ additional nurses to enable surgical services to remain in the Lower Yorke Peninsula.

The services will go from every end of the state. In Mount Gambier, there will be $2.13 million for a renal dialysis unit at the Mount Gambier hospital. At the other end of the state, in the APY lands, we will be investing $50,000 for permanent dialysis on the APY lands. The level of investment required in that service going forward will be significantly reduced because of the decision of the federal government to make those services MBBS fundable.

To again pick up on the honourable member's request specifically to address services in his electorate, there will also be $720,000 over four years to fund services at the private not-for-profit Ardrossan Hospital. One of the most important investments for rural health will be the $20 million investment over four years to the development and implementation of a rural health workforce strategy to address the shortage of a whole range of health practitioners in rural areas.

I know that my honourable colleagues are well aware that, in spite of the tremendous need for rural health services, in spite of all the money you put into capital, all of the community support, it comes to nought if you cannot employ the health professionals to deliver the service. We are very keen to work in capital works and recurrent funding and in health workforce development to make sure that country South Australia gets the services they need.

Mr PICTON: On the same budget line as previously in terms of the SA Ambulance Service, Budget Paper 4, Volume 3, page 72: has the minister an allocation or a budget saving that has been allocated in terms of the outsourcing of NALHN patient transfers?

The Hon. S.G. WADE: This is a measure identified in one of the budget press releases. As I understand it—and I will take this on notice to check whether I am wrong—no figure has been identified at this stage. The network will need to develop the model and test the market.

Mr PICTON: Was it something recommended by the network to you?

The Hon. S.G. WADE: I do not intend to go into the budget process of cabinet.

Mr PICTON: It is nothing to do with cabinet, it is whether the network recommended it. When do you expect, if there was a successful tenderer, for the service to start?

The Hon. S.G. WADE: I do not believe I have been given a projected start date. What I have been advised is that the current contract with SAAS goes through to 30 June. I do not think I have been advised as to whether NALHN expects that this process can be completed in time for any new arrangements to start from 1 July next year, but I am happy to take that on notice.

Mr PICTON: Can the minister guarantee to the people in the north-eastern suburbs that this will not result in any less paramedic support than they would currently receive from that ambulance service?

The Hon. S.G. WADE: The very nature of a non-acute service is that the patients do not need the same level of intensive support, so the service will be relevant to the needs.

Mr PICTON: So, potentially, it could be fewer staff than are currently in place now, hence why it will be a good budget saving for you?

The Hon. S.G. WADE: The government intends, through NALHN, to test the market. One of the options to be looked at specifically will be delivering the service with SAAS. The SAAS model may well include using their paramedics.

Mr PICTON: I refer to Budget Paper 5, pages 78 and 79, in terms of an efficient public pathology service and an efficient public imaging and diagnostic service. Did the minister have any discussions with any private pathology or medical imaging companies about the privatisation of SA Pathology or SA Medical Imaging prior to the state budget?

The Hon. S.G. WADE: I would make clear to the committee that the government is not committing to outsourcing or privatising SA Pathology. What we are committing to do is look at efficiency measures within the pathology service so that we can provide a quality service to South Australians in the most sustainable way.

Mr PICTON: Is the minister planning on answering the question? The question was: did you have any discussions with any private pathology or private imaging companies prior to the state budget?

The Hon. S.G. WADE: Lots of people have suggested where there are opportunities in South Australian health services to provide more efficient services. One source was the former Labor government, which employed Ernst and Young to develop what I think was called an efficiency improvement program. I remind honourable members that the former Labor government saw that there were opportunities for efficiencies in SA Pathology. We do not disagree.

Mr PICTON: I will ask it for a third and final time. Hopefully we get an answer this time. Have you had any discussions with any private pathology or medical imaging companies?

The Hon. S.G. WADE: I certainly have not had discussions with pathology companies about the government privatising SA Pathology because that is not on the government's agenda. What is on our agenda is having a review done to look at opportunities for efficiencies.

Mr PICTON: Have you talked to them about that?

The Hon. S.G. WADE: No, I have not spoken to any companies about the PwC review.

Mr PICTON: Have you attended any fundraising events with private pathology or medical imaging companies?

The CHAIR: I remind the member for Kaurna if he could refer to a particular line and budget item which relates to fundraising events that the minister might attend.

Mr PICTON: Yes, Budget Paper 5, page 78 and 79.

The CHAIR: It is a very broad question, not quite in the scope. It is up to the minister to determine if he wants to answer that question.

The Hon. S.G. WADE: To be honest with you, I would not know where to start in terms of the number of community and party and fundraising events that I attend to know what the invitation list is at each event. I can assure you that I have never been to a progressive business function.

Ms BEDFORD: Also on SA Pathology, which is the same budget line the member for Kaurna is using, Budget Paper 5, page 78: how many bad debts and non-collectable bills capable of attracting Medicare rebates did SA Pathology identify last year? If all of those are collected, would the service be profitable? Has that level of bad debt reduced?

The Hon. S.G. WADE: I thank the honourable member for her question. I do not recall that issue having been raised with me but a similar issue has been raised in terms of coding of medical episodes within hospitals. Certainly in that context there was a significant revenue shortfall by not in a timely way achieving coding. I do not recall it having been raised with me but it would not surprise me if that was the case. I would certainly expect that any review of SA Pathology efficiency would make sure that it took into account where there may be opportunities for efficiency improvements.

The PricewaterhouseCoopers review will take about six months and will examine in detail the public and commercial services provided by SA Pathology. SA Pathology will engage staff, unions and stakeholders through that process. As I expect in a range of these measures, I am very keen for there to be active engagement with staff and their employee organisations because often it is the staff and their employee organisations who are particularly aware of opportunities for efficiencies that management might pursue.

Ms BEDFORD: I understand there is a shortage of trained medical technologists and pathologists. Since the technicians and pathologists are trained by SA Pathology, and the organisation actively monitors emerging public health issues, has this cost been factored into health and treasury number crunching? How will any form of privatisation of the service provide South Australians with these non-commercial rebatable public health services?

The Hon. S.G. WADE: I thank the honourable member for her question. It is certainly our practice to include training outcomes in the assessment of efficiencies such as this. As I referred to earlier in answer to a question from the member for Narungga, the ongoing quality and viability of the health system in South Australia is significantly dependent on our capacity to train and retain health workers, so training would be factored into any plans.

Mr PICTON: The same budget line, Budget Paper 5, page 78, and an efficient pathology service. Was looking into SA Pathology part of the scope of the KordaMentha review?

The Hon. S.G. WADE: I am advised that the KordaMentha report does not involve detailed analysis of SA Pathology's efficiency. Certainly it is quite distinct from the PricewaterhouseCoopers' report. However, I make the point that KordaMentha looks at CALHN in both the narrow and the broader sense: CALHN in the sense of the Central Adelaide Local Health Network, and CALHN as the Central Adelaide Local Health Network including the statewide clinical and support services.

Mr PICTON: So it is not as detailed as the PwC report but it is in the broader scope of the KordaMentha review?

The Hon. S.G. WADE: Yes.

Mr PICTON: Is the minister aware that KordaMentha has engaged Mr Michael Stanford as part of the review into CALHN, and that Mr Stanford sits on the board of Australian Clinical Labs, one of the largest private pathology services in the country?

The Hon. S.G. WADE: I will ask the Deputy Chief Executive to answer that question.

Mr FRATER: The department is aware of the issues you have raised. We have asked KordaMentha to ensure that those potential conflicts of interest are managed appropriately. From memory, the advice from KordaMentha was that Dr Stanford is not engaged in terms of the discussions or looking at pathology services. He has worked mainly in terms of the clinical aspects across the hospital.

Mr PICTON: Obviously, you are aware that there is a significant conflict of interest with KordaMentha looking into pathology, but hiring someone who is on the board of one of the private pathology people—which, presumably, are going to apply if you were to privatise pathology services. Is that something that was part of their bid? Of course, no-one else bid for it; they were just directly given an almost million-dollar contract from you, but was that part of the proposal to the government before the contract was signed, to have Dr Stanford as part of it?

The Hon. S.G. WADE: I will ask the Chief Executive to answer that question.

Dr McGOWAN: In looking at CALHN, KordaMentha have no real interest in scope in terms of looking at SA Pathology, other than the price out of the hospital they are paying for pathology. As the Deputy Chief Executive said, we are very aware of this. We know there is a conflict if it is not managed well, so Dr Stanford will have nothing to do with any issues to do with SA Pathology.

Mr PICTON: Have you engaged probity advisers to advise you on this?

The Hon. S.G. WADE: KordaMentha is not part of the discussions in relation to the scrutiny of SA Pathology efficiencies, so KordaMentha is not part of the discussions.

Mr PICTON: To be frank, minister, about five minutes ago you said that SA Pathology was in the scope of the KordaMentha review, and that was not the question at all. The question was: have you engaged any probity advisers in relation to what your deputy chief executive has said is a significant conflict of interest?

The Hon. S.G. WADE: Mr Chair, it will not help the committee if the shadow minister wants to rephrase statements quite inaccurately. In terms of my comments earlier about KordaMentha, CALHN is both, if you like, the central hospital network and also the hosting LHN for statewide clinical and support services, which includes SA Pathology, SA Medical Imaging, dental services and others. The focus of KordaMentha is on the efficient operation of the hospitals and, as my officers have indicated, the primary relevance of SA Pathology in that context is the price that is asked of the local health networks. The efficiency review of SA Pathology is being undertaken as a discrete project by PricewaterhouseCoopers.

Mr PICTON: For the third time, have there been any probity advisers appointed?

The Hon. S.G. WADE: Sorry, was it probity advice sought or probity advisers appointed?

Mr PICTON: Either.

The Hon. S.G. WADE: I am advised no.

Mr PICTON: Has there been any independent oversight of what you are now saying is going to be managed, that Dr Stanford does not have anything to do with the SA Pathology side of any recommendations from KordaMentha?

The Hon. S.G. WADE: The KordaMentha project is overseen by an executive steering committee which is chaired by Mr Raymond Spencer, who is the incoming chair of the board of the Central Adelaide Local Health Network. The whole project will be overseen by the executive steering committee.

Mr PICTON: Can the minister confirm that Michael Stanford worked with the current executive director of SA Pathology, Glenn Edwards, when he was at St John of God Health Care, that has now, I understand, been purchased or merged with Australian Clinical Labs?

The Hon. S.G. WADE: I will take that question on notice.

Mr PICTON: Have you asked for any independent investigation into connections there?

The Hon. S.G. WADE: Considering I am taking on notice whether there is a connection, I will take on notice the honourable member's question.

Mr PICTON: Can the minister guarantee that under any privatisation of SA Pathology that complex cases currently handled in the community sector by SA Pathology would still be able to be dealt with in South Australia, and would not have to go interstate or overseas?

The Hon. S.G. WADE: PricewaterhouseCoopers will undertake a review over the next six months which will engage staff, unions and other stakeholders. All of these issues, I expect, will be canvassed in that review.

Mr PICTON: Will you ensure that the review also examines the impact that privatising SA Pathology will have on bulk billing and primary healthcare outcomes in the state?

The Hon. S.G. WADE: I need to stress again that the SA Pathology review is an efficiency review. As a result of their work with Ernst and Young, the former Labor government set up efficiency targets for SA Pathology. Following the PricewaterhouseCoopers process, should efficiencies not be achieved, the option would be open to the local health network boards to procure services from alternate providers. We are not committed to using external providers, and I am not going to presume what decisions local health network boards might make in the years to come.

Mr PICTON: When is the deadline in terms of when you will say whether the savings have been met or not? Will you make a decision after the first year of cuts that you put in the budget or at the end of the forward estimates of cuts?

The Hon. S.G. WADE: I am interested in the member using the term 'cuts' in his comments.

Mr PICTON: Just answer the question, please.

The CHAIR: Sorry, member for Kaurna, the minister is answering the question appropriately. Ultimately, I determine what is being answered and what is not. We will continue. Member for Davenport, do you have a question?

Mr MURRAY: Yes, I do.

Mr PICTON: So he is not going to answer the question at all?

The CHAIR: The member for Davenport has the call.

Mr PICTON: Outrageous.

The CHAIR: Do you want to be back here tomorrow morning at 9.30?

Mr PICTON: Happy to.

The CHAIR: Good, because I will be naming you if you continue. The member for Kaurna—sorry, Davenport—has the call.

Mr MURRAY: Davenport, Mr Chair. That is very close to the Repatriation General Hospital.

The CHAIR: Member for Davenport, just ask the question.

Mr MURRAY: Yes, I was just being helpful to those opposite, Mr Chair. My question relates to Budget Paper 4, Volume 3, page 63, in particular the consultation process that is being undertaken to re-establish the services at the site, which of course was never, ever going to be sold under a Labor government. I wonder what the key elements of the consultation process were, how much it has cost and when does the government expect more services at the site?

The Hon. S.G. WADE: I thank the honourable member for his question. To facilitate the activation of health and wellbeing services at the Repat, SA Health developed a staged stakeholder consultation and engagement process. That included extensive consultation with clinicians and health service leaders, health consumer groups, NGOs, external stakeholders and the local community. The first step of this process involved key stakeholders from SA Health, NGOs and the local community in two workshops to generate ideas and test the options for potential services on the site. A large number of high-quality ideas and themes came out, which were distilled into three preliminary concepts.

On 15 August, I officially launched a four-week consultation process at a community forum event where the three master plans were presented to facilitate community discussion. On 1 September, a second consultation event was held, which provided guests with an opportunity to discuss the proposals with clinicians, SA Health and stakeholders. The process was extremely well received by the community, with almost 1,500 members of the community participating, 1,325 online poll results and approximately 100 submissions via letter and email. The public response has been overwhelming and confirms how much the community values the Repat site.

In tandem, SA Health released an expressions of interest process, inviting private and non-government organisations to describe how they could partner with SA Health to maximise the reactivation opportunities that the Repat site presents. The closing date for submissions to the EOI was 14 September 2018, with over 30 EOIs received. SA Health will now shortlist potential partners from the EOI process in alignment with the results from the community and stakeholder feedback and begin negotiations with those shortlisted organisations. The government will also develop a fully costed conceptual master plan based on the feedback from the public and other input. The master plan is expected to be released for public comment either late this year or early next year, with the site's further activation commencing in 2019.

Regarding the honourable member's questions in relation to cost, I am advised that the stakeholder consultation and engagement process has been delivered at a total cost of approximately $90,000, excluding GST.

The CHAIR: I think the member for Kaurna has a question.

Mr PICTON: Yes, thank you very much. The reference is Budget Paper 4, Volume 3, page 67: the expenses of the Women's and Children's Hospital network. Does the minister stand by his previous comments that patients will continue to be treated by the Australian Craniofacial network from overseas as per practice over the past 40 years?

The Hon. S.G. WADE: My comments to the parliament and beyond in relation to the Australian Craniofacial Unit were particularly in relation to the 15 international patients per year paid for by the South Australia government. I am advised that that arrangement is still in place. Issues have been raised in relation to the ongoing operation of the Indonesian clinics and also some other elements of the engagement of support of clinicians in terms of humanitarian work.

In terms of the issues in relation to the selection process of visiting medical specialists at the end of last financial year, and in relation to issues raised by SASMOA that led to me referring matters to the Office for Public integrity, I am in the process of referring some further issues to the office to clarify whether or not they are matters that the office would want to consider.

Mr PICTON: What are the details of the other issues that you are referring to?

The Hon. S.G. WADE: As I said, I have met my reporting obligations and provided information to the OPI. I am currently considering whether further information needs to be provided to them.

Mr PICTON: Has the minister received a letter from Professor David David, the South Australian of the Year, dated 21 September, raising significant concerns about patients in outreach clinics in Indonesia who had started their treatment but have been stranded, unable to get their treatment in South Australia, as would have previously been the case?

The Hon. S.G. WADE: When I was referring to Indonesian clinics, I was referring to that more recent communication from Professor David. As I said, I intend to refer that matter to the Office for Public Integrity and I have received some initial advice from the department and I am seeking a fuller briefing.

Mr PICTON: Thank you for the clarity that that is what is being referred to the OPI. As well as that, is the minister going to ensure that these patients, who have been stranded in Indonesia, are treated before any OPI investigation needs to take place?

The Hon. S.G. WADE: The fact of the matter is that I am seeking a full briefing. Once I have that, I will consider the appropriate response. The reason why I am seeking a briefing as well as referring it to the OPI is to make sure that if earlier action is required it will be taken.

Mr PICTON: In light of this new information, does the minister change his perspective that he has previously expressed that there has been no change to the unit in how it is operated?

The Hon. S.G. WADE: As I have said, I have made a referral to the Office for Public Integrity, and, as I have said to the parliament, I do not intend to ventilate those issues further.

Mr PICTON: Is the minister aware of an email from Lisa Lynch, the Chief Operating Officer of the Women's and Children's Health Network, dated 20 June 2018, in which she said, in response to draft letters to be sent that:

The service profile won't change and also that the patients will still be from overseas, interstate etc. Wondering whether we need to think about this section. In some ways, we have already changed the service/patient profile with the changes to dental and also don't want to lock us in to overseas and interstate in the future.

What is your response to that?

Mr ELLIS: Mr Chair, is that a question from a budget paper?

The CHAIR: I was just consulting with Mr Riggs and we are actually trying to find that in the budget papers, member for Kaurna. I am happy for the question to stand if you can just draw me back to the budget papers.

Mr PICTON: Yes; the budget papers refer to the expenses of the Women's and Children's Hospital Network, including the Australian Craniofacial Unit, which is part of the Women's and Children's Health Network, in Budget Paper 4, Volume 3, page 67.

The CHAIR: I think that is a very, very broad question and I will leave that to the minister's discretion.

The Hon. S.G. WADE: The issues that the honourable member is referring to are clearly issues that were being discussed at the time of the matters being referred to the Office for Public Integrity. In that context, I stand by my comments to the parliament. I have met my reporting obligations and provided the information to OPI, and I am unable to make any further statements about this matter at this time.

Mr PICTON: What was the process that the minister went through in appointing the independent public servant to review the appointment of Dr Ben Grave in the craniofacial unit in the Women's and Children's Health Network?

The Hon. S.G. WADE: If the honourable member is suggesting that I personally made the appointment of an independent reviewer, that is not the case. I asked the Women's and Children's Network in discussions to facilitate an independent review.

Mr PICTON: Was it the case that the people that you asked in the Women's and Children's Health Network to appoint somebody independent, were the same people who had made the initial appointment or were they different people?

The Hon. S.G. WADE: The initial appointment of whom?

Mr PICTON: The review was going to be over the appointment of the VMO position that Dr Grave originally had, and somebody else was appointed instead. Did you go to the people who made that appointment and ask them to appoint somebody to review their own decision or did you ask somebody higher up the chain to review what had happened?

The Hon. S.G. WADE: I asked the Women's and Children's Health Network to facilitate an independent review. I will take on notice who identified that person.

Mr PICTON: Is the minister aware of an email from Cindy Molloy, who is Executive Director, Medical Services at the Woman's and Children's Health Network, who was the person who made the original appointment, and who wrote in an email, after your decision to get somebody to appoint, where she stated:

Mark Moore and I met with Minister Wade yesterday. Amongst other things he continues to make inquiries as to the HR process in the recruitment of Dr Ben Grave. He wished someone from the department to check if I had undertaken the process correctly and fairly and come to an equitable decision. He did not want to do this himself. Happily, after Mark and I met with him, he met with Professor David and the publicity appears to be calmer in today's Advertiser. Who do you suggest in the Department or can we count Kieran. Regards, Cindy.

Is it not clear that Cindy Molloy, who made the appointment, was the person who was choosing who was going to do the independent review of her own decision?

The CHAIR: Minister, before you proceed to choose or not to answer that question, I once again rule that out of order for my purposes. This is not the lower house question time where that would definitely be ruled out of order—it properly sits up here. Once again, whether there has been an email received is not pertinent to the budget and the statements that are open in front of us, but if the minister chooses to answer he so can but I give him very broad scope in his desire to answer that question.

The Hon. S.G. WADE: I have asked the Commissioner for Public Employment to look at the recruitment process for the Visiting Medical Specialist (VMS) and I do not intend to comment further.

Mr PICTON: After all of this happened, after all the discussion about this, will you actually ask for an independent investigation into the operation of the unit at a clinical level, putting aside the public integrity issues that you have referred to and, at a clinical level, make sure that the unit is running properly, make sure that the original intent that South Australia has always supported for this unit over the past 40 years, is maintained?

The Hon. S.G. WADE: There is quite a bit of work being done at the moment in relation to the unit. There is the work of the Office for Public Integrity, there is the work of the Commissioner for Public Employment, who I understand has put the matter in the hands of the ICAC commissioner, and there is also consideration by the South Australian Employment Tribunal. I have indicated to Professor David that if matters are not dealt with in those processes then there may well be the need for further inquiry. The need for a clinical review of the unit I think is something that we need to consider once we have a better idea of what the OPI will be looking at.

Mr PICTON: I refer to Budget Paper 5, page 78, the contracting arrangements, and Budget Paper 4, Volume 3, Sub-program 1.1: System Performance and System Delivery, page 50, and also to your press release that announced cuts to HIV services—

The CHAIR: Member for Kaurna, I remind you that government press releases and briefing notes are not the subject of examination of this committee, so if we just stick to the budget papers, that would be wonderful.

Mr PICTON: Has the minister been to Centacare's Cheltenham Place HIV service?

The Hon. S.G. WADE: The answer to the honourable member's question is no, and clearly the member from the lower house—

Mr PICTON: I went; you should go. It is worthwhile. See what you are cutting.

The CHAIR: Order! I hope the minister is not about to reflect on the lower house of parliament, which is of course a most important body.

The Hon. S.G. WADE: It is the case that I have not visited the Cheltenham facility, but then clearly neither has the member for Lee, because he suggested it was located in the western suburbs when in fact it—

Mr PICTON: I have been, and I can advise you it is very worthwhile to visit and see the services that you are cutting.

The CHAIR: Member for Kaurna, it is not relevant where you have been and have not been.

Mr PICTON: It is not relevant whether the member for Lee has been.

The CHAIR: No, no—

Mr PICTON: He is the health minister. He is the one cutting the service.

The CHAIR: I think the Minister for Health was merely reflecting the Hansard of the parliament from the last sitting, which is entirely appropriate.

Mr PICTON: Just answer the question.

The CHAIR: But, minister, if you can just answer the question in your good time please, sir.

The Hon. S.G. WADE: I have not visited Cheltenham.

Mr PICTON: Have you met with Centacare to discuss the cut to their HIV service at Cheltenham Place?

The Hon. S.G. WADE: No, I have not.

Mr PICTON: On what basis did the minister conclude that the HIV service was purely for homeless people, as per statements that were put out during the budget process?

The Hon. S.G. WADE: I am not aware of any statement in any government documents that suggest that the service was purely homeless.

Mr PICTON: Your press release did.

The CHAIR: As I said previously, government press releases are not subject to budget estimates proceedings.

The Hon. S.G. WADE: I would simply make the point that about half the client group of Cheltenham Place are assessed as having issues with accommodation, homelessness or being at risk of homelessness.

Mr PICTON: How did the government form the view, as stated by the Minister for Energy in the House of Assembly, that the Centacare model of care was not contemporary?

The Hon. S.G. WADE: The response to HIV continues, but the epidemic has changed and services need to evolve. In the early stages of the epidemic, the majority of clients at Cheltenham Place were gay men. Now people living with HIV are a much broader group, including people from high prevalence, religiously conservative countries. A centre-based respite service is less relevant to the contemporary client group.

In 2017, while Labor was in government, the communicable diseases control branch of SA Health interned a masters student from the University of Adelaide to investigate best practice support services for people living with HIV in South Australia. No outcome was predetermined, and the intern consulted people living with HIV across South Australia as part of their project.

The masters student report noted that while around 1,300 South Australians are living with HIV, 49 per cent of those diagnosed with HIV between 2011 and 2016 in this state were not born in Australia, with the majority of those born in sub-Saharan Africa or South-East Asia. The profile of people living with HIV in this state has changed significantly, particularly for new notifications, and now include significantly more heterosexual women and heterosexual men and women from religiously conservative countries. The masters student noted:

Since the advent of antiretroviral drugs the prognosis for people living with HIV in South Australia has improved dramatically. No longer synonymous with AIDS and premature death, a diagnosis of HIV may now be treated as a chronically manageable condition. People living with HIV/PEL-HIV who receive antiretroviral therapy (ART) are expected to have next-to-normal life expectancies.

The report also goes on to note:

This trend of diminishing demand for HIV-specific respite has been observed globally in other countries with similar burdens of HIV. A literature research reveals Ireland, Wales and New Zealand no longer provide HIV-specific respite services, and few remain in Canada, England and Australia.

Mr PICTON: The reason why I ask whether the minister has visited or talked to Centacare is that I certainly learnt a lot about the service from doing that. Can you confirm, minister, whether the service was actually changed three years ago when they got their new contract and previous to that was just a centre-based model, as you have been talking about in your speech, but is now an outreach service as well, so a lot of the centre-based staff have been converted to outreach staff and provide service across the community for people who are suffering from HIV in the community and make sure that they are managed well and stay out of emergency departments?

The Hon. S.G. WADE: I certainly agree that we need to have a broad range of services for this client group. The client group has complex needs, particularly in relation to mental health and drug and alcohol issues. It is SA Health's view that these needs are more effectively addressed by specialist mainstream services, and there is a range of mainstream service providers who are well placed to provide the support. So the funding decision has been made in the context of the range of services available to meet the needs of this client group.

Mr PICTON: Was that decision made following clinical advice from the department, including the Chief Medical Officer?

The Hon. S.G. WADE: Yes.

Mr PICTON: How is cutting this service and not replacing it with anything else consistent with what you previously said is what you want to do in terms of increasing out-of-hospital care, and particularly what your chief executive has said in terms of ramping up out-of-hospital care to try to keep pressure off hospitals?

The Hon. S.G. WADE: I would remind the committee that the former government reduced the Cheltenham Place service from a seven day a week respite service to a three day a week service. The fact of the matter is the government needs to continue to focus resources on the best possible use, and the decision has been made that this service will not continue to receive SA Health funding.

Mr PICTON: When Cheltenham Place and Centacare raised concerns about this, they said that there were reports that they had from the AIHW that showed that their support was providing a benefit to the health service of double what it was costing, so $800,000 compared to the $400,000 it was costing. You said on ABC TV that SA Health has its own figures that have a different estimation. I am wondering if you can outline for the committee what those different estimates are?

The Hon. S.G. WADE: I do not recall talking about a cost-benefit analysis of AIHW or competing figures from SA Health.

Mr PICTON: You said that SA Health has its own figures.

The Hon. S.G. WADE: Sorry, Mr Chair, I was just hoping to answer the question.

The CHAIR: Correct, thank you.

The Hon. S.G. WADE: SA Health has information about the service, the client group, contemporary models and the like. SA Health's decisions will be made in the context of all the data available to it.

Mr PICTON: Will the minister publicly release the information he relied upon to justify cutting this program?

The Hon. S.G. WADE: I think it is important to realise that SA Health develops a whole series of grant programs without seeking to have the minister make the decision. I imagine there are hundreds of grants made by SA Health each year. They do not all get ministerial approval.

Mr PICTON: If there were issues with the model of care—which, as I said, was only updated three years ago in their revised model of care that the department agreed to—why were no issues presented to Centacare before the budget came out?

The Hon. S.G. WADE: I am happy to take on notice the shadow minister's question, if I could take it to mean what discussions were had between Cheltenham Place and SA Health about the development of their service.

Mr PICTON: And if that is the case, why have the communicable diseases branch of your department, on a number of occasions, told Centacare that they were performing well and in fact they could not think of any suggestions for how they should improve their service?

The Hon. S.G. WADE: I have already taken on notice what discussions occurred between SA Health and Centacare in relation to this program.

Mr PICTON: Is the minister aware that HIV rates last year increased and that that increase was the highest in four years in South Australia?

The CHAIR: Member for Kaurna, can I just bring you back to the budget. I am not sure if HIV rates are one of the named performance indicators or activity indicators in the budget. The member for MacKillop has a question.

Mr McBRIDE: Thank you, Mr Chair. The topic for my question is Murray Bridge—

Mr Picton interjecting:

The CHAIR: The member for Kaurna, you are not going to reflect on the Chair or what I think or do not think.

Mr Picton interjecting:

The CHAIR: No, no. Member for Kaurna, it is completely and utterly—

Mr PICTON: Point of order, Chair. I asked a legitimate question.

The CHAIR: There is no point of order. Alright, let's be realistic. I am keeping tally: I think we have had about 47 opposition questions and we are now on to our third government question. If you think I am being unreasonable, please let me know.

Mr PICTON: You are being unreasonable.

The CHAIR: If you think I am being unreasonable—

Mr PICTON: You are being unreasonable. I think it is an important service. I think it is an important matter for the state as to whether HIV rates are increasing or not, and you trying to protect the minister from answering that is a significant issue.

The CHAIR: Member for Kaurna, I am not protecting the minister. The minister can look after himself. This is your estimates.

Mr PICTON: That is why we are trying to ask this question.

The CHAIR: You are wasting your time.

Mr PICTON: Why are you trying to stop the question from being asked?

The CHAIR: I want to continue to ask you: are you reflecting on my ability to chair?

Mr PICTON: I am raising a point of order.

The CHAIR: Which is what?

Mr PICTON: The point of order is that this is highly relevant to the budget.

The CHAIR: Relevance is not a point of order in terms of what I determine to be relevant or not, under the standing order.

Mr PICTON: On what basis have you ruled the question out of order?

The CHAIR: I am not ruling the question out of order. I am giving the go for the member for MacKillop. You can come back to your question after him. The member for MacKillop.

Mr McBRIDE: Thank you, Mr Chair. My topic is Murray Bridge Soldiers' Memorial Hospital. I refer to Budget Paper 5, page 89. To the minister, how will the $7 million investment in the Murray Bridge Soldiers' Memorial Hospital ED improve services for people in Murray Bridge and surrounding areas? Has the number of presentations of that ED changed in recent years, and what are the projections going forward?

The Hon. S.G. WADE: I thank the honourable member for his question. As a metropolitan based MP myself, I appreciate the honourable member is not only a regional member but also a regional member who uses the Dukes Highway and comes up through Murray Bridge. Not only do we have the ongoing growth of the Murray Bridge community and the ongoing need for Murray Bridge as a transit site for people across the South-Eastern region and interstate accessing South Australia, but we also have the establishment of the motor sport park at Tailem Bend, which will be a major, if you like, risk in terms of a medical response, so addressing the longstanding capital needs at the Murray Bridge Soldiers' Memorial Hospital is a priority for the government. I would ask the director of capital to answer the member's question.

Mr HEWITT: Thank you, minister. As the minister has touched on, Murray Bridge is one of the larger centres in country SA. It has an estimated population of 18,382 and provides a critical regional centre for health services in the Murraylands region. It is growing at an average rate of 1.4 per cent per annum. The current emergency department facility at Murray Bridge Soldiers' Memorial Hospital is 30 years old and has only one trauma bay and three treatment bays, with no nurses' station and limited storage space.

As the population of Murray Bridge and the surrounding areas has grown, the demand for emergency services has increased, and there has not been enough capacity at the emergency department to manage those requirements. A partnership approach with the Bridge Clinic medical practice for a number of years has enabled the emergency workload to be partly managed by basing the duty doctor at the GP clinic during business hours, maximising the care that could be delivered for both emergency patients and walk-in urgent cases. However, the demand has outgrown this arrangement and it has also increased the workload for the SA Ambulance Service transferring patients between the sites.

Demand at the hospital has grown 11 per cent in the past four years and is now close to 7,000 presentations per year. In addition, the presentations at the Bridge Clinic, which may shift to the hospital once the redevelopment is finished, have been factored into the future demand. The new emergency department has been designed to handle up to 15,000 presentations a year, meeting the needs of the projected population growth and other demand from services in that region. A range of people have been involved in the concept design, including local doctors and nurses, SA Ambulance, infection control specialists and clinical leaders at Country Health SA.

The new emergency department will be more than double the size of the existing emergency department, and will include two resuscitation bays, which is one more than currently available, and seven treatment bays, four more than is currently available. The new emergency department will also include a dedicated waiting room for patients and a separate quiet room for vulnerable patients, two procedure rooms, two consulting rooms, an ambulance lobby, nurses station, access toilet and shower facilities, and a relative room. With the large workload at the new ED, a different approach to medical and nursing staff will be needed, which will be developed in partnership with clinicians over the coming 12 months.

The CHAIR: Member for Kaurna, I think you might have a question on the Centacare provisions of HIV services.

Mr PICTON: Thank you, Chair, for the opportunity to ask an important question.

The CHAIR: My pleasure.

Mr PICTON: I refer, with an abundance of caution, to Budget Paper 4, Volume 3, page 50, System Performance and System Delivery, and that includes the communicable diseases control branch that monitors HIV infections in South Australia. Can the minister confirm that last year we saw an increase in HIV infections in South Australia, and the highest rate for the past four years?

The Hon. S.G. WADE: I am happy to take that question on notice to provide the committee with detailed stats. In terms of data that can provide comparisons with other states and territories, my understanding is that the Kirby Institute recently released some statistics, which suggest that South Australia had 61 notifications of new HIV cases in 2017, but I will get more information on both the department's statistics and the findings of the Kirby Institute.

Mr PICTON: I refer to Budget Paper 5, page 80, Health Consumers Alliance discontinue. On what basis did the minister make the decision to defund 100 per cent of the funding that went to the Health Consumers Alliance from SA Health?

The Hon. S.G. WADE: The government is withdrawing central funding of the Health Consumers Alliance in the context of its decision to devolve health management to the regions and establish regional boards. When we are devolving health management to the regions through boards, it is appropriate to also devolve consumer engagement to the regions. Statewide collaboration in relation to consumer engagement will be driven by the networks. Considering that the Health Consumers Alliance has expertise in this area, it is well placed to undertake funded project work for local health networks.

Mr PICTON: So is the minister saying that there are no statewide issues that need clinician involvement?

The Hon. S.G. WADE: No, I am not saying that. What I am saying is that I think that a consumer advocacy body that relies on centralised funding is less likely to be accountable and responsive to its membership and the communities across the state. I believe the changes will promote accountability and actually strengthen the consumer voice.

Mr PICTON: How does the minister believe in the future he will be engaging consumers in the delivery, implementation and review of health issues, noting that the Health Consumers Alliance has been involved in a number of issues at the central level of the state's determination, particularly including things like EPAS but also in terms of the review after Oakden and a number of those statewide issues that cover a whole range of things, including public health issues that your department looks after that do not necessarily involve any local health network at all?

The Hon. S.G. WADE: I think the honourable member is conflating the issue of central funding and ongoing funding. What has been withdrawn is the SA Health central funding from the Health Consumers Alliance.

There is already money going from SA Health to the Health Consumers Alliance on a project basis. I anticipate that would continue; in fact, I expect that would increase. It is the responsibility of the Health Consumers Alliance to put in place a business model which provides a sustainable organisation. They provide a range of services that could be both project funded or paid for on a fee-for-service basis such as training and my expectation is that Health Consumers Alliance is well placed to provide services in those areas.

Mr PICTON: With respect, minister, my question was in terms of the central roles of the Department for Health and Wellbeing, as it is now called. Those roles are not being devolved to local health networks and they would not be subject to any future hypothetical funding agreement between an LHN and Health Consumers Alliance should it still exist. So how would your department, dealing with central issues that cover the whole state, whether it be public health or any other issue, engage clinicians without any central funding and support going to the Health Consumers Alliance?

The Hon. S.G. WADE: There are certainly a number of organisations in South Australia that provide a statewide voice, peak bodies, and my view is that the local health networks will find value in the services provided by the Health Consumers Alliance. To the extent that the SA Health central requires services from Health Consumers Alliance, they may well purchase those on a fee-for-service basis. The alliance is a membership organisation and yet receives less than 1 per cent of its income from membership fees. I do not think that is a strong basis for accountability and a strong consumer voice.

Mr PICTON: How much do you think it would be sensible for patients to have to subscribe to the Health Consumers Alliance to get a voice from your health department?

The Hon. S.G. WADE: The membership of the organisation is both organisational and individual.

Mr PICTON: Yes, but you are suggesting that the alliance has to survive on membership from basically hospital patients in your hospitals. I presume that they are not going to be running around emergency departments asking for people to chuck in $100 to give them a voice so that they can actually contribute to your statewide running of the health system. So how much do you think it would be worthwhile for patients to have to contribute of their own money to keep this organisation going now that you have defunded it?

The Hon. S.G. WADE: I suggest the honourable member looks back at my earlier answers. I did not say that membership fees from patients is the only source of income for the Health Consumers Alliance.

Mr PICTON: The minister referred to other peak bodies continuing to be funded at a central level. Why has the minister not applied the same logic that he has to the Health Consumers Alliance to other peak bodies—and they are numerous—that the health department funds at a central level that are not being devolved or having all their funding cut in the same way that the Health Consumers Alliance is, with the expectation that they are going to have to ask LHNs for money now?

The Hon. S.G. WADE: I do not know the peak bodies which the honourable member is referring to.

Mr PICTON: Budget Paper 4, Volume 3, page 64: SALHN expenses. How much of the SALHN expenses in 2018-19 are to be spent on the provision of services at the Repatriation General Hospital?

The Hon. S.G. WADE: The government has just closed the request for community input into the options for the Repat site and also closed the expressions of interest process with private and non-government organisations in relation to what services they might like to provide on the Repat site. That input will be considered in the decision-making of government in relation to the future use of the Repat site. The government will release a fully costed, fully funded plan either late this year or early next year. In the context of those decisions, the extent to which state government funding will be required—both capital and recurrent—will be determined and funding allocations made.

Mr PICTON: Thank you, minister. I am sure that answered some question but it did not answer my question. How much of the SALHN expenses detailed in the budget are going to the Repat?

The Hon. S.G. WADE: The budget reflects the fact that the government is forgoing $20 million in revenue from unwinding the decision of the former government to break its promise to never close the Repat. The former government closed the Repat and contracted to sell off the land. Fortunately for the people of South Australia that sale was not concluded by the time of the election and, as minister, I terminated that contract. So that $20 million is reflected.

There is certainly money that may well be utilised at the Repat; for example, part of the $45 million for elective surgery and colonoscopies. In relation to capital works, there is money that has been earmarked for capital works which may be applied at the Repat.

Mr PICTON: For the third time, minister, how much money of this budget is going to health services at the Repat—in a dollar amount? If you do not know just say 'I don't know,' or if it is nothing then say 'It's nothing.'

The Hon. S.G. WADE: In terms of the Repat reactivation planning works, there are the Repat reactivation planning works that have been progressed within residual funds of $2.71 million previously allocated to the decommissioning of the Repat. I also understand there would be funds within the SALHN budget, and I will take that on notice.

Mr PICTON: Does that $2.7 million provide health services?

The Hon. S.G. WADE: It relates to the Repat reactivation planning works. I will take on notice what that consists of.

Mr PICTON: On what date will the elective surgery operating theatres be opening for surgery at the Repat?

The Hon. S.G. WADE: As I have indicated to the committee, decisions will be made by the government by the end of the year or early next year in terms of the future use of the site, and time frames will be clear then.

Mr PICTON: I refer to Budget Paper 5, page 81, and the introduction of local health network governing boards. Is the full $13 million allocated in the budget for establishing these boards over the forward estimates the entire cost of restructuring under the health system, or are there other costs that will have to be borne either by the department or the local health networks? If there are, can you please detail them?

The Hon. S.G. WADE: The figures referred to in the budget relate to costs associated with the establishment of the regional governing boards. The costs associated with the restructuring of the health system will become clear as decisions are made in what we call stage 2 of the board governance reforms. We are confident that over the forward estimates the enhanced corporate and financial management of the health networks through board governance will lead to efficiencies that more than offset the costs.

Mr PICTON: I understand that this budget of $13 million going for the boards is just stage 1, and the minister is saying there is another future stage 2 that is going to cost an uncertain amount. Does he have any estimates as to what that future stage is going to cost? I think his chief executive next to him provided some estimates to Budget and Finance Committee. Do they still stand or are there any revised estimates that you can provide?

The Hon. S.G. WADE: My understanding is that the chief executive, in the Budget and Finance Committee, suggested an upper limit for costs if we were to fully replicate. That is not our intention but we do not have a new estimate of the lower figure.

Mr PICTON: For those unknown stage 2 costs, are they going to be subject to a future bid to Treasury for additional supplementary funding, or will they be borne from within the resources of the local health networks or the department?

The Hon. S.G. WADE: I reiterate the point that we anticipate that the efficiencies will more than offset the costs but the specifics in terms of the Treasury accounting would need to be the subject of discussions with Treasury in future budget bilaterals.

Mr PICTON: So, minister, you can guarantee that those additional unknown stage 2 costs will not have to come from the local health networks' budgets that have been allocated in this budget?

The Hon. S.G. WADE: I have already indicated that it is the expectation of government that the efficiencies delivered by local health networks under the guidance of their boards will more than outweigh the costs. The accounting in relation to Treasury will be the subject of future budget bilaterals.

Ms BEDFORD: I refer the minister to Budget Paper 5, page 84. The budget includes $23 million over four years to establish an HDU, or what I prefer to call a level 1 ICU at Modbury Hospital. How is the amount of $23 million calculated, and what clinical advice was used re the cost of establishing and operating a safe and sustainable unit at Modbury?

The Hon. S.G. WADE: The establishment of a four-bed high dependency unit at Modbury Hospital is a key commitment of government and will enable the provision of care to patients requiring high levels of extensive care and observation. I ask the director of capital to address the specifics of the member's question.

Mr HEWITT: The establishment of the $23 million budget was built upon a requirement for $5 million in capital for the creation of the beds and then $18 million in the operating budget over the four years to actually operate the facility with the doctors, nurses and clinical staff.

Ms BEDFORD: On my reading of the budget papers, the allocation of the Modbury money includes $5 million of capital funding, all of which is expected to be spent by June 2019. Has the tender been issued for these capital works and, if not, when do you expect that tender to go out?

The CHAIR: Member for Florey, all questions are to go through the minister.

Ms BEDFORD: I am looking over there, and it does not matter who I am—

The CHAIR: Yes, it does matter.

Ms BEDFORD: But I am looking over there.

The CHAIR: Minister, if you are happy for that to be answered?

The Hon. S.G. WADE: I thank the honourable member for her question. I will ask the director of capital to answer that question.

Ms BEDFORD: I will look over here now.

The CHAIR: Just be consistent, member for Florey.

Ms BEDFORD: Okay. It is elder abuse, really, is it not?

The CHAIR: That infers that you are old, member for Florey. I think you are very young. Minister.

The Hon. S.G. WADE: I have asked the director of capital if he can respond.

Mr HEWITT: We are on a plan to go out to tender for a managing contractor in the coming month of October and are expecting that the works for the Modbury redevelopment will commence early in 2019.

Ms BEDFORD: So—

The CHAIR: Last one, member for Florey.

Ms BEDFORD: Yes. The allocation of $2.470 million for the operating costs this financial year suggests that, at the time the budget papers were finalised, you expected the unit would be up and running in the early part of 2019. Has the time frame for this project slipped since the budget papers were finalised? If so, what has led to the delay?

The Hon. S.G. WADE: Thank you, member for Florey. I will ask the director of capital to answer that.

Mr HEWITT: Since the handing down of those budgets, we are looking at integrating the works for the high dependency unit with the rest of the redevelopment works for Modbury Hospital in order to get the best outcome. So yes, it will result in a delay in the commencement of operations of the high dependency.

The CHAIR: Member for Wright.

Mr BOYER: I refer to the same budget line: Budget Paper 5, page 84, regarding Modbury Hospital. Just to build on what the member for Florey was asking, how long will the delay in establishing and having an operational HDU at Modbury Hospital be, given your previous answer?

The Hon. S.G. WADE: I thank the member for his question and ask the director to respond.

Mr HEWITT: The first works that we have to do at Modbury relate to some decanting works through the space. We plan on commencing work on the high dependency unit with the extended acute surgical unit later in 2019. It is probably expected that those works will take a little over 12 months, so it will be early in 2020-21 before they are fully operational as a complete new capital development.

Mr BOYER: Minister, I am wondering if you are able to be a bit more precise in terms of when in 2019 you think the work—best-case and worst-case scenarios—might begin on the HDU at Modbury?

The Hon. S.G. WADE: The officer has highlighted the interplay between the general redevelopment at Modbury Hospital and, specifically, the HDU. There may be a range of options for the timing of the delivery of the HDU, and they will be worked out as part of the overall project.

Ms BEDFORD: I have a question on the extended stay in emergency.

The CHAIR: Member for Florey, you have the call.

Ms BEDFORD: We have been promised the extended stay area in the emergency section for years.

The CHAIR: A direct question, member for Florey.

Ms BEDFORD: Same budget line, to the minister: is there any light at the end of the tunnel for that?

The Hon. S.G. WADE: The Modbury development project includes the establishment of an extended emergency care unit and an acute medical unit, both located next to the hospital's emergency department.

The Hon. L.W.K. BIGNELL: My question, minister, is related to Budget Paper 5, page 72. For the McLaren Vale hospital there is a $500,000 payment for a solar panel array and building a shed for volunteers. Can you guarantee that the McLaren Vale hospital will stay open for the next four years?

The Hon. S.G. WADE: I am not accountable for the McLaren Vale hospital as it is a community facility, but I have no reason to believe that it would not be continuing to operate.

Mr PICTON: Supplementary to that: are you going to ensure that the same level of funding provided to treat public patients in the McLaren Vale hospital is continued over the next four years?

The Hon. S.G. WADE: My understanding is that the public patient services at McLaren Vale hospital are delivered as a contract with the Southern Adelaide Local Health Network. Those contracts are negotiated as they fall due and that will fall, primarily, to the local health network board.

Mr PICTON: I refer you to Budget Paper 4, Volume 3, Sub-program 2.1: Central Adelaide Local Health Network, page 56. I understand you have said that under your watch you will continue what was originally planned in terms of St Margaret's and Hampstead moving into other sites. For St Margaret's, does that mean that any health services will remain on the site, and if not, will you be selling that site?

The Hon. S.G. WADE: The St Margaret's facility, on my understanding, is a facility controlled by a trust and so the government will be seeking advice as to how best to deliver relevant services in the context of the trust.

Mr PICTON: So there is no commitment to continue to provide health services of any description on that site?

The Hon. S.G. WADE: I remind the committee that the government is continuing the decision of the former government. In terms of the implications of the trust, my understanding is the fact that the trust has limitations in terms of uses of the site would suggest that health services would be ongoing on that site, but SA Health has decided that, over time, it will not need the services being provided at St Margaret's as part of its Central Adelaide Local Health Network service model.

Mr PICTON: If you are moving all the services off the Hampstead site, what is the future of the pool there, which is used for a number of community purposes? Will that stay as a government service, or will you be seeking to transfer that to the private sector?

The Hon. S.G. WADE: The decision in relation to the pool will be taken in the context of the overall capital works plan.

Mr PICTON: So no decision has been made in terms of the future of the pool, at this stage?

The Hon. S.G. WADE: Yes: no decision has been made about the future of the Hampstead hydrotherapy pool, at this stage.

Mr PICTON: I refer to Budget Paper 5, page 77: Establishment of a sustainable, efficient health system, which sets a target to reach national efficient pricing by 2021-22. Do you have any estimate in terms of what change in workforce would be required, in terms of the numbers of doctors and nurses compared to now, to reach that?

The Hon. S.G. WADE: South Australia is operating significantly above the national efficient price. Obviously, as I said earlier, there is a range of efficiency measures available to government to bring us closer to the national efficient price. I am not aware of any staffing modelling because there are all sorts of strategies that are available to government to move towards efficiency.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 72, SAAS expenditure and FTEs. Has the minister received any advice in terms of the need for additional paramedics in the South Australian Ambulance Service?

The Hon. S.G. WADE: The South Australian Ambulance Service strategic working group was established to bring together key stakeholders to review statewide service delivery arrangements and to agree plans for future delivery of ambulance services. That group was established in July 2017 and has met regularly since. It involves SAAS, the Ambulance Employees Association, the SAAS Volunteer Health Advisory Council, the Department of Health and Wellbeing, the Department of the Premier and Cabinet and the Department of Treasury and Finance.

These stakeholders have been brought together to help review SAAS's current statewide service delivery arrangements and explore plans for the future delivery of emergency ambulance services in South Australia, particularly in the context of increasing demand. The central element of the SWG's work was the consideration of new approaches to patient care underpinned by a model which ensures that the ambulance services in South Australia are efficient and appropriately resourced; that is, ensuring that ambulance services are accessible, that people receive the right care and treatment at the right time and that the need for professional development and work-life balance meets the needs of SAAS employees.

This has resulted in the development of a five-year service delivery plan and provides a clear picture as to how SAAS can improve the design and implementation of services. Cabinet will consider this plan shortly, and I look forward to ensuring that SAAS is an efficient, sustainable and responsive ambulance service for years to come.

Mr BOYER: Minister, I take you back to Budget Paper 5, page 84, Modbury Hospital. Has it been decided yet where in the hospital the HDU will be located?

The Hon. S.G. WADE: I am advised that it will be on level 1.

Ms BEDFORD: Budget Paper 5, page 84, talks about more affordable hospital car parking. What similar arrangements will be put in place for relatives of patients at the Lyell McEwin health service and Modbury Hospital, and what improvements are being planned for the appalling parking situation in Elizabeth at the Lyell McEwin health service?

The Hon. S.G. WADE: The Marshall Liberal government is committed to ensuring that affordable car parking fees are applicable at all South Australian public hospitals. Under the former Labor government, parking rates for visitors to long-stay patients at the NRAH cost nearly twice as much as any other metropolitan hospital, that being $65 as opposed to $38. These prices put an extra emotional and financial burden on South Australians experiencing significant stress.

In response, the Marshall Liberal government committed, at the 2018 election, to a specific plan to ensure affordable parking fees. This included reducing car park charges at the Royal Adelaide Hospital for relatives of long-stay patients from $65 a week to $38 a week, and the government delivered on that fee reduction within the first 100 days.

We also committed to establishing a new patient and carer parking scheme to apply at all metropolitan hospitals. The scheme will specifically provide support for patients with frequent outpatient appointments, parents or carers of long-stay patients, relatives or carers of a young child patient, and families and friends of palliative care patients. The government also committed to openly disclosing car parking fees, fee exemptions and availability of car park passes. This open disclosure will be on both websites and at car parks.

In relation to Modbury Hospital in particular, parking in the open-air car park is free for the first two hours. After that the cost is $2.50 for two to three hours and rising to $13 for more than 10 hours in one day. The weekly rate for visiting long-stay patients is $38. I acknowledge the concerns that the honourable member has raised with me in the past, particularly in relation to disability access as well and I appreciate that is an issue of concern. In terms of the changes at the Lyell McEwin, I will ask Mr Hewitt if he might address that.

The CHAIR: Minister, unfortunately we are out of time. I declare the examination of the proposed payments for the portfolio SA Health completed. In accordance with the agreed timetable, the committee stands suspended until 3.15.

Sitting suspended from 15:01 to 15:15.

Departmental Advisers:

Assoc. Prof. J. Brayley, Chief Psychiatrist.

Mr C. Burns, South Australian Mental Health Commissioner.

Dr C. McGowan, Chief Executive, SA Health.

Mr D. De Cesare, Acting Chief Finance Officer, SA Health.

Mr D. Frater, Deputy Chief Executive, SA Health.

Ms M. Bowshall, Acting State Director, Drug and Alcohol Services, SA Health.

Mr A. Knez, Manager, Executive Services and Projects, SA Health.

The CHAIR: Welcome back. We are now with SA Health, mental health and substance abuse, being the Minister for Health and Wellbeing, and with estimates of payments being Department of Health and Wellbeing, $4,046,725,000, and the South Australian Mental Health Commission, $2,058,000. I call on the minister to introduce his advisers and make an opening statement if he so wishes.

The Hon. S.G. WADE: I introduce Associate Professor John Brayley, Chief Psychiatrist, to my right; to my left Ms Marina Bowshall, the acting director of Drug and Alcohol Services, South Australia; Dr Chris McGowan, Chief Executive, SA Health; Mr Chris Burns, the South Australian Mental Health Commissioner; Mr Danny De Cesare, the Acting Chief Finance Officer of SA Health; Mr Don Frater, the Deputy Chief Executive of SA Health; and Mr Andrej Knez, Manager, Executive Services and Projects, SA Health.

In terms of an opening statement I make the clear point that mental illness has a substantial impact on the personal, social and economic levels in our society. It is well recognised that mental health problems and illness are among the greatest causes of disability, diminished quality of life and reduced productivity. The recent Fifth National Mental Health and Suicide Prevention Plan reminds us of some very salient statistics. One in five Australians aged under 16 will experience mental ill health each year. Mental health and substance abuse disorders are the third-largest burden of disease in Australia, after cardiovascular disease. In 2015 there were 3,027 deaths by suicide, or an average of eight deaths every day across Australia, yet most early deaths of psychiatric patients are due to physical health conditions.

During the election campaign the Marshall government promised to develop a national statewide mental health services plan within 12 months. South Australia has not had a state mental health plan since the Stepping Up mental health plan expired in 2012. This plan will chart the future direction for mental health and wellbeing services.

In recent years, gaps and failures in mental health care have led to multiple reviews and consultancies. Building on the vision and direction provided by the South Australian Mental Health Strategic Plan 2017-22, which was developed under the auspices of the Mental Health Commission, we now need an integrated services plan to guide the commissioning and delivery of state government funded mental health and wellbeing services in the state.

The plan will benefit service users and enable our skilled and dedicated staff to deliver best practice. The mental health plan will be a blueprint for services that deliver prevention, early intervention, acute care and rehabilitation and will apply to all age and population groups. The plan will be codesigned and co-produced with people with lived experience and will also engage clinicians and providers across sectors in South Australia who either deliver SA government-funded mental health and wellbeing services, work with them or refer to them.

The net cost of service for mental health services for the 2018 financial year are budgeted at $398.7 million, some $15.4 million more than the 2017-18 budget of $383.3 million. The 2018 state government budget contains a number of initiatives to improve mental health services over the next four years. These include $2.5 million for additional suicide prevention services, $10 million to establish a specialised statewide borderline personality disorder service and $3.345 million for paediatric eating disorders services.

This government is committed to addressing the recommendations of the Independent Commission Against Corruption report in relation to Oakden, which will be implemented as two consecutive service improvement initiatives. The first is the reform of the Older Persons Mental Health Service across the state. The second is the improvement in mental health services governance facilities, staffing mix, the understanding and use of safety and quality mechanisms and the Mental Health Act. The Chief Psychiatrist has commenced a more rigorous announced and unannounced inspection regime and has completed 20 inspections so far in 2018.

The South Australian government is committed to the ongoing support of psychosocial services it funds to those with severe mental illness who are not eligible for the NDIS. South Australia has set up an NDIS psychosocial disability transition task force that comprises members from SA Health, the LHNs, the Department of Human Services, primary health networks, the National Disability Insurance Agency, Lived Experience and community representatives. The task force functions are to monitor the impact of the NDIS transition arrangements on both clients and service providers with a particular focus on continuity of service to clients, advice on appropriate action to address continuity of service and identifying future issues that might arise.

Further, this government is committed to addressing the harms associated with alcohol and drugs. The government is committed to implementing the South Australian alcohol and other drugs strategy, working with the Ministerial Drug and Alcohol Forum to provide a coordinated response to tobacco, alcohol and drug-related issues.

We are also committed to reducing smoking prevalence in the community. The review of the Tobacco Products Regulation Act has been completed and a bill has recently been introduced to ensure we have strong and clear legislation to effectively regulate e-cigarettes. A number of important initiatives have been supported in the recent budget, including $7.5 million over three years to achieve a real-time prescribing monitoring program, an additional investment of $160,000 over two years to support people in the Riverland who are struggling with methamphetamine use, and $6.2 million over four years to support all South Australian prisons to go smoke-free by 2019.

I conclude my opening remarks by acknowledging the work of health professionals, peer workers and others across both SA Health and the non-government partners for their support, hard work and dedication to deliver quality and safe care.

Mr PICTON: Just as a quick opening statement, it is a bit disappointing to have yet another opening statement from the minister taking up another five minutes of this valuable time, but we will persist.

The CHAIR: Member for Kaurna, I would have thought after your interactions earlier you would have known that it is your question, so do not waste your time.

Mr PICTON: Despite the attempt, we will try to get as many questions in as possible. I hope there are no Dorothy Dixers, unlike what we saw in the last session.

The CHAIR: Member for Kaurna, remember that this is a committee of the parliament. I remind the parliament and the committee that government members are entitled, on behalf of their constituencies and electors, to ask the executive any question that they like.

Mr PICTON: And I am entitled to make an opening statement.

The CHAIR: I think, not being a member of the executive at the moment, member for Kaurna, it is disappointing that you reflect on other members who may wish to ask a question at some point. If you have a question, I would love to hear it.

Mr PICTON: Minister, I refer to Budget Paper 4, Volume 3, page 55, Health Services. How many mental health patients in the past six months have waited more than 24 hours for a bed in a public hospital?

The Hon. S.G. WADE: I will take that on notice and get the data the honourable member seeks.

Mr PICTON: Do you as minister receive any updates in terms of the number of patients who have to wait more than 24 hours?

The Hon. S.G. WADE: I receive a range of statistical and other information, and I have undertaken to take the honourable member's question on notice.

Mr PICTON: Do you have any information here today, given that this is part of the information you receive as updates, in terms of how many patients do wait more than 24 hours in an emergency department?

The Hon. S.G. WADE: In terms of emergency department waiting times generally, there has been an improvement in the timely delivery of care since 2014. The percentage of mental health patients waiting in a metropolitan emergency department for more than 24 hours has fallen by 11 percentage points over the past four years. It was 20 per cent in October 2014, which is an absolute number of 262; and 9 per cent in August 2018, which is an absolute number of 145 patients.

The average waiting time for adults and older mental health patients in metropolitan hospital emergency departments reduced from 18.5 hours in October 2014 to 11.8 hours in August 2018. There has been deterioration in waiting times over the past 13 months, and that is not insignificantly related to the transition to the new Royal Adelaide Hospital and the failure, to this point, to be able to open the PICU (psychiatric intensive care unit) on that site.

Mr PICTON: Given that you have just said that there has been a deterioration, do you have any update in terms of the figures over that period of time where there has been a deterioration?

The Hon. S.G. WADE: In May 2017, the emergency department average waiting times were as low as 7.6 hours compared to the current waiting time for August 2018 of 11.8 hours. In terms of the mental health unit, currently four of the 10 beds are open. They are not open as full PICU beds, they are open as general mental health beds, but the 10 PICU beds that are provided at the Glenside site continue to be available to CALHN.

Mr PICTON: Those figures represent, from my quick maths, almost a 50 per cent increase in terms of the waiting times for mental health patients in emergency departments over a year. Can the minister confirm that that is across the whole health system, not just one particular hospital?

The Hon. S.G. WADE: I would ask the Chief Psychiatrist to provide information to the committee.

Dr BRAYLEY: The details of the long waiting times can be broken down on notice. These figures that have been presented are across the metropolitan mental health system, but when the figures are graphed you can see a deterioration, particularly from September 2017. Most of the impact here relates to the changes in the Central Adelaide Local Health Network since the commissioning of the new Royal Adelaide Hospital.

The Northern Adelaide Local Health Network generally appears to be coping better, but it is currently waiting for five additional short-stay unit beds to start operating after the closure of a short-stay unit in December last year, so there will be more capacity up north as well as the additional capacity at the Royal Adelaide Hospital in the PICU area.

The Hon. S.G. WADE: If I could add to the Chief Psychiatrist's comments, as well as the impact of the move to the new Royal Adelaide Hospital, the balance of supply and demand would have been impacted upon by the fact that, I think in July 2017, the Oakden facility was closed, with a significant reduction in beds. I think there are about 16 beds at Northgate, but there is a net reduction as a result of that. Some of that reduction in supply may well be impacting on people in general mental health wards.

Mr PICTON: When does the minister expect that waiting times will reduce to the level he has previously mentioned of about 7½ hours, rather than about 11½ hours, where they are currently?

The Hon. S.G. WADE: Implicit in my responses to the earlier questions is that getting the mental health beds at the Royal Adelaide Hospital operating for their design capacity is crucial to the effective operation of that hospital, with knock-on benefits to the wider system. My advice is that significant progress is being made in dealing with the duress alarm issues and that we can be hopeful of progress in the next month or so.

Mr PICTON: So you are expecting within the next month that those PICU beds are going to be opened?

The Hon. S.G. WADE: Yes, that is my expectation. The key steps, obviously, are to deal with the IT issues that currently mean that the duress alarms are not fit for purpose, and of course the final sign-off for the fact that they are fit for purpose is a decision for the Chief Psychiatrist.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 63, SALHN. I understand that a senior business manager from the Southern Adelaide Local Health Network was congratulating staff for not filling vacancies in mental health. Has any action been taken against that senior business manager?

The CHAIR: Member for Kaurna, we have canvassed this issue earlier in the previous session. We are looking at page 63 and there are seven dot points, and if we can refer our questions on those, please, in relation to SALHN I am happy to do that, but it is not in order to canvas what someone may or may not have said at one level or not.

Mr PICTON: I refer to page 64, which refers to the number of full-time equivalent staff in 2017-18 in SALHN, which directly refers to how many people were filled in vacancies. The minister has had a staff member who has been congratulating staff for not filling these vacancies, which would affect these FTE numbers in the budget.

The CHAIR: Perhaps page 64 is more FTE relevant—perhaps a direct question around FTEs. I will give you a chance to reshape your question to get to where you want to.

Mr PICTON: Is the minister disappointed that a staff member of his has been congratulating staff for not filling FTE numbers in mental health positions in SALHN?

The Hon. S.G. WADE: I am advised that the email to which the honourable member is referring was unauthorised, inappropriate and inaccurate in content and context. I am told that the email did not reflect the entire picture in that the south has invested more in mental health compared with the last financial year. I am advised that SALHN has not reduced mental health staff. I am advised that figures demonstrate that the south has employed more than 40 additional full-time equivalent staff within its mental health services compared with this time last year. A range of concerns have been raised with me in relation to southern mental health services. I have discussed those with the Chief Psychiatrist, who is looking into matters and will report back to me in due course.

Mr PICTON: Is the minister's concern not that the email was sent—the advice that he has received, can I seek confirmation from him that he is telling the committee that the email was not accurate and that vacancies have been filled in SALHN?

The Hon. S.G. WADE: I am advised that the email does not present the entire picture. That is the view of SALHN, and that is what I have been advised by SALHN.

Mr PICTON: How does that compare with the advice that has been received, as I understand it, by you from the Australian Nursing and Midwifery Federation, which has said there are significant staffing pressures in SALHN mental health services and that staff are at the end of their tether?

The Hon. S.G. WADE: As I said, a range of concerns have been raised with me in relation to southern Adelaide mental health services. I have discussed those concerns with the Chief Psychiatrist, who is looking into a range of matters and has undertaken to report back to me. I do not intend to comment further until I have received that advice. The government is determined to ensure that mental health services operate with quality and safety.

Mr PICTON: When will you receive the advice from the Chief Psychiatrist?

The Hon. S.G. WADE: I am not aware of a time frame.

Mr PICTON: He is right next to you—you could ask him.

The CHAIR: Member for Kaurna, it is up to the minister to answer the question how he sees fit.

The Hon. S.G. WADE: I am not aware of a time frame.

Mr PICTON: So it could be next year, in five years—when are you expecting it? Presumably it is an urgent matter on which you wish to be urgently briefed.

The Hon. S.G. WADE: There is a range of concerns in relation to the Southern Adelaide Local Health Network in relation to mental health, and I am looking forward to the report from the Chief Psychiatrist.

Mr PICTON: Will you be releasing the Chief Psychiatrist's report?

The Hon. S.G. WADE: My understanding is that it is not the normal practice for Chief Psychiatrist reports to be released.

Mr PICTON: There has been, particularly in the last year, a very famous instance of a Chief Psychiatrist's report being released. Why is not this report important to be released? Why is not this something where, particularly residents in the south, who are concerned about the state of mental health services, are able to see what the Chief Psychiatrist has determined the state of mental health services in the southern network to be?

The Hon. S.G. WADE: I presume that whether or not a Chief Psychiatrist's report is released is a decision for the chief psychiatrist. Some of the matters that Chief Psychiatrists need to investigate are intensely personal and I certainly will not be making open-ended commitments without consulting the Chief Psychiatrist.

Mr PICTON: Once again, he is right next to you. Will the Chief Psychiatrist's report have the ability to cover all staffing related issues in the southern local health network, including why the vacancies were not filled, according to the email that has been leaked?

The Hon. S.G. WADE: The member asks: does the Chief Psychiatrist's report have the capacity to look at the adequacy of staffing? My understanding is that the Chief Psychiatrist is able to look into all matters in relation to quality and safety, including staffing levels.

Mr PICTON: Can the minister assure the committee that nowhere else in the health system are vacancies being held open to meet budget savings targets?

The Hon. S.G. WADE: That is an extremely broad question. I would also remind the honourable member that this is the mental health and substance abuse line. If he wants to ask catch-all questions in relation to health, he perhaps might have put the catch-all questions during the health session.

Mr PICTON: I will ask it specifically in terms of mental health services then.

The Hon. S.G. WADE: I am not aware of any systematic practice to hold vacancies open to meet financial targets. The fact of the matter is any organisation carries vacancies from time to time and that obviously needs to be factored into your budgeting because otherwise your budgets would not be realistic.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 55: Health Services. Has the minister done any further work in relation to the recommendations from the Coroner that an additional 200 mental health beds are critically needed?

The Hon. S.G. WADE: I am aware that following the Coroner's inquest into the death of Ms Chrystal Ross in January 2015 the Coroner has recommended a fourfold increase in the number of mental health beds in South Australia. This recommendation will be formally considered in a new South Australian mental health services plan that is being developed by the Chief Psychiatrist and the Mental Health Commissioner and will review services and funding now and into the future. I might ask the Chief Psychiatrist whether he might want to expand on that planning process.

Dr BRAYLEY: The mental health services plan is going to be an outcomes based plan that will define the expectations that our local health networks and contracted services will be expected to deliver. We intend it to be codesigned with consumers, carers and community, and to have strong staff engagement. There are a number of key areas that are being looked at to develop this outcomes based plan. So it will define the outcomes. The local services will then need to meet those outcomes and develop the models of care to do that. Those areas include access to services, and we have other groups looking at service excellence, continuity of care, recovery and rehabilitation, and early intervention and workforce.

So in the access section, the modelling of the number of beds that we require and the amount of community services that are needed will be done. There is a national mental health framework that has been developed by a group led by Professor Harvey Whiteford in Queensland that is used extensively by state governments and primary health care networks, and that modelling will help guide us on the number of beds that are required.

In terms of the quality and this issue of access to service, it is critical that people have access to a mental health bed when they need it. It needs to be available to provide care so that in tragic circumstances, such as the one the Coroner reviewed, people are not waiting for beds for a long time. Other problems can develop because of those delays and their flow-on effects. So the beds have to be available.

Will it be four times the number of beds? On our preliminary look at the modelling that would not be the figure the modelling is showing, but there will be recommendations about bed numbers. It is more likely that longer term beds in the community would need to increase rather than acute beds, because there is a group of people who have multiple readmissions to hospital who, if they were better supported and then did not need to come back into hospital, would no longer require acute beds. Therefore people with a crisis admission, who do need that support, would have better access.

The mental health services plan will deliver some recommendations. In the interim, I guess, with the pressures being experienced in the system, steps like opening some extra beds in the PICU and getting the Lyell McEwin shortstay unit beds up and running are some of the immediate steps, but there needs to be medium and longer term strategies as part of the plan to address this issue.

Mr PICTON: Given that reference was just made to the preliminary modelling not showing that need, what is the preliminary modelling showing as the need for mental health beds?

The Hon. S.G. WADE: I suggest we should allow the Chief Psychiatrist, the Mental Health Commissioner and the other member of that team to do the full services plan, rather than giving us progress reports over the next few months.

Ms BEDFORD: I have a question on acute mental health, and I refer to Budget Paper 4, Volume 3, sub-program 1.3, page 54. What allocations and plans are proposed for improving infrastructure and services at NALHN's Woodleigh House?

The Hon. S.G. WADE: I know the member for Florey appreciates this, but Woodleigh House, for the benefit of other members, is a 20-bed acute adult inpatient service situated in the grounds of Modbury Hospital. It was opened in 1982 and was based on institutional thinking and practices at that time. I have had the privilege of visiting Woodleigh House with the Premier, and I am sure he would agree that Woodleigh House does not meet contemporary standards for mental health care and requires significant capital investment.

Its design was contemporary for its day, but it is not contemporary now. Woodleigh House is one of the few remaining adult mental health services in Australia located over two levels, and therefore will remain as a high risk to SA Health until issues regarding the building infrastructure can be addressed. All the client bedrooms are on the first floor and all client showers and toilets are of a communal type common to old institutions. Patients who are frail, bariatric or who have limited mobility or other medical issues are not able to be admitted. I appreciate that means the honourable member's constituents who need care and who are in those categories have to go further afield to get it.

At the time of its design significantly less emphasis was placed on limiting or mitigating ligature points, so the main areas of risk arise from areas that are out of direct line of sight, including patient toilets, bathrooms and bedrooms. In July 2017 and again in February 2018 an audit was undertaken on ligature points at Woodleigh House, and the audit identified 35 high risk ligature issues. A significant body of work has occurred to rectify those issues, and I am advised that 34 out of those 35 high risk ligature issues have been resolved. It is anticipated that the outstanding issue will be dealt with shortly.

Of course, the challenge is to balance the management of risk via ligature whilst operating under the Mental Health Act and the principles of least restrictive practice. NALHN is particularly mindful that Woodleigh House is not a psychiatric intensive care unit or a prison setting. The government is mindful of the need for capital investment to respond to the mental health needs of people in the northern area. This an example of infrastructure that is well past its useful life.

Mr PICTON: I refer to both Budget Paper 4, Volume 3, page 55, Health Services, and Budget Paper 5, page 86, Rehabilitation in the Riverland. Is the $160,000 over two years for the Riverland rehabilitation measure the only new item in the budget that the government has allocated to deal with substance abuse and, in particular, the use of ice in the community?

The Hon. S.G. WADE: As I mentioned in my opening statement, as well as the Riverland rehabilitation investment there is also an investment in relation to real-time prescribing monitoring, which is directly relevant to Schedule 8 drugs, and also investment in relation to smoke-free prisons.

Mr PICTON: I do not think smoking cigarettes in prisons relates to ice in any way but, hopefully, that is not going to be the only way that people stop using ice in prisons. I am sure ice is not being sold through our pharmacies either, so I am sure that is not a measure that helps with ice at all. This new government has come in and said that we have an ice crisis, and has only put in $160,000 to address it in the Riverland.

The Hon. S.G. WADE: I appreciate that the honourable member is referring to the budget reference specifically, but the total project cost for the Riverland rehabilitation unit is higher than that. Let me address that: the total indicative project budget for this pilot program is $593,000 over 24 months. There is the specific budget allocation and the remainder of the resources will come from within SA Health's budget.

Mr PICTON: Are you therefore satisfied that that is enough resources to deal with the ice crisis across the state?

The Hon. S.G. WADE: The government will continue to use a range of resources that are available to the state government to maximise its contribution to minimising substance abuse. We believe this initiative is a valuable addition to a range of services available across the state.

Mr PICTON: In April this year, the minister said, and I quote:

South Australia is experiencing a disturbingly high level of abuse of methamphetamine and we hope to secure a larger share of the federal funding available under the National Ice Strategy.

The CHAIR: Member for Kaurna, as I ruled yesterday and the day before, it is not relevant what the federal government does and does not do. Once again, I refer you to the items in the budget that the minister is responsible for, and ask you to shape your questions through that prism, please.

Mr PICTON: Sorry, Chair. I appreciate your interruptions and continual ability to frustrate—

The CHAIR: I do not know if you really do.

Mr PICTON: —the opposition's questions. I refer specifically to page 55, Health Services, Commonwealth revenues. My question is: given your desire to receive more funding from the federal government, how much additional funding has the minister secured from the commonwealth ice strategy to date?

The Hon. S.G. WADE: The state government has had discussions with the commonwealth, and my understanding is that those discussions are likely to lead to announcements shortly. I do not intend to pre-empt them.

Mr PICTON: So you are confident that there will be additional funding coming to South Australia?

The Hon. S.G. WADE: Yes.

Mr PICTON: I again refer to Budget Paper 4, Volume 3, page 55, Health Services, specifically in terms of mental health services. What action has been taken to stop block funding for mental health programs being cut by the commonwealth government?

The CHAIR: Once again, I remind the committee that the minister is not responsible for federal government decisions.

The Hon. S.G. WADE: I am at a loss to see how a state appropriation estimates committee can ask me how much—

The CHAIR: Thank you, minister. I just made that very same point.

The Hon. S.G. WADE: Sorry. Okay, I am following your drift.

The CHAIR: Finally!

Mr PICTON: In relation to that, is the government going to provide any funding for services that have had their funding cut by the commonwealth government?

The Hon. S.G. WADE: In my opening statement, I referred to the work of the task force that the state government established. It is certainly true, and I have said it time and time again, that the state government is very keen that all governments honour their NDIS transitional bilateral agreement commitments to ensure mental health clients receive continuity of support. It is the view of the state government that the commonwealth should continue to provide support for individuals who would have been otherwise receiving a service, only reducing the support as these individuals access either the NDIS or National Psychosocial Support Measure services.

The issue was raised by the South Australian government at the COAG Health Council meeting held on 2 August. The council discussed and agreed to South Australia's proposal that the COAG Health Council monitor the ongoing transition to the NDIS of mental health clients and identify any emerging service gaps that need to be addressed in order to ensure continuity of services. Ministers agreed that the Australian Health Ministers' Advisory Council work with the Disability Reform Council Senior Officials Working Group and provide advice at the next COAG Health Council on actions to resolve the interface issues between health and disability.

The current planning for the NDIS, as it relates to people with primary psychosocial disability, is being managed by the NDIS mental health implementation group, convened by the SA Health Mental Health Strategy Unit, which includes representatives from the commonwealth, state, non-government service providers, SA government mental health workers and service users. As I mentioned in my opening statement, a South Australian NDIS psychosocial disability transition task force has been established, comprising members from SA Health, the LHNs, Department of Human Services, primary health networks, the National Disability Insurance Agency, Lived Experience, community representatives and non-government organisations.

The task force functions are to monitor the impact of the NDIS transition arrangements on both clients and the service providers, with a particular focus on continuity of service to clients to advise on appropriate action to address continuity of service. This will include remedial action necessary by services, programs and jurisdictions to identify future issues that may arise. SA Health, for its part, has extended all non-government mental health service provider agreements from 1 July 2018, on a one plus one year basis, while the full impact of the NDIS is being assessed to ensure that existing services are maintained and continued for those clients who are not eligible for the NDIS.

Mr PICTON: Minister, you just referred to the extension that is being given to providers of mental health for non-government services in the community until, I believe, 30 June 2019—so about nine months away. Does SA Health have, in the forward estimates, provisions for funding to continue those programs?

The Hon. S.G. WADE: I will take that question on notice.

Mr PICTON: So you are not sure whether there is any funding or not in the forward estimates for all of those NGO programs?

The Hon. S.G. WADE: If the member wants an answer, I have undertaken to take it on notice. The answer will come.

Mr PICTON: Does the minister believe that there is a need for those programs after 30 June of next year?

The Hon. S.G. WADE: Currently, for 2018-19, SA Health will provide about $24.7 million for psychosocial services, which the government has endorsed for continuation. Based on current best estimates for the current eligibility criteria, it is estimated that approximately $6 million of this may be allocated for NDIS-eligible clients. This funding will be transferred to the Department of Treasury and Finance as part of South Australia's NDIS commitment to the commonwealth government, leaving around $18.7 million for ongoing mental health clients who require a state-funded NGO service.

Mr PICTON: Just to clarify: the minister does or does not believe that there needs to be those non-government services after 30 June next year when the funding expires?

The Hon. S.G. WADE: Consistent with the answer I have just given, it is my understanding that in the 2019-20 financial year, there will be in the order of $18.7 million for ongoing mental health services.

Mr PICTON: In 2018-19 you said?

The Hon. S.G. WADE: In 2019-20.

Mr PICTON: Are you satisfied that that is enough?

The Hon. S.G. WADE: I will be interested to see whether the mental health services plan has any observations to make on that matter.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 55, Program 2: Health Services. Is the government investing any additional mental health services to help farmers affected by the current drought?

The Hon. S.G. WADE: I am advised that officers of the Office of the Chief Psychiatrist were involved in meetings with officers across government in relation to the response to the challenges in relation to the climatic conditions. The primary response to support the industry, in my understanding, is being led by the Department of Primary Industries and Regions. I will undertake to ask the responsible minister whether they might be kind enough to provide advice to this committee.

The CHAIR: Thank you, minster. The member for Davenport has been waiting for some time.

Mr PICTON: I bet he has.

The CHAIR: He actually has. He has been very well behaved.

Mr MURRAY: There have been 113 questions today, three from here, one of them on the Repat and you are whining like the diff on an old taxi.

The CHAIR: Member for Davenport, if you could just ask your question.

Mr MURRAY: You are unbelievable. Sook. Thank you, Chair. My question refers to Budget Paper 5, page 74. I just want some details on how the Premier's Council on Suicide Prevention will support suicide prevention and postvention services in SA.

The Hon. S.G. WADE: Thank you, member, for the question. In South Australia, the suicide rate is 34.5 people per 100,000. South Australia is the only state where the rate is statistically the same in both country and metropolitan areas. The rate of 13.5 per 100,000 is higher than the national metropolitan average of 11.7 people per 100,000 and lower than the national country average of 15.3 per 100,000. For South Australia, this means we must continue with our effective actions in rural and remote South Australia to seek further reductions, but must intensify our efforts in metropolitan areas.

The government has committed $2.5 million over four years to support the vital work of the state's suicide prevention networks and associated voluntary groups working in postvention—that is, work that aims to reduce the impact of suicide death and mitigate the risk of further related suicide deaths. The Premier's Council on Suicide Prevention will drive the agenda and direction for this election commitment. The Office of the Premier's Advocate for Suicide Prevention has been established within the Department for Health and Wellbeing, and I will ask the Chief Psychiatrist whether he might give us an update on its operation since being established.

Dr BRAYLEY: Certainly. The first meeting of the Premier's Council on Suicide Prevention was held on 27 July 2018, which coincided with the Suicide Prevention Australia National Conference, and the second meeting is scheduled to be convened tomorrow. There are 12 members of the council who represent extensive experience in the field of mental health, suicide prevention, backgrounds in clinical research and academia, medical practice and community outreach service, including people who are on suicide prevention networks.

The Premier's Advocate, the Hon. John Dawkins MLC, will be working with the Commissioner for Public Sector Employment in relation to the development of the suicide prevention issues group which will be chaired by Mr Sam Duluk MP, and include senior officers from all state government agencies. The issues group will feed information into the Premier's Council on Suicide Prevention, and terms of reference have been developed consistent with the Fifth National Mental Health and Suicide Prevention Plan, the SA Mental Health Strategic Plan and the SA Suicide Prevention Plan 2017-21.

The current operations in suicide prevention are based on that Suicide Prevention Plan 2017-21 and include the continued implementation of connecting with people's suicide mitigation training, a comprehensive all of community approach to suicide assessment, mitigation and safety planning, work translating evidence into practice, and empowering communities with suicide prevention networks. There are currently 26 suicide prevention networks established with the eventual aim to have a suicide prevention network in every council region of South Australia. That is the update on suicide prevention at the moment.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 50, System Performance and Service Delivery. I ask the minister whether he still believes his comments last year when he said that bringing strategy into the Chief Psychiatrist's remit 'just undermines the people's confidence that they are being completely independent'.

The Hon. S.G. WADE: It is important to highlight to the committee the importance of the Mental Health Services Plan, which I think will be a very important refocusing on mental health services after a period of a lack of focus. In that context it will be of interest to see whether there are any observations from the group in terms of the governance, particularly in relation to LHN governance of mental health services.

There are also other governance issues which are raised, in my view, particularly by the Oakden report by the Chief Psychiatrist and the ICAC inquiry into the Oakden events which have implications for governance. I certainly believe that we need to make sure that as we refresh the governance framework going forward, we make sure that we minimise conflicts of interest and make sure that we get the balance right now.

There is a range of models that is used for mental health management and mental health oversight around Australia. There is no doubt that, as we look to refresh our governance framework, I will need to not only speak with all relevant officers in my agency but also have discussions with my cabinet colleagues. I am particularly thinking of the Attorney-General and the Minister for Human Services. We have already had discussions in terms of the interface of issues that we face.

For example, the Principal Community Visitor is an office I rely on strongly for mental health oversight. That office will be significantly impacted by the shift to the NDIS, because, as I understand it, the community visitor function for the NDIS will be taken on by the commonwealth disability framework. There will be issues across portfolios that will impact on any steps we take on mental health governance improvement, but I am still of the view that we need to do work in that area.

Mr PICTON: Same budget line, minister. Let me say at the outset: I do not have any problem with you appointing the Chief Psychiatrist to develop and lead the policy and strategy for the SA mental health service plan, but you yourself, minister, last year said that it would undermine public confidence for the Chief Psychiatrist to be involved in strategy. So have you now departed from the view that you held last year, or is there an issue with public confidence in you appointing the Chief Psychiatrist to run the strategy for our mental health services?

The CHAIR: Member for Kaurna, can I just remind you once again that it is not so much about opinions of the minister; it is about delivery and budget line items in the budget that we have open for examination. If there is a specific question in relation to budget and delivery of service, I think that is important; otherwise, the questions are quite broad and once again we will receive a broad answer from the minister.

The Hon. S.G. WADE: The fact of the matter is that what I was trying to inform the committee was that I do regard that interface as an unresolved issue, which I believe needs to be looked at again. I think that consideration should run parallel to the mental health services plan. If the member for Kaurna is suggesting that I should insist that no mental health services planning be undertaken until we are comfortable that the mental health governance framework needs no further refinement, I do not agree.

Mr PICTON: What I am suggesting is that—attaching to the budget—this is the strategy that determines all of our mental health services and strategy and spending across the state. You previously were very critical of the Chief Psychiatrist having an operational, policy, strategy role for our health services when you were in opposition, and as soon as you got into government you have decided to ignore your previous concerns and appoint the Chief Psychiatrist to determine the plan for the whole state.

Mr Ellis interjecting:

The CHAIR: Point of order, member for Narungga.

Mr ELLIS: This is entirely about a previous point made some time ago. It is not even remotely related—

The CHAIR: I do concur. I just remind the member for Kaurna to ask questions in relation to the budget and delivery of budget programs, which is what we are here to examine.

Mr PICTON: So you are not going to answer that?

The Hon. S.G. WADE: To be frank, I think it is a clear misrepresentation of the answers I have previously given.

Mr PICTON: Budget Paper 4, Volume 3, page 46, Investing expenditure summary. What is the status of the government's proposed three older persons mental health facilities in each LHN as promised by your government in its election promises?

The Hon. S.G. WADE: As I mentioned earlier, the consequences of the former government's mismanagement of the Older Persons Mental Health Service meant that last year the Oakden facility was closed, with a significant reduction in the available capacity for older persons mental health services. One of the opportunities that the Marshall Liberal team identified before the election to help redress the impact of that loss of supply was the reactivation of the Repat site. The former Labor government vigorously opposed that proposal right up to the election, and they continue to do that right up to today.

Mr PICTON: Chair, point of order: this is not a question about the opposition. It is a question about whether the government is delivering on its election policies.

The CHAIR: This is the problem we get when we ask broad ranging questions; we get broad ranging answers.

Mr PICTON: It was not a broad ranging question.

The CHAIR: It has been happening all day.

Mr PICTON: It was a specific question about whether this is being delivered or not.

The CHAIR: I am happy to listen to the minister, and if I feel he is out of order, I will so reflect.

The Hon. S.G. WADE: One of the exciting opportunities with the reactivation of the Repat site is to get access to the former Ward 18, which is a purpose-built older persons mental health facility. The consultation with the community in relation to the Repat site I have already referenced in answer to a question from the honourable member for Davenport. That closed, I think, if my mental calendar serves me correctly, nine days ago, and the EOI process two days before that.

The feedback from the Repat consultation will be relevant in terms of plans for that site. The director of the Older Persons Mental Health Service—the statewide service—was actively involved in that process, so I look forward to the work from the Repat feeding into the planning for the older persons mental health services. I expect there will be an opportunity to progress the facility's plan towards the end of this year.

Mr PICTON: When does the minister expect each of those three sites that he has promised to be open?

The Hon. S.G. WADE: I expect to be able to make a further announcement on the development of the older persons mental health services later in the year.

Mr PICTON: So you do not have any estimates at all that you can give the parliament in terms of when those centres will be open?

The Hon. S.G. WADE: As I said, the development of the older persons mental health facility strategy, to use a working title rather than a program name, will be progressed in parallel with the work on the Repat.

Mr PICTON: Do you have any estimate of when work will start on any of those three sites?

The Hon. S.G. WADE: I refer the honourable member to my earlier answer.

Mr PICTON: Do you have any estimate in terms of how much each of those sites will cost?

The Hon. S.G. WADE: I refer the honourable member to my earlier answer.

Mr PICTON: Do you have any estimate in terms of how many beds each of those sites will cost?

The Hon. S.G. WADE: I would refer the honourable member to the Chief Psychiatrist's report in relation to the Oakden facility. He gave some very detailed estimates of forward projections, particularly I think based on the Brodaty model. Those forward projections of population base need were taken up by the—

Mr PICTON: I am aware of the report.

The Hon. S.G. WADE: The honourable member I thought was asking me about population needs.

Mr PICTON: No.

The Hon. S.G. WADE: The projections in the Groves report were taken up by the implementation group, whose reports were released earlier this year.

Mr PICTON: So is the minister saying that for those three sites, for which there is no budget and no estimated time frame for construction or completion, the determination of how many beds is reflected in the Groves report? That is the government's position as to how many beds each of those sites will have?

The Hon. S.G. WADE: I think it is important to appreciate that older persons mental health services going forward will not be delivered solely by the state government. The federal government has made announcements in relation to particularly dementia-related facilities that they are intending to invest in. There is certainly capacity to partner with particularly non-government providers who have experience in this area. We will be continuing to work with a range of stakeholders and other governments to meet the needs of older persons with mental health issues.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 45, Department for Health and Wellbeing, key agency outputs. The government has made commitments in terms of youth treatment orders for young people. How much money has been committed over the forward estimates to delivering on that promise?

The Hon. S.G. WADE: Youth treatment orders is a legislative regime, not a service model. As services are developed, cabinet will make the relevant allocations.

Mr PICTON: So there are zero dollars allocated in the forward estimates for any of the youth detention orders that are part of your election promise?

The Hon. S.G. WADE: I would make the point again that the youth treatment orders regime is a legislative regime, not a service model. The fact of the matter is that youth treatment orders, depending on the legislation finally approved by parliament, if that is its will, will be available both within state government services and beyond. For example, a person with a youth treatment order might be in youth detention.

Mr PICTON: So there is going to be no cost to the health services through that legislation?

The Hon. S.G. WADE: I would refer the honourable member to my earlier response that anticipated cabinet considering resource allocations.

Mr PICTON: Are you making a further submission to cabinet asking for more money for those orders?

The Hon. S.G. WADE: I refer the honourable member to my earlier response.

Mr PICTON: Is there any potential that agencies in the health area will have to find funding from their internal resources to meet these new youth orders?

The Hon. S.G. WADE: I would have to rely on the wisdom of the Chair as to whether that was a hypothetical question. It sounded pretty hypothetical to me.

The CHAIR: It has been the nature of the day; that is okay.

Mr PICTON: I have a question in relation to Budget Paper 4, Volume 3, page 52 and DASSA. Why is the government estimating a decrease in the number of in-patient DASSA sessions from the estimated 2017-18 result?

The Hon. S.G. WADE: I will ask acting state director, Marina Bowshall, to answer that question.

Ms BOWSHALL: Drug and Alcohol Services has a target of 1,600 in-patient separations a year, which we exceeded in the 2017-18 financial year, and the target is 1,600 again for the 2018-19 financial year. That has been a fairly stable target over several years, and we are consistently meeting it.

Mr PICTON: Have there been any budget efficiency savings to DASSA?

The Hon. S.G. WADE: I am advised that DASSA is not being asked to provide efficiency savings in this financial year.

Mr PICTON: What about future financial years?

The Hon. S.G. WADE: My presumption is that they would not be in a position to answer that at this time.

Mr PICTON: I ask in terms of Budget Paper 4, Volume 3, page 55, health services, is the minister satisfied with the uptake in terms of mental health clients into the NDIS?

The Hon. S.G. WADE: No, I am not. I have real concerns that NDIS could do better in terms of timely assessments. I have certainly had concerns expressed to me that NDIA is underestimating the level of disability that people with mental health issues are experiencing.

Mr PICTON: What action have you taken following those concerns?

The Hon. S.G. WADE: I refer the honourable member to my earlier answers where I talked about the fact that I had raised the issue in the COAG Health Council and that I have asked the Chief Psychiatrist to chair, in shorthand form, the NDIS transition task force.

Mr PICTON: How many mental health clients in our hospitals or other health services should be being looked after by the NDIS at this moment?

The Hon. S.G. WADE: I do not have figures on that specifically. I will take that on notice.

Mr PICTON: In relation to Budget Paper 5, page 76, borderline personality disorder service, can the minister confirm that no extra additional funding has been allocated to this and that it is having to be found from existing resources and therefore, presumably, cuts to other services?

The Hon. S.G. WADE: I am advised that all of the allocation for borderline personality disorder is new money to mental health, but not necessarily new to health.

Mr McBRIDE: The topic is South Australian Mental Health Commission, Budget Paper 4, Volume 3, pages 53 and 54. What have been the main achievements of the South Australian Mental Health Commission since the release of the South Australian Mental Health Strategic Plan 2017 to 2022 late last year, and what work does the commission have planned going forward?

The Hon. S.G. WADE: I thank the honourable member. I might ask the Mental Health Commissioner, Chris Burns, who is with us today, if he might address that question.

Mr BURNS: The Mental Health Commission, on the back of significant consultation with 2,200 South Australians, developed the Mental Health Strategic Plan for the state, which was delivered in late December last year. On the back of that plan we have now committed to running a series of activities, which includes a pilot project known as SMS4dads South Australia, a project to support new and expectant fathers in terms of anxiety and depression that they experience during that period.

We have also run a series of forums with industry leaders, with media and in this house, with politicians and their staff, to help them understand the language around mental health and suicide, but also to focus on self help and how to help their colleagues. We co-convened just recently the mental health services conference—a major international conference held here in Adelaide—and we have done activities with the South Australian National Football League and the AFL through the Crows.

We have done a lot of work around mental health first-aid courses, and within the Public Service employment agreement now there is a requirement for the number of mental health first-aiders in the workplace to equal the number of St John first-aiders. We have launched the inaugural older persons mental health first-aid course in South Australia.

We are also working with Bowls SA about how we get the message of mental health and mental health fitness throughout the state. In terms of the future, we are now focused very much on working with the Chief Psychiatrist on the development of the mental health services plan. We are working with the National Mental Health Commission on a mental health leadership fellowship, which will see people come from around the country here to South Australia, and South Australians go to other states to develop leadership in this space. We are conducting an audit of workplace mental health initiatives that are being conducted within the state, and we are doing a lot of work around developing a professionalised peer workforce.

The Hon. S.G. WADE: I thank the commissioner for his answer.

The CHAIR: Minister, is there anything you would like to add to that?

The Hon. S.G. WADE: I would like to add to an earlier answer I gave. In relation to the BPD service, in the forward estimates it is currently budgeted at $13.5 million. Of that, $7.4 million is SA Health repurposed funding. Thank you, Chair, for your indulgence.

Mr PICTON: Further to the line on the SA Mental Health Commission, regarding Budget Paper 4, Volume 3, page 53, has the government committed funding over the forward estimates to continue the Mental Health Commission?

The Hon. S.G. WADE: I am advised the Mental Health Commission is in the forward estimates.

Mr PICTON: Has the government got a commitment to continue the Mental Health Commission over the next four years?

The Hon. S.G. WADE: We have no plans to abolish the Mental Health Commission, if that is what the honourable member is asking.

Mr PICTON: Has the government got any plans to legislate for an independent mental health commission?

The Hon. S.G. WADE: I refer the member to my earlier answers which were in relation to what I see as the need to refresh the mental health governance framework. One of the options in that regard would be to establish the Mental Health Commission as a freestanding statutory authority. I note that the former Labor government chose not to do that when the Mental Health Commission was first established. There are a range of models of mental health commissions operating across Australia and I know that our Mental Health Commissioner is a regular participant in a forum of mental health commissioners. As I said, I believe as a minister, and I am talking to my other colleagues, that in the wake of Oakden we should take the opportunity to ensure that our oversight framework is as robust as possible.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 63 regarding SALHN and the 2018-19 target to establish Repat services. I also wonder if the minister can confirm that the government's election promise is for two mental health services on the site, as follows:

We will…use Ward 18 as an older persons' mental health facility to provide accommodation for people who until recently would have been admitted to Oakden…Build a new older persons' mental health facility for people with Tier 7, extreme BPSD (behavioural and psychological symptoms of dementia).

The Hon. S.G. WADE: I refer the honourable member to my earlier answer in that the development of the plan for older persons' mental health will interact with the plan for the Repat site itself. I would almost add to the challenges that are highlighted in the pre-election comments because I think it is becoming increasingly clear that we need to specifically provision services for people with enduring mental illness. People with enduring mental illness have significantly different care needs to people with behavioural and psychological symptoms of dementia, and we need to be ensuring that we provide a range of services for the range of challenges that people face.

Mr PICTON: I ask why you are reactivating the Repat discussion paper. It seems to have these two separate election commitments for two separate facilities merged into one. Is that just a drafting error in the document that has been provided to the public, or does this reflect that the government is now breaking what its promise was originally to build two separate services and now is going to merge them into one mental health service?

The Hon. S.G. WADE: I will certainly have a look at the document that the honourable member refers to and, if I need to clarify it, I will provide an explanation to the committee. In terms of broken promises, I can assure that we never promised to never ever close the Repat. It was your former government that promised that and broke it in spite of the ongoing opposition—

Mr PICTON: Point of order, Chair: there was a very specific question in terms of the discussion paper and talking about the opposition is not within standing orders.

The CHAIR: I remind the minister that obviously we are looking at the budget, but if I could just remind everyone, given there are the 2017-18 estimated results within our budget lines, it is pertinent to talk about what happened in last year's financial year compared to this year's financial year. Minister, please continue.

Mr PICTON: What a fair and impartial chair you are!

The CHAIR: That is a line that the member for Florey once imposed on me when I was asking questions and she was in the chair.

Ms BEDFORD: You are not reflecting on a ruling I made some years ago? Is that allowed?

The CHAIR: It is a ruling that is sound and to be upheld. Minister, please continue your answer.

The Hon. S.G. WADE: I would make the point that it is a bit rich for the honourable member for Kaurna to try to compare and contrast a pre-election Liberal Party document—

Mr PICTON: Point of order. This is a very specific question in terms of what the government is proposing to do in its budget.

The CHAIR: Thank you, member for Kaurna. The question was about services at the Repat and the minister is answering regarding services at the Repat. I think it is entirely appropriate and germane.

The Hon. S.G. WADE: I reiterate the earlier answer I gave, which is that the planning for the development of facilities for older persons mental health services is continuing in parallel with the planning for the reactivation of the Repat site.

Mr PICTON: The paper talks about trying to receive expressions of interest from public providers to take on an older persons mental health facility. Has the government received any such expressions of interest? What will you do if you receive no such expressions of interest: will you commit government funding or will you not establish the facility?

The Hon. S.G. WADE: Chair, I do not know what the practice of the member's house is, but that sounded remarkably like two questions to me.

The CHAIR: The question is in order.

The Hon. S.G. WADE: It is somewhat hypothetical. Whilst I have received a broad preliminary indication of the expressions of interest, I have not received the evaluation from that expressions of interest process. I look forward to seeing what options come forward. Certainly I would be hopeful that there would be organisations with expertise in older persons mental health services that would partner with us on that site.

Mr PICTON: Has the minister received any estimates from his department about what the cost would be of retrofitting Ward 18 as a tier 7 facility?

The Hon. S.G. WADE: I will take that on notice.

Mr PICTON: When will construction commence on the tier 7 facility?

The Hon. S.G. WADE: I will continue to refer the member to my earlier answers.

Mr PICTON: So you do not know?

The Hon. S.G. WADE: I will continue to refer the member to my earlier answers.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 46. On what date is the government going to release the first progress report against the recommendations of the Oakden Oversight Committee?

The Hon. S.G. WADE: I am advised we are expecting the next report late this year, probably December.

Mr PICTON: I refer to Budget Paper 5, page 74, and additional suicide prevention services. Why did the minister not increase the budget and FTE position under this new budget measure to add a staff member dedicated to the suicide prevention council?

The Hon. S.G. WADE: Would the member mind stating that question again?

Mr PICTON: Why did the minister not increase the budget and FTE position under this new budget measure to add a staff member dedicated to the suicide prevention council, instead of adding it to his ministerial office? Why was this not part of this budget measure for the department and why has that staff member gone to your ministerial office instead?

The Hon. S.G. WADE: I am advised that there are two relevant FTEs: one funded from the $2.5 million over the next four years, although the council only has a lifespan of two years, and another from ministerial office funding. My understanding is that those decisions were made at a Treasury level, and you might want to ask that question of the Treasurer.

Mr PICTON: Do you think it is a bit odd to have the staff member for the suicide prevention council as part of your political office rather than as part of the department serving what I would have thought is an important service and council for the whole state?

The Hon. S.G. WADE: The honourable member has misconstrued the nature of the office. The person who supports the Premier's suicide prevention council is not a political operative in my office. In fact, they are not even located in my office.

Mr PICTON: They are located in your office in the budget, so where physically are they located?

The Hon. S.G. WADE: I am advised that they are located in the health department building.

Mr PICTON: So is it not a bit odd to have a staff member allocated in the budget papers to your office, who is not actually in your office?

The Hon. S.G. WADE: These decisions are made at Treasury level and far be it from me to express what is an oddity and what is not.

Mr PICTON: Who is this staff member responsible to? Are they responsible to you, given they are in your office?

The Hon. S.G. WADE: It is clear that the person's role is to support the Premier's suicide prevention council, which is part of my department. As I said, one of the officers is funded through the ministerial office.

Mr PICTON: Does this person involve themselves in staff meetings in your office?

The Hon. S.G. WADE: No.

Mr PICTON: Are they involved in political discussions in your office?

The Hon. S.G. WADE: I refer the honourable member to my earlier answer. I have an ongoing dialogue with the Hon. John Dawkins in his role as the Premier's Advocate for Suicide Prevention, and incidental engagement with his staff in that context. Suicide prevention is a high priority for this government and we will continue to demonstrate that commitment, both through the work of the council and the work of the issues group.

Mr PICTON: Just for clarity, does this person report to you, your chief of staff, to the chief executive of the department or to the Hon. John Dawkins?

The Hon. S.G. WADE: The primary reporting line of this person is to the Premier's Advocate for Suicide Prevention, who is the chair of the Premier's suicide prevention council.

Mr PICTON: Is there a precedent for a backbench member of parliament who has no executive appointment from the Governor to be responsible for a public servant and be the direct reporting line for a public servant?

The CHAIR: Just a point of clarification: the minister is not responsible for backbench members. As such, once again, the minister if he chooses and is happy to can answer that question, but he is under no obligation to answer that question.

The Hon. S.G. WADE: It was a very broad question and considering I am not a historian of the South Australian executive, I do not propose to answer it.

Mr PICTON: Just for absolute clarity, you are saying that the Premier's Advocate for Suicide Prevention, who is a backbench government MP, has the direct supervisory role over a public servant who is accountable under the Public Sector Act?

The CHAIR: Member for Kaurna, I have previously indicated that the minister is not responsible for—

Mr PICTON: Well, he is responsible for the suicide council, and he is responsible for staff members within his own office.

The CHAIR: He is not responsible for the oversight of a member of what is commonly known as the backbench.

Mr PICTON: Chair, with respect, this person is allocated to the minister's own office. He is responsible for his own office.

The CHAIR: I am just advising what the minister is and is not responsible for.

The Hon. S.G. WADE: I think the honourable member is misunderstanding the nature of the role. One of the FTEs is funded through the ministerial office; ipso facto, they are not employed under the Public Sector Management Act. I will certainly take it on notice, and if the advice I have just given you is incorrect, I will advise the committee accordingly.

Mr PICTON: So they have a political contract with the Premier and they are not a public servant; is that right?

The Hon. S.G. WADE: The person is employed. One of the FTEs who supports the Premier's suicide prevention council is a person who is employed under the minister's office budget. My understanding, as I said, is that they are not a public servant in the normal sense, but I will seek advice to make sure that that advice is accurate.

Mr PICTON: Minister, you and I both have some experience in this as former ministerial advisers and chiefs of staff, back in the day. As you would be aware, people are either public servants under the Public Sector Act and are accountable to the chief executive, or they are political appointments with a contract to the Premier and responsible to their minister and undertake political activities. What you are saying is that this person, who is nominally there to provide for the suicide council and who you are saying is not political, is on a political contract and is responsible to the Hon. John Dawkins.

The CHAIR: Member for Kaurna, the minister has indicated quite a few times that he will take these questions on notice, seek clarification and report back to the committee in a timely manner. I am happy to go down this line if the minister proceeds, but I am letting you know that, by and large, the questions are out of order.

The Hon. S.G. WADE: I appreciate the creativity of the member being able to ask the same question in so many different ways, but I will choose to provide the same answer to the same question.

Mr PICTON: That is so dodgy. In reference to Budget Paper 4—

The CHAIR: Member for Kaurna, I ask you to withdraw that statement.

Mr PICTON: I withdraw it, Chair. Budget Paper 4, Volume 3, page 64, SALHN targets, under the dot point beginning 'Commence Adult Community Mental Health reform'. By what date will SALHN implement the recommendations from the review of community mental health services?

The Hon. S.G. WADE: I need to take that question on notice.

Mr PICTON: Will SALHN be publishing progress reports against the recommendations as they progress through their reforms?

The Hon. S.G. WADE: I will take that on notice.

Mr PICTON: We might do the omnibus questions now, if that is alright?

The CHAIR: If you wish, member for Kaurna.

Mr PICTON: I think the member for Wright is very keen.

The CHAIR: Member for Wright, step up.

Mr BOYER: Thank you. I am very pleased indeed at the opportunity.

The CHAIR: One day you will be a shadow, too.

Mr BOYER: May I get straight into it, Chair?

The CHAIR: Yes, please.

Mr PICTON: You could get a job from the Hon. John Dawkins.

The Hon. S.G. WADE: You are not a shadow. Are you not an assistant shadow?

Mr BOYER: I am an assistant shadow.

The Hon. S.G. WADE: I think it is a reflection on the honourable member; he is an assistant shadow.

Mr BOYER: In that case, do I get a staffer, too? That is how we are doing it now.

The CHAIR: You get two FTEs and a trainee. Ask your omnibus questions.

Mr BOYER: I will put my hand up. No worries.

1. Will the minister provide a detailed breakdown of expenditure on consultants and contractors with a total estimated cost above $10,000, engaged between 17 March 2018 and 30 June 2018 by all departments and agencies reporting to the minister, listing the name of the consultant, contractor or service supplier, the estimated total cost of the work, the work undertaken and the method of appointment?

2. Will the minister provide a detailed breakdown of the forecast expenditure on consultants and contractors with a total estimated cost above $10,000 for the 2018-19 financial year to be engaged by all departments and agencies reporting to the minister, listing the name of the consultant, contractor or service supplier, cost, work undertaken and method of appointment?

3. For each department and agency for which the minister has responsibility:

(a) How many FTEs were employed to provide communication and promotion activities in 2017-18 and what was their employment expense?

(b) How many FTEs are budgeted to provide communication and promotion activities in 2018-19, 2019-20, 2020-21 and 2021-22, and what is their estimated employment expense?

(c) The total cost of government-paid advertising, including campaigns, across all mediums in 2017-18 and budgeted cost for 2018-19.

4. For each grant program or fund the minister is responsible for please provide the following information for the 2017-18, 2018-19, 2019-20, 2020-21 and 2021-22 financial years:

(a) The name of the program or fund;

(b) The purpose of the program or fund;

(c) Balance of the grant program or fund;

(d) Budgeted (or actual) expenditure from the program or fund;

(e) Budgeted (or actual) payments into the program or fund;

(f) Carryovers into or from the program or fund;

(g) Details, including the value and beneficiary, of any commitments already made to be funded from the program or fund; and

(h) Whether the grant was subject to a grant agreement as required by Treasurer's Instructions 15.

5. For the period of 17 March 2018 and 30 June 2018, provide a breakdown of all grants paid by the department/agency that report to the minister, including when the payment was made to the recipient, and when the grant agreement was signed by both parties.

6. For each department and agency reporting to the minister:

(a) The total number of FTEs in that department or agency;

(b) The number of FTEs by division and/or business unit within the department or agency; and

(c) The number of FTEs by classification in each division and/or business unit within the department or agency.

7. For each department and agency reporting to the minister, could you detail:

(a) How much is allocated to be spent on targeted voluntary separation packages in 2018-19?

(b) How many of the TVSPs are estimated to be funded?

(c) What is the budget for TVSPs for financial years included in the forward estimates (by year), and how are these packages to be funded?

8. For each department or agency reporting to the minister in 2018-19 please provide the number of public servants broken down into headcount and FTE's that are (1) tenured and (2) on contract and, for each category, provide a breakdown of the number of (1) executives and (2) non-executives.

9. Between 30 June 2017 and 17 March 2018, will the minister list the job title and total employment cost of SA executive positions—(1) which has been abolished and (2) which has been created?

10. Between 17 March 2018 and 30 June 2018, will the minister list the job title and total employment cost of SA executive positions—(1) which has been abolished and (2) which has been created?

11. For each year of the forward estimates, please provide the name and budget for each individual program administered by or on behalf of all departments and agencies reporting to the minister.

12. For each year of the forward estimates, please provide the name and budgeted expenditure across the 2018-19, 2019-20, 2020-21, 2021-22 financial years for each individual investing expenditure project administered by or on behalf of all departments and agencies reporting to the minister.

13. For each department or agency reporting to the minister how many surplus employees are there at 30 June 2018 and for each surplus employee, what is the title or classification of employee and the total cost of the employee?

The CHAIR: Thank you very much, member for Wright. With that, I declare the examination of the proposed payment for the portfolio of SA Health, Mental Health and Substance Abuse, and the estimate of payment for the South Australian Mental Health Commission completed.

Departmental Advisers:

Dr C. McGowan, Chief Executive, SA Health.

Mr D. Frater, Deputy Chief Executive, SA Health.

Ms J. Walters, Acting Executive Director, Policy and Governance, SA Health.

Mr D. De Cesare, Acting Chief Finance Officer, SA Health.

Mr A. Knez, Manager, Executive Services and Projects, SA Health.

The CHAIR: Moving on to the portfolio of the Office for the Ageing, with the minister appearing being the Minister for Health and Wellbeing. I declare the proposed payment open for examination and refer members to the Agency Statements, Volume 3. I ask the minister to please introduce his advisers and, if he wishes to, to make a short statement.

The Hon. S.G. WADE: Thank you, Mr Chair. I introduce Ms Jeanette Walters, Acting Executive Director, Policy and Governance, SA Health, to my right. To my left is Dr Chris McGowan, Chief Executive, SA Health. We are also joined by Mr Don Frater, Deputy Chief Executive, SA Health, Mr Andrej Knez, Manager, Executive Services and Projects, SA Health, and Mr Danny De Cesare, Acting Chief Finance Officer, SA Health.

The Office for the Ageing, soon to be renamed the office for ageing well if legislation is passed by parliament, leads a range of policy initiatives at the system, community and individual level that support older South Australians to age well. Our goal is to create an age-friendly South Australia, ensuring that older South Australians feel valued and can participate in all aspects of life as they age.

In 2018, the Office for the Ageing has been undertaking an age-friendly government services resource and training pilot project to improve the customer experiences of older people who access a range of government services. Aligned to the Marshall government's commitment to combating ageism through challenging the way ageing is framed in the language and structure of the services our government delivers, this project will support older people using government services to feel valued, listened to and have a dignified experience.

To ensure the resources and training are relevant across a range of government service settings, representatives from a number of South Australian government departments have been involved with a group of older age-friendly volunteer advisers in codesigning and pilot testing the resources and training materials. In addition to the age-friendly resources and training materials being developed through this project, raising awareness about the rights of older South Australians complements other work being undertaken by the Office for the Ageing to promote and safeguard the rights of older South Australians.

On World Elder Abuse Awareness Day I launched the Stop Elder Abuse public awareness campaign, which ran for eight weeks from June to August 2018 and included advertisements on radio, in newspapers, on bus shelters and on the backs of Adelaide Metro buses. In addition to the general community, the 2018 campaign particularly focused on raising awareness amongst people working in the banking and real estate industries about the signs of elder abuse.

In 2018, the Office for the Ageing will continue to deliver the Stop Elder Abuse public awareness campaign, with a focus on sharing the message with financial planners and hairdressers as well as the general community. However, raising awareness is only the first step which is why in the lead-up to the state election in March the Marshall team made a commitment to introduce adult safeguarding legislation into parliament as an early priority.

The Office for the Ageing (Adult Safeguarding) Amendment Bill 2018, developed in close consultation with Professor Wendy Lacey, the dean and head of the Law School at the University of South Australia, is the first legislation of its kind in Australia. The bill provides for the establishment of an adult safeguarding unit with statutory responsibility and accountability for responding to reports of abuse or neglect of vulnerable adults and builds on the work already being undertaken in this area by the Office for the Ageing in raising community awareness of elder abuse, awareness of the rights of older people, and building age-friendly communities and services.

Following the bill's passage through parliament, the newly named office for ageing well will work with key stakeholders across government, non-government and the community to develop regulations to support the act, as well as a code of practice and charter of the rights and freedoms of vulnerable adults. Consolidating partnerships across government and the non-government organisations and engaging our older Australians in the decisions that affect them is an important component of all the work undertaken by the Office for the Ageing. That is why, in 2018, the Office for the Ageing partnership partnered with the Australian Centre for Social Innovation to conduct its second statewide conversation with older South Australians to find out what matters most to older people when it comes to ageing well.

The voices of more than 1,500 people were heard through more than 80 community conversations and over 1,200 survey responses, which included people from disadvantaged, culturally and linguistically and gender diverse and Aboriginal backgrounds, as well as those living in regional areas. In 2018-19, the office for ageing well will use the outcomes of these statewide conversations to guide the development of the next state ageing plan which will outline the state government's vision for ageing well over the next five years. This work will focus on the key themes of the home and community, navigating and managing change and meaningful connections which emerged strongly from the conversations.

Another important way the office for ageing well works with and for older South Australians is through the administration of the South Australian Seniors Card program which provides around 380,000 older South Australians with a range of benefits, including public transport concessions, local business discounts and offers and access to information. I would like to take this opportunity to thank the staff of the office and our broad range of partners, including older persons themselves who are collaborating to ensure that current and future older South Australians are in the best position to age well.

The CHAIR: The member for Kaurna may have an opening statement. If you do not, a question.

Mr PICTON: I will forgo the opening statement but note my disappointment at another opening statement from the minister. Budget Paper 4, Volume 3, page 50, System Performance and Service Delivery—I understand is where the office sits. There is no separate line despite the separate line in estimates so all the questions will be about that. On what basis did the minister cut funding to ethnic ageing grants?

The Hon. S.G. WADE: From 1 January 2019 the ethnic ageing grants program will be refocused to ensure that ageing well initiatives and safeguarding information engage older people from a broader range of culturally and linguistically diverse communities to reflect the diversity of South Australia's older population. Approximately 25 per cent of older South Australians were born in non-English-speaking countries. Under the ageing well and CALD communities grant program, $30,000 per annum will be provided to the five current recipients that support three cultural groups, those being the Italian, Greek and Polish communities. Current recipients will receive 50 per cent of their existing funding from July to December 2018, and $15,000 from 1 January to 30 June 2019.

Under this new grants program the Multicultural Communities Council of South Australia will also receive a $60,000 per annum grant to expand the program to a broader range of ageing CALD communities. The government's objective in these changes is to increase the access to a broader range of South Australians from culturally and linguistically diverse communities.

Mr PICTON: Previously, how many organisations received funding? How much funding did they each receive?

The Hon. S.G. WADE: In relation to the Associazione Nazionale Famiglie degli Emigrati Inc., in 2017-18, they received $85,000. I am advised that in the financial year we are currently in they will receive $58,500. In relation to the Federation of Polish Organisations in South Australia, I am advised that they received $56,000 in 2017-18 and will receive $43,500 this financial year. In relation to the Co-ordinating Italian Committee Inc., I am advised that they received $50,000 in 2017-18 and will receive $40,500 in the current financial year.

In relation to the Greek Orthodox Community of SA Inc., I am advised that they received $29,000 in the 2017-18 financial year and will receive the same amount in the current financial year. In relation to the Greek Welfare Centre, I am advised that they received $66,000 in the 2017-18 financial year and that they will receive $48,500 in the current financial year. As I said earlier, the Multicultural Communities Council of South Australia was not previously receiving a grant under this program and will, going forward.

Mr PICTON: Is that the extent in terms of the cuts? Will the 2018-19 grant figures for those organisations carry through to 2019-20 and so forth, or will they continue to reduce?

The Hon. S.G. WADE: I would refer the member to my earlier answer, which talked about future funding.

Mr PICTON: Sorry, so what will their funding be for 2019-20?

The Hon. S.G. WADE: I have already answered that in my earlier answer.

Mr PICTON: I thought you were talking about 2018-19.

The Hon. S.G. WADE: My initial answer, as I understand it, advised that ongoing they will receive $30,000 per annum.

Mr PICTON: Okay. So for each organisation there is a step down in 2018-19, and then they will all go down to $30,000 from 2019-20 and onwards?

The Hon. S.G. WADE: I would refer the honourable member to my earlier answer.

Mr PICTON: Did the minister consult with any multicultural organisations prior to these cuts to the grants?

The Hon. S.G. WADE: I am advised that the Office for the Ageing over time has had discussions with a range of stakeholders about the need to make this grants program more contemporary. For the information of the honourable member, there is a significantly large number of communities in South Australia beyond the three that are the focus of the current program.

Mr PICTON: So this would not have been any surprise to those organisations at all? They would have been expecting this to happen?

The Hon. S.G. WADE: I do not answer for organisations. I am at a loss to know how I can answer whether or not an outside organisation would be surprised.

Mr PICTON: How much money is the government saving in 2018-19 and 2019-20 in total through these cuts?

The Hon. S.G. WADE: I am advised that, in 2018-19, the relevant amount is $36,500 and, in 2019-20, it is a figure of $73,000.

Mr PICTON: What is the total grant funding set aside for Ageing Well and other grants pertaining to the ageing portfolio in 2018-19, and how does that compare with 2017-18?

The Hon. S.G. WADE: The net cost of services for the Office of the Ageing for the 2018-19 financial year is budgeted at $4.5 million, representing a $0.6 million increase from the 2017-18 estimated result primarily associated with the 2018-19 state budget funding for the Adult Safeguarding Unit. In relation to the grant programs, I will undertake to obtain information for the honourable member and provide it to the committee.

Mr PICTON: Between 2017-18 and 2019-20, have there been any changes to the grant pool allocated to the Age Friendly SA grant round and the Grants for Seniors and Positive Ageing Grant programs? If so, what have been the changes?

The Hon. S.G. WADE: I am advised that there have been no changes.

Mr PICTON: When are the Positive Ageing Grants and the Grants for Seniors likely to open, noting that the 2017 round of both of those programs opened in mid-August, so it is already a month later than last year?

The Hon. S.G. WADE: I will ask the acting executive director of policy and governance to answer that question.

Ms WALTERS: The opening date for those grant rounds has yet to be determined, but it will be happening this calendar year. It is adjusted on a year by year basis, so each year there are slightly different opening times depending on other activities that are underway.

Ms BEDFORD: I refer to Budget Paper 5, page 86, which talks about the new Adult Safeguarding Unit. I wonder how that is going to work and how it might interface with federal government bodies around aged care and instances of elder abuse. How is it going to work?

The CHAIR: Once again, as I have advised the member for Kaurna, member for Florey, this question with regard to interface with the federal government is broad. Obviously, the minister is not responsible for the administration of federal projects, but I am sure he is happy to take the question.

Ms BEDFORD: I am sure he has an idea of how he sees it working. I guess I am trying to find out whether it will interface at all with federal government bodies.

The Hon. S.G. WADE: I am somewhat constrained at a couple of levels because I think the member's question draws in clusters of issues. One is how it is going to operate, which is your fundamental issue, but at the same time the chamber you are sitting in currently has before it the adult safeguarding bill, so I can only answer in the context of the government's proposed bill, and I would not want to presume on the consideration of this place or the other place.

In relation to the ongoing reforms at the federal level, first of all, there are the waves of reforms that the federal government initiated in response at least in part to the Oakden experience. Secondly, the federal government has announced a royal commission into commonwealth aged care. In fact, the state government has been asked to provide terms of reference to that royal commission. This is a dynamic area.

I would make the point that the adult safeguarding unit is a response to the recommendations of the Closing the Gap report in 2011, which was reiterated in the more recent report, which I think was made last year, of the Australian Law Reform Commission in relation to elder abuse, both of which recommended vulnerable adults type legislation, and it was certainly a priority of the incoming Marshall government that we would establish such a unit.

As I said, I think in my opening statement, we were committed to tabling the legislation in the first 100 days, and we did that. Following the passage of the legislation through the parliament, the newly named office for ageing well will work with key stakeholders across government, non-government and the community to develop regulations to support the act, as well as a code of practice and a charter of the rights and freedoms of our vulnerable adults.

As the bill creates a legislative obligation to respond to all reports of abuse or suspected abuse that are made to the adult safeguarding unit, further consultation will be undertaken with the relevant stakeholders to explore key issues, in particular the process of individual case management and referrals, how the relevant agencies see the legislation working with their existing remit and the capabilities so as not to duplicate effort and information sharing.

My expectation would be that in the context of that work, there would be discussion with commonwealth agencies. There is no doubt that there would be reports made to the state agency in relation to people who are residing in commonwealth aged-care facilities. Whether the abuse relates to the actions of the person who is providing the residential aged care or, for example, a member of their family who is abusing them while they are a resident of residential aged care, the potential for interface is significant.

The government is strongly anticipating that the office will take a coordination role between state government agencies, and I would hope that sort of cooperation would also happen with commonwealth government agencies. I suppose, just as the Health and Community Services Complaints Commissioner interfaces with other bodies such as AHPRA, we would expect the adult safeguarding unit to work cooperatively with federal government agencies.

Mr BOYER: I refer the minister to Budget Paper 4, Volume 3, page 50. Given the disproportionately high number of older citizens who use Service SA centres, what advice did the office for ageing well provide to the new government on the planned closure of three Service SA centres in the metropolitan area before that decision was made?

The CHAIR: Member for Wright, the minister before us is not responsible for Service SA. I believe that is minister Knoll, who is appearing before Estimates A on Thursday, so if you have questions about Service SA, I suggest you go down there.

Mr BOYER: Point of order.

The CHAIR: No, there is no point of order. I have not finished. As I have said all day and all week, should the minister choose to answer, he is allowed to. I have given the ministers latitude all day, which allows you the opportunity for your question to be answered, but I remind you that the minister is not responsible for Service SA.

The Hon. S.G. WADE: I reiterate the point I made earlier that budget considerations are traditionally confidential. I intend to respect that.

Mr BOYER: I refer to the same budget line again, Budget Paper 4, Volume 3, page 50. Minister, was your agency in this respect, the office for ageing well, consulted about the decision that your government has made to close Service SA centres?

The Hon. S.G. WADE: I refer the member to my earlier answer.

Mr PICTON: I refer to the same budget line. How much money is the government saving by defunding the Radio for the Third Age?

The Hon. S.G. WADE: The member includes an incorrect assertion. The money is being transferred, not cut. The elder protection grant of $44,000—

Mr Picton interjecting:

The Hon. S.G. WADE: Sorry, if members want answers, they might let me provide one. The elder protection grant of $44,000 provided to the Radio for the Third Age will be reallocated to the Aged Rights Advocacy Service to support older South Australians at risk of, or experiencing, elder abuse.

Mr PICTON: What was it about the Radio for the Third Age that made you decide to reallocate that funding away from it?

The Hon. S.G. WADE: The Radio for the Third Age was funded under an elder protection grant, and the Office for the Ageing believed that there was a need to strengthen the provision of services with a specific focus on older Aboriginal communities, and in that context ARAS was identified as an appropriate agency to deliver that enhanced service.

Mr BOYER: Again, I refer the minister to Budget Paper 4, Volume 3, page 50. What work is the office for ageing well doing to make sure that age appropriate services are retained for citizens who may not be inclined to use the internet?

The Hon. S.G. WADE: I will not ask the honourable member whether the former member for Heysen, Isobel Redmond, put him up to this question, but it has certainly been a concern of a number of members over time that, whilst we need to make sure that our services are more accessible, we should not in the process deprive people who are less able to engage with technology to get access.

In 2017-18, the Office for the Ageing allocated $22,500 to undertake a project to develop resources and training to improve the customer experience of older people who access a range of government services. It is a project that is aligned to the state government's commitment to combat ageism by challenging the way ageing is framed in the legislation and structure of government services, so work is aimed to ensure that resources and training are relevant across a range of government settings and aligned with current staff orientation and training.

The project has worked in collaboration with age-friendly local government providers, including the cities of Unley, Salisbury and Onkaparinga, to recruit and support a group of older people who are age-friendly volunteer advisers to the project. Their role is to bring their own experience of government services and that of their peers to the codesign process. Consultation with a selection of key government stakeholders to codesign the age-friendly government resources and training materials was conducted to ensure relevance across a range of government customer service settings.

The Office for the Aging pilot tested the codesign tools and resources with Housing SA and the Department of Planning, Transport and Infrastructure to further refine the draft resources and training approaches, and recommendations for broader implementation across government services will be developed. I was going to ask the acting executive director whether she might add to that answer.

Ms WALTERS: Following a successful pilot program in the Riverland in 2017-18, Office for the Ageing partnered with public library services, Service SA and Telstra to deliver the Tech Savvy Seniors South Australian program throughout regional South Australia, providing free digital literacy training to older residents to encourage them to embrace information technology and improve their digital skills. This engaged with 2,250 people over 543 sessions.

The Hon. S.G. WADE: So the government is both helping older South Australians to access technology but also trying to remind state government providers that they need to ensure that their services remain accessible.

The CHAIR: It being 5.15pm, I declare the examination of the proposed payments for the portfolio Office for the Ageing and the estimate of payments for the Department for Health and Wellbeing completed.

At 17:15 the committee adjourned to Wednesday 26 September 2018 at 09:00.