Department for Health and Wellbeing, $5,513,116,000

Commission on Excellence and Innovation in Health, $5,962,000

Wellbeing SA, $20,915,000

Membership:

Mr Picton substituted for Mr Gee.

Mr. T.J. Whetstone substituted for Mr McBride.

Hon. A. Koutsantonis substituted for Mr Szakacs.

Ms Stinson substituted for Mr Boyer.

Minister:

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

Departmental Advisers:

Dr C. McGowan, Chief Executive, Department for Health and Wellbeing.

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

Mr D. Frater, Deputy Chief Executive, System Leadership and Design, Department for Health and Wellbeing.

Ms J. TePohe, Deputy Chief Executive, Corporate and System Support Services, Department for Health and Wellbeing.

Mr T. Packer, Director, Capital Projects, Department for Health and Wellbeing.

The CHAIR: Welcome back to Estimates Committee B. In this afternoon's session, we will be examining proposed payments in relation to the portfolio of SA Health. First, I will make some opening remarks, given we have a new minister and new advisers. The estimates committee is a relatively informal procedure and, as such, there is no need to stand to ask or answer questions.

I understand that the minister and the lead speaker for the opposition have agreed to an approximate time for the consideration of 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 previously distributed is accurate.

Mr PICTON: From my perspective, I would suggest that, given the current COVID emergency, it would be appropriate to spend more time on the Department for Health in the health general section, if that were agreeable to the government.

The Hon. S.G. WADE: My understanding is that the representatives of the government and the opposition have agreed to the schedule. I propose we honour those commitments.

The CHAIR: The minister has proposed that the commitments that have been entered into and agreed stay the same in terms of the timetable. From my perspective, that will be the case, unless there is any further objection.

Changes to committee membership will be notified as they occur. Members should ensure that the Chair is provided with a completed request to be discharged form. If the minister undertakes to supply information at a later date, it must be submitted to the Clerk Assistant via the answers to questions mailbox no later than Friday 5 February 2021.

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

A member not on 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 or referenced. Members unable to complete their questions during the proceedings may submit them as questions on notice for inclusion in the assembly Notice Paper.

There is no formal facility for the tabling of documents before the committee; however, documents can be supplied to the Chair for distribution to the committee. The incorporation of material in Hansard is permitted on the same basis as applies in the house, that is, that it is purely statistical and limited to one page in length.

All questions are to be directed to the minister, not to the minister's advisers. The minister may refer questions to advisers for a response. The committee's examinations will be broadcast in the same manner as sittings of the house are broadcast, through the IPTV system within Parliament House via the webstream link to the internet and the Parliament of South Australia video-on-demand broadcast system.

I will now proceed to open the following lines for examination. Today's session will run from 3.30pm to 5.30pm on the examination of proposed payments in relation to SA Health. The minister appearing is the Minister for Health and Wellbeing. The estimate of payments relates to the Department for Health and Wellbeing, the Commission on Excellence and Innovation in Health and to Wellbeing SA.

I declare the proposed payments open for examination and refer members to the Agency Statements, Volume 3. I call on the minister to make an opening statement, if he so wishes, and to introduce his advisers for the benefit of the committee.

The Hon. S.G. WADE: I would like to introduce my department executives to the panel: Dr Christopher McGowan, Chief Executive, Department for Health and Wellbeing; Ms Julienne TePohe, Deputy Chief Executive, Corporate and Systems Support Services; Mr Don Frater, Deputy Chief Executive, System Leadership and Design; Mr Jamin Woolcock, Chief Finance Officer; and Mr Tim Packer, Director, Capital Projects.

As this past week and a half has demonstrated, the COVID-19 pandemic remains an active threat to the community of South Australia as we see case numbers growing in other countries around the world and a significant cluster in our own state. In this context, I thank the opposition for their flexibility in the estimates program. Many of my leadership team are engaged in the pandemic response. Accordingly, I come with a smaller set of advisers, and you will appreciate this means I am likely to need to take more questions on notice during this committee.

The pandemic has created unprecedented disruption across the health system and has required rapid response from the entire SA Health team. I am particularly proud of the leading role taken by SA Health and how well our health system has responded and adapted and evolved over the last nine months. I would like to sincerely thank our frontline staff: the doctors, nurses, midwives, paramedics and allied health professionals, along with our administrative teams. The staff are committed and dedicated, working tirelessly each day to deliver quality and safe care across our health system. But without the cooperation of the community, all their efforts would not be enough.

The Marshall Liberal government has shown it is not afraid to take the decisions necessary to maintain the health and wellbeing of South Australians. In the course of the pandemic we have secured our supply of PPE in the context of high global demand. We have seen SA Pathology ramp up its capability to record testing highs of over 10,000 tests processed in a single day. We have secured dedicated facilities as part of our response and worked with the private hospital sector to ensure the hospital capacity was on hand should we need it.

At the same time, we have been working to address the core business of the health portfolio. This year, we have continued the downward trends in ambulance ramping, begun following last September's high. We have cut elective surgery numbers from the high of 2,781, as of 31 May, and were the first Australian jurisdiction to recommence elective surgery following the pause in non-urgent elective surgery during the first phase of the pandemic. Although there has been a spike due to the recent community pause, we have seen a decrease of 34 per cent, or nearly 1,000.

We have also seen further investment in the new Women's and Children's Hospital, bringing the total investment to date to $685 million, including an unprecedented $600,000 for clinician engagement and an expansion of The Queen Elizabeth Hospital stage 3 redevelopment, with an additional $50 million to deliver an expanded clinical services footprint.

On top of this, the budget has invested another, I think, $800 million in the health system, meaning the government has invested an additional $2.3 billion in health since the March 2018 election. The budget demonstrates the Marshall Liberal government's commitment to resourcing the public health response to the global pandemic while building the health infrastructure South Australia needs for its future and delivering better services for South Australians.

I conclude my opening remarks by acknowledging again the commitment and dedication of our doctors, nurses, midwives, paramedics, allied health professionals and other SA Health staff across the system. I thank them for their support and hard work every day in delivering safe and quality care to all South Australians.

The CHAIR: Lead speaker for the opposition, did you wish to make an opening statement?

Mr PICTON: Yes, thank you, Chair. We, too, appreciate and acknowledge the exceptional and unprecedented events of this year in regard to the COVID-19 pandemic, and thank the doctors, nurses, scientists, and allied health professionals—the public servants and contact tracers—everybody who has been involved in this effort from the Chief Public Health Officer, who has done an exceptional job, and her deputies, right down to those people collecting the samples at testing sites. We thank all those people involved in the response.

I think this really does highlight the importance of a strong public health system in South Australia, strong not just in hospital services but out of hospital services, in public health and in prevention; they are enormously important in terms of our state's health system. I am happy to go to questions.

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

Mr PICTON: I refer to Budget Paper 5, page 76, protecting SA from the spread of COVID-19 and specifically the operation of a robust hotel quarantine system. Who is ultimately in charge of the hotel quarantine system?

The Hon. S.G. WADE: Obviously the government is, but the leadership of the medi-hotel systems in South Australia is, I would say, overseen by the State Coordinator. Not only is the State Coordinator responsible for the whole pandemic response but also, as the police commissioner, he is responsible for SA Police, and SA Police provide the end-to-end oversight of the system, from international travellers arriving at the airport to international travellers being discharged from medi-hotels.

Mr PICTON: Minister, I asked a similar—

The CHAIR: Member for Kaurna, if you could please wait to be given the call. That is how this chamber has operated all week, and we have continued to do that.

Mr PICTON: Really? Okay, very formal.

The Hon. A. KOUTSANTONIS: I thought it was informal.

The CHAIR: It is informal but, as I said, the questions will go from one side to the other in an order that is appropriate for that to be done. The call needs to be distributed. Member for Kaurna.

Mr PICTON: My goodness. I asked a similar question of the police minister today and he said that SA Health was the control agency in regard to hotel quarantine. If that is correct, that SA Health is the control agency in regard to hotel quarantine, who in SA Health is ultimately in charge of the hotel quarantine system?

The Hon. S.G. WADE: The Minister for Police is correct in saying that SA Health is the control agency. The control agency operates under the State Coordinator. Be that as it may, we certainly see this as a partnership. The partnership is very strong between SA Health and SA Police and is perhaps nowhere more demonstrated than in the medi-hotels. Our officers have been working alongside one another for months now. I think we might have started medi-hotels in March, so it is a well-established program, and the basic model is the same; it continues to evolve.

In terms of our own arrangements—I might just check formally. I think it is best to put it this way: obviously Dr McGowan, as the Chief Executive of the Department for Health and Wellbeing, is responsible for SA Health's involvement in the hotel quarantine system, as in relation to any other service that is delivered by SA Health, but on a day-to-day basis the team at the hotel quarantine is the Rapid Response Nursing and Midwifery Service.

Mr PICTON: Is that service led by the Chief Nurse?

The Hon. S.G. WADE: I would correct the member: the Chief Nurse is a position that no longer exists. The relevant officer is the Chief Nurse and Midwifery Officer, and the service I referred to does report through the Chief Nurse and Midwifery Officer.

Mr PICTON: Who is responsible at each site? For instance, who was the responsible officer at the Peppers Hotel site?

The Hon. S.G. WADE: I imagine that varies from day to day, but I am happy to take that on notice.

Mr PICTON: Do the people responsible at, for instance, the Peppers Hotel site have responsibility for not just SA Health staff but also hotel staff and private security staff as well?

The Hon. S.G. WADE: I am advised that the Rapid Response Nursing and Midwifery Service is not in a position to direct hotel and other staff.

Mr PICTON: Who do hotel and other staff report to?

The Hon. S.G. WADE: My understanding is that on a day-to-day basis SA Police, SA Health represented by the service, and hotel management work in partnership.

Mr PICTON: The Jane Halton report, as it has been called—the national report into hotel quarantine—said that South Australia and SA Health had an Effective Quarantine Workstream. What is the Effective Quarantine Workstream? Is that the same thing as the Rapid Response Nursing and Midwifery Service? Who leads that and who do they report to?

The Hon. S.G. WADE: The honourable member is correct to say that Ms Halton reflected positively on the arrangements in South Australia. In particular, I suspect she was referring to the Effective Quarantine Workstream. We have a number of workstreams operating within the governance framework for the pandemic. They have changed from time to time during the pandemic, depending on the particular challenges we face, but the workstream that is responsible for hotel quarantine is called the Effective Quarantine Workstream.

Mr PICTON: Is that the same thing as the Rapid Response Nursing and Midwifery Service, or is the Effective Quarantine Workstream a separate area of the department?

The Hon. S.G. WADE: No, the service is the men and women who are providing on-the-ground services at the medi-hotels. The Effective Quarantine Workstream is a group of officers, which I imagine would include members of that service but also involve other officers from SA Health who might be involved in other aspects of effective quarantine. Medi-hotels are only one part of our quarantine and isolation services.

I would imagine that the Effective Quarantine Workstream would involve not only people from the medi-hotels service but also people involved in infection control, people who might be involved in home quarantine or isolation, people who might be providing mental health services to people in quarantine and isolation, and of course the workstream itself, like the other sister workstreams to that workstream, feeds into what in Health are often called situation meetings where different workstreams work together to make sure that our response is integrated.

Mr PICTON: Who provides leadership for that Effective Quarantine Workstream? Is that the chief executive that you mentioned or is that the chief nursing and midwifery officer?

The Hon. S.G. WADE: I am advised that the workstream is co-chaired by two officers, but neither of those officers are involved in the Rapid Response Nursing and Midwifery Service.

Mr PICTON: Who are those two officers?

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

Mr PICTON: Is there any regular auditing that takes place in regard to the hotel quarantine facilities, so regular, not the once-off review you have already mentioned? If so, who undertakes that auditing?

The Hon. S.G. WADE: I am advised that police regularly conduct audits.

Mr PICTON: Is there a risk register for the hotel quarantine program?

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

Mr PICTON: Can you also take on notice: is there a risk register for each hotel site, who compiles that risk register, and who is it provided to?

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

Mr PICTON: How, as minister, do you provide oversight for the hotel quarantine system?

The Hon. S.G. WADE: By providing oversight to the Chief Executive of the Department for Health and Wellbeing.

Mr PICTON: Have you received written or verbal briefings in regard to the hotel quarantine system?

The Hon. S.G. WADE: I have received a range of briefings both by the chief executive and other officers.

Mr PICTON: Have you asked questions about the program, and, if so, which questions have you asked about it?

The Hon. S.G. WADE: Yes, I have asked questions.

Mr PICTON: What is the process by which MSS Security have been engaged to provide private security guards for hotel quarantine? Is that using the existing contract that SA Health has with MSS Security to provide security for hospitals, or is there a new contracting arrangement in place?

The Hon. S.G. WADE: I am advised that MSS is engaged through an extension of the existing contract.

Mr PICTON: What is the cost and what is the term of the extension to the existing MSS contract?

The Hon. S.G. WADE: With all due respect, this pandemic is not over. The cost to when?

Mr PICTON: To date.

The Hon. S.G. WADE: Again, cost to date—we have not done today's reckoning. I will take that on notice.

The Hon. A. KOUTSANTONIS: So you have not budgeted for it?

The Hon. S.G. WADE: He asked me the cost to date.

Mr PICTON: What are the responsibilities of MSS private security staff in hotel quarantine?

The Hon. S.G. WADE: I am advised that the primary role of security officers in medi-hotels is to monitor the compliance of residents with their quarantine requirements and to advise police if there is any noncompliance.

Mr PICTON: Are there any guarantees or commitments in the contract with MSS Security regarding infection control or the training of staff?

The Hon. S.G. WADE: I am advised—I would not call them guarantees. Under the contract, MSS has an obligation to ensure that security officers are appropriately trained, in particular in relation to infection control, and training is provided both online and face to face.

Mr PICTON: What face-to-face training is provided and have there ever been any guards who have worked a shift without receiving face-to-face training?

The Hon. S.G. WADE: I am happy to take those two questions on notice.

Mr PICTON: Who provides the training for MSS's private security staff? Is it SA Health or an external agency?

The Hon. S.G. WADE: I am advised that the online training was developed by SA Health, and I understand that the face-to-face training is delivered by SA Health.

Mr PICTON: Can the minister assure the committee that no private security guard who has not received that face-to-face training has worked a shift at hotel quarantine?

The Hon. S.G. WADE: I refer the member to my previous answer to a previous identical question.

Mr PICTON: The contract between SA Health and MSS states that MSS must 'keep an up-to-date security register of all supplier staff'. Has SA Health been provided with a register of all security staff who have worked in medi-hotels? Who holds that register?

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

Mr PICTON: Does SA Health know the details of all security guards who have worked in medi-hotels and what shifts they have worked?

The Hon. S.G. WADE: Similarly, I will need to take that one on notice.

Mr PICTON: Has SA Health undertaken any background checks of those private security staff from MSS who work in hotel quarantine?

The Hon. S.G. WADE: I would be surprised if SA Health had done background checks. After all, there are regulatory frameworks for security guards, licensing arrangements and the like. I imagine we rely on them.

Mr PICTON: Is SA Health provided with a police check or a working with children check for each security guard working in the hotel quarantine program?

The Hon. S.G. WADE: I imagine that police checks are part of the regulatory regime for security officers, and I would be very surprised if they would need working with children checks, considering the role of security officers in the medi-hotel context.

Mr PICTON: Well, I am surprised: there are children in the medi-hotels.

The Hon. S.G. WADE: And security officers should be having no contact with them.

Mr PICTON: I would hope so. Given that this is the same contract that is being used for public hospitals, are there any MSS security staff who are concurrently working in public hospitals and in hotel quarantine?

The Hon. S.G. WADE: I draw the honourable member's attention to the announcement by the Premier yesterday, in relation to dedicated health facilities. The government intends that no one staff member should work in two high-risk environments. So, in that context, a person who works in one of our hospitals would not be permitted to also work in medi-hotels.

Mr PICTON: So up until yesterday does that mean that there have been security staff who have been working in medi-hotels as well?

The Hon. S.G. WADE: I did not say that.

Mr PICTON: Have there been any security staff, up until yesterday, who have also worked in medi-hotels?

The Hon. S.G. WADE: I am not aware of any.

Mr PICTON: Up until yesterday, was there a prohibition on any security guards working in hospitals as well?

The Hon. S.G. WADE: I am happy to take that on notice, but I am not aware of any prohibition.

Mr PICTON: So there may well have been. The contract with MSS and SA Health states that MSS must notify the minister immediately if MSS or any of its security officers are subject to any disciplinary action or their licence is suspended or placed under condition. Have any such notifications been provided to the minister or the department in relation to MSS hotel quarantine private security guards?

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

Mr PICTON: Under their contract with SA Health, MSS is required to notify SA Health of any conduct complaints within 24 hours in writing. Have any such notifications regarding conduct complaints been made in relation to hotel quarantine services of private security guards?

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

Mr PICTON: If there were issues in regard to private security guards, who would be notified within SA Health regarding those issues?

The Hon. S.G. WADE: I am advised that each of the major contracts within SA Health have a contract manager, and the responsibility of the contract partner would be to report to the contract manager.

Mr PICTON: Is that contract manager part of the Effective Quarantine Workstream or in a separate area of the department?

The Hon. S.G. WADE: As I said, the Effective Quarantine Workstream brings together a range of officers from across the department. I will check whether the contract manager in relation to that contract is part of the workstream.

Mr PICTON: And take it on notice?

The Hon. S.G. WADE: That is what I said.

Mr PICTON: You said you would check. Is MSS security subcontracting out any of its medi-hotel services?

The Hon. S.G. WADE: I am advised that we understand that MSS is subcontracting some of its activities, but of course MSS still carries the primary responsibilities of the contract.

Mr PICTON: Who is MSS subcontracting to?

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

Mr PICTON: Has the minister or his delegate given written approval for MSS Security to subcontract any of its hotel quarantine services as is required under the contract which says that MSS must not subcontract any part of the security services without the written approval of the minister?

The Hon. S.G. WADE: I will take that on notice. The contract manager manages the contract.

Mr PICTON: Do you remember signing written approval as the minister under the contract for MSS to subcontract its services as you have said that it is doing or is MSS doing that outside the bounds of the contract?

The Hon. S.G. WADE: As I have indicated before, the day-to-day contract management of this contract is undertaken by the contract manager. I do not recall having had any role in the day-to-day contract management.

Mr PICTON: When did MSS first begin subcontracting its services for hotel quarantine?

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

Mr PICTON: The contract with MSS gives the minister broad ranging powers including to require information, acquire records, carry out audits of operations, question and observe any MSS individual or subcontractor, and access premises, documents and computer records. Have any of these powers been utilised regarding MSS's hotel quarantine services?

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

Mr PICTON: The MSS contract requires for each site where MSS services are operating a brief weekly report to SA Health and a much more detailed monthly report including an issues log, quality and compliance inspection reports, and details of any complaints or emergencies, risks or harms. Have those weekly and monthly reports been provided to SA Health for each of its hotel quarantine sites?

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

Mr PICTON: Would those weekly and monthly reports as required by MSS be provided, as you said at the outset, to the responsible officers in the department, the chief nursing and midwifery officer, and the chief executive officer?

The Hon. S.G. WADE: What I said was that the contract is managed by the contract manager. I suspect any relevant reports would go to the contract manager.

Mr PICTON: Would you not expect that any issues including issues, logs, quality and compliance inspection reports, details of complaints and emergencies regarding hotel quarantine would be provided to at the very least the Effective Quarantine Workstream or the responsible officers undertaking the oversight of hotel quarantine in SA Health?

The Hon. S.G. WADE: As I indicated, the contract manager is responsible for the day-to-day week-to-week management of the contracts. I am sure that the contract manager engages all relevant officers as issues arise.

Mr PICTON: Have you, as minister, sought any information from your department regarding the compliance of MSS with its requirements under the contract?

The Hon. S.G. WADE: I have been briefed from time to time on the medi-hotel operations.

Mr PICTON: And have you been briefed in regard to the operations of MSS Security as the provider of security services in hotel quarantine?

The Hon. S.G. WADE: The briefings have been broad ranging.

Mr PICTON: Are staff working for MSS Security, or as we learn now one of its subcontracting services, employed on a full-time, casual or part-time basis?

The Hon. S.G. WADE: I am advised that is a matter for the supplier.

Mr PICTON: So SA Health has no interest in terms of the employment arrangement of staff under this contract?

The Hon. S.G. WADE: SA Health has an acute interest to make sure that the contracted services that we pay for are delivered and contractual requirements are met.

Mr PICTON: Is SA Health provided with information regarding how much staff are paid under the contract with MSS Security, either for MSS or one of the, as we know now, subcontracted services?

The Hon. S.G. WADE: I do not know.

Mr PICTON: Will you take that on notice?

The Hon. S.G. WADE: Yes.

Mr PICTON: Has any consideration been given to providing staff working for MSS with more secure work or higher paid work that means that they might have less need to work in multiple locations?

The Hon. S.G. WADE: The issue of people working at more than one location has been considered in the context of medi-hotels. Recently, the chief executive of my department wrote to the AHPPC and sought any advice they might have on employment arrangements.

Mr PICTON: Of the subcontracting that has occurred under the MSS contract, what is the total number of subcontracted services that are now working for MSS?

The Hon. S.G. WADE: I would have to take that on notice.

Mr PICTON: Under the contract with MSS for hotel quarantine, does MSS need to request permission for each subcontractor from SA Health or is there a blanket approval to subcontract those services?

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

Mr PICTON: Under the contract with MSS Security, does SA Health vet and consider the appropriateness of each subcontracting service for hotel quarantine security services, or do you not have information regarding the veracity of each of those services?

The Hon. S.G. WADE: MSS, as the primary contractor under the contract, is responsible for meeting the obligations of the contract.

Mr PICTON: Was subcontracting under the contract occurring at the time of the national quarantine review undertaken by Jane Halton?

The Hon. S.G. WADE: I do not know.

Mr PICTON: Is subcontracting of MSS Services being undertaken at each medi-hotel site or are there only specific sites where subcontracting is occurring?

The Hon. S.G. WADE: I am not aware.

Mr PICTON: Is subcontracting occurring in relation to hospital services under the MSS contract or just in relation to the hotel quarantine services?

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

Mr PICTON: Since the program started, in relation to hotel quarantine, how many breaches have occurred across the program?

The Hon. S.G. WADE: This information has previously been in the public domain, but I am happy to provide the honourable member with an update on notice.

Mr PICTON: So you do not have any information before you in relation to how many breaches there have been?

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

Mr PICTON: Is the minister aware of any recommendations by the Victorian inquiry into hotel quarantine regarding subcontracting of private security services?

The Hon. S.G. WADE: No. I have not read the Victorian review.

Mr PICTON: Can the minister confirm that he has not read the Victorian inquiry into hotel quarantine?

The Hon. S.G. WADE: As I said, I have not read the Victorian review.

Mr PICTON: Has the minister been briefed in regard to the Victorian inquiry into hotel quarantine?

The Hon. S.G. WADE: Not that I am aware.

Mr PICTON: Do you think you should have been briefed in relation to the Victorian inquiry into hotel quarantine?

The Hon. S.G. WADE: The Victorian inquiry came out recently. I am particularly mindful of the national review by Ms Halton, which went to national cabinet. We note that the Victorian review made recommendations that we would not support in terms of the public reports, but we continue to evolve our quarantine model.

Mr PICTON: Is the minister aware that the Victorian inquiry into hotel quarantine was released on 6 November, 20 days ago and almost two weeks before the Parafield cluster was identified?

The Hon. S.G. WADE: That is what I would call 'recently'.

Mr PICTON: Does the minister not believe that, within the space of that time, it would have been appropriate to receive a brief regarding learning the lessons of that inquiry?

The Hon. S.G. WADE: My officers continue to work with their national networks, particularly the AHPPC. I will seek further advice from the Chief Public Health Officer. I would expect that the Victorian Chief Health Officer would have briefed the AHPPC.

Mr PICTON: What lessons did you learn from the Victorian hotel quarantine review, and what actions were taken following the review?

The Hon. S.G. WADE: As I said, I expect that the Victorian Chief Health Officer would have briefed the AHPPC, and we have members on that committee.

Mr PICTON: Did SA Health or you as minister engage with either the Victorian inquiry process or the Victorian government about the inquiry?

The Hon. S.G. WADE: I refer the honourable member to my previous two answers.

Mr PICTON: The Victorian inquiry said:

[These] security guards actually could not 'ensure' that detainees remained in their rooms…Their actions were limited to the use of 'verbal de-escalation techniques' in which, as holders of security licences under relevant Victorian legislation, it was assumed they were trained. [Unlike police officers] The guards had no legal authority to physically restrain, or to touch, any detainee.

Do the security officers employed under the MSS contract have any additional powers in relation to their ability to provide that security than what was identified in the Victorian inquiry?

The Hon. S.G. WADE: The honourable member highlights the fundamental difference between the botched Victorian Labor government medi-hotel program and the South Australian program. The South Australian program from day one has been overseen, from departure off the plane to discharge from the medi-hotel, by SA Police. It is SA Police that have the relevant powers to ensure that compliance is delivered.

Mr PICTON: Whose idea was it to use private security guards under the existing MSS contract with SA Health to provide private security guards for hotel quarantine?

The Hon. S.G. WADE: The South Australian model was developed in partnership between SA Police and SA Health.

Mr PICTON: Are you suggesting that SA Police were involved in the decision to use the SA Health contract with MSS Security?

The Hon. S.G. WADE: What I am saying is that SA Police in partnership with SA Health developed the model. It certainly would not have been implemented without the support of both organisations.

Mr PICTON: Were you briefed on the decision to use MSS Security under the existing SA Health contract to provide private security for the hotel quarantine program?

The Hon. S.G. WADE: I refer the honourable member to my previous answer, where I indicated that I have been briefed on medi-hotel arrangements from time to time.

Mr PICTON: Did that include the use of private security guards by MSS?

The Hon. S.G. WADE: I was certainly aware that private security guards were operating, under the oversight of SA Police.

Mr PICTON: So they are under the oversight of SA Police, even though they are on contract with SA Health?

The Hon. S.G. WADE: Yes.

Mr PICTON: So is there a variation to the contract in which it says that they are now under the direction of SA Police as opposed to the contract which says they are under the direction of SA Health?

The Hon. S.G. WADE: As I said earlier, SA Health and SA Police and hotel management work together on the sites. The role of security officers is to ensure compliance by the residents. Of course, they do not have the full powers of sworn police officers. They work in partnership.

Mr PICTON: Ultimate responsibility under the contract, is that with SA Health or SA Police?

The Hon. S.G. WADE: In relation to contractual obligations, clearly that is with SA Health.

Mr PICTON: The Victorian hotel quarantine inquiry, which you have not read, says that surfaces should be tested in hotel quarantine. Has that occurred in our hotel quarantine sites and, if not, why not?

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

Mr PICTON: If there was testing, as the Victorian inquiry recommended, how regularly did that occur at the Peppers site and what were the results of that?

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

Mr PICTON: The Victorian inquiry, which the minister has not read, further recommended that a contact tracing team and prevention and control unit be embedded within each quarantine facility. Has that been in place in South Australia?

The Hon. S.G. WADE: I am advised that it has not, and to be frank I cannot see the purpose of doing that.

Mr PICTON: The Victorian inquiry recommended that regular reports be provided to the minister regarding the quarantine program, including details about compliance, monitoring and the risks at each site. Does that occur in South Australia, and if so, how often do you receive those reports?

The Hon. S.G. WADE: The matter that the honourable member refers to sounds similar to the contract management we were discussing earlier.

Mr PICTON: Except that this is a report to the minister. Are you receiving reports regarding compliance monitoring of risks at each site?

The Hon. S.G. WADE: As I said earlier, the contract management is looked after by the contract manager.

Mr PICTON: The Victorian inquiry, which the minister has not read, recommended that all hotel cleaning practices be developed, directed and overseen by infection prevention and control experts. Has that occurred in South Australia's hotel quarantine?

The Hon. S.G. WADE: Infection control in medi-hotels is supervised by SA Health.

Mr PICTON: Have they had oversight over all hotel cleaning practices, and have they developed, directed and overseen the processes for that cleaning?

The Hon. S.G. WADE: As I said, infection control has had a fundamental role in the delivery of medi-hotels.

Mr PICTON: The Victorian inquiry also recommended each quarantine facility have regular independent safety audits. Has that been adopted here? Who conducts those reports? How frequently are they provided to the minister?

The Hon. S.G. WADE: I do not know what a safety audit refers to in that context.

Mr PICTON: It would have been good to read the report. The Victorian inquiry also recommended, as I said, regular and timely reports be provided to the minister, including compliance and risk registers of the hotel quarantine system. Are there compliance and risks registers, and what format are they in?

The Hon. S.G. WADE: Yes, I suspect the honourable member is asking the same question that he asked me earlier and so I refer him to my earlier answer.

Mr PICTON: The Victorian inquiry recommended the site manager roles at each facility be filled by a person who has experience in the management of complex healthcare facilities. Is there a site manager for each of our hotel quarantine sites, and do they have experience in the management of complex healthcare facilities?

The Hon. S.G. WADE: I will ask Dr Chris McGowan to answer that question.

Mr McGOWAN: I can advise you that the Victorian report has been read by executive staff involved in the management of the medi-hotel program. We have reviewed the recommendations. I think there are something like 76 or 79. We have considered which ones we think are relevant and useful to adopt—some are and some are not. We are working through it and, as we continue to review the medi-hotel program, we will adopt the ones we think are worthwhile.

Mr PICTON: Specifically at the Peppers Hotel, since it opened how many incidents and breaches have been reported to SA Health?

The Hon. S.G. WADE: My understanding is that would be part of the information I will be providing in response to an earlier question on notice.

Mr PICTON: Is there a safety learning system operating for hotel quarantine and, if so, where do those reports go?

The Hon. S.G. WADE: I will take that on notice in relation to the SA Health component. It certainly would not be my expectation that SLS would be used by other entities such as police or hotel management, but I will need to check in relation to the service.

Mr PICTON: How many hotel quarantine staff have been disciplined for breaches that have been identified across the system?

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

Mr PICTON: At a joint press conference with you, minister, and the Deputy Chief Public Health Officer, Dr Cusack, on 17 August, it was announced that there would be an ongoing active surveillance program of testing hotel quarantine workers. Who was responsible for carrying out this active surveillance testing program?

The Hon. S.G. WADE: My understanding is that the active surveillance is overseen by the community testing workstream.

Mr PICTON: What is the community testing workstream?

The Hon. S.G. WADE: It is one of the workstreams that feeds into the leadership group, the situation group that coordinates SA Health's COVID response.

Mr PICTON: How many tests have been undertaken of hotel quarantine staff in the active surveillance testing program since 17 August?

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

Mr PICTON: How often was each hotel quarantine staff member tested under the active surveillance testing program?

The Hon. S.G. WADE: I will also have to take that on notice. It is probably important to indicate here that my understanding is that each worker presenting to work at a medi-hotel is required to indicate whether or not they have symptoms at each presentation.

Mr PICTON: Yes, however, this was a program announced by Dr Cusack for an active surveillance program. It was mentioned, referenced, as being similar to that undertaken for truck drivers, and the like. It was said that they would carry on a steady basis of testing into the future so that there would be no possibility of leakage of the virus outside the hotel system, and for anyone who would have the opportunity to come into contact with residents in the hotel. So between 17 August and 15 November, how many hotel quarantine staff were actively tested as part of the surveillance program?

The Hon. S.G. WADE: I think that is a repeat question.

Mr PICTON: Did the surveillance program request tests from staff who would come into contact with people at their work with the opportunity to come into contact with residents at the hotel, and did this include private security guards and all the hotel guests services staff?

The Hon. S.G. WADE: I am sorry, would you mind repeating that question?

Mr PICTON: Happy to. As was announced by Dr Cusack on 17 August, did the surveillance program request tests from staff, quote: 'Staff who would, for any point of their work, would have had the opportunity to come into contact with the residents of the hotel'? Did that include all private security guards, and did that include all hotel guest services staff?

The Hon. S.G. WADE: I will seek further advice, but my understanding is that all staff were able to seek voluntary tests and that all staff could avail themselves of active testing surveillance.

Mr PICTON: Obviously, all staff, as with anybody in the community, were able to access testing, but how did this active surveillance program work? Did people go to the staff and say, 'We would like you to participate in this program'? Were they asked to get a test? How often were they asked to do that? How did this active surveillance program roll out? Obviously, anybody could get testing, but that is not an active surveillance program.

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

Mr PICTON: Were you briefed on the active surveillance testing program, and how often were you briefed on it and by whom?

The Hon. S.G. WADE: The active testing surveillance program, as I said, is overseen by the surveillance workstream. It was one of the matters that I was briefed on from time to time during this pandemic.

Mr PICTON: Was the chief executive, who, as you mentioned, had ultimate oversight of the hotel quarantine system, provided with information briefings regarding the active surveillance testing program?

The Hon. S.G. WADE: I imagine he was.

Mr PICTON: Did this active surveillance testing program actually happen?

The Hon. S.G. WADE: SA active testing surveillance has been in place for a number of months. The focus shifts from time to time under the oversight of the workstream, and my understanding is that that was under a framework, a plan.

Mr PICTON: Why did the focus shift from time to time, particularly when hotel quarantine is obviously a risk that the state would have to mitigate? Why would focus shift away from that ever?

The Hon. S.G. WADE: One example of a shift in the active testing surveillance program might be when our borders are opened or closed to particular states. It might increase or decrease the need for truck drivers to be tested. To be frank, we have been significantly impacted by the propensity of other states to undertake testing for particular cohorts. Often when other states are less willing to undertake tests for certain cohorts, we need to increase our effort.

Mr PICTON: Dr Cusack said on 17 August, 'I'd see it as ongoing.' What the minister is saying is that that was not necessarily ongoing and the focus changed from time to time, and therefore perhaps this was happening at some time but was not happening continually from 17 August until today.

The Hon. S.G. WADE: I have nothing to add to my previous answer.

Mr PICTON: What dates was the active surveillance testing program actually operating?

The Hon. S.G. WADE: I think that is a question that I have already been asked.

Mr PICTON: By what date last week were all hotel quarantine staff, including private security guards, including hotel staff, subjected to proactive COVID testing?

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

Mr PICTON: In relation to the Halton review, the national quarantine review—I might just call it the Halton review from now on—there is very little detail in that in regard to South Australia. The minister misquoted me before saying that I agreed it spoke highly of South Australia. It does not speak at all about South Australia in terms of a positive or negative assessment. But the Chief Public Health Officer said in the past few days, 'We were given a few small suggestions, but nothing major in terms of improvements.' Noting that those small suggestions were not listed in the report, can you outline what those suggested improvements were that came out of that report?

The Hon. S.G. WADE: The Halton report was a report to national cabinet and so the Premier is the relevant minister and the Chief Public Health Officer had access through the AHPPC.

Mr PICTON: So did you not receive, as the minister who has oversight of the Department for Health and Wellbeing, the suggestions that came out of the Halton report?

The Hon. S.G. WADE: The Halton review itself has been published, but the comparative analysis is in appendices which national cabinet has not made public.

Mr PICTON: Have you seen the appendices?

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

Mr PICTON: Why have you not read the appendices from this report?

The Hon. S.G. WADE: It is a confidential national cabinet document.

Mr PICTON: So it is confidential from the Minister for Health? You are not allowed to see this report?

The Hon. S.G. WADE: As a former political staffer in the federal parliament—

Mr PICTON: You were a staffer, too.

The Hon. S.G. WADE: —the honourable member would recall that national cabinet, as a part of the federal cabinet, is subject to very strict confidentiality requirements.

Mr PICTON: Who in your department has seen the appendices to the Halton report? Has anybody?

The Hon. S.G. WADE: My understanding is the Chief Public Health Officer has access, and I will seek confirmation of that.

Mr PICTON: So the people who you have mentioned at the beginning of this who were responsible for hotel quarantine, particularly the chief executive, the chief nursing and midwifery officer, they have not seen the appendices to the Halton report into an assessment of our hotel quarantine system?

The Hon. S.G. WADE: I have nothing to add to my previous answer.

Mr PICTON: How have you declared that South Australia received a gold star in the Halton report when such a statement is not made in the report that has been released publicly and you have not read and do not have access to the appendices that are attached to it?

The Hon. S.G. WADE: I have been advised that the Premier and by the Chief Public Health Officer, and I am also advised that the secretary of the federal department has similarly confirmed that with the department.

Mr PICTON: How can your department implement the recommendations of the appendices to the Halton report if you or your chief executive do not have access to the appendices?

The Hon. S.G. WADE: As I have indicated, the Chief Public Health Officer is a member of the AHPPC and has access.

Mr PICTON: Who was responsible for the oversight of the implementation of recommendations in the appendices to the Halton report?

The Hon. S.G. WADE: We understand the recommendations are in the main body.

Mr PICTON: Have all suggestions, recommendations or advice in the appendices to the Halton report been implemented?

The Hon. S.G. WADE: It is as I have said. I refer the member to my previous answer.

Ms BEDFORD: I refer to Budget Paper 4, Volume 3, page 15, in relation to the Modbury Hospital upgrade and development. Can the minister advise the committee how many acute cases requiring surgery have been transferred to other hospitals because of the closure of all four operating theatres at the Modbury? What hospitals have been performing these operations and how many of them were performed at each of those sites?

The Hon. S.G. WADE: I need to seek that information on notice.

Ms BEDFORD: I refer to Budget Paper 4, Volume 3, page 12, Sub-program 2.4: Women's and Children's Health Network, which is detailed on page 39. What are the current and planned arrangements for the outsourcing of surgery from the Women's and Children's Hospital? Which private hospitals will be performing these services? Have any patients already had their operations undertaken off site?

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

Ms BEDFORD: My last question is, can you explain why there appears to be no new funding to address identified substantial deficiencies in resources, staffing and equipment at the Women's and Children's Hospital?

The Hon. S.G. WADE: With all due respect, the funding for the network has increased.

Ms LUETHEN: I refer to Budget Paper 4, Volume 3, page 63. Could the minister outline how the expanded My Home Hospital program will provide better healthcare services closer to home?

The Hon. S.G. WADE: I would ask the chief executive of the department to provide you with an answer.

Dr McGOWAN: The My Home Hospital program recognises the fact that many people who occupy beds in our hospitals do so because there is a lack of effective services in the home. The proposition is essentially that if somebody has an illness, such as cellulitis or a urinary tract infection or something like that which requires more care than a GP can provide in his or her practice in the context of a fee-for-service business model, currently they end up in hospital.

That creates use of beds and blockage in the emergency departments and so on and so forth. So the proposition is that if we can give those people a service at home—quality nurses and doctors visiting and monitoring them at home, where it is safe to do so—it will provide a much more convenient service for the patient. It will mean the ambulance is not having to wait to get them into care, because essentially they are getting the service at home at a reduced cost to the community, thereby relieving pressure on our hospitals.

We think this is an exciting new direction for health that essentially tries to populate the gap between the general practice, our excellent general practitioners, and our very expensive and very sophisticated hospital system. This will go live. I think at the moment on 17 December it is expected to start taking its first patients. Initially, it will focus on providing care to people in nursing homes, and we would like to see it grow out to a significant part of the health system architecture over the coming years.

Mr DULUK: I refer to Budget Paper 4, Volume 3, page 16, row 3, Repatriation Health Precinct Reactivation. How much funding in this year's budget has been allocated to surgery services at the Repat? What is the time frame for surgery to return to the Repat precinct? Have any preferred private providers been identified for the project, or has SA Health had any difficulties in sourcing preferred surgery providers for the Repat site?

The Hon. S.G. WADE: A preferred surgery partner has been identified for the Repat site, and discussions are going on between the preferred provider and the Department for Health and Wellbeing on the appropriate workload and mix.

Mr DULUK: How much has been allocated to surgery services in this year's budget for the Repat?

The Hon. S.G. WADE: It is very much linked to those discussions. The primary source of the funding is from within the current allocations of the networks.

Mr PICTON: I refer to the same budget line as before, Budget Paper 5, page 76 and the operation of a robust hotel quarantine system. For patient zero of the Parafield cluster, the security guard, who was identified yesterday, when was the last time that that security guard received a negative test?

The Hon. S.G. WADE: I am not going to engage in clinical matters. My understanding is that inquiries are still going on as to the composition of that cluster.

Mr PICTON: Did that patient zero, the first private security guard, breach any infection control procedures at any time that they had been working in the medi-hotel system?

The Hon. S.G. WADE: I would refer the honourable member to the public comments made by the Chief Public Health Officer yesterday.

Mr PICTON: Did that patient zero, the first private security guard, have a record of any breaches in the hotel quarantine system?

The Hon. S.G. WADE: I am not willing to take questions on notice on matters that actually relate to individual security guards.

Mr PICTON: How long had that security guard been working for the hotel quarantine system as a private security guard?

The Hon. S.G. WADE: As I said, I appreciate the broad scope of the estimates committee inquiry. That is why I have been quite willing to take questions on the programs, but on the circumstances of individuals I am not.

Mr PICTON: Have all private security guards and cleaners been interviewed as part of the investigation into the outbreak?

The Hon. S.G. WADE: That is a very broad question. Are we talking about the cleaners at the Stamford as well?

Mr PICTON: No, at Peppers.

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

Mr PICTON: At Peppers, are there any shared facilities whereby the virus could have transmitted between staff, such as a lunchroom or other shared facilities?

The Hon. S.G. WADE: I am not aware.

Mr PICTON: Have you made inquiries as to whether there are shared facilities such as lunchrooms, etc., where security guards and cleaners may have mixed?

The Hon. S.G. WADE: If the honourable member is asking me, 'Do I have such little confidence in SA Health and SA Police that I would want to second-guess their investigation?', the answer is no.

Mr PICTON: What is the current status of the investigation, and have you received any briefings in relation to the investigation?

The Hon. S.G. WADE: I have certainly been involved in conversations with the Chief Public Health Officer, and she has also made public comments that the investigation is ongoing, particularly related to communicable disease specialists looking at the material.

Mr PICTON: What was the procurement process for the contract with Peppers or its parent, the Accor group?

The Hon. S.G. WADE: My understanding is that Peppers engaged in this program through responding to a public expressions of interest process. I also make the point that different hotels involved in this program are involved in different hotel groups.

Mr PICTON: What is the value of the contract with Peppers and what is the term of the contract?

The Hon. S.G. WADE: I am advised that different providers in the panel have different arrangements. I am happy to provide further advice to the member.

Mr PICTON: Who supervises the contract with Peppers and with other hotels involved in the hotel quarantine program?

The Hon. S.G. WADE: Similar to my answers to the security contract, there is a contract manager for the panel of medi-hotel providers.

Mr PICTON: What guarantees are given in the contract regarding infection control or the training of staff?

The Hon. S.G. WADE: Similar to my answer in relation to security services, rather than guarantees there are obligations under the contract. I will certainly seek a summary of those for the honourable member.

Mr PICTON: What training do the hotel staff receive in regard to infection control?

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

Mr PICTON: Do hotel groups—i.e. Accor, which runs a number of the hotels in the program—share staff across hotel quarantine sites in the group?

The Hon. S.G. WADE: I am advised that that has occurred.

Mr PICTON: Sorry, did you say that staff have worked across multiple sites?

The Hon. S.G. WADE: I understand that that has occurred.

Mr PICTON: How many hotels has that occurred across?

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

Mr PICTON: Has that been something where SA Health have provided approval for that to occur?

The Hon. S.G. WADE: I will seek advice.

Mr PICTON: Is that still the practice as of today, that staff are working across different sites?

The Hon. S.G. WADE: I refer the honourable member to my earlier answers on a similar question.

Mr PICTON: Does that mean that they are still occurring as of right now?

The Hon. S.G. WADE: That means that the answer is still relevant.

Mr PICTON: So the answer that they are still working across sites is still relevant as of today?

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

Mr PICTON: Does each hotel or hotel group have their own COVID procedures or does each of them follow a common SA Health procedure?

The Hon. S.G. WADE: Obviously, hotel management has the right to run their own hotel, but in relation to infection control they need to operate in accordance with SA Health's infection control arrangements.

Mr PICTON: So there is a common infection control procedure that applies across each hotel?

The Hon. S.G. WADE: My understanding is that SA Health infection control specialists work with the management in relation to infection control arrangements that are appropriate for their particular site.

Mr PICTON: Thank you, minister, but does each hotel have a separate infection control procedure or is there a common infection control procedure across every site?

The Hon. S.G. WADE: My understanding is the infection control arrangements would need to be sensitive to the particular site.

Mr PICTON: Are those infection control procedures drafted by SA Health or are they drafted by each hotel or hotel group?

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

Mr PICTON: So, minister, you are not aware whether SA Health are the ones who have come up with the infection control procedures or whether the hotels are coming up with the infection control procedures?

The Hon. S.G. WADE: SA Health infection control specialists drive infection control practices at medi-hotels.

Mr PICTON: Does SA Health approve each infection control procedure at each of the hotels?

The Hon. S.G. WADE: I have nothing more to add to my previous answer.

Mr PICTON: Why was it only yesterday that deep cleaning took place at the Peppers Hotel given that the issues there have been known since 15 November?

The Hon. S.G. WADE: I am advised that deep cleaning occurs on an ongoing basis as a positive case departs a room. Obviously, the full deep cleaning of Peppers will need to await the full decanting of active cases.

Mr PICTON: So the deep cleaning of Peppers has not yet occurred?

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

Mr PICTON: Has any further deep cleaning of medi-hotels happened, particularly including the Stamford, since 15 November?

The Hon. S.G. WADE: My understanding is that the deep cleaning of rooms in each of the hotels is ongoing as active cases leave particular rooms.

Mr PICTON: What about the shared facilities that are used by the staff at the medi-hotels?

The Hon. S.G. WADE: I am happy to seek advice for the honourable member in relation to the cleaning schedule for common areas at medi-hotels.

Mr PICTON: As clearly has been mentioned publicly, the Victorian review—I am sure the minister knows, even though he has not read it—states that private security guards should only be employed solely at the hotel quarantine sites and not be working at other locations. I understand the government has not gone down that path, but does the South Australian government know about secondary employment of security guards and other hotel staff? As of today, are you aware of the secondary employment of all those staff?

The Hon. S.G. WADE: As it is not a requirement under the contract, my understanding is that we would not be advised, but this is exactly the sort of issue that will be addressed by the AHPPC as they respond to the government of South Australia's request for any advice on secondary employment and related issues.

Mr PICTON: Even if you, minister, and the government obviously do not want to go down the path of prohibiting secondary employment, why would it not make sense to put out a request for all those staff to provide details of their secondary employment to at least make sure that, if there were to be another outbreak, there is readily available information in regard to that secondary employment?

The Hon. S.G. WADE: That is exactly the sort of opportunity that I expect the AHPPC will address in its advice.

Mr PICTON: Do you not believe that there might be a need to act quicker rather than waiting for a report in terms of asking for details of secondary employment?

The Hon. S.G. WADE: I will pass the honourable member's suggestion to the Chief Public Health Officer.

Mr PICTON: When will the government's contract with Wakefield Hospital expire?

The Hon. S.G. WADE: I am advised that the current contract expires on 22 February 2021.

Mr PICTON: If that was to be used as the new health facility, what would be the government's plans after February next year?

The Hon. S.G. WADE: I suggest to the honourable member, with all due respect, that it is a hypothetical question.

Mr PICTON: Is the minister aware that a private developer owns that site and has signalled their intention to create an ageing and health precinct?

The Hon. S.G. WADE: In broad terms I am aware of that.

Mr PICTON: Would the government consider using emergency powers to compulsorily acquire or otherwise prevent that from occurring?

The Hon. S.G. WADE: As I indicated to the honourable member, I am not willing to wander into the realm of hypotheticals.

Mr PICTON: I note that in an answer to a question on notice you provided, as of 17 June there had been no staff who had stayed at a so-called health heroes hotel. Up until today's date have there been any staff who have stayed in a health heroes hotel?

The Hon. S.G. WADE: I will need to take that on notice to seek an update. I would make the point that South Australia, fortunately, has had a lower number of active cases in recent times—shall we say since the first wave. Also the fact that a service has not needed to be used does not mean it is not valued.

Mr PICTON: Is there a current health heroes hotel available?

The Hon. S.G. WADE: My understanding is that there is an established relationship in place, but I will seek further information on notice.

Mr PICTON: Does SA Health have the ability to approve flights and arrivals into South Australia, or is that a responsibility of the federal government and we are just notified when they are occurring?

The Hon. S.G. WADE: My understanding is that the federal government and the state government work together in a cooperative way in that regard. South Australia indicated recently that we sought a pause in the flights, and that request was respected.

Dr HARVEY: My question relates to Budget Paper 4, Volume 3, page 15. Can the minister please provide an overview of the $40 million budgeted for the Modbury Hospital redevelopment? What services will this provide to Modbury once the redevelopment is complete?

The Hon. S.G. WADE: I thank the honourable member for his question, and I will ask Mr Tim Packer to provide an answer.

Mr PACKER: The South Australian government has committed a total budget of $98 million to upgrade and provide additional services at Modbury Hospital, including the re-establishment of a four-bed high-dependency unit. The main works construction commenced in October 2019, and the planned completion date is December 2021.

The government is committed to ensuring that people in the north and the north-eastern suburbs are provided with more healthcare services close to home. The project will deliver the following:

an emergency extended care unit, which was opened in August 2019;

a short stay general medical unit located next to the hospital's emergency department;

a new surgical unit, including additional procedural spaces and new operating theatres;

a new four-bed high-dependency unit;

a new state-of-the-art purpose-built palliative care unit with 20 individual rooms;

a new outpatient department and upgrade of the building facade; and

significant engineering infrastructure upgrades.

There has also been a refurbishment of a further level within the tower building. The funding of $40.15 million provided in 2020-21 will complete the outpatient department, the surgical unit, including the HDU, and to progress the construction of the palliative care unit, the short stay general medical unit and the engineering upgrades.

Obviously, the works will continue to be delivered in a staged manner, reflecting the operational nature of Modbury Hospital. Components will be progressively delivered as they come online to allow the hospital to continue to deliver clinical functions throughout the project. With the reduction in elective surgeries there was an opportunity to complete all four operating theatres in one stage rather than over multiple stages. This work is currently ongoing and will be completed in April 2021, which is eight months ahead of the program.

Works are currently underway to Level 1 West and North surgical unit with the installation of services and internal partitioning. The location of the HDU has been created on Level 1 East and the completion of this work has created some additional bed capacity which is available.

Ms BEDFORD: I refer to my earlier question on the Women's and Children's Hospital, Budget Paper 4, Volume 3, Program 2 to Sub-program 2.4, and ask how much of the capital upgrade was spent on consultants through to the previous two years, and was any of that money left over?

The Hon. S.G. WADE: I will seek an answer to the honourable member's question on notice, but I have heard suggestions of the amount spent on consultants in relation to this project which I am assured by the network are without foundation, but I will seek specific advice. My understanding is that the type of consultancy work that would have been undertaken on a project like this would incur normal project-related consultancy costs. Every project needs to engage a range of skills to be delivered.

Mr PICTON: I refer to Budget Paper 4, Volume 3, Sub-program 2.1: CALHN, page 29. What are the contractual arrangements for KordaMentha returning to CALHN? We understand the media from the other day saying that there was a pause in their contract and they were given a payment of $57,000 during that time. What payments are they receiving under the revised contract, and what is the total sum of the contract now?

The Hon. S.G. WADE: I am advised that the cost of the varied contract is $4.403 million, which represents a saving to government of about $10 million, compared with the previous extended contract. In terms of the focus of the work, I am advised that the team is working both remotely and on the ground, and they will focus on initiatives and opportunities to assist CALHN's operational services workforce capability and flexibility for the remainder of the contract extension.

Mr PICTON: Has there been any approval for KordaMentha staff who are based in Melbourne or Victoria to travel physically to Adelaide as part of their work for CALHN?

The Hon. S.G. WADE: I am not aware of any exemptions being provided.

Mr PICTON: I refer to an email from KordaMentha, Natalie Chin, on 14 February to, amongst others, your chief executive, Chris McGowan, their 'CALHN Organisational Recovery—Weekly Update', which refers to:

Key meetings and discussions were with:

various meetings with the CALHN Executive and 2020 Delivery to develop a new March-June Bed Plan to increase standby beds to assist in improving efficiency and meeting financial budget.

Key activities and updates include:

Worked with Executive and 2020 Delivery on the various detailed patient efficiency initiatives to reduce occupancy/increase standby beds and feed into the preparation of a new March-June Bed Plan.

What were the contents of the March-June bed plan, and how many beds have been transferred from active beds to standby beds in CALHN this year?

The Hon. S.G. WADE: I am happy to approach CALHN and seek answers to those questions on notice for the honourable member.

Mr PICTON: How many overnight beds are currently available in CALHN, as opposed to the same time last year?

The Hon. S.G. WADE: I would like to highlight to the member that the CALHN efforts to establish beds on standby is key to their strategy to make sure the hospital works effectively. A hospital does not work properly if it is packed to the rafters. Making sure that there are beds on standby means they have the ability to respond to surges when they come.

Mr PICTON: I refer to Budget Paper 4, Volume 3, Workforce summary, page 13. How many voluntary separation packages were offered and accepted in the 2019-20 calendar year across the local hospital networks and the department, and how many so far in the 2020-21 financial year?

The Hon. S.G. WADE: In terms of the 2019-20 financial year, I am advised that a total of 321 separation packages were accepted, and I am advised that nine of them related to the department. I think it is really important to see voluntary separation packages in the context of the overall work force. One of the key positive opportunities that volunteer separation packages give to both workers and to management is to refresh organisations.

The fact that voluntary separation packages are being offered does not necessarily mean that the workforce is being reduced, and in that context I would refer the honourable member to the Auditor-General's Report, which indicates that, in spite of those separation packages being offered, there has been an increase in the size of the health workforce this year. In particular, the number of doctors employed by SA Health has grown by 120 this year.

Mr PICTON: Budget Paper 5, page 77, Transport relief for hospital staff to support COVID-19 Response. The funding for this measure only expires this financial year. Does that mean that, as of next financial year, there is no funding in the budget to provide transport relief for hospital staff or their car parking fees?

The Hon. S.G. WADE: The government has indicated that we are keen to recognise the work of the health workforce in the context of the pandemic, and the initiative is linked to the duration of the pandemic.

The CHAIR: The time agreed and allocated for the examination of proposed payments in relation to the portfolios of SA Health has expired; therefore, there are no further questions and I declare the examination completed.

Sitting suspended from 17:31 to 17:45.

Membership:

Ms Wortley substituted for Ms Stinson.

Departmental Advisers:

Dr C. McGowan, Chief Executive, Department for Health and Wellbeing.

Dr J. Brayley, Chief Psychiatrist, Department for Health and Wellbeing.

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

Ms M. Bowshall, State Director, Drug and Alcohol Services, Department for Health and Wellbeing.

The CHAIR: We move to the examination of proposed payments in this session, from 5.45 until 7.15 this evening, in regard to the portfolio of SA Health (mental health and substance abuse). The minister appearing is the Minister for Health and Wellbeing. The estimates of payments are in relation to the Department for Health and Wellbeing, as previously mentioned, the Commission on Excellence and Innovation in Health and Wellbeing SA. I advise that the proposed payments remain open for examination and refer members to the Agency Statements, Volume 3. Minister, if you would like to make an opening statement and introduce your advisers, please proceed.

The Hon. S.G. WADE: I would like to introduce my department executive to the panel. To my left is Dr Christopher McGowan, Chief Executive, Department for Health and Wellbeing. Behind me is Dr John Brayley, Chief Psychiatrist; Ms Marina Bowshall, State Director, Drug and Alcohol Services; and Mr Jamin Woolcock, Chief Finance Officer, Department for Health and Wellbeing.

I would like to acknowledge the strain that the COVID pandemic has placed on our community and its impact on health and wellbeing. The government of South Australia has acted swiftly to support the South Australian community through this difficult time by establishing new support programs and expanding existing services.

The South Australian Virtual Support Network, which was established in direct response to COVID-19, focuses on early intervention and mental health prevention services, increases drug and alcohol service capacity, and provides initiatives for children and young people affected by social isolation and the economic impacts of COVID-19.

I would like to sincerely thank our frontline staff, the doctors, nurses, midwives and allied health professionals, along with our administrative staff, for their ongoing commitment to delivering services and working tirelessly to provide quality and safe care across the health system.

The Marshall government has made mental health a key priority. On 2 November 2019, we released the South Australian Mental Health Services Plan 2020-2025. The plan will guide future resourcing options and enable the safe stewardship of the state's existing investment in mental health services.

Key themes of the plan include a life course approach, therapeutic engagement, recovery-oriented services, consumer participation and peer support services, carers (including young carers), equity of access to services, staff wellbeing, Aboriginal mental health and effective suicide prevention. Significant progress has also been made towards the establishment of the Urgent Mental Health Care Centre, with the successful service provider engaged in September this year.

The Marshall government continues to focus on addressing the harms associated with alcohol, tobacco and other drugs. We recognise their impact not only on the health of the individual but also on the health of our community. It is estimated that these issues cost the Australian community $55 billion per annum in social costs, such as health care, productivity and crime.

Such figures highlight the importance of coordinating efforts both within health and across other portfolios to ensure harm is reduced and the impact of substance abuse is reduced for individuals, families and the community as a whole. I would like to acknowledge the work of Drug and Alcohol Services South Australia in leading efforts both within and across other portfolios, as well as the non-government and private sectors, to ensure harm is reduced for individuals, families and the community.

I am pleased to report briefly on some of the significant health gains that have been achieved as a result of these efforts. In 2019, 9.7 per cent of South Australians aged 15 years and over reported daily smoking, confirming the downward trend observed in recent years. The proportion of 15 to 19 year olds who abstain from alcohol increased from 38 per cent in 2011 to 53 per cent, and the use of methamphetamine in South Australia decreased significantly from 1.9 per cent in 2016 to 1 per cent in 2019.

I conclude my opening remarks by once again thanking all our staff for their support, hard work and dedication to delivering quality and safe care.

The CHAIR: Lead speaker for the opposition, did you wish to make an opening statement?

Mr PICTON: No.

The CHAIR: With opening statements concluded, I call on members for questions. The member for Kaurna.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 29, Central Adelaide Local Health Network (CALHN). Did the minister receive a letter from 28 emergency department doctors at the Royal Adelaide Hospital dated 9 September raising concerns about the care of mental health patients?

The Hon. S.G. WADE: My recollection is that I did.

Mr PICTON: Has the minister read the letter from the emergency department doctors?

The Hon. S.G. WADE: Yes, the work that is being done at the Central Adelaide Local Health Network in relation to the development of our services, particularly the model of care, emanates from an inspection by the Chief Psychiatrist, and the Chief Psychiatrist continues to liaise with CALHN in the development of services.

Mr PICTON: What is the minister's reaction to the letter to the chair of the board, copied to him and the Premier, saying that the current efforts to reform CALHN mental health services are unlikely to lead to meaningful change?

The Hon. S.G. WADE: My response is that I have great confidence in the Chief Psychiatrist, the management and board of CALHN and the goodwill of clinicians as they work together to deliver quality and safe care.

Mr PICTON: The minister says people are working together to deliver quality and safe care, but the letter clearly states:

Daily, ED nurses and doctors are forced to provide care that they know is suboptimal, and at times, unethical. In addition, they work with a continual risk of violence or assault that increases with the time patients spend in the continual light and noise of the ED.

Does the minister agree that the care being provided to patients at the moment is suboptimal and unethical?

The Hon. S.G. WADE: What I want to make very clear is that I have no doubt that all of the people who are participating in this conversation have, first and foremost, the desire to deliver the best possible care. There are clearly issues in terms of delivering on that. Some of those issues were highlighted by the Chief Psychiatrist as a result of his inspection. The Chief Psychiatrist put in place a gazettal, which has led to a whole piece of work being done. I would perhaps ask the Chief Psychiatrist if he could explain to the committee the work that is being done.

Dr BRAYLEY: As you may be aware, the gazettal conditions, using the powers of the Chief Psychiatrist in the Mental Health Act, were put in place because of concerns about the lack of a model of care at the Royal Adelaide emergency department, also the lack of an interview room and the need to make sure that instances of restrictive practice were clinically recorded so that they could be reviewed with the aim of reducing the use of restrictive practices.

That gazettal condition actually followed an inspection in January. Because there had not been sufficient change, on review later in the year, by I think about late June, the gazettal condition was put in place. That led to extensive work at CALHN. I was very pleased to see the involvement of the board executive, clinical leaders and clinicians in developing that work. Towards the end of that three-month period, I received quite an extensive report from CALHN about the progress that had been made at that time.

I thought that the work that was presented to me was intensive and of high quality. It looked at the areas of the gazettal condition but it also encompassed issues of hospital diversion and the complete flow through their system because, at the same time, other initiatives, such as Hospital in the Home and looking at the further expansion of the mental health ambulance co-response, were also being discussed. With that, the gazettal conditions were lifted, but we continued to monitor the situation, recognising, for example, that the basis of a model of care is in place but that that model of care is still subject to consultation and is yet to be finally implemented.

I believe that the sorts of concerns that we saw in our inspection are similar to the concerns of clinicians and consumers. I think the most important caveat is that our gazettal condition is not a reflection on the individual clinicians at the Royal Adelaide ED or in mental health. It reflected the need to have improved systems in place, rather than reflecting the dedicated work of clinical staff.

Mr PICTON: Minister, is it now your view that the concerns raised by 28 emergency department doctors at the Royal Adelaide—that the care that they know is suboptimal and at times unethical—are now resolved?

The Hon. S.G. WADE: My understanding of the advice that the Chief Psychiatrist gave us is that that work is still ongoing.

Mr PICTON: So there is still care that is being provided that is suboptimal and unethical to this date.

The Hon. S.G. WADE: The Chief Psychiatrist continues to work with the CALHN management and board and, for that matter, the teams of clinicians at the hospital to ensure that we deliver the best possible care to patients.

Mr PICTON: With respect, minister, that may be the answer to some question but not to my question, which is: is there care currently being provided in CALHN which is suboptimal and unethical, as was stated by 28 emergency department doctors only a couple of months ago?

The Hon. S.G. WADE: As I indicated, there is still room for improvement.

Ms LUETHEN: Referring to Budget Paper 4, Volume 3, page 21, could the minister please outline the measures implemented to provide mental health support to the South Australian community during the COVID-19 pandemic, particularly for people living in the northern suburbs of Adelaide?

The Hon. S.G. WADE: I will ask the Chief Psychiatrist to respond to that question.

Dr BRAYLEY: The COVID-19 mental health support was mentioned by the minister in the introduction. It was initially called the Virtual Support Network and still is, because a lot of the services were being delivered virtually but then came to be more face-to-face services.

In terms of the budget side of this, there was an initial amount of $1.277 million allocated in 2019-20, which was invested to establish the network. This stage 1 of the Virtual Support Network included the COVID-19 Mental Health Support Line. It also encompassed support for carers, people from culturally and linguistically diverse communities and Aboriginal communities, and people already with a lived experience of mental illness.

In May 2020, cabinet approved further funding $4.421million for stage 2 of this response. This enabled increased drug and alcohol service capacity, enhanced use of digital technology, initiatives for children and young people, increased capacity for mental health services for older persons, to residents, enhancing in-reach into aged care, increased counselling services, prison in-reach services delivered by forensic mental health and allied health.

There were resources for the Commissioner for Public Sector Employment to provide enhanced mental health and wellbeing support for public sector employees. In addition, there was funds allocated to the Mental Health Coalition to assist with preparedness in the event of a further outbreak, preparedness for the mental health NGO sector. There is a governance oversight group that looks at how the money is spent and re-prioritises according to need.

Most recently, stage 3, as announced in the budget, was the $10.711 million, which has further expansion of drug and alcohol in-reach and outpatient support, and also expands the mental health co-response with ambulance, because by the time stage 3 came about we were seeing significant increases in calls to our crisis lines, increases in mental health and drug and alcohol presentations to emergency departments. So the response has been flexible and overseen by that committee. These are predominantly statewide services that can be accessed by people across SA, including the people in the north of Adelaide.

Specifically with regard to NALHN, in the second phase, the Northern Adelaide Local Health Network received $350,166 in that period, which covered clinical resources, digital resources and money for older persons in-reach residents in aged care. There was also $203,000 to establish forensic mental health assessment and treatment for prisoners, because there were concerns about prisoner mental health during this period. There was a similar initiative with CAMHS for youth who were in contact with the justice system. That is a run-down for the state and some specific information about funding to NALHN.

Mr PICTON: I refer to the same budget line as before in relation to CALHN, Budget Paper 4, Volume 3, page 29. The letter from the 28 emergency department doctors stated:

Recent public criticism—explicit and implied—and scapegoating of ED staff for outcomes that relate to CALHN’s inability to provide adequate mental health services has had a catastrophic effect on morale.

Minister, when you received that letter outlining the concerns about public criticism, what action did you take to address the issue of morale of the staff of the emergency department?

The Hon. S.G. WADE: Certainly, at around that time, I had a number of discussions with the Chief Psychiatrist and people at CALHN. I was confident that a respectful conversation was the goal of the leadership and I believe that relations have significantly improved since the time of that letter.

Mr PICTON: Do you believe that the emergency department staff were being scapegoated for blame?

The Hon. S.G. WADE: I do not believe they were being scapegoated. I appreciate that people were concerned about being scapegoated but, as the honourable Chief Psychiatrist indicated just minutes ago, we do not blame the clinicians for the services that they have inherited. Let's be clear that the Royal Adelaide Hospital transferred from the old Royal Adelaide Hospital site to the new Royal Adelaide Hospital site without a model of care and that is an element of the legacy of the former government which we are trying to address.

Mr PICTON: Minister, have you taken action to make sure that the emergency department staff of the Royal Adelaide know that they are able to speak publicly about their concerns? In their letter to the chair of the board and to you, they said:

SA Health's insistence that clinicians are also not allowed to speak publicly about these issues compounds the distress that many staff are suffering.

The Hon. S.G. WADE: I have repeatedly made public statements which indicate that I respect the right of clinicians to speak publicly on matters of concern. But fundamentally, we look to clinicians, management, boards and, for that matter, oversight bodies such as the Chief Psychiatrist to work together. I believe much can be achieved collaboratively and the media does not always help.

Mr PICTON: Is there an insistence from SA Health that clinicians are not allowed to speak publicly?

The Hon. S.G. WADE: I am advised by the chief executive of the department the answer is no.

Mr PICTON: Did you offer to meet with the clinicians after receiving this letter from them?

The Hon. S.G. WADE: Not that I recall.

Mr PICTON: You did not make an offer. You have not met with them, I presume, following the receipt of this letter from the 28 doctors.

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

Mr PICTON: Did you ask anyone from the department or from CALHN to speak to these doctors and address their concerns?

The Hon. S.G. WADE: As I indicated earlier, I had discussions with both the Chief Psychiatrist and with representatives of CALHN. I was aware of the ongoing discussions and I am pleased that progress is being made.

The CHAIR: Member for Kaurna, I have been very generous through this hearing so far. If I can please just bring you back to providing a budget reference for each question, and I remind you that questions should be guided to a relevant budget line and you need to be able to reference that budget line in your question.

Mr PICTON: Yes. I refer to Budget Paper 4, Volume 3, page 29, Central Adelaide Local Health Network. There was a number of suggestions raised by the 28 doctors in their letter to you regarding the provision of mental health services at the Royal Adelaide Hospital. I would like to ask your response to each of them and what actions you have taken. The first is:

Ending localised bed management: it is not acceptable that a patient waits days in the Royal Adelaide ED while a mental health bed is available in SALHN or NALHN. We have repeatedly asked why this should be the case and have not received an answer.

The Hon. S.G. WADE: Localised bed management is a longstanding issue of concern and it certainly predates this government. I wonder if the Chief Psychiatrist might give us a perspective on the issues involved.

Dr BRAYLEY: The question of localised bed management is currently under review. In the Office of the Chief Psychiatrist, the Director of Planning, Policy and Safety is doing that work. We have also looked at modelling about what happens if you change the localised bed management model, because when it was put in place it was considered to have an important role in the way the system operates. Some of that modelling and review of data would suggest that, basically, localised bed management might work but then, when there are peaks, the system becomes more flexible in terms of having systems with other LHNs taking referrals.

Currently, this assistance will occur on an urgent basis. The chief operating officers do have regular teleconferences when there are significant bed demands, but the localised bed management policy—that question, this particular approach that has been in place—is likely to be modified so that it is more flexible at peak times.

The Hon. S.G. WADE: I think it would be fair to say that CALHN is particularly affected by localised bed management because people from all over the city and all over the state might come to the Royal Adelaide and not be accessing the services of other hospitals.

Mr PICTON: The second issue that the 28 doctors raised with the government in their letter of concern was:

An equitable distribution of rural and remote patients requiring transfer: these patients continue to be sent overwhelmingly to the RAH ED; even when the only available beds may be in SALHN or NAHLN.

Why is there not a better distribution of those regional patients?

The Hon. S.G. WADE: I will ask the Chief Psychiatrist to respond to the honourable member's question.

Dr BRAYLEY: When the localised bed management policy was put in place, when people in rural areas are transferred into the city, there are particular flows as to which hospital they will go to. As you can imagine, people from the Fleurieu Peninsula would be going to the SALHN area. People from the region just north of NALHN would go to the Lyell McEwin and significant numbers of people, including those who come in via air transfer, do go to the Royal Adelaide Hospital.

That has been operating for some time, but this is the very issue of simulation modelling that we have looked at in terms of how those flows can be changed for rural people in terms of their emergency department assessment, noting that the rural and remote unit for many of these people is going to be the place where they will get their inpatient admission on the Glenside campus.

The rural and remote unit is run by Barossa Hills Fleurieu, but in the model that was put in place a few years ago, basically the work on the Glenside campus and the Royal Adelaide was linked together, which is why the RAH ED has had these people referred through it. Indeed, that is something to be changed, particularly at peak times, and has also been the subject of modelling that can show the benefit of changing those flows.

Mr PICTON: The third issue that was raised, minister, with you and the board was:

Re-examination of the types of patients in Mental Health beds: we have been assured in the past that the opening of additional Forensic beds would mean that patients requiring forensic care would no longer have to wait in the RAH ED for such a bed; but we still see long waits for these beds and it is not clear why this continues to be the case.

In relation to that recommendation, minister, what action did you take?

The Hon. S.G. WADE: Two of the initiatives of the Marshall Liberal government directly relate to forensic services. This government opened 10 forensic mental health beds at Glenside and introduced a court diversion service. I am advised that the allocation of the additional forensic mental health beds has improved services for forensic mental health patients but, in the spirit of continuous improvement, NALHN, which is the network responsible for the Forensic Mental Health Service, is currently reviewing the utilisation of those beds.

Mr PICTON: How many emergency department beds in CALHN are typically occupied by mental health patients, noting that the doctors in this letter approximated that it was 25 per cent to 50 per cent?

The Hon. S.G. WADE: We do not have that data with us. We will take that on notice.

Mr PICTON: Have any inpatient mental health beds been added to CALHN to address the concerns raised by these 28 doctors in their letter of concern?

The Hon. S.G. WADE: Yes.

Mr PICTON: How many?

The Hon. S.G. WADE: There were an additional four beds, with an intention to add to those. I cannot tell you how many have been added since the initial four.

Mr PICTON: How many of those four or eight beds are open today?

The Hon. S.G. WADE: I think my previous answer made it clear that that is not clear.

Mr PICTON: What percentage of rural and remote patient transfers are sent to CALHN, as opposed to other LHNs, for mental health patients?

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

Mr PICTON: Have there been any budget cuts to mental health programs within CALHN?

The Hon. S.G. WADE: The member used the word 'any'. I will need to consult with the local health network to be able to answer that question.

Mr PICTON: Given that this is budget estimates and CALHN is a feature of the budget, will CALHN have the same funding for mental health in this financial year as it had in the previous financial year, or will there be a reduction or an increase?

The Hon. S.G. WADE: Funding for mental health services is provided by the government to the Central Adelaide Local Health Network. It is their responsibility to allocate that money and deliver quality and safe services as efficiently as possible.

Mr PICTON: So no-one in the Department for Health and Wellbeing knows what the budget for mental health services in the largest LHN, CALHN, is?

The Hon. S.G. WADE: A significant proportion of mental health funding is activity-based funding, particularly inpatient services. In terms of CALHN's investment, I am aware of an increase in investment. CALHN, for example, has been a leading advocate for the Mental Health Co-Responder program, which has mental health clinicians sitting alongside SAAS paramedics to provide mental health consumers with the opportunity of community-based responses rather than needing to go to an emergency department to receive the mental health care they need.

The board and management, of course—going back to the discussion we were having about the model of care—are working with their teams to develop services with the funding that is provided to them.

Mr PICTON: So are there any budget savings that apply to mental health services in CALHN this financial year?

The Hon. S.G. WADE: I am advised that there are no mental-health-related savings mandated by the Department for Health and Wellbeing.

Dr HARVEY: My question relates to Budget Paper 4, Volume 3, pages 28 to 59. Could the minister please outline the matters that have been discussed by the NDIS psychosocial transition task force in the last 12 months?

The Hon. S.G. WADE: I thank the member. I will ask the Chief Psychiatrist if he can provide a response.

Dr BRAYLEY: The NDIS transition task force was set up back in June 2018 to monitor the impact of the NDIS implementation on South Australians who experience mental illness, and service providers. During this period, task force lobbying has contributed to the introduction and implementation by the NDA of the streamlined access process for people with psychosocial disability, and the establishment of the recovery coach role which provides case management type services for people with primary psychosocial disability and improved NDIS pricing arrangements for the delivery of capacity-building psychosocial services.

The statement is that we have contributed to that. Obviously, the NDIA would hear these messages from consumers, carers, and service providers all around the country, but our task force has been a venue where senior NDIA people, as well as people from commonwealth departments, state departments, statutory bodies, the safeguarding commission, consumers and carers and NGOs talk about this work and raise the issues using a risk register to structure the identification of issues and the solutions that need to be put in place.

This year, while the meetings are occurring monthly, earlier in the year there were a number of panels where providers brought specific client concerns to be addressed and to be escalated. We have also used this to look at the needs of people who need very high-level support, with complex needs, who have been in hospital and have been part of a particular 31 Homes program.

The task force has monitored the statistics of the transition of the people who are identified, and not just our transition statistics from state services to the NDIA, but the commonwealth makes their statistics available. Interestingly, in terms of the past 12 months, that initial task force focus, we have looked at our role. People were very keen to meet because it is a continue meeting, it gives an opportunity for the sector to get together.

There was a project that the Mental Health Coalition did looking at transition and the best way to transition, which was guided by the task force, but there has also been a lot of COVID-related discussions—not strictly NDIS but it was just a very useful venue to help get people prepared and responding in March and April when there was a lot of anxiety with the first wave of COVID. Of course, this led to the project I mentioned earlier that the Mental Health Coalition is doing in terms of supporting their sector with COVID-related matters. That has taken some of the task force time this year as it has continued to meet virtually.

Ms BEDFORD: Budget Paper 4, Volume 3, and the question is whether there is any planned investment in Woodleigh House at Modbury Hospital, or are we keeping it as a film set for a movie?

The Hon. S.G. WADE: The Marshall Liberal government is investing heavily in the Modbury site, but I certainly share the honourable member's view that Woodleigh House is well past its use-by date. The Chief Psychiatrist did impose gazettal conditions on Woodleigh House. I might just clarify that.

Dr BRAYLEY: Yes, this would have been approximately early 2019, so during 2019 there was improvement work. It was conditions related to the physical infrastructure and models of care.

The Hon. S.G. WADE: As a result of the gazettal process there were improvements in the model of care and in some of the physical attributes of the site, but I certainly do not suggest that they address the long-term need for investment, and the government is aware of that need.

Ms BEDFORD: When might we see something change at Woodleigh House for the better?

The Hon. S.G. WADE: I can only assure you that we are very mindful of the need and, as we continue to work through our capital works and service budgeting going forward, it is very much on our radar.

Mr PICTON: Just picking up the same budget line, in terms of CALHN, page 29 of Budget Paper 4, Volume 3. The minister said just before the member for Newland asked a question that there were no savings of mental health for CALHN imposed by the Department for Health. Does that mean there may be savings that are not imposed by the Department for Health?

The Hon. S.G. WADE: The answer is the answer.

Mr PICTON: The answer is the answer. Are there any potential savings or any savings at all, whether or not they are imposed by the Department for Health and Wellbeing, at CALHN for mental health services?

The Hon. S.G. WADE: We expect all local health networks to continue to improve their services, looking for opportunities for continuous improvement. Often, when efficiencies are identified, they go to fund service improvements.

Mr PICTON: How it is possible, given the concerns raised by these doctors, given the concerns raised clearly in the order that was placed on the RAH, given the demand of patients and the number who were stuck for more than 24 hours, that savings could be found from mental health services in CALHN?

The Hon. S.G. WADE: The honourable member is referring to a particular segment of the CALHN services. I would like to ask him to pause, and in that letter I would remind him that the clinicians said:

For at least a decade, patients presenting to the RAH emergency department who require inpatient psychiatric care, have suffered unacceptable delays in transfer to appropriate beds.

That was the case when he was a health minister under the former Labor government.

Mr PICTON: I was never the health minister.

The Hon. S.G. WADE: You were the assistant minister for health. So it is true for at least a decade, as those honourable clinicians said, so his moral outrage sounds somewhat hypocritical.

Mr PICTON: If it is possible to answer a question, how is it possible that savings could be found, given the tremendous stress on mental health services in CALHN at the moment?

The Hon. S.G. WADE: As I said, services can be improved by identifying inefficiencies and turning them into service improvements.

Mr PICTON: Can you assure the committee that there will be no reduction in clinicians or direct services to patients out of potential savings in CALHN this year through mental health services?

The Hon. S.G. WADE: I am very confident in the work that has been done by the Chief Psychiatrist, in partnership with the management and board of CALHN, together with the clinicians. I am very confident that the development of the acute mental health model of care will see a significant improvement in care at that facility. The fact that we did not have a model of care that we could receive from the outgoing government is disappointing. We are intending to address that legacy.

Mr PICTON: Where do you believe the fat could be cut in terms of mental health services? You said that efficiencies can be found. Whereabouts would there be efficiencies in terms of the delivery of mental health services in CALHN?

The Hon. S.G. WADE: I have nothing to add to my previous answers.

Mr PICTON: I refer to Budget Paper 4, Volume 3, Program 2: Health Services, page 28. What has been the longest wait for a mental health patient in an emergency department for a bed over the past year?

The Hon. S.G. WADE: I do not have maximum wait visit times at EDs, but in terms of the latest 12-month comparison at metropolitan hospitals from September 2019 to September 2020, there was a slight decline from 12.7 hours for an average visit time to 11.8.

Mr PICTON: In terms of the number of patients who have been waiting over 24 hours in an emergency department, which I believe is commonly referred to as a 24-hour breach, can the minister give the committee the numbers in the past financial year who have breached that 24-hour mark?

The Hon. S.G. WADE: I thank the honourable member for his question. For the same parameter, from the latest available to a 12-month comparison, the percentage of presentations greater than 24 hours has decreased from September 2019 at 12.7 to September 2020 being 8.8.

Mr PICTON: So 12.7 was 2019-20? Is that right?

The Hon. S.G. WADE: Sorry, just to be clear: in both cases, I was talking about the change from September to September, because the September figure is the latest available. In September 2019, the percentage of presentations that were greater than 24 hours was 12.7, and the rate in September 2020 was 8.8.

Mr PICTON: Do you have figures for the entirety of the 2019-20 financial year?

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

Mr PICTON: Also, do you have the total numbers (what you said were percentages) of patients who had breached that 24 hours across the emergency departments in the 2019-20 financial year, if possible?

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

Mr PICTON: What is the current occupancy rate of mental health beds across CALHN?

The Hon. S.G. WADE: I will need to take that on notice because the dashboards change all the time.

Mr PICTON: How many acute mental health care beds are there currently in the system in total, and what is the difference compared to 12 months ago?

The Hon. S.G. WADE: I am advised that there are 369 mainstream acute beds and that is current, and I will seek a number for last year.

Mr PICTON: What has been the average length of stay for mental health patients in public hospital emergency departments in the previous financial year?

The Hon. S.G. WADE: I believe that that is the question I took on notice just a few minutes ago.

Mr WHETSTONE: Referring to Budget Paper 4, Volume 3, page 24, minister, would you please advise the committee the commitment that the government has made to investing in non-government provided treatment services in South Australia to support people who are impacted by alcohol and other drug problems?

The Hon. S.G. WADE: Mr Chair, I would ask Marina Bowshall if she would answer that question.

Ms BOWSHALL: Just over $15 million has been allocated in the 2020-2021 financial year to the non-government sector to provide alcohol and other drug assessment treatment, support and harm reduction services. The Department for Health and Wellbeing has commissioned a range of alcohol and other drug treatment services across metropolitan and regional areas in South Australia and enabled these services to be delivered from 1 July 2020 to 30 June 2023. Services include:

counselling services, which incorporates psychosocial interventions, such as outpatient counselling through a range of different therapies, and police drug diversion initiative appointments, and they are available in multiple locations across the state;

residential rehabilitation programs in four metropolitan Adelaide locations as well as Whyalla, Berri and Mount Gambier;

sobering up services, available in metropolitan Adelaide, Ceduna and Port Augusta;

mobile assistance patrol services in the Adelaide central business district and Ceduna; and

an integrated youth substance misuse specialist service based at Stepney, but able to provide services to young people across the state, which includes outpatient counselling, sobering up and residential rehabilitation.

We also fund a range of family support groups across metropolitan Adelaide, the Barossa, Mount Barker and Port Augusta and these services are complemented by a telephone support service, which is provided by Family Drug Support. We also fund the peak non-government agency, the South Australian Network of Drug and Alcohol Services, to coordinate non-government programs and provide advice to the government about the non-government sector.

We recognise the important work of the non-government sector in collaborating and building upon the services provided by government. They make a very significant contribution to the wellbeing of South Australians in the state. We recognise that the provision of their alcohol and other drug treatment services are of incredibly high quality and support individuals and families as they seek to address their substance use and build a healthier future for themselves.

Ms BEDFORD: Supplementary: I noticed in your response that you mentioned the mobile assistance program for Aboriginal people. I am wondering what other Indigenous focus programs you have and what you have for culturally and linguistically diverse people?

The Hon. S.G. WADE: Could I ask Ms Bowshall to respond to that question.

Ms BOWSHALL: We provide services that are funded to ensure that they are culturally sensitive and appropriate for all Aboriginal people across the state. We do fund Aboriginal community-controlled services for sobering up and also for tobacco control programs. We also have a range of Aboriginal clinical services based within Drug and Alcohol Services itself, providing services on the APY lands and assertive outreach programs in the inner city of Adelaide.

In regard to CALD programs, we embed access to all our programs with interpreter services and we engage with consumer groups that have CALD representation to ensure they are culturally appropriate. That is certainly another area that we want to develop further as we go through and continue to develop and enhance our services.

Ms BEDFORD: Just to squeak one more question in.

The CHAIR: One more, member for Florey.

Ms BEDFORD: Thank you for being very indulgent. Do your programs have anything to do with the prison sector? How are substance abuse programs administered through Corrections, or is that not something you can help me with?

The Hon. S.G. WADE: Ms Bowshall is from Drug and Alcohol Services South Australia. That service does provide an inreach service to youth justice facilities, but inmates of adult correctional facilities receive their drug and alcohol support from the Prison Health Service, which is a service overseen by the Central Adelaide Local Health Network.

Mr PICTON: I refer to Budget Paper 5, page 72, Adult Mental Health Centre. When is the Urgent Mental Health Care Centre currently expected to open?

The Hon. S.G. WADE: My understanding is that it is expected that the service will be operational by February 2021.

Mr PICTON: Where will the facility be?

The Hon. S.G. WADE: On Grenfell Street, in the city.

Mr PICTON: How many staff have been dedicated to work in the centre particularly? What is the breakdown in terms of how many psychologists and nurses there will be? Will there be any doctors working in the centre?

The Hon. S.G. WADE: Neami, our partner in this project, has been involved in a codesign process and, I am advised, has begun recruiting two positions. I will seek details in response to the honourable member's question and provide an answer to him.

Mr PICTON: What is the highest acuity level of emergency department presentation that would be diverted to the centre?

The Hon. S.G. WADE: I am advised that the centre will be designed to provide an option for people with mental health issues in the triage 3, 4 and 5 categories.

Mr PICTON: Given that triage level 3 can be quite serious mental health patients, what security measures or backup facilities will be available in place at the centre?

The Hon. S.G. WADE: The centre will be established with triage guidelines for both SAAS and police. The centre itself will have de-escalation strategies, which they will deploy with both peer workers and other health workers. The facility is close to police and, of course, the wider range of SA Health services are available to support the centre.

Mr PICTON: Given the Australasian College for Emergency Medicine lists category 3 mental health patients as including people who are very distressed, acutely psychotic or potentially aggressive, will all of those category 3 patients be able to be deferred to the Urgent Mental Health Care Centre with peer workers?

The Hon. S.G. WADE: I am concerned at the honourable member's attempts to be critical of this model.

Mr PICTON: Point of order: I did not do anything of the sort. I am asking a question in terms of which patients will be going there?

The Hon. S.G. WADE: I would like to remind the honourable member of the responses of some of the leaders of mental health services in South Australia. The Mental Health Coalition of South Australia said that they welcome the news that South Australia's new Urgent Mental Health Care Centre will be delivered by local community mental health service provider Neami, with RI International.

The coalition talked about this much-needed centre. It is the first of its kind in Australia. While similar models have been operating for a number of years in the United States, they say that it will provide a high-quality alternative to the emergency department and has been developed based on strong feedback from the experience of people with mental illness, their families, as well as clinicians.

The centre is completely within the spirit of the 2020-2025 Mental Health Services Plan. In fact, the centre was explicitly referred to as a strategy in that report. We believe that whilst it may be novel for Australia, it is well based on evidence. It has the strong support of the peak body in South Australia and we look forward to working with all the mental health services that will interact with the centre to make sure that it delivers higher quality and safe care.

Mr PICTON: That was not quite an answer to the question, but we will move on. Why was the CALHN tender proposal for this centre rejected?

The Hon. S.G. WADE: My understanding is that there was more than one provider who submitted to the open market expression of interest and those bids were assessed. The Neami proposal was accepted.

Mr PICTON: Is it correct that the CALHN tender or expression of interest offered additional hours of operation for the service compared to the winning tenderer?

The Hon. S.G. WADE: My understanding is that all of the bids to the open market expressions of interest are commercial-in-confidence but I assure the honourable member that the hours of operation of each of the proposals would be one of the factors that would have been considered by the evaluation panel.

Mr PICTON: How is it commercial-in-confidence for one part of the government to propose something to another part of the government? Where is the commercial interest for a part of the government, the Central Adelaide Local Health Network?

The Hon. S.G. WADE: I am mindful of the criticism of the honourable member of the Neami proposal—

Mr PICTON: Point of order: I am not criticising anything. I am asking a question.

The CHAIR: The minister is providing an answer.

The Hon. S.G. WADE: I am allowed to give your question an answer. I am aware of the honourable member's comments in the public domain criticising the acceptance of the Neami bid as privatisation. I just make the point that the CALHN consortium bid involved non-government partners. If he wants to criticise the Neami proposal on that basis, I would ask him to reflect on that. In terms of the so-called probity freedom for government to show commercially confidential information across different organs of government, I respectfully disagree.

Mr PICTON: Is it correct that the CALHN tender offered additional clinical FTE staff for the same price as the winning tenderer?

The Hon. S.G. WADE: As I said, all of the relevant elements of the service model would have been considered in the evaluation process.

Mr PICTON: Will any RI International staff be present in Australia to deliver on this project?

The Hon. S.G. WADE: I do not know the particular arrangements that Neami and RI are planning in terms of virtual visits or physical visits, but again I would refer the honourable member to the comments made by the Mental Health Coalition. I understand that Geoff Harris, the executive director, said:

The successful bidders are the not-for-profits Neami and RI International. Neami have been delivering specialist mental health services in SA for 18 years and are one of the largest specialist mental health service providers in Australia. RI International has a strong track record of delivering this kind of [care] in several states of the USA and will be responsible for assisting Neami to implement the model in SA.

For those who are followers of changes of government in South Australia, Neami has been in South Australia, as Mr Harris said, for 18 years. They have received tens of millions of dollars from the former Labor government, and to be criticised as being a party to a privatisation I think is disrespectful to the non-government sector.

Dr HARVEY: My question relates to Budget Paper 4, Volume 3, page 24. Could the minister please provide an update on the prevalence of alcohol, tobacco and other drugs within the South Australian population, including any new trends?

The Hon. S.G. WADE: I thank the honourable member for his question. I might ask Ms Bowshall to provide us with information on that.

Ms BOWSHALL: In 2020, the National Drug Strategy Household Survey was released. This survey is conducted every three years by the Australian Institute for Health and Welfare and was released in July 2020. In the survey, 2,660 South Australians aged 14 years and older provide information based on their views, understanding and use of substance use patterns, attitudes and behaviours.

The South Australian data show there have been significant decreases between 2016 and 2019 in recent use of methamphetamine and recent illicit use of pain reliever medications and opioids, while recent use of alcohol, tobacco and cannabis has remained stable. Compared to the national average, South Australia has lower prevalence for a range of substances including methamphetamine, cannabis, cocaine and ecstasy. South Australia is also below the national average for recent illicit drug use with 15.4 per cent reporting use at least once in the last 12 months compared to 16.4 per cent nationally.

The recent use of methamphetamine, as the minister mentioned in his opening address, has decreased significantly in South Australia from 1.9 per cent in 2016 to 1 per cent, which is lower than the national average, or national prevalence, of 1.3 per cent. In addition, the prevalence of daily smoking in South Australia is 11.9 per cent, which is equivalent to the national figure of 11 per cent. There was no change in South Australia's prevalence of daily drinking or lifetime and single-occasion risky drinking; however, there was an increase in the proportion of ex-drinkers within the state, from 6.6 per cent in 2016 to 8.5 per cent in 2019, which is similar to the national average of 8.9 per cent.

The results of the survey showed that in a number of important areas South Australia's substance use prevalence has decreased significantly between 2016 and 2019, and South Australia's prevalence particularly for use of illicit substances is lower than the national average. We continue to be committed to continuing that trend to decreasing the prevalence of harmful drug use in the community and are working with individuals, families and the community as a whole to progress actions to continue these downward trends.

Mr PICTON: I have a question in relation to Budget Paper 4, Volume 3, page 39, Women's and Children's Health Network. What is the average wait between obtaining a referral and attending an appointment with CAMHS?

The Hon. S.G. WADE: I do not have that information with me. I am happy to take that on notice but hasten to add that the Office of the Chief Psychiatrist is aware of issues in relation to the intake process into CAMHS and is working with WCHN to seek to address those issues.

Mr PICTON: How many children with a referral are currently on the waiting list for an appointment with CAMHS?

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

Mr PICTON: How many incidents of restraint and seclusion have there been in Boylan Ward in the year to date this year?

The Hon. S.G. WADE: Unsurprisingly, we will need to take that on notice.

Mr PICTON: Have any issues of restraint and seclusion been raised with either you or the Chief Psychiatrist in regard to Boylan Ward?

The Hon. S.G. WADE: I take it in the last year?

Mr PICTON: Yes.

The Hon. S.G. WADE: In terms of the information the honourable member has sought, I am happy to take that on notice. The fact that the government is committed to high-quality mental health services for children and adolescents is demonstrated by the fact that, as part of our $50 million Women's and Children's Hospital sustainment project, we are upgrading the existing Boylan Ward.

Construction works for the new ward commenced in January 2020 and I understand will be completed shortly. The opportunity of a new facility—shall we say, a renovated facility; I appreciate it is within the constructs of the old hospital—does give clinicians an opportunity to design a facility that can better support their model of care and reduce the prospect of restraint and seclusion being used.

Mr PICTON: What has been done to address the severe shortage of psychologists working with five to twelve year olds, as was publicly raised by the Commissioner for Children and Young People last month?

The Hon. S.G. WADE: I will seek advice from the Women's and Children's Hospital Network in relation to that question.

Mr PICTON: Have you met with the Commissioner for Children and Young People to discuss her concerns?

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

Mr PICTON: Are you aware of her concerns?

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

Mr PICTON: What have you done following becoming aware of her concerns?

The Hon. S.G. WADE: I have not sought to meet with her, and as far as I know she has not sought to meet with me.

Mr PICTON: Are there any plans to outsource any of the services currently being provided by CAMHS?

The Hon. S.G. WADE: I am not aware of any.

Mr PICTON: Will the full range of services currently being provided at the Women's and Children's Hospital for children with mental health conditions or who need services be available at the new hospital?

The Hon. S.G. WADE: The design of the new Women's and Children's Hospital is actively underway. Just as happened with the new Royal Adelaide Hospital, the local health network, I am sure, will be looking at opportunities to re-evaluate what services might be best delivered from a hospital site. There may well be, for example, outpatient services that can be more effectively delivered for patients in a community setting rather than on the hospital site itself?

Mr PICTON: Will the new Women's and Children's site house additional inpatient mental health beds, given the significant demand placed on Boylan Ward to date at the current site? How many total mental health care beds are being planned?

The Hon. S.G. WADE: Those figures will not be finalised until the business case is finalised.

Mr PICTON: When is the business case scheduled to be finalised?

The Hon. S.G. WADE: Next year.

Mr PICTON: Is there a particular time next year?

The Hon. S.G. WADE: My understanding is the second quarter of next year.

Mr PICTON: So how was there a report in The Advertiser, I think it was even during the lockdown, where you were quoted in terms of the number of beds that would be open at the Women's and Children's Hospital?

The Hon. S.G. WADE: My recollection of the phrase I used was 'preliminary planning'.

Mr PICTON: In relation to preliminary planning for the new Women's and Children's Hospital, how many mental health care beds are in the preliminary planning?

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

Mr PICTON: In relation to Budget Paper 5, page 73, COVID-19 Mental Health Support, why does South Australia have the lowest spend per capita out of every mainland state in its response to the mental health care impact of COVID-19?

The Hon. S.G. WADE: I do not support the premise of the honourable member's question. I think one of the risks here is that people may not have realised that the government has committed to the mental health response in three tranches, for want of a better word. I will ask the Chief Psychiatrist to explain that to us.

Dr BRAYLEY: The first part of the virtual support network was $1.277 million and that was until the end of June; then July to September, $4.421 million; and now in the budget, $10.711 million. This basically includes our community initiatives delivered by LHNs and by non-government organisations. It does not include some other expenditures. For example, there was the use of the Adelaide Clinic for a period of time to help with decanting during the first wave, and that has been activated again through CALHN, or some of the mental health costs that have been in quarantine services.

The Hon. S.G. WADE: I thank the Chief Psychiatrist for his answer. I would also like to add to it by saying that the government has also allocated $5.3 million for the statewide wellbeing strategy which encourages South Australians to 'open your world' to sports, arts and physical activity during the pandemic.

I think it is really important to appreciate that the pandemic was always going to impact on the broader South Australian community. This government recognised early that we had both an economic crisis and health crisis, but we also recognised that within the health crisis there was both the physical health threat, and the mental health threat. The mental health threat was not only for people with already present mental health issues, but the threat was there for the broader community.

The CHAIR: The time agreed and allotted for the examination of payments in relation to SA Health (mental health and substance abuse) is complete; therefore, there are no further questions and I declare the examination of the portfolio agency completed.

Departmental Advisers:

Dr C. McGowan, Chief Executive, Department for Health and Wellbeing.

Ms C. Mason, Director, Office for Ageing Well, Department for Health and Wellbeing.

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

The CHAIR: We are examining proposed payments in relation to Office for the Ageing. This session runs from 7.15pm to 7.45pm. The minister appearing is the Minister for Health and Wellbeing. The estimated payments are as referenced earlier to the Department for Health and Wellbeing, to the Commission on Excellence in Innovation and Health, and to Wellbeing SA. I advise that the proposed payments remain open for examination and refer members to the Agency Statements, Volume 3. Minister, if you wish to make an opening statement in regard to this portfolio you have the ability to, and to also introduce your advisers.

The Hon. S.G. WADE: By way of clarification, this is the Office for Ageing Well, not simply the Office for Ageing.

The CHAIR: That is not on my sheet, unfortunately.

The Hon. S.G. WADE: I would like to introduce my departmental executive staff. To my left is Dr Christopher McGowan, Chief Executive, Department for Health and Wellbeing. Behind me is Cassie Mason, Director, Office for Ageing Well, and also Mr Jamin Woolcock, Chief Finance Officer.

The COVID-19 pandemic has been challenging for all South Australians but especially older South Australians. Nationally, the majority of deaths from coronavirus have been of people aged 60 years and over. In South Australia, our four deaths were all individuals older than 60, with an average age of 72. Whilst compared with other countries, Australia has done very well in limiting the spread of the virus, older people continue to be particularly vulnerable to this disease.

South Australia moved rapidly to develop plans and put in place measures to protect residents of aged-care facilities and I am very pleased that, to this point, South Australia has been able to avoid the tragic outcomes to the scale that have occurred in some other jurisdictions.

Weekly meetings, hosted by the Office for Ageing Well, commenced in April 2020 with aged-care peak bodies, advocacy groups and providers to identify and work through issues associated with the operationalising provisions of the emergency management arrangements. These meetings have been crucial for ensuring our residential aged-care facilities are able to modify their practices and operations rapidly in response to new public health advice and directions.

As well as playing a vital role in delivering the government's COVID response, the Office for Ageing Well has continued its core business, developing and implementing a range of social policies and programs at the individual community and system level that reflect the diversity of opinions, needs and priorities of older South Australians.

In the last 12 months, the Office for Ageing Well has undertaken extensive consultation that culminated in the release of the South Australian Plan for Ageing Well 2020-2025. The plan is for all South Australians and includes a call to action on a range of matters, including tackling ageism, embracing diversity and increasing accessibility.

One of the most significant developments for the Office for Ageing Well over the past year was the establishment of the Adult Safeguarding Unit, which commenced operations on 1 October 2019. The unit has a legal mandate to respond to reports of abuse and neglect of older South Australians who may be considered vulnerable.

In response to the tragic death of Ann Marie Smith, the focus of the unit recently expanded to include adults living with a disability who may be vulnerable to abuse. This is just a brief summary of some of the important and varied work being led by the Office for Ageing Well, in particular with a broad range of stakeholders, particularly older people themselves, to ensure that current and future older Australians are in the best position to age well.

The CHAIR: Lead speaker for the opposition, do you wish to make an opening statement?

Mr PICTON: No.

Ms BEDFORD: I refer to Budget Paper 4, Volume 3, page 21, where reference is made to the State Ageing Plan 2020-24. This appears to be the only reference in the budget papers to the role of the Office for Ageing Well. It is my understanding that the Office for Ageing Well continues as a statutory office. Given this, can you explain the administrative position of the office within SA Health, and am I right in my understanding that the office is now totally subsumed within Wellbeing SA?

The Hon. S.G. WADE: No, I can assure the honourable member that this unit is not subsumed within Wellbeing SA.

Ms BEDFORD: Can you elaborate?

The Hon. S.G. WADE: The arrangements between this office and the department are the same this year as they were last year, and Wellbeing SA was established last year.

Ms BEDFORD: I understand the Office for Ageing Well continues with the responsibility for administering the Retirement Villages Act, which is up for review in the near future. Could you indicate to the committee when this review might occur and outline the issues you expect will be canvassed?

The Hon. S.G. WADE: The Department for Health and Wellbeing administers the Retirement Villages Act 2016. The object of the act is to provide a balance between the rights and responsibilities of residents of retirement villages and operators. The Retirement Villages Unit, which is within the Office for Ageing Well, consists of four staff. The unit investigates complaints, and those complaints are monitored on an ongoing basis to inform the upcoming review of the legislation.

The unit has been surveying residents and operators on various provisions of the legislation in preparation for a review of the act in 2021. The act requires the legislation to be reviewed three years from commencement; as such, a review is required in 2021. An open consultation round will commence in January 2021 through the release of a discussion paper on the YourSAy website, publicising the review on the SA Health website, and a direct mail campaign to key stakeholders.

Ms BEDFORD: What consideration has been given to appointing a regulator to ensure the Retirement Villages Act is being adhered to by retirement village operators, given the position of relative power they hold with respect to their residents? Beyond mediation, how are retirement village operators currently monitored and overseen regarding their compliance with the act, and does the Office for Ageing Well impose any penalties for noncompliance?

The Hon. S.G. WADE: As I indicated, the Retirement Villages Act will be subject to a review, which will start next year. Any proposals for a change in the regulatory framework, including the establishment of a regulator, could be put forward through that process. In relation to current activity to ensure compliance with the current act and regulations, I will ask Ms Mason whether she could respond to that query.

Ms MASON: The Retirement Villages Unit investigates and assesses a whole range of complaints and allegations of breaches of the act and regulations. In 2019-20, the compliance activity of the Retirement Villages Unit has focused on the new legislative provisions that have been introduced to improve transparency of resident finances at annual meetings as well as resident protections. This includes ensuring certificates of title are properly endorsed to protect residents' interests in the village and that the financial transparency at annual meetings is adhered to.

Our office chose randomly 15 per cent of operators, and they were required to present their documentation to our unit, which was checked against the requirements of the legislation, and the feedback was provided to operators. Pleasingly, the majority of provisions were complied with. There was minor noncompliance, but for the most part it has been really pleasing to see operators complying.

Mr PICTON: Mainly because I am not sure about my ability to manage time, I might ask the omnibus questions now so that we do not run out of time for that.

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

What is the actual FTE count at 30 June 2020 and the projected actual FTE count for each year of the forward estimates?

What is the total employment cost for each year of the forward estimates?

What is the notional FTE job reduction target that has been agreed with Treasury for each year of the forward estimates?

Does the agency or department expect to meet the target in each year of the forward estimates?

How many TVSPs are estimated to be required to meet FTE reductions over the forward estimates?

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

How much is budgeted to be spent on goods and services for 2020-21, and for each of the years of the forward estimates period?

The top ten providers of goods and services by value to each agency reporting to the minister for 2019-20; and

A description of the goods and/or services provided by each of these top ten providers, and the cost to the agency for these goods and/or services.

The value of the goods and services that was supplied to the agency by South Australian suppliers.

3. Between 1 July 2019 and 30 June 2020, will the minister list the job title and total employment cost of each position with a total estimated cost of $100,000 or more which has either (1) been abolished and (2) which has been created?

4. Will the minister provide a detailed breakdown of expenditure on consultants and contractors above $10,000 between 1 July 2019 and 30 June 2020 for all departments and agencies reporting to the minister, listing:

the name of the consultant, contractor or service supplier;

cost;

work undertaken;

reason for engaging the contractor; and

method of appointment?

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

How many FTEs were employed to provide communication and promotion activities in 2019-20 and what was their employment expense?

How many FTEs are budgeted to provide communication and promotion activities in 2020-21, 2021-22, 2022-23 and 2023-24 and what is their estimated employment expense?

The total cost of government-paid advertising, including campaigns, across all mediums in 2019-20 and budgeted cost for 2020-21.

6. For each department and agency reporting to the minister, please provide a full itemised breakdown of attraction and retention allowances as well as non-salary benefits paid to public servants and contracts between 1 July 2019 and 30 June 2020.

7. What is the title and total employment cost of each individual staff member in the minister's office as at 30 June 2020, including all departmental employees seconded to ministerial offices?

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

(a) How much was spent on targeted voluntary separation packages in 2019-20?

(b) What department funded these TVSPs? (except for DTF estimates)

(c) What number of TVSPs were funded?

(d) What is the budget for targeted voluntary separation packages for financial years included in the forward estimates (by year), and how are these packages funded?

(e) What is the breakdown per agency/branch of targeted voluntary separation packages for financial years included in the forward estimates (by year) by FTEs?

9. For each department and agency reporting to the minister, how many executive terminations have occurred since 1 July 2019 and what is the value of executive termination payments made?

10. For each department and agency reporting to the minister, what new executive appointments have been made since 1 July 2019, and what is the annual salary, and total employment cost for each position?

11. For each department and agency reporting to the minister, how many employees have been declared excess, how long has each employee been declared excess, and what is the salary of each excess employee?

12. In the 2019-20 financial year, for all departments and agencies reporting to the minister, what underspending on operating programs (1) was and (2) was not approved by cabinet for carryover expenditure in 2020-21?

13. In the 2019-20 financial year, for all departments and agencies reporting to the minister, what underspending on investing or capital projects or programs (1) was and (2) was not approved by cabinet for carryover expenditure in 2020-21? How much was sought and how much was approved?

14. For each grant program or fund the minister is responsible for please provide the following information for 2019-20, 2020-21, 2021-22, 2022-23 and 2023-24 financial years:

(a) 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; and

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

15. For the period of 1 July 2019 to 30 June 2020, 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.

16. For each year of the forward estimates, please provide the name and budgeted expenditure across the 2020-21, 2021-22, 2022-23 and 2023-24 financial years for each individual investing expenditure project administered by or on behalf of all departments and agencies reporting to the minister.

17. 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.

18. For each department and agency reporting to the minister, what is the total cost of machinery of government changes since 1 July 2019 and please provide a breakdown of those costs?

19. For each department and agency reporting to the minister, what new sections of your department or agency have been established since 1 July 2019 and what is their purpose?

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

What savings targets have been set for each year of the forward estimates?

What measures are you implementing to meet your savings target?

What is the estimated FTE impact of these measures?

I refer to the budget paper which I think is the only budget paper that references the office, which is Budget Paper 4, Volume 3, page 20, System Leadership and Design. When was the Department for Health and Wellbeing or the Office for Ageing Well or the Adult Safeguarding Unit informed about the death of Ann Marie Smith, and what did it do once it was informed of that death?

The Hon. S.G. WADE: The Adult Safeguarding Unit was not made aware until after it had been made public.

Mr PICTON: Does that include the Office for Ageing Well and the department as well?

The Hon. S.G. WADE: Certainly, it does relate to the Office for Ageing Well, because the ASU is within that office. In terms of the department, I am happy to take that on notice, and I will take it on notice in terms of the broader portfolio because the department itself is an administrative unit and it would be unlikely to be informed.

Mr PICTON: I refer to Budget Paper 4, Volume 3, page 28, Health Services. How many state-run aged-care facilities have failed to meet accreditation standards since the last estimates, and which are those facilities?

The Hon. S.G. WADE: I am advised that there are no current notices of noncompliance in South Australian government aged-care facilities. The Bonney Lodge and Hawdon House matters have now been archived.

Mr PICTON: Just to clarify, there have been no additional matters that have been raised since last estimates?

The Hon. S.G. WADE: I cannot handle something as general as 'any matters being raised'.

Mr PICTON: Well, any state-run aged-care facilities that have failed to meet accreditation standards.

The Hon. S.G. WADE: I am advised that there are no current notices of noncompliance in South Australian government aged-care facilities.

Mr PICTON: Have there been any notices of noncompliance since last estimates?

The Hon. S.G. WADE: There have certainly been matters in relation to non-government home care providers, but I do not answer for them.

Mr PICTON: Have there been any matters of noncompliance of state-run aged-care facilities since estimates last met?

The Hon. S.G. WADE: I am not aware of any.

Mr PICTON: Are there any plans to privatise or outsource any current state-run aged-care facilities or services?

The Hon. S.G. WADE: With all due respect, the Office for Ageing Well is responsible for older South Australians and their support. The matters the honourable member is referring to are completely within the governance of the local health networks. That budget line has been closed.

Mr PICTON: Well, actually no, it has not.

The CHAIR: The budget line has not been closed, but for the portfolio that is open at the moment and for which we are examining those payments that is not relevant. I uphold the point of order that the question is out of order, member for Kaurna.

Mr PICTON: It is shocking that you would not want to answer that. I reference the same budget line, page 20, which I believe is the only reference in the budget to the Office for Ageing Well. What is the total amount of funding that has been dedicated by the state government to state-run aged-care facilities to assist with their COVID response?

The Hon. S.G. WADE: The Office for Ageing Well has a range of initiatives that have been funded to address COVID-19 aged-care matters since March 2020. In that context, the Office for Ageing Well relates to all aged-care providers, government and non-government. There was $30,000 assigned to the Aged Care Industry Association to develop sector workforce resources and strategies to assist in COVID preparedness and to implement emergency management direction requirements. Of course, those sector workforce issues are just as relevant to government providers as non-government providers.

Funding was also provided to draft a multi-outbreak strategy to assist residential aged-care facilities in the management of multiple outbreaks. This work resulted in the release of the COVID-19 Integrated Response Framework for the Management of Multiple Outbreaks in Residential Aged Care Facilities in South Australia and involved considerable consultation with the aged-care sector and across the Department for Health and Wellbeing.

Funding has also been provided to contact and infection control expertise to assess the 268 infection control plans submitted by facilities to the department as a requirement of Emergency Management (Residential Aged Care Facilities) Direction. Those control plans were also required of government sites as well as non-government sites.

Funding has also been provided to extend the work of the aged-care consultant on developing a community outbreak management guideline for residential aged-care facilities and to further identify tools and resources to assist the State Control Centre Health and residential aged-care facilities in the event of having to respond in community outbreak scenarios. That is an overview of some of the work being done by the Office for Ageing Well. That support assists our local health networks in delivering quality and safe services.

I would hasten to add that the amazing collaboration of the residential aged-care sector has really come to the fore in the context of the Parafield cluster. The residential aged-care facility at Brompton is a facility run by Anglicare, which has a particularly high cohort of residents who come with long-term vulnerabilities and chronic conditions, so it is a particularly challenging site.

As I understand it, four of the aged-care workers at that site have tested positive but, thankfully, no resident has tested positive for COVID-19 at that facility. Considering the high vulnerability of residential aged-care facilities to COVID-19, I think that is a tribute not only to the collaborative work of the Office for Ageing Well and the wider sector but particularly to the high-quality work done by Anglicare at that facility. I would like to pay tribute to the local management team but also to Reverend Peter Sandeman at AnglicareSA for their care for the safety of their residents.

Mr PICTON: As part of the government's response to protecting aged-care facilities, it temporarily closed a number of country emergency departments. Which of those still remain closed?

The Hon. S.G. WADE: As that matter is related to budget lines in relation to local health networks, I am happy to take that question on notice.

Mr PICTON: For the government's CCTV trial in aged care, when is that trial commencing, when will it conclude and what are the total number of sites included?

The Hon. S.G. WADE: The commencement of the trial has been slightly delayed due to COVID, but we are hopeful that it might get underway before Christmas. In terms of sites, it is currently scheduled for two sites.

Mr PICTON: Are there going to be any other sites considered? Is the total budget still $785,000?

The Hon. S.G. WADE: The answer is no and yes.

The CHAIR: With that answer, the time agreed and allotted to the examination of payments in relation to the portfolio of Office for the Ageing has expired; therefore, there are no further questions and I declare the examination of the portfolio agency of the Office for the Ageing complete and the estimate of payments for the Department for Health and Wellbeing, Commission on Excellence and Innovation in Health and Wellbeing SA closed. I lay before the committee a draft report. I move:

That the draft report be the report of the committee.

Motion carried.

At 19:46 the committee concluded.