Department for Health and Wellbeing, $4,814,787,000

Wellbeing SA, $20,952,000

Commission on Excellence and Innovation in Health, $6,049,000

Membership:

Ms Stinson substituted for Mr Fulbrook.

Mr Whetstone substituted for Hon. J.A.W. Gardner.

Ms Pratt substituted for Mr Pisoni.

Mrs Hurn substituted for Mr Cowdrey.

Minister:

Hon. C.J. Picton, Minister for Health and Wellbeing.

Departmental Advisers:

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

Ms J. Tepohe, Deputy Chief Executive, SA Health.

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

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

Ms K. Swaffer, Executive Office Manager, SA Health.

The CHAIR: The estimates committees are a relatively informal procedure and, as such, there is no need to stand to ask or answer questions. I understand the minister and the lead speaker for the opposition have agreed 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?

The Hon. C.J. PICTON: Yes.

Mrs HURN: Yes.

The CHAIR: Changes to committee membership will be notified as they occur. Members should ensure the Chair is provided with a completed request to be discharged form. If the minister undertakes to supply information at a later date, it must be submitted to the Clerk Assistant via the answer to questions mailbox no later than Friday 2 September 2022.

I propose to allow both the minister and the lead speaker for the opposition to make an opening statement of about 10 minutes, if they so wish. There will be a flexible approach to giving the call for asking questions. A member who is not on the committee may ask a question at the discretion of the Chair. All questions are to be directed to the minister not the minister's advisers. The minister may refer questions to advisers for a response.

Questions must be based on the 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. I remind members that the rules of debate in the house apply in committee. Consistent with the rules of the house, photography by members from the chamber floor is not permitted while the committee is sitting.

Ministers and members may not table documents before the committee; however, documents can be supplied to the Chair for distribution. 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.

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 declare the proposed payments open for examination. I call on the minister to make a statement, if the minister wishes, and to introduce advisors. I call on the lead speaker for the opposition to make a statement, if the member wishes. I call on members for questions.

The Hon. C.J. PICTON: Thank you very much, Chair. It is great to be here today. Happy estimates day; it is a very exciting day on the parliamentary calendar. I would first like to introduce my advisers, the departmental staff who are here: firstly, there is Lynne Cowan to my immediate right, who is the Acting Chief Executive of SA Health, Department for Health and Wellbeing. To my left is Julienne TePohe, who is the Deputy Chief Executive of SA Health. To my further right is Jamin Woolcock, who is the Chief Finance Officer of SA Health. Behind me is Brendan Hewitt, who is the Executive Director of Infrastructure at SA Health, and also Kris Swaffer, who is the Manager of Executive Services in the Department for Health and Wellbeing.

To the committee this is exciting because this is fundamentally a health budget. This is a budget that delivers on our election promises to invest in the health system to deliver more beds, more doctors, more nurses, more paramedics and more ambulances, and to fix the ramping crisis that South Australians have been bearing the brunt of. The new state government has been elected on a strong platform of investing in health, with a clear agenda to fix the ramping crisis and reduce the access block within our hospital system.

The central theme is care: care for patients and care for a strong public healthcare system. This will be achieved by investing more in staffing and more in beds to support our healthcare system to care for patients. There is a significant investment in doctors: 101 doctors; 300 nurses; 350 paramedics and ambulance officers, 151 of whom will be based in regional South Australia; and well over 300 new beds across our hospitals to help our hospitals flow better, which will allow ambulances to get off the ramp and back into the community and will allow 000 calls to get ambulances responding on time again.

Too often, governments are insisting upon efficiency within our existing resource base rather than recognising that the resource base needs to be expanded. Our government is committed to that, recognising that we do not currently have the capacity to deal with the crisis in our healthcare system.

A critical part of that is improving mental health care. I am proud that this government will deliver the largest boost to mental health care beds in South Australia in a generation. Off the back of the exceptional work of our public health team during the pandemic, we will leverage the learnings now to take action in preventative health and help people stay out of hospital.

This budget represents our commitment to deliver a healthcare system for today, for the next generation and for a healthy future for all South Australians. As Minister for Health and Wellbeing, I look forward to delivering these commitments and to working with our hardworking frontline healthcare professionals—our doctors, nurses, allied health professionals, paramedics and other staff—who have been working so hard over the past few years under very difficult circumstances. Some of the key election commitments this health budget delivers funding for over the forward estimates include:

$120 million over four years to build a brand-new SA Ambulance headquarters, which will include the State Emergency Operations Centre for SA Ambulance, the State Health Control Centre to coordinate the system and a new CBD ambulance station;

$13.6 million in 2022-23, increasing to $49 million in 2025-26, to employ 350 paramedics and ambulance officers;

$66 million of investing expenditure over four years, in addition to the SA Ambulance headquarters, for new, expanded or upgraded ambulance stations and ambulance vehicles;

$222 million across four years in relation to 136 additional beds at the Flinders Medical Centre, Lyell McEwin Hospital, Modbury Hospital and Gawler hospital;

$169 million to build and operate 78 additional mental health rehabilitation beds; these include Mount Gambier hospital, The Queen Elizabeth Hospital, Modbury Hospital and Noarlunga Hospital;

$12 million towards 20 community mental health care beds;

$220 million, of which $127 million is in the forward estimates, to build a new hospital for the people of Mount Barker, with triple the number of beds;

$100 million, of which $25 million is over the forward estimates, for 50 more paediatric beds to be built as part of the new Women's and Children's Hospital;

$28 million across the forward estimates towards drug and alcohol rehabilitation beds;

$28 million to establish a new Modbury Hospital cancer centre;

$6 million per annum in relation to 76 additional nurses across our hospital system, which will rise to $8.9 million per annum, indexed from 2024-25;

$5.2 million for Nganampa Health to better support remote nurses and implement Gayle’s Law;

upgrades to Naracoorte hospital, Port Pirie hospital, Port Augusta hospital, Kangaroo Island hospital and Mount Gambier hospital; and

$900,000 over three years to establish three 24-hour community pharmacies in central, northern and southern metropolitan Adelaide, and $1.75 million in separate initiatives in the pharmacy space to help people stay healthy and out of hospital.

Ultimately, these commitments are all about making sure our health system has the resources that it needs and that we can help care for people, ultimately addressing that access block, which on a day-to-day basis is the reason why we are seeing ramping at such outrageous levels that we do in the system at the moment, where people cannot get out of the emergency department because there are other resources for people to go to.

I would like to again thank all of our hardworking staff: doctors, nurses, midwives, paramedics, allied health professionals and other SA Health staff across the system. They have made significant sacrifices over the past few years. We are now delighted to make these investments to help assist them care for the patients who need their support across South Australia.

The CHAIR: Thank you, minister. Member for Schubert.

Mrs HURN: I am happy to get straight into questions.

The CHAIR: Go for it.

Mrs HURN: I refer to Budget Paper 4, Volume 3, page 13, workforce summary. How many doctors, nurses, paramedics, ambulance officers and allied health staff will be needed to activate the beds foreshadowed in the budget?

The Hon. C.J. PICTON: We have made a clear commitment in terms of 300 additional nurses across the system. We have also made a commitment in terms of 101 additional doctors across the system. These have been timed in terms of when the beds come online and, in particular, the beds that will be opening within the forward estimates period.

In relation to nurses, we have arrangements in place for nursing, which, while it is not a strict ratio at the moment, we will be transferring to that over time. It is at the moment a calculation of nursing hours per patient day. For each new bed that opens, there are a certain number of nurses that will be required in the system.

We will be, as part of the construction of new wards, undertaking clinical consultation across each of those sites in terms of the exact make-up and calculation for those nursing hours per patient day. We believe we have put the resources in place to enable that to occur at the moment. It reflects work done through the Independent Hospital Pricing Authority that we looked at, looking at the efficient cost of services in those areas to make sure that we have in place the resources to open those beds.

Particularly, when you are looking at health, the vast majority of those resources are in relation to staff—doctors, nurses but also, importantly, allied health professionals as well. We have been asked: what are the specific numbers of allied health professionals that will be in place in relation to bed numbers? That is something that needs to be worked through once we do that detailed model-of-care work for each of those beds, but we have an allocation of funding based on the additional activity that will be there.

In addition, there is a process that is undertaken every year through the department, working with the local hospital networks on a commissioning basis. So we commission the local health networks in terms of the services that they operate, in terms of the activity that they will see, and then those flow through to funding that will be commissioned for those services. As each one of those services is commissioned, there will be a resultant amount of funding that will be provided to local health networks. The vast majority of that funding goes to the doctors and nurses who provide those services.

While we have said very clearly that 300 nurses in the system is our commitment and funded in this budget, it may be in excess of that, based on activity growth funding that will be there in the future to make sure that we can provide services over time. There is obviously also going to have to be additional staff, whether they be allied health staff or administrative staff, to go along with additional services that we are going to be opening.

Mrs HURN: I have a series of questions on the same budget line, so I do not propose that I will read that out.

The Hon. C.J. PICTON: Could you remind me what the budget line was again?

Mrs HURN: It is Budget Paper 4, Volume 3, page 3, workforce summary. What does the government say to ANMF claims that 3,000 nurses will be needed?

The Hon. C.J. PICTON: I certainly have had discussions with the Australian Nursing and Midwifery Federation and its CEO, Associate Professor Elizabeth Dabars, and also their Executive Director, Mr Rob Bonner, about what I think are their real concerns about how we are going to make sure that we are doing appropriate workforce planning. This is something where we certainly are seeing the crunch right around the country in terms of insufficient workforce planning that has taken place over a number of years.

What we have seen previously is that we have not been doing the detailed workforce planning at a state level, I think largely because there was a view, probably about a decade ago, that the commonwealth was taking that role over through Health Workforce Australia. Health Workforce Australia was then abolished under the Abbott federal government and so there has not been sufficient planning in place of workforce planning.

This is something where we made a clear commitment that we need to get back into this space of properly planning our workforce, working with universities and working with training providers to make sure that we have the sufficient pipeline of nurses coming through the system to fill those vacancies that will be there over coming years.

Clearly, it is not just about nursing; it is about medical professionals and it is about allied health professionals, as well as paramedics. We have been very clear that we think there are some areas in terms of recruitment, such as paramedics, that will be easier because we know that there is a strong pipeline of paramedics coming through our university system at the moment whom we are not offering employment to.

In relation to nurses, there are certainly more we can hire from our current pipeline. One of the issues that we have is in relation to specialist nurses. This has been something that the ANMF has been very keen to raise with me, particularly around mental health nursing and intensive care nursing, these really specialised areas. We are seeing people reach the end of their career and retirement without the necessary flow-through of people coming through the system.

I think their chief concern that they have raised with me is about making sure that we get that planning right, because over the coming years clearly when you factor in retirements within the system there is a need for thousands more nurses, because we are going to have to recruit more to replace people, not only for additional capacity in the system but also for retirements that will happen and people leaving the system.

The other factor, very clearly, which I have raised in my first discussions with the new federal health minister is that workforce is a key concern at a whole federal level. We know that there is an issue in terms of lack of nursing workforce within aged care. That is a factor that impacts upon our hospital system as well. We want to see more nurses in aged care.

The new federal government has commitments in that regard as well, but clearly that is going to place additional demands on workforce overall in our system, across the broader health system, if you like, and so we need to plan working between the states and the commonwealth—and this is something the other states are very keen on as well—to make sure that we can fill those demands in our hospitals, in primary care, and in aged care as well, because all those factors are going to be very important.

Mrs HURN: Back onto that question, would you agree with Elizabeth Dabars that between 3,000 and 4,000 nurses are going to be needed over the next four years to staff your beds?

The Hon. C.J. PICTON: I would agree with her in the concerns that she has raised with me, specifically where she has said that—

Mrs HURN: But the publicly stated concerns that she has? She has said—

The Hon. C.J. PICTON: I cannot comment on comments that you are raising with me. I can comment on what she has said to me, which is clearly that there is a concern in terms of our future workforce planning, that we do need to make sure that we are properly planning for nurses in the future. I certainly agree with that and we need to do that.

Mrs HURN: I presume on the basis of those questions that the government does have a workforce plan for each of the health professions?

The Hon. C.J. PICTON: This is an unfortunate factor where we are coming in and we do not have those things in place, to be honest. This is something where we need to do a lot more work, and I am very delighted that the Department for Health and Wellbeing has recently brought on a senior person, put in charge of workforce issues, who is now working on these issues and preparing workforce plans across the whole system but also looking at specific areas.

This is something where a whole lot of work needs to happen and we also not just need to look at it ourselves, we need to work with universities and other training providers. We need to work across the federal-state divide as well, but we also need to look at specific areas where there are concerns, mental health being a primary one, but in any discussion of workforce we absolutely need to make clear the issues that we have in terms of regional workforce.

Those issues are very real. I was only just down in Mount Gambier last week, visiting the hospital, meeting the board and it is very clear that, with the workforce shortages they already have and the vacancies that they are trying to fill at that hospital, we need to do more at a regional level, not just across the state.

Mrs HURN: Who is the person in the department who is looking at these workforce plans and, if there is no name, can you either take it on notice or read out the title, and also could you outline or take on notice what are the health profession workforce plans that they are specifically working on currently? Statewide was mentioned, but I just wonder what specific work is being done, just across the health professions with streams in particular.

The Hon. C.J. PICTON: The person that I was mentioning earlier is the Executive Director of Workforce Services in the Department for Health and Wellbeing. They are working on a statewide workforce strategy, which obviously needs to look at each of those components in terms of all of those professions as part of that.

Mrs HURN: And they are doing that, they have already started doing that work, so we can expect to see a workforce plan released publicly for each of the health professions?

The Hon. C.J. PICTON: We can expect to see a statewide health workforce plan prepared and released—

Mrs HURN: For each profession?

The Hon. C.J. PICTON: I think it needs to cover all of the professions and it needs to make sure that it is action oriented to make sure that we are working on this across not just ourselves, in SA Health, but also with universities, with other training providers, with the private sector, with the commonwealth, to tackle what is a very significant issue.

Mrs HURN: Does the government intend to make bonus payments to health professionals, as has been announced in New South Wales and Victoria, and if not, do you think that that will undermine the prospects of recruiting from those jurisdictions?

The Hon. C.J. PICTON: We have been very clear in this budget that we are investing in frontline healthcare services. That is our number one priority and that is why we have invested an additional $2.4 billion in frontline healthcare services. We have not announced any plans to take action on those sorts of matters as you are raising. What we have announced plans to do is to hire more doctors, nurses, paramedics and other staff to make sure that we can provide improved services, to make sure that we can provide improved care to patients.

Mrs HURN: In the same budget line, why is the government cutting the health workforce from 36,683 to 34,745?

The Hon. C.J. PICTON: Thank you for the question. In Budget Paper 3, on page 23, there is a clear table in relation to the operating expenditure and then page 26 is in relation to the FTEs in SA Health. I am sure it will not surprise you or anyone to know that clearly there has been a very significant issue that SA Health has been dealing with in COVID that has resulted in a significant number of additional public health functions.

What this breaks down is in terms of the underlying health FTEs, excluding COVID-19 and time-limited programs. You can see from this table that in 2022 the estimate is 33,857, and that increases in 2023 to 34,288, so I do not accept the characterisation you have made, and I think this table in Budget Paper 3, page 26, very clearly outlines what the underlying health FTEs are, and a significant increase.

Mrs HURN: Just quickly back on to the workforce plans, I am keen to know when that will be complete. Do you have a time line on when the workforce plans will be complete?

The Hon. C.J. PICTON: I think the short answer is as soon as possible, but I do not want to rush to an artificial time line. I want to get this right, and I want to make sure that all the work is done that is appropriate to making sure that this is going to be effective. There is a bit of a history of plans that have been done that are rushed out for the sake of saying, 'Oh, we've got a plan.' They do not really say a lot, they sit on the shelf and nothing really happens with them. This is one we need to get right. I am happy to take on notice any estimate in terms of the time frame, but my focus is to make sure this is going to be done properly.

The CHAIR: I believe the member for Kavel has a question.

The Hon. D.R. CREGAN: Chair, I have four questions that I hope to be able to develop speedily so that other members can continue to make a contribution. Minister, a question was asked, as you are aware, in the house as to whether a decision had been made to build on the existing site at Mount Barker for a new hospital or to find a greenfields site.

I understand you also intimated in that answer the assistance from the member for Frome, and I appreciate her guidance to me that some discussions might occur this week in relation to that matter. Taking you to Budget Paper 4, Volume 3, page 15, which contemplates in a line item the new Mount Barker hospital: are you able to update the committee in relation to that planning process, the scope of works and likely timing?

The Hon. C.J. PICTON: I thank the member for Kavel for his question. I note his very strong interest in the development of the new Mount Barker hospital. I can give some news to the house that we have now gone out to a whole range of key architectural and other planning firms in relation to a request for proposal to get on board the planning initial team to start work on planning for the new Mount Barker hospital.

This will be a process where we will be putting in place an architectural firm that will be the lead professional services contractor. It will involve health planners, cost consultants, building services consultants and traffic consultants. We want them to start work in terms of planning for the new hospital and also to undertake a rapid assessment in terms of building on the existing site versus a greenfields development.

As we said before the election, our preference is to rebuild the hospital on the existing site, if we can; however, we are open-minded as to whether that could be done on a greenfields site. However, I think a greater advantage could be that if we build on the existing site that may well mean that we can open components of that hospital earlier than would otherwise be the case. Therefore, this new team we will be engaging will be undertaking a rapid assessment on that, as well as starting initial planning works.

This will be a very exciting development for the Mount Barker community, involving 102 beds, which is a tripling of the number of beds at the current hospital, involving a 12-bed mental health unit, rehabilitation beds, maternity beds, additional medical and surgical beds and palliative care beds. We have also in this budget brought forward funding; we had initially said we would provide $95 million within the forward estimates—we are now providing $127 million within the forward estimates because we would like to see the program of works accelerated as much as possible.

The Hon. D.R. CREGAN: My remaining questions are in relation to this budget line item. Will the planning work also consider a future aerial retrieval site?

The Hon. C.J. PICTON: That is part of the work that will be considered as we get into the planning stage of this project in relation to talking with SA Ambulance and MedSTAR in relation to needs for aeromedical transport at the site, considering whether a helipad is necessary and what the arrangements would be in relation to that. That will be part of the detailed planning work that will happen either within the initial stage of this planning or in relation to subsequent, more detailed planning.

The Hon. D.R. CREGAN: I have two further questions in relation to the same budget line item. Has any planning work been undertaken, or will be performed, to meet the demand for paediatric care in Mount Barker and the Adelaide Hills overall?

The Hon. C.J. PICTON: Yes. This is a key issue for the community. When I was recently at Mount Barker hospital, along with the member, after the budget, speaking to the clinicians, both doctors and nurses there, paediatric services were raised with us as a very key concern for the community there. It is a growing population. I am familiar from my own electorate with what new housing developments look like. A couple will buy a house and inevitably have some kids pretty shortly afterwards, so there are a lot of kids about to be growing up in the Mount Barker region.

We currently provide a very low self-sufficiency of paediatric services in Mount Barker. That means a lot of people have to travel to the Women's and Children's Hospital to get the care that they need. That puts more pressure on the Women's and Children's Hospital, so if we can provide more services for paediatric care at Mount Barker, that will be of great benefit to the community, and that will be a key part of the planning that we do in this next stage.

The Hon. D.R. CREGAN: On the same budget line item, if a greenfield site is to be considered, how will the existing Mount Barker hospital, including the emergency department, funded in large part through federal funds, which is under construction, and the community gardens be retained for an appropriate community use?

The Hon. C.J. PICTON: This will have to be a key part of the consideration of that rapid assessment of a greenfield site. As I said, I think there is a preference that we have stated from the beginning. If we can rebuild on the existing site, that is certainly our preference. I think there are a number of benefits from that: one is the ability to open elements of it sooner, the other is to utilise the existing new emergency department that is under construction. I think if we were to go down the path of a greenfield site, which is less likely, then we would absolutely have to consider, in terms of the emergency department, what the use of that building will be and also the community gardens and any other assets.

Ms PRATT: Picking up the workforce theme, minister, on the same line that we referenced—Budget Paper 4, Volume 3, page 13—my question is: how many paramedics and ambulance officers are expected to be recruited over the forward estimates and, in particular, can you provide a breakdown of vacancies by SAAS regions, and would you consider taking on notice a similar question in relation to specialist nurses and allied health professionals? It is a workforce question but specifically paramedics and breakdown by SAAS regions.

The Hon. C.J. PICTON: We have certainly made very clear 350 paramedics and ambulance officers across the forward estimates, and I can run you through some of that detail. This is broken down into both paramedics and ambulance officers. The paramedic FTE will increase—and I will run through the four years of the forward estimates—by 77, 136, 202 and 278. Ambulance officers will increase by 22, 40, 66 and 72. That involves emergency services staff, ambulance officers and also emergency medical dispatchers who work in the headquarters. The end of that program is where we get to the 350 staff.

Of those staff, 151 will be involved in providing care in regional South Australia, which we are very proud of and excited about. The breakdown of those, of the paramedics, firstly, is 18 will be in the Limestone Coast, 27 in the Adelaide Hills, 24 in the Fleurieu Peninsula, 24 in Gawler and Mallala, 21 in Upper Spencer Gulf and 13 in Wallaroo.

Then, for the ambulance officers, there will be six in the Limestone Coast region, three in the Adelaide Hills region, three in the Gawler and Mallala region, and nine in the Upper Spencer Gulf region. I am happy to take on notice what detail we can provide, secondly, in relation to the nursing, but, as I said previously, the vast majority of those nurses are allocated to where additional beds will be opening, which we have set out very clearly in the budget papers.

Also, there are an additional 76 specialist nurses that are set out in the budget papers and they align with a number of priorities that we have set out before the election but also a number of nurses will help us in terms of getting to the point where we can properly implement nursing hours ratios across our system in a similar way to what Victoria and Queensland have done.

Mrs HURN: I refer you to Budget Paper 4, Volume 3, page 13, workforce summary, again. Which enterprise bargaining agreements in relation to health workers have expired and what progress is being done in relation to each of them?

The Hon. C.J. PICTON: The first one I can tell you about is in relation to the SA Ambulance staff, which is an agreement where the last pay rise for ambulance officers was back in 2017. Just think about how long ago that is and think about all of what our ambulance officers have had to go through over the past five years without a pay rise. I think that is an absolutely disgraceful delay that our ambulance officers and paramedics have faced over that period of time in not having a resolved enterprise bargaining agreement.

While these matters are under the purview of the Minister for Industrial Relations and Public Sector, as they were under the previous government, this is something that obviously he and I talk about regularly. We do want to make sure that we resolve that issue as soon as possible in an appropriate way to make sure that people can get appropriate pay. Also, as the member herself alluded to earlier, having appropriate pay will make sure that it is easier for us to recruit people from interstate as well, whereas if you have not given your workers a pay rise in five years and other states have done so, then that clearly is an issue.

In relation to other agreements, the other one I am aware of is the SA Health Clinical Academics Enterprise Agreement. That expired as of 31 March this year. I understand that negotiations are soon to commence in relation to that. I understand that there is a limited number of staff who are covered by the Clinical Academics Enterprise Agreement—off the top of my head, I would say 68, but let's say between 60 and 70 clinical academics in our system—and there is clearly a connection historically between the Salaried Medical Officers Enterprise Agreement that was resolved earlier this year and the Clinical Academics Enterprise Agreement; one usually follows the other.

Mrs HURN: What was the total number of redundancies offered and accepted via voluntary separation packages across the department and all LHNs this financial year? How many of those were nurses or midwifery staff? Can you also advise if there will be any further voluntary separation packages offered?

The Hon. C.J. PICTON: I can provide a very detailed breakdown in relation to voluntary separations. What I can outline is if we look at 2018-19, 19 separation packages were accepted and of those there were four nurses, two allied health professionals, 10 administrative services staff and three other portfolio staff. In 2019-20, 321 separation packages were accepted. The vast majority of those were in the Central Adelaide Local Health Network. Of those, 114 were nurses, including midwives; four doctors; seven allied health professionals; 46 scientists; 90 administrative services staff; and 60 other health portfolio staff. These led into that 321 across that 2019-20 financial year.

In 2020-21, 177 separation packages were accepted, of which again Central Adelaide Local Health Network had the largest number of 107. That breakdown of those 177 was 98 nurses, seven allied health professionals, 65 administrative services staff, and seven other health portfolio staff, bringing it to a total of 177 in that financial year.

In the 2021-22 financial year there have only been 31, of which I understand the vast majority—if not the entirety—were prior to the election. Certainly, this government has a policy of no longer offering voluntary separations to frontline health staff, of which in this financial year just ending there were 12 nurses, six allied health professionals, nine administrative services staff and four other health portfolio staff.

If you add up the 12 nurses this financial year, the 98 nurses last financial year, the 114 nurses the previous financial year to that, and the four nurses in the previous financial year to that, you have well over 200 nurses. I have to say, it would be great to have those nurses working in the system right now as we battle very significant issues within our hospital system. That is why we will not be proceeding with further voluntary separation packages for frontline staff.

Mrs HURN: I move now to Budget Paper 4, Volume 3, page 60. How frequently does SAAS provide transfer of care data to the minister or his office?

The Hon. C.J. PICTON: Thank you for your question. As we have traversed a number of times in the house, there is clearly minute-by-minute information in relation to transfer of care data that is collected. There is a consolidation of that data on a monthly basis, and that information that was previously put out by the previous government on a three-monthly basis we have agreed—I will take one step back. We called on the previous government to release that information monthly, we committed ourselves to releasing that information monthly, and we are releasing that information monthly.

There is, of course, operational data that the department, SA Ambulance Service, will go through on not just a daily basis but sometimes on a much more frequent basis than that. I am advised that that data does need to be consolidated to make sure that it is accurate to publish at the end of each month. That is the process that happened under the previous government, albeit a three-monthly reporting process, and it is now happening under our government on a one-monthly reporting process.

Mrs HURN: Is it yourself or your office that receives the operational information from SAAS or the department? Do you have access to that daily as well?

The Hon. C.J. PICTON: There is a whole range of information that the chief executive will discuss with me, whether it is the number of people within emergency departments, whether it is the delays within our emergency departments, whether it is the ramping delays data. We discuss that on a frequent basis. It is very important that the minister is abreast of the situation, and I can inform the chamber that, unfortunately, the situation is very serious at the moment. There is no getting around that situation. In terms of statistical publishing of that information, that is happening on a monthly basis, as we committed to do.

Mrs HURN: I am just trying to get clarity. The operational information that you referred to, is that something that you are provided daily or weekly? I understand the point that you are making in relation to what is published but, when it comes to the operational information, is that something that you or your office get daily or weekly?

The Hon. C.J. PICTON: There is operational information we are provided in a number of different forms, some on an as-needs basis—

Mrs HURN: Specifically, to the transfer of care data.

The Hon. C.J. PICTON: —some in relation to particular issues that have occurred, some on a more frequent basis, where particular issues are occurring, and some where there will be issues that have been reported up, where there have been particular issues that have occurred that need to be informed to the minister, and that is absolutely appropriate.

It is also worth repeating that everybody has access to information involving what the delays of ambulances are in hospitals in real time under the Ambulance Service dashboard, which is available freely on the SA Health website, where everybody can get a live picture of what has been happening in the past few hours at our emergency departments for the delays of ambulances clearing those emergency departments.

Mrs HURN: Again on the operational information, is this something you have asked to see on a daily basis, given that obviously we have experienced the worst ramping in history for the month of May? Is it something that you have asked SAAS to provide to your office as minister, because presumably you would like to be aware of the operational information and, if you have not asked for it, why not?

The Hon. C.J. PICTON: I have asked the department to keep me abreast of important issues in relation to the operation of our health services.

Mrs HURN: Again, I am just trying to get to the bottom of the operational information specifically. Have you asked your department or your office, or anyone from SAAS, to get daily information? If not, why have you not asked for that? I understand that it is the health portfolio, that you get a lot of information, but specifically have you asked for the operational information in relation to the transfer of care data? If you have not, why not? Therefore, what I can draw out from that is that you only are aware of ramping data on a holistic basis per month.

The Hon. C.J. PICTON: The problem with what you are stating and accusing in your question is that there is only holistic ramping transfer of care data available every month. As I said at the beginning, this information does need to be collated and this information does need to be checked so that there is not a—

Mrs HURN: I accept that, but I am just trying to get to the bottom of—

The Hon. C.J. PICTON: —smaller level of that data which goes through that process to make sure that it is qualified. What I absolutely expect, as I am sure the previous minister expected, is to be provided information as appropriate in terms of the issues in the health system. We know, clearly, that the health system has significant issues.

One of the things that I have been very clear about, though—one of the issues that I think we face in the health system at the moment—is that there is no control centre, there is no statewide minute-by-minute response centre in the same way that, for instance, we have had on COVID for the past few years, where people are working together across the LHNs and SA Ambulance to resolve these issues on a minute-by-minute basis. That is what we are looking to achieve.

We have certainly committed to doing that as part of the new SA Ambulance headquarters, but we are looking at how we can bring that forward and put that in place much sooner. That operational level of coordination across the system, despite the best efforts of a number of people, is not in place at the moment.

Ultimately, that is what I want to see, as the minister with policy control and within the role of minister, to make sure that we put in place systems that can manage that on a day-by-day and night-by-night basis and that we can appropriately coordinate services between our hospital system and our SA Ambulance Service and other services, such as the Virtual Care Service, to make sure that we can manage demand, we can address issues when they arise and we can address issues that are very predictable that are going to happen.

For instance, we always know that Mondays are bad ramping days, so we need to be able to coordinate the system to respond to that, I think, better than has happened previously. There are fantastic people who are all doing their jobs, but I think additional coordination will help that.

Mrs HURN: I suppose from those answers the only insinuation that I really get from that is that you do not get operational information from SAAS on a daily basis despite the fact that it is available and you have not asked for it, so that is certainly interesting. Can you provide a breakdown of transfer of care delays for the last 12 months, per month, for each of the hospitals?

The Hon. C.J. PICTON: We will take that on notice.

Mrs HURN: Just on the dashboards, can you explain the reason that real transfer of care data is not available on the SA Health dashboard? I am expecting you to have similar answers, minister, but it does appear that it is simply the clearance of ambulance times. There is no indication on the dashboard as to how long an ambulance has been waiting on the ramp; it is from when they are cleared, which does not of course take into account meal breaks or, for instance, if they are cleaning their vehicle there. If you could just explain, for the benefit of everyone, because I do think there is some confusion as to why transfer of care is the only missing link on the dashboard.

The Hon. C.J. PICTON: There is a measure, which is clearance time, which is, as you say, what the Ambulance Service dashboard refers to, and there is a measure, which is transfer of care time. I would argue very strongly that both those measure ramping because there is a third criteria, which is just looking at between the transfer of care and when the ambulance leaves, which is purely when just that clearance time is looked at without the transfer of care time. What is on the dashboard, as I understand—and someone will correct me if I am wrong—covers both times.

What has been very clear over a long period of time is that the purely clearance time—the time that an ambulance officer, a paramedic takes between transferring the patient and being off to the next job—has had very little change in that time. What has dramatically increased over the past four years is the transfer of care time, which has increased. What you can see very clearly on the Ambulance Service dashboard when it looks at the clearance times is that whole picture of the time from when an ambulance arrives at the hospital and when it leaves the hospital. The time between the patient being transferred and leaving the hospital is not where we see the issues.

Ambulance officers cleaning their vehicles, as you say, is not where we are seeing the delays. When you very clearly see delays on Monday afternoons on the Ambulance Service dashboard, then there is a very clear correlation to ramping occurring at that particular hospital at that particular time because it is showing that there are delays for ambulances at those times. I think it is accurate to be able to describe that by looking at that dashboard you can get a live picture, unfortunately, of what the delays are for ambulances across the network in the previous three hours.

Mrs HURN: In the previous three hours. Is there any scope then for SA Health and the minister to consider making public a daily wrap-up of the transfer of care data, and if not daily is there scope or is it possible to release data on a weekly basis?

The Hon. C.J. PICTON: We are committed and delivering on our commitments in relation to monthly release of that data.

Mrs HURN: Would you concede that it is possible, given there is operational data available daily? Indeed, you have said that minute by minute there is data available. Is there capacity or is it possible to be able to wrap that up on a weekly basis?

The Hon. C.J. PICTON: I have not asked that question because the questions that I ask and my emphasis and focus are on trying to fix the problem and trying to make sure that we can invest the resources in our healthcare system to make sure that we do not see these extreme waits that we are unfortunately seeing at the moment.

Mrs HURN: Do you think it would be possible to ask whether they can release it weekly?

The Hon. C.J. PICTON: Again, I would state that we have made our commitment. We are delivering on our commitment, and our focus is on investing in these services in this budget, the $2.4 billion of health services, to make sure that we fix this problem.

Mrs HURN: I have one other question on this.

Ms STINSON: Can we clarify what budget line we are on.

Mrs HURN: It is Budget Paper 4, Volume 3, page 60. It is the SAAS budget. Where can members of the public find the monthly transfer of care reports that the government has committed to releasing publicly, because all I can see is a couple of lines from a media release. Is there more of a holistic piece of information that is made public for people to be able to see?

The Hon. C.J. PICTON: I will take that on notice, but it certainly is available in the media releases that we have released.

Mrs HURN: How many additional 000 emergency dispatch officers are to be recruited? How many will be recruited in each of the next four financial years?

The Hon. C.J. PICTON: As part of our additional investment commitment, we have committed to 10 additional emergency dispatchers in the 2022-23 financial year, then that increases to 15 in the 2024-25 financial year.

Mrs HURN: I refer to Budget Paper 5, page 52. Can you explain why the budget allocation for 350 more paramedics and ambulance officers is $16 million more than Labor's election commitment?

The Hon. C.J. PICTON: The reason is that there were 51 paramedics and ambulance officers that the previous government committed to. The previous minister told the parliament that they were in the Mid-Year Budget Review, but it turned out that that was not the case so they have been included in this package as well.

Mrs HURN: On that, would you concede that over the next four years it is actually 475 paramedics and ambulance officers that need to be recruited, taking into account the 125 paramedics and ambulance officers that the former government committed to, that is, there were 47 in the budget and the 51 that were announced, plus the 350 that the new government has promised—that is 475. Is that still the target? I suppose the question is: is the 125 of the former government taken into account?

The Hon. C.J. PICTON: No, I cannot confirm that. Essentially, you are combining a few different things there. You are combining 74, off the top of my head, that previously occurred or is in the very late stages of occurring now.

Mrs HURN: Was budgeted for.

The Hon. C.J. PICTON: The 51 was never budgeted and now we are delivering 350.

Mrs HURN: Would you therefore say that actually this new government is only committed to delivering 276?

The Hon. C.J. PICTON: Is 276 the number of paramedics? So 278 paramedics we are committed to and then 72 ambulance officers, adding up to 350.

Mrs HURN: So that is on top of what was already budgeted for by the former government, which is 74 paramedics and ambulance officers?

The Hon. C.J. PICTON: Yes.

Mrs HURN: So that is on top of.

The Hon. C.J. PICTON: That is on top of the 74, correct.

Mrs HURN: And on top of the 51?

The Hon. C.J. PICTON: No, because the 51 was not in the budget.

Mrs HURN: Budget Paper 5, page 52: has the SAAS Code of Conduct been updated or reviewed following the state election in March? Is it underway or is there expected to be a review?

Ms STINSON: Sorry, just a point of clarification about which budget line we are up to at the moment.

Mrs HURN: Yes, Budget Paper 5, page 52, in relation to SAAS.

The Hon. C.J. PICTON: I am not sure how this question relates to 350 more paramedics and ambulance officers.

Ms PRATT: SAAS new stations, Budget Paper 4, Volume 3, page 15, ambulance station boost: what is the expected cost for each new ambulance station? For the sake of the record, I will list them: Norwood, Edwardstown, Golden Grove and Woodville. What FTEs are expected to be created from each project?

The Hon. C.J. PICTON: The exact project planning work is starting now in relation to those stations, or has already started, I should say. It will inform the exact breakdown between those different sites. However, I can outline broadly, in terms of the different categories of station, the allocation of funding that has been provided:

$29.6 million has been allocated to build new ambulance stations across the four priority areas of Edwardstown, Golden Grove, Norwood and Woodville;

$20.4 million is allocated to rebuild four ambulance stations in Campbelltown, Gawler, Mount Barker and Victor Harbor;

$7 million has been allocated to upgrade 10 ambulance stations in Aldinga, Elizabeth, Goolwa, Keith, Mallala, Marion, Mount Barker, Peterborough, Wallaroo and Whyalla; and

$9 million has been allocated to purchase an additional 36 ambulances.

In addition, there is some recurrent funding of $400,000 in 2024-25, increasing to $800,000 per annum from 2025-26, in relation to the operation of the four additional new stations in the high-priority areas.

Ms PRATT: I have a supplementary on that: could the minister provide a breakdown of the works, specifically the completion dates for the 10 upgrades that you mentioned? What are the completion dates for those stations, please?

The Hon. C.J. PICTON: I am happy to take that on notice. Essentially, we are undertaking the detailed planning works now that will inform the exact completion dates. We are also trying to align this work with where we would have priorities for additional crews to go; hence, there may be some areas in which we would want to start sooner rather than later. Particularly, some of the metro sites would be high-priority issues for us to provide additional capacity to. That work is being done at the moment to try to align where we are seeing additional crews with the work that needs to take place in terms of the planning for those sites. We want to make sure that we get them as soon as possible, basically, but in a way that aligns with those ambulances.

I should say, while we are in the process of constructing some of the additional capacity, that that is not necessarily delaying us from bringing additional crews on. In the next month or so, we will be starting, for instance, the nominal new crew for the Norwood area. Obviously, we have not yet built a new Norwood ambulance station, so that crew will be starting out of the Parkside Ambulance Station and will ultimately transfer to the new Norwood ambulance station when it is completed.

Ms PRATT: I note—with the member for Chaffey sitting alongside me—that the Riverland is poorly represented in the three sets. Just a final question: does the minister anticipate that any of those stations that are existing would have to temporarily close or have their facilities impacted during the works?

The Hon. C.J. PICTON: I am happy to take that on notice.

Mrs HURN: I have my budget line now in relation to the SAAS Code of Conduct and whether it has been updated or is in the process. Thank you for so diligently following the process, minister.

The Hon. C.J. PICTON: Happy to assist.

Mrs HURN: On Budget Paper 4, Volume 3, page 60, has the SAAS Code of Conduct been updated or reviewed following the state election in March?

The Hon. C.J. PICTON: I will take that question on notice.

Mrs HURN: I would appreciate if you could also take on notice if it is expected to be reviewed, if it is not currently underway already.

The Hon. C.J. PICTON: I will also take that question on notice.

The Hon. D.R. CREGAN: I take the committee to Budget Paper 4, Volume 3, page15, the same line item as referenced by the member for Frome, ambulance station boost. The budget statement proposes a rebuild of the Mount Barker Ambulance Station. Will this occur on the existing site or on a greenfield site?

The Hon. C.J. PICTON: As the member will be aware, the Mount Barker Ambulance Station is on a very cramped site as it is and so I think the likelihood of that happening on the existing site is near zero. We are doing some work urgently with Renewal SA, also talking to the city of Mount Barker in relation to potential site options. I am aware that the local council has had a desire for an emergency services precinct in the area. That is certainly one of the options that we will be considering. We have started some discussions, I understand, between officers and the council already in relation to whether that could be a site.

This is a high-priority site for us but it is also one where we know there will be growth in the future. Having a site with sufficient space is going to be important if they might need to expand in the future. We also know that, when planning ambulance sites, it is important to consider a range of factors, including accessibility to major transport routes and the like.

One of the issues that the paramedics and ambulance officers in Mount Barker have raised with me is that the current site located sort of in the middle of town sounds ideal but actually can be problematic in terms of their access in and out when they need to rush to a job that is not within the township or the city of Mount Barker because you are rushing through the inner city area, which probably is not ideal.

The Hon. D.R. CREGAN: That was a very comprehensive answer and in fact has absorbed the subject that I was going to develop further. I hope it will not offend the member for Schubert if in consequence of that very substantial answer I move to the Gumeracha hospital—

Mrs Hurn interjecting:

The Hon. D.R. CREGAN: Thank you, member for Schubert. I acknowledge her graciousness in including me in an invitation to participate in a community forum on 26 July. Minister, you will know that this is a significant issue for both myself and the member for Schubert. Our communities depend on the hospital. Are there any plans to reopen the Gumeracha emergency department?

The Hon. C.J. PICTON: Thank you very much for your question on this. I can inform the member and the committee that it has now been over 650 days that the Gumeracha emergency department has been closed, which is obviously of concern to that community. This was closed a few years ago under the previous government. It is unfortunate for that community that the previous government did close that facility.

I have been repeatedly raising this issue, as well as other emergency departments, with the Barossa Hills Fleurieu Local Health Network CEO and only again in the last week. This is clearly an issue where the now limiting factor is in relation to the medical workforce. This is, I am sure everyone would agree, a small emergency department that was provided support for its life by local general practitioners.

Local general practitioners are in an unfortunate situation where, under the commonwealth rules for payments and support for regional general practitioners, they are just outside the line in which additional support would be provided. This has meant that it is harder for them to recruit additional staff. I understand from discussions that they have had with the local health network that this is one of the key limitations on them providing continual services to support the reopening after its closure of the Gumeracha emergency department.

This is something where I am keen to work with members. I know you have raised this with me, and I am looking forward to further discussions with you and also community campaigners around this issue. I spoke recently in the last few days with Joel Taggart, who has been somebody who has been campaigning on this issue. I believe we are meeting soon also with local doctors, who I have met with just prior to the election, on what options are available in terms of: could this closed emergency department under the previous government be reopened and services provided to that local community?

There are also a number of other emergency departments that are in this category as well. One of the other significant ones that we are looking at is Strathalbyn, where we are clearly making a commitment from our election commitments in additional paramedics into the Strathalbyn region, where there are only volunteer services provided, which is fantastic. The volunteers do a great job, but given the busyness of services we are now going to provide additional crewing into that area as well.

Ms STINSON: Budget Paper 4, Volume 3, page 30: South Australian public hospitals are obviously facing a difficult winter with pressure from COVID and also flu cases, plus the usual winter demand, as well as the impact of being under-resourced over the past four years. How are commonwealth funding arrangements impacting on South Australian public hospitals?

The Hon. C.J. PICTON: Thank you very much to the member for the question. This is a really important issue, because we know that there are issues in terms of the funding that we receive from the federal government. This is an area where there were arrangements in place under reforms a decade ago that have since been abandoned, and that has a real impact in terms of the funding that we receive as a state government and therefore how many additional services we can provide.

If we had additional funding—and we have made this commitment very clear publicly, that we would provide any additional funding that we get from the commonwealth government straight into additional health services on top of our already additional health budget that we are putting in place. Across Australia, funding for public hospitals is a shared responsibility. Unfortunately, we have had previously a blunt funding instrument that was in place. It did not recognise growth for demand for services.

The previous Rudd-Gillard governments implemented a reform process that made sure that the commonwealth was an equal partner in terms of funding hospital services. That national health reform funding agreement, which was struck by the Gillard government and states and territories, introduced activity-based funding for hospitals to set the commonwealth contribution at 45 per cent of efficient growth by 1 July 2014 and up to 50 per cent from 1 July 2017. This reform meant that hospitals would be funded by the commonwealth based on their activity.

Unfortunately, what we saw was that the Abbott Coalition government, upon election, subsequently scrapped the increase to 50 per cent and capped the commonwealth contribution at 45 per cent. This has had a profound impact on public hospitals. In addition, they put in place a funding cap, that only 6½ per cent growth in funding could happen in a particular year.

That change to the funding arrangements has meant that South Australian hospitals have lost out. This was something that I was very keen on upon forming office, that we get the report, as part of the incoming government brief, on what exactly has that meant for our public hospital system. The answer is pretty shocking, I think.

I am happy to reveal this to the committee for the first time, which is that between 2017-18 and 2019-20 that change in funding arrangements meant that South Australian hospitals missed out on $426.1 million of funding that would have otherwise gone to our healthcare system if we had increased that funding to 50 per cent. That is the equivalent of 68,286 admitted acute separations or 540,208 emergency department presentations.

Additionally, as I said, the Turnbull government introduced a cap on commonwealth hospital funding, meaning that the states and territories were solely responsible for funding beyond 6.5 per cent growth in hospital costs. In 2018-19, hospital costs in SA increased by 9.1 per cent, meaning that South Australian hospitals missed out again on $34 million in commonwealth funding that financial year. Therefore, we were missing out on $426 million plus missing out on $34 million. That is a lot of extra hospital beds, doctors and nurses that we could otherwise be providing.

I am very delighted that, as we are meeting here today, national cabinet has been meeting and health has been a top priority at that meeting. I am very excited that there has now been agreement in terms of a new process of health reform between the states and the commonwealth. It is looking at not just funding arrangements but also the other issues that impact upon our hospitals that are impacted by the commonwealth, particularly workforce, as we have talked about extensively this afternoon, but also aged care, NDIS and primary health care. They are key contributors to pressure on our hospital system.

Ms PRATT: Minister, returning to the rural general practitioner fee-for-service agreements, I refer to Budget Paper 4, Volume 3, page 58 in reference to the Yorke and Northern LHN, close to my heart. Given that the minister has referenced Gumeracha and Strathalbyn in a previous answer, what rural GP fee-for-service agreement contracts are outstanding and, where LHNs and hospitals cannot finalise an agreement, what steps can you as the minister take to resolve this critical issue for communities?

The Hon. C.J. PICTON: I am very happy to answer this question because this is a concern to me in how stretched out this process has been over the past couple of years. This is something that regional general practitioners raised with me repeatedly before the election in terms of their concerns about how long the previous government dragged their feet on resolving a funding agreement. Sadly, we saw during that process a number of fantastic general practitioners leaving their regional health services. I am sure you would agree on how difficult a regional GP is to replace from many country locations.

As the member is also aware, the previous government put in place a network of six different regional local health networks, who all report to their own governing boards. How that process is managed is set out in the legislation. Each of those boards employs a CE, and each of those CEs negotiates with those hospitals. To be honest, we see some local health networks who have been making great strides in working with their local general practitioners. My role is encouraging all the local health networks to make sure that their relationships with their local GPs are as good as possible, making sure that we connect with them and value their role in the system.

The contractual relationship is one important factor but it is not the only factor. We need to make sure that they are key allies, key contributors and key partners in our work across our hospital system. Certainly, the message that I will have for our boards and CEs across these six local hospital networks is to work much more closely with our general practitioners.

Ms PRATT: If I can just repeat, the question I am seeking an answer to is: what contracts are you aware of that are outstanding to be resolved? I understand that you are going to continue working with them, but you will appreciate that, in my role as shadow regional minister, I am keen to see a statewide overview beyond Frome. That is my question: how many?

The Hon. C.J. PICTON: I will take it on notice to get the exact answer of which ones are outstanding, but I know that there has been a lot of activity to make sure that these agreements get finalised. Certainly, I have been encouraging to make sure that they get finalised as soon as possible, because, as I said, it is one component, not the only component, of our relationship between GPs and our hospital network, but it is a very important one. It is not something that the department controls centrally, because it has now, under the previous government's reforms, devolved to the six different networks in terms of their local decision-making and local contractual arrangements. We will seek that information and reply to you.

Mrs HURN: With respect, minister, you are saying as soon as possible a bit today. I do say that with respect, but in this instance does as soon as possible mean by the end of this year, in the next few months? Can you guide local communities who will be very interested in your answer? What does that mean for them?

The Hon. C.J. PICTON: As I said, I will get an answer in terms of the exact breakdown of each different hospital network where there are outstanding agreements in place. I would expect these to be resolved definitely this year, if not much sooner, to make sure that we have those agreements in place. However, there may be complicating factors outside of our control in a particular local area that we will have to look into.

I, from my perspective, want them to happen. I would have much preferred, to be honest, this happened a year ago, or two years ago. That has not been the case. These negotiations dragged on for a significantly long period of time. This was something that was heavily criticised by the Rural Doctors Association and the Australian Medical Association. They put out some scathing statements in relation to how this process was managed and in relation to the delays that happened for resolving these agreements. There is now a central agreement across the board, which I am thankful for. It now needs to be operationalised at each local level, and I will seek that update that the member has requested.

Mrs HURN: I am certainly pleased to hear that you have been in touch with Joel Taggart in relation to Gumeracha, so thank you for doing that off the back of the Courier article. I will be very pleased to make myself available at any stage for a meeting as well, because this is an issue that does concern my local community.

I refer to Budget Paper 4, Volume 3, page 60. I would like to ask a question in relation to the Premier's ride in the ambulance on 4 June. Can you confirm whether that media appearance was booked in before or after learning about the worst ramping stats on record for the month of May?

The Hon. C.J. PICTON: I will have to take that on notice in terms of when exactly the Premier's experience of seeing how our frontline healthcare workers operate and the pressure that they are under was booked in by the Premier's office. I suspect that it was much earlier than we received any particular information in relation to that month's transfer of care data.

Mrs HURN: Thank you for taking that on notice. What steps were taken to protect the privacy of sick patients during the Premier's ride with the SAAS crews recently?

Ms HUTCHESSON: Which budget line is this?

Mrs HURN: Budget Paper 4, Volume 3, page 60, relevant to South Australian Ambulance Service.

The Hon. C.J. PICTON: I am not sure that the—

The CHAIR: Is this a budgetary issue?

Mrs HURN: It is related to SAAS, which is funded out of South Australian Ambulance Service, so I would argue that it is.

The CHAIR: It sounds like—

Mrs HURN: Thank you for your indulgence, Mr Chair.

The Hon. C.J. PICTON: I think it is a bit of a stretch to connect that with the budget. However, I can assure the member and the committee that the Premier was at pains to make sure that he followed any and all requirements placed by SAAS to make sure that patient confidentiality was protected and to make sure that all appropriate operational procedures were in place, and certainly made sure that he followed all appropriate instructions from SA Ambulance. I think it is really important that leaders of the government are not just receiving paper briefings and not just receiving minutes and letters about what is going on but actually see what is going on themselves. That is something that the Premier and I share an opinion on.

The CHAIR: There is plenty of scope in question time for questions of this nature, so if we bring it back to something more specific in relation to the budget that would be good.

Mrs HURN: I will move on. I feel as though I have my answer out of that little media appearance, so I will move on now to Budget Paper 4, Volume 3, page 16. The completion of the new Women's and Children's Hospital has been delayed by 15 months. Can the minister outline the reasons for the significant delay on this program?

The Hon. C.J. PICTON: I would be very happy to outline the delays that we have seen, unfortunately, on this program over a long period of time.

Mrs HURN: Specifically to the 15 months that has been outlined in this one.

The Hon. C.J. PICTON: The member says 15 months, but unfortunately this has been delayed many more years than that because the original time frame announced by the previous government for this project was that this project was going to be completely open—

Mrs HURN: We can have the history lesson all the way back to 2010, minister, but the specific question is just about the 15-month delay.

The Hon. C.J. PICTON: As I said—

The CHAIR: We have provided you with latitude as well, so I will give the minister some latitude.

The Hon. C.J. PICTON: Thank you, Chair. As I said, the previous government committed to this project being complete in 2024. For a project of this scale to be open in 2024, there would be cranes in the sky, there would be concrete settling and you would have to be getting pretty close to the finish of major construction works. That is obviously not occurring. There are no construction works happening on the site, and we have seen delay after delay in terms of this project.

When you look back, there were significant delays that occurred after the task force report was presented to the government. It was basically a year, in 2019, when not very much happened, when that was being considered before the next steps occurred. As we know from briefings that have been released publicly, back when that task force report happened the estimates were that the hospital would cost $1.4 billion. That clearly is not the case now: it is going to be in excess of $2 billion and it is subject to continual delays in terms of time frames for the project.

Upon forming government, we were informed of the escalation of the project in terms of its price increasing. There had been briefings to the executive steering committee prior to the election in February that there had been at least $100 million of additional cost in the program, and we were advised that there had been more delays in the program. At that stage, as an incoming government, we made an appropriate decision that we needed to take stock of where this project was up to and if there were other options that should be considered, particularly in terms of the site.

The site is very constrained, and the constrained site leads to a lot of the complexities that have no doubt led to the cost escalation and the delay in the project. The team that has been working on this are fantastic people and they are doing a great job, but they are working with a very difficult set of circumstances in being able to manage this project.

We made the decision that it was appropriate to have a good look at where this project was up to, to bring in some external expertise to look at whether there could be other sites in the precinct that could be considered, to look at what the real scale was, in terms of the cost and the delay of the project, and to consider the project site, the cost and the time frames all in terms of each other.

That work has now been led by Jim Hallion, who is one of the foremost former public servants in the state, a former chief executive of transport, a former chief executive of Premier and Cabinet and a former State Coordinator-General. He has been doing a great piece of work with our team looking at those sites. We will be considering what the best option is for taking this project forward to make sure that not only do we get the best outcome in the short term but that we get the best outcome in the long term for the state. One of those key factors is making sure that there is expansion capacity available at both the Royal Adelaide Hospital and the Women's and Children's Hospital into the future.

Ms HUTCHESSON: I refer to Budget Paper 4, Volume 3, page 134, provision of management across government services. How has the new Across Government Facilities Management Arrangements contract, signed by the former government, impacted South Australian public hospitals and patients?

The Hon. C.J. PICTON: Thank you very much to the member. Unfortunately, there have been significant issues in relation to the privatisation through the facilities management arrangement to Ventia, as we saw happen under the previous government. During July 2021, the former government awarded a contract for Across Government Facilities Management Arrangements to Ventia as a single service provider that commenced on 1 December 2021.

They are responsible for providing key facilities management across South Australian public hospitals, in both metropolitan and regional areas, as part of this contract. Unfortunately, I have been briefed in relation to the number of issues in relation to how this is being delivered. I was advised that, since December last year, there has been widespread and continued dissatisfaction across SA Health about this new contract and service provider and the impact that it is having on critical hospital facilities, assets and staffing.

I am advised that there has been poor performance in responding to urgent and priority breakdown maintenance at hospitals. Unfortunately, only 52 per cent of priority 1 maintenance requests, which are the most urgent, are completed within the agreed time frame established under the contract. I have been advised that on some occasions, clinical staff have been forced to deal with maintenance issues on weekends and out of hours, where breakdowns have occurred on hospital sites because of delays in Ventia responding to urgent priority 1 and 2 emergency calls seeking assistance.

Clearly, this distracts clinical staff from focusing on their core role of providing patient care. There have been examples provided to me by local hospital networks where critical assets requiring urgent maintenance and repairs have not been attended to within the specified contract time frames, including blocked sewer pipes within the ward, blocked drains, automatic door faults within an emergency department, combi oven breakdown in a hospital kitchen, fire door hardware repairs, toilet blockages, hot water service faults and air conditioner outages.

As well, I have been advised that routine and preventative maintenance servicing on critical assets is not being appropriately scheduled, performed or validated to ensure that legislative compliance requirements are being met. This includes work on hospital passenger lifts, fire systems, and electrical and mechanical infrastructure.

Local hospital networks have advised a number of further incidents where the facilities management service provision, including critical and often urgent breakdowns of equipment and assets, is not attended to within the contract time frames: preventative maintenance on infrastructure and assets not being undertaken within the month it was due, and often claimed as completed, with limited supporting information or financial reporting; trade contractors having non-qualified staff and subcontractors undertake preventative maintenance on fire prevention systems; delayed provision of the proposed 2022-23 service delivery maintenance plans; minor works projects being delayed, not within the allocated budget and not within the required time frames, which presents risks of deferred or lost funding or important projects not being completed in alignment with the service need; provision of trade quotes taking excessive time; and local health network staff undertaking additional activities and responsibilities that should be undertaken by Ventia.

Under the previous facility management arrangements Flinders Medical Centre, which had ageing infrastructure and significant maintenance needs, was provided with a dedicated service, with 24/7 responses to facilities management issues by the Department for Infrastructure and Transport. This service ceased being provided by DIT and was not included in the new contract. I am advised that the Southern Adelaide Local Health Network has negotiated an interim solution with Ventia for a service that will support FMC's ageing infrastructure.

The department has advised that, across our hospitals, this contract poses a risk of adverse events, increased infrastructure and asset failure, increased financial impacts and, more importantly, impacts to risk to staff retention and wellbeing. SA Health is regularly communicating with the Department for Infrastructure and Transport on concerns, and ongoing meetings are occurring with Ventia to seek improved facilities management outcomes across our hospitals.

Unfortunately, this is yet another example of an issue that we have inherited from the previous government that is causing significant concerns within our hospital system and yet another example of privatisation not being the answer to addressing the service functions that should be provided within our own Public Service.

Mrs HURN: I refer to Budget Paper 4, Volume 3, page 17 and the line item of small projects. Can you outline the details of these projects? What are the projects and what are the projected time lines for those projects?

The Hon. C.J. PICTON: I think we will take that on notice.

Mrs HURN: That would be excellent, thank you. As the local member, it would be remiss of me not to ask whether one of those is indeed the Barossa hospital?

The Hon. C.J. PICTON: The member will be glad to know that the Barossa hospital is not included in the small projects.

Mrs HURN: It is a big project.

The Hon. C.J. PICTON: We see it as much bigger than fitting in the budget in small projects.

Mrs HURN: I am so pleased that you confirmed that. Thank you very much, minister. I would like to move on to Budget Paper 4, Volume 3, page 16, so not too far to move. Is the minister committed to building a single, integrated Women's and Children's Hospital to replace the current Women's and Children's Hospital?

The Hon. C.J. PICTON: Yes, that certainly is the government's policy objective. Obviously, we are going to be considering work from Jim Hallion's team, in terms of looking at all the options, but that certainly is our objective in terms of a consolidated service.

Mrs HURN: Can the minister confirm that patients needing transfer, retrieval or an adult ICU from or to any clinical part of the new Women's and Children's Hospital will not need to use ambulance transfer to get access?

The Hon. C.J. PICTON: Looking at the transfer between the Women's and Children's Hospital and the Royal Adelaide Hospital, in whatever form, whether the current proposed site or any other site, the means in which that would happen is certainly a key criteria, in terms of assessing that project, as well as considering all other clinical elements of the project.

Mrs HURN: Can the minister confirm that it is the government's position that the Parklands north-west of the railway line are available to be used as part of the new Women's and Children's Hospital build, as proposed by the Marshall government?

The Hon. C.J. PICTON: Do you mean where the car park was proposed to be?

Mrs HURN: Yes.

The Hon. C.J. PICTON: Certainly, we are not proposing that that would not be considered as part of where the site will be, if that is what you mean.

Mrs HURN: If you could also please advise: are there any services or units that the former government proposed to have on the railway yard site that are now being considered to be located elsewhere? I am referring to things like admin or outpatient clinics or gynaecology, for instance.

The Hon. C.J. PICTON: I am not entirely sure that the question was correct in that my advice is that that was not necessarily what was planned to be on that site under the previous government, but I think it is fair to say that we are looking at every possible reasonable option in terms of a site in that precinct and the pluses and minuses of it in terms of what services could be provided.

One of the key issues that leads us to the point where we are doing this piece of work is in terms of, as I said, that site and its restrictions, which has meant that, with a number of factors, there have needed to be compromises, including that, upon forming government, the plan was to include at least 160 staff who are currently on the Women's and Children's Hospital site involved in the SAHMRI 2 building, the Bragg building, which will be quite disconnected from the Women's and Children's Hospital. So all of these factors in terms of the staffing across the board in terms of where they will be located and the pressure on that site clearly need to be considered.

Mrs HURN: The crux of the question was whether the government is exploring alternative sites for part of the Women's and Children's Hospital, so whether there would be other services, for instance, that were to go, say, at the Lyell McEwin Hospital, whether it would be a hub and spoke model of the new Women's and Children's Hospital—that was the crux of the question.

The Hon. C.J. PICTON: A hub and spoke model is not under active consideration. The previous government's clinical planning was very clear in terms of saying that growth in terms of hospital services would be provided at other hospitals, whereas we have been clear that we need to provide for growth in the new Women's and Children's Hospital site, not just in other hospital sites, bearing in mind that those other hospital sites, such as the Lyell McEwin Hospital, were not funded in terms of any projects happening there either.

Mrs HURN: Since the beginning of this year has the steering committee of the new Women's and Children's Hospital sought an increase to the project cost and sought increased funding?

The Hon. C.J. PICTON: I will take that question on notice, but clearly we have been doing this work with Jim Hallion, as I have said, which is looking at the cost of the current project. Clearly, we have come in with a lack of confidence that what was in place was necessarily the full picture in terms of what the costs would be.

I think the Treasurer outlined this very clearly on budget day as well, that we need to do a proper assessment of what is the cost of this project and then consider that versus other options that may be available within that site, within that broader precinct, in terms of where the location of the hospital could be and whether that may lead to any additional benefit from an alternative proposal within the broader precinct once we get a proper picture of what the exact likely cost of it is on that site.

Mrs HURN: I refer to the review being undertaken by Jim Hallion. What is the time frame of completion for that review?

The Hon. C.J. PICTON: This is something where we are wanting to make a decision quickly, but we also want to make sure we get this work right. This is something where cabinet is involved, through a subcommittee of cabinet, in terms of assessing the work. We have had a number of briefings already and we will have more briefings in the future, but we have pretty rapidly started this work.

We need to pretty rapidly work out the approach to make sure that we can resolve what has been a project that has not landed in terms of its final plan for a number of years and to make sure that we not only land what is going to be a good outcome for now but what will be a good outcome in 10, 20, 30 or 40 years' time, ultimately, in terms of not only the services at that hospital site but also future expansion capacity that may be necessary.

Mrs HURN: Just following on from that, on 3 June on the ABC you did report that the review would provide advice in the next few weeks. I am wondering whether we can expect that next week. It is in relation to Budget Paper 4, Volume 3, page 16. Given that the question was answered in relation to the review, I imagine there is no problem answering a question in relation to the time frame.

The Hon. C.J. PICTON: I will take on notice the exact time frame.

Ms PRATT: I refer to Budget Paper 5, page 55, public health functions. Is Tom's Court still operating as a medi-hotel?

The Hon. C.J. PICTON: Tom's Court is the last premises we have in relation to the quarantine program. We recently exited the Pullman hotel in Hindmarsh Square, and we have retained Tom's Court, which is one of the smaller facilities we had, but it is also one that was dedicated to higher level needs in terms of COVID-positive patients being accommodated there.

We have a contract with Tom's Court that runs for a little while to come. We do not currently require people to be in that facility, but we have a number of months to go on the contract. With all these public health functions, we are obviously considering not only what the need is right now but also what the need might be in the future if there were to be changes in the unpredictable face of this pandemic.

One piece of work that is underway is by the police commissioner, Grant Stevens. He is looking at our various COVID functions and how we can make sure that we will be able to stand things up in the future, should there be the requirement from particular variants or particular waves that would need further quarantine facilities to be in place. Another thing to mention in terms of quarantine facilities is that we have had regional quarantine facilities in place. This has been an arrangement that has been in place with Humanihut, which have been providing services. They have had a facility in Port Augusta and a facility in Ceduna, and I can give you some information on that.

The Emu Farm and Press Road centres have been provided through a consortium with Humanihut. The model has been supported by SA Health staff. The Press Road site accommodated 269 guests. The Emu Farm site accommodated 222 guests. Demand for the site has now reduced following the cessation of the declaration of a major emergency. The site is being decommissioned following the departure of the last guests on 25 May 2022. In relation to the Press Road site, that has significantly decreased in line with in-community management of COVID-19 and that site is now decommissioned.

Ms PRATT: Minister, when does the contract with Tom's Court expire? Are you saying that there are currently no patients, guests, clients in the hotel?

The Hon. C.J. PICTON: We will take on notice the exact month. I think it is still a few months to go. Correct, there are no requirements for people to be in that facility at the moment.

Ms PRATT: Finally, can you detail how many staff would be employed in maintaining the building while it is under contract to the government—hotel staff, SA Health staff, police?

The Hon. C.J. PICTON: When there are no people being accommodated there, there is no need for SA Health or other SAPOL, etc., personnel to be there, so they have been returned to other duties. Obviously, the people who work in the hotel will still be employed by the hotel but, in relation to our staff, they are not actively at that site. If we needed to have them there, then obviously we would.

Ms PRATT: My question is: how many staff are employed to service an empty building with no SAPOL, no SA Health staff present? It is contracted to the government, but the hotel would still be providing property managers, cleaners, repair people as part of the contract.

The Hon. C.J. PICTON: I will take that on notice, but certainly we do not have any people there and we do not have any staff there. We are not providing staff from our SA Health operations for zero people. If we need to use that site, then we will bring back staff to manage it and make sure appropriate quarantine facilities are in place. We have gone from eight different hotels down to one, so that has been a very significant change, and including two different regional facilities that were in operation.

We are down to the last hotel for the last few months of the contract, and we are now putting in place arrangements in terms of how we can stand things back up if we need to in the future. I think that is the appropriate course for us to take in relation to a relatively unpredictable course of the pandemic.

Ms PRATT: Finally, would it be the government's intention to extend that contract?

The Hon. C.J. PICTON: I do not believe so, no.

Mrs HURN: I move to Budget Paper 5, page 56. In relation to the Flinders Medical Centre upgrade and expansion, I was interested to note that this budget lists the FMC and the Repat projects jointly. Why was that done?

The Hon. C.J. PICTON: Yes, this is a very exciting development in that we will be partnering with the commonwealth government for a major rebuilding operation of Flinders Medical Centre. There is an associated element of that, which is an upgrade of the Repatriation site as well. A key part of making sure that you can upgrade the Flinders Medical Centre on its existing site is making sure we have some additional other capacity in the system as well, and so to decant some space from Flinders Medical Centre we will need an additional 24 beds at the Repat to do that. That is why that is part of that project.

The whole project in entirety is 160 beds, of which there are 136 at the Flinders Medical Centre site and 24 at the Repat site. They will involve the recommissioning, or essentially the gutting and refurbishment, of a number of disused wards—I believe where there used to be ICU and other facilities—at the Repat to make sure we can provide modern accommodation. This is something that we are looking to get cracking on immediately. It is not without difficulty in terms of a heritage site, as all the works at the Repat have had to encounter so far, but we are excited that this will be a component of those works.

Then at the Flinders Medical Centre, the key components will be a new clinical building to be constructed, as well as additional facilities to be built on top of one of the more modern facilities that is built at Flinders Medical Centre, as well as some refurbishment within the hospital itself. Importantly, this is really stage 1 of what needs to be a whole series of works at Flinders Medical Centre, which is now overall one of our oldest pieces of kit in terms of the metropolitan hospital system.

It has not necessarily seen as much refurbishment as other hospitals in the metro area have. It is celebrating 50 years of operation next year. What has been apparent in the last few years at Flinders is (a) the lack of capacity that it has and (b) the facilities in terms of things like single rooms. The Royal Adelaide Hospital and Lyell McEwin Hospital, with more up-to-date modern facilities, have been much better geared up to manage COVID-19 patients rather than what we have seen at Flinders, where there unfortunately has been spread of people contracting COVID-19 within the facility.

I know that has been something of great concern to the local hospital network board. Mr Mark Butcher has raised this with me as a key concern, and it was certainly one of the drivers that we looked at as part of why we would prioritise getting this redevelopment underway.

Mrs HURN: A quick question on Budget Paper 4, Volume 3, page 30: what portion of income at CALHN is hospital car parking for staff and what is the actual cost? If you could provide a monthly breakdown—I understand you may need to take that on notice—that would be helpful.

The Hon. C.J. PICTON: Our chief financial officer knows most things but was not able to remember this exact figure off the top of his head—

Mrs HURN: He is forgiven.

The Hon. C.J. PICTON: —so I will take on notice to get an answer for you.

Mrs HURN: That would be helpful, thank you.

Ms PRATT: I refer to Budget Paper 4, Volume 3, page 21, a target of commencing demobilising in regard to vaccination programs. My question is: where the budget declares your government will commence demobilising the vaccination program and transitioning services back to LHNs, what does this mean for the vaccination and testing of clinics around South Australia; and could you please provide a breakdown of the staged demobilising statewide? For example, we note one in Berri will be closing.

The Hon. C.J. PICTON: There are a couple of different things wrapped up in that question. Firstly, I think the budget line you are talking about is about vaccination rather than testing. Certainly, I can say in relation to vaccination that all these clinics were scheduled to be demobilised as of now. When we came to government, plans were in place for them to close within a matter of a couple of months. We made a decision to extend them for a period to try to increase our vaccination rate even higher.

Obviously, it is fair to say that the vast majority of people in South Australia have been vaccinated. The vast majority have one, two and now three doses of the vaccine and a significant number of people have now come forward, fantastically, to get their fourth dose of the vaccine, so we are seeing a reduction in demand for vaccination clinics. At the same time, we are seeing an increase in availability of vaccinations through general practice and pharmacies as well. While that was an element of the program that was slower probably to stand up originally than some of the mass vaccination sites, we are seeing demand where people are finding it easy to go to their pharmacist to get a vaccine rather than having to go to a mass vaccination site.

Clearly, there needs to be a phased process of how we reduce capacity and our staffing allocated to it to meet what actually the demand is for people coming forward, bearing in mind that the vast majority of people have done so already and that those who have not may not necessarily do so. Therefore, we are doing a lot of work between the department and the local hospital networks around what facilities and what mobile clinics we may need to have in place into the future. It clearly will not be to the extent of huge vaccination hubs where hundreds of people are getting vaccinated at the same time because, simply, the vast majority of people have already done that.

Similar to what I said previously, there may well be an additional need for vaccinations into the future. Part of this work that you are referring to and the budget refers to is connected to that work being led by the police commissioner on how do we make sure that we learn all those procedures and lessons that we have had in place for the past couple of years on how we can stand these things up if we need to. If there is a new vaccine that comes out for a particular new variant, for example, or additional requirements for vaccinations, how could we stand things up to meet the demand if they could not be met through general practice and pharmacies? That is the work that is underway at the moment.

Mrs HURN: I refer to Budget Paper 5, page 56. Is the government committed to honouring the partnership with Nexus to deliver elective surgery at the Repat?

The Hon. C.J. PICTON: I understand that there was a contract or an agreement with a contractual legal basis that was signed by the previous minister either the day before caretaker or a couple of days before caretaker was entered into, and so that is clearly binding on the Crown. I have not sought to change that arrangement. I think this is something that we will look into in time as to whether we are getting the best deal out of that arrangement that was put in place by the previous government, but we are not necessarily looking to tear up that arrangement and that contract that was signed by the previous minister just before caretaker was entered into.

Mrs HURN: Budget Paper 5, page 55, which is just COVID public health functions. What impact has the COVID booster advertising campaign had on the uptake of COVID booster shots?

The Hon. C.J. PICTON: Absolutely right, we have run a very important campaign to try to encourage people to come forward—and we are not calling it a booster dose, we are calling it their third dose, because it is important to make sure that people know that it is not an optional thing, that particularly for Omicron double-vaxxed is not fully vaxxed is the key message. We are clearly targeting a very hard-to-reach group in terms of these people. These are the people who have not come forward in the first few months of this being available to do so.

We are encouraged that we have seen, I think, off the top of my head, some 27,000 people since the campaign was launched come forward to get vaccinated. We have also seen, off the top of my head, I think 91,000 people coming forward for their fourth dose since the campaign was launched as well, and encouraged by that, but it is something where it is clearly more difficult to get people in that last percentage of people to come forward and get vaccinated rather than people who were much more eager at the beginning of the program to do so.

Any time that we can spend money to help protect somebody to invest in that clear prevention activity of the vaccination program ultimately helps to prevent more people contracting, more people getting serious illness because of COVID, more pressure on our hospitals and, sadly, more mortality, and therefore it is absolutely worth it.

The CHAIR: Thank you, Minister. Our allotted time is up. There being no further questions, I declare—

Mrs HURN: There are plenty.

The CHAIR: I am sure there are. I declare the examination of the portfolio of SA Health completed.

Sitting suspended from 16:17 to 16:30.

Membership:

Mrs Pearce substituted for Ms Hood.

Departmental Advisers:

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

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

Dr J. Brayley, Chief Psychiatrist, SA Health.

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

Ms K. Swaffer, Executive Office Manager, SA Health.

The CHAIR: Welcome to this session. The portfolio is mental health and substance abuse and the minister appearing is the Minister for Health and Wellbeing. I advise that the proposed payments remain open for examination. I call on the minister to make a statement, if the minister so wishes, and to introduce his advisers. I call on the lead speaker for the opposition to make a statement, if the member wishes. I call on members for questions.

The Hon. C.J. PICTON: I will not make an opening statement, other than to introduce the team that we have for this next session. Again, Lynne Cowan, the Acting Chief Executive of SA Health, is now joined by Dr John Brayley, Chief Psychiatrist, and Ms Marina Bowshall, the State Director of Drug and Alcohol Services SA. We have also kept on board Jamin Woolcock, the Chief Finance Officer of SA Health, and Kris Swaffer, the Manager of Executive Services, SA Health.

Mr WHETSTONE: I refer to budget Paper 5, page 58. With mental health beds, given that none of the additional 78 mental health beds foreshadowed in the budget come onstream in the first three years of the government, why is the government taking a slow-lane approach to delivering key promises?

The Hon. C.J. PICTON: I do not think a generational investment in mental health services is slow at all. We are very committed to making sure that we build these additional beds. We have 78 additional mental health beds, as you have said, but also 20 additional community mental health bed services. In relation to these additional beds, we need to build them. They do not exist at the moment.

This is something that I have been very clear about: while we have opened over 180 beds in addition to what was in place since we came to government, we are tapping out our ability to open up extra beds, but we do not have additional mental health beds, so this is something where we need to build additional capacity. That is why the budget delivers exactly that.

Mr WHETSTONE: On Budget Paper 4, Volume 3, page 13, workforce, how many unfilled positions are there in SA Health mental health services?

The Hon. C.J. PICTON: Given that covers a significant number of local hospital networks, we will need to take the question on notice, but there are clearly a number of vacancies that have been in place under the previous government. This is an issue that refers to our discussion earlier in the day around workforce planning. As I said earlier in the day, one of the key challenges we have is in relation to mental health nursing, in particular, in addition to psychiatry positions and other allied health professionals in mental health, particularly psychologists, etc.

We do see that we need train up and get into our system a lot more mental health professionals to provide this care. That is why this is something that is a key part of the workforce planning that is underway. It is also a key focus of Dr Brayley and his team in SA Health in terms of how we can utilise resourcing to improve our training and to improve the number of people we can get into mental health training and ultimately providing services to people.

Mr WHETSTONE: On the same budget line, which currently funded mental health services are not operating or are operating in curtailed form because of the lack of staff?

The Hon. C.J. PICTON: The one that I am aware of is the Southern Intermediate Care Centre. This was a service that closed under the previous government, and it was a service I am familiar with because it is in my electorate. Unfortunately, it closed under the previous government in relation to staffing issues there. I have been very keen that we take action to reopen those services, because it is a relatively new facility, and to make sure that we utilise it to provide care for mental health patients.

We did reopen that centre and provide services from that facility recently. Unfortunately, there have now been some plumbing problems there, so we have had to vacate it and undertake an urgent plumbing fix. We will then be using that service and that centre to make sure that we utilise every capacity we can in the system.

Mr WHETSTONE: Considering the current level of vacancies in the workforce, the oncoming beds and that you have said that there will be a pipeline of newly trained mental health nurses and staff, is the government confident it can deliver its mental health commitments?

The Hon. C.J. PICTON: We absolutely are committed to delivering our commitments. That is why we are treating workforce with such urgency in the mental health area—because we are going to need more nurses, more allied health professionals and more psychiatrists in mental health. Some of the commitments we made at the time were very difficult, in that we made additional commitments, in particular in child and adolescent mental health services, which is an area under significant strain.

Child psychiatrists do not grow on trees; we do not have an overabundance of them in South Australia, and that is why at the same time we announced our program for additional investments in CAMHS. We also announced $400,000 to go into workforce planning, specifically into that area, for child psychiatrists and child psychologists, to make sure that we can do the workforce planning and also do the proper searching, because we may well need to attract from interstate or overseas to try to increase our staffing into that service.

Mr WHETSTONE: On the same reference point, minister, are you aware of the Mental Health Nursing Workforce Strategy 2020-2030?

The Hon. C.J. PICTON: Yes, I understand that this is work that is being undertaken by the Chief Nursing and Midwifery Officer.

Mr WHETSTONE: Are you aware of what progress has been made on that strategy?

The Hon. C.J. PICTON: I am happy to take on notice the exact progress. I understand that some progress has happened in relation to that. The latest briefing I received was that some of the money has been spent, but there are still a significant number of key priorities that are yet to be delivered from what the previous government had in place under that strategy.

Mr WHETSTONE: On the same reference point, minister, what strategies will you as a minister or the government use to recruit the mental health workforce needed? Will the government rule out lowering or suspending standards for mental health qualifications required for nurses working in mental health service facilities?

The Hon. C.J. PICTON: There is certainly no desire to lower standards as the member was suggesting, but we certainly are keen to make sure that we can increase mental health training for as many nurses as possible. There are some programs, which I understand were not necessarily started under us but perhaps under the previous government as well, in which we are looking at how we can improve training for general nurses in the system with additional mental health training that would enable them to safely provide care under the supervision of other accredited mental health nurses in the system.

Another issue that has been raised with me repeatedly is how we can try to have a system where we can expose more people to what it is like to work in mental health before they have to go through the whole process of undertaking quite extensive training to become qualified, because it is a big jump to say, 'I am going to undertake a year or two-year course,' without actually knowing what it is like. We are looking at how we can concurrently provide training and opportunities for people to see if it is worthwhile and can be a very rewarding career for people. It might not necessarily be something that all the workforce has had prior experience in or awareness of that working environment. Those sorts of opportunities are definitely ones that we are looking at.

Mr WHETSTONE: Moving on to Budget Paper 4, Volume 3, page 13, nurse:patient ratios, will the government's proposed legislation to entrench nurse:patient ratios impose ratios for specialty areas such as mental health or is it only at the general level?

The Hon. C.J. PICTON: This is an important commitment that we have made to introduce this. What we are doing is really on the back of what has been introduced in Victoria and Queensland. I understand in those jurisdictions the latest advice I have is that they do not have mental health ratios in place. I think that is something that we will look at as part of the detailed implementation work before we bring a bill to parliament in relation to whether that is something that could be extended to mental health care or whether that is something that would not necessarily be part of the legislation but may well be looked at into the future.

Mr WHETSTONE: On Budget Paper 5, page 58, mental health beds, in terms of the metropolitan mental health bed commitment, can you provide a breakdown of the $124 million of investing expenditure between The QEH, Modbury Hospital and Noarlunga Hospital? While there, can you give me a breakdown of the number of beds allocated to each hospital?

The Hon. C.J. PICTON: There are 24 beds at The Queen Elizabeth Hospital, $53.7 million; 24 beds at Modbury Hospital, $53.7 million; and 24 beds at Noarlunga Hospital, $50.4 million.

Mr WHETSTONE: While we are on those particular beds, can you give me a breakdown of how many mental health beds will be operational in each site in the metropolitan area following the implementation of the additional 72 beds?

The Hon. C.J. PICTON: The short answer is it will be the current number of beds we have, plus these beds opening. We will see if, during the course of this time, we have an updated number on the number open at the moment so that we can add those two together, but, if not, I will take it on notice.

Mr WHETSTONE: What FTEs are expected to be created by this project?

The Hon. C.J. PICTON: What was the budget line again?

Mr WHETSTONE: Budget Paper 5, page 58.

The Hon. C.J. PICTON: As you can see, in Budget Paper 5, page 58, it says the 2025-26 estimate is that 153 FTEs would be created under that. Having said that, as I flagged earlier, for each project, for each one of these new wards that will be created, there is detailed model-of-care work that will need to be undertaken, not only looking at nurses and doctors but also allied health professionals and other staff who will be working in those facilities, to arrive at the exact figures. But these have clearly been estimates based on other mental health facilities, other mental health beds that are in place, as I referenced earlier, looking at efficient pricing and the staffing that goes into providing those services. The exact numbers need to follow detailed work, which will be taking place.

Mr WHETSTONE: Can you give me a time line from the start of the project to completion, so when those beds will be operational?

The Hon. C.J. PICTON: I will take that on notice to give the exact time frame of each event, but essentially concurrently with construction of the wards will be taking place work on the model of care, will be taking place work on workforce attraction and retention to make sure that when those wards are completed we will be able to staff and open them and provide those services.

Mr WHETSTONE: Can you explain if there is a process taken to ensure that the number of beds will adequately support the program, or the beds needed in the metropolitan area? So you have a number of beds; is there a strategy or is there a process that has been used to adequately cover the number needed?

The Hon. C.J. PICTON: This was work that we undertook prior to the election. These are obviously election commitments. The work that we undertook was in liaison with a number of different bodies, including the Royal Australian and New Zealand College of Psychiatrists as well as the Australasian College for Emergency Medicine, which advocated very strongly to us that there was a need for additional mental health rehabilitation beds of a less acute sector, to free up the more acute beds to make sure that people can get the care they need and reduce the access block that we see in our hospital system at the moment.

These numbers were devised with advice from those professional colleges. We were therefore very happy to make those commitments before the election, and now we are delivering them in the budget.

Ms PRATT: Minister, referring to Budget Paper 5, page 59, Mount Gambier hospital mental health beds, what factors were evaluated when considering the placement of mental health beds in Mount Gambier?

The Hon. C.J. PICTON: The number one factor was pressure on the Mount Gambier hospital. Last year, the now Premier and I visited the hospital and heard issues in terms of the number of mental health patients in the hospital there, issues within the emergency department, and we determined that we needed to take action in terms of providing additional services at that hospital site.

This is a hospital that has a six-bed mental health inpatient unit at the moment but quite often has had a history of many more patients who have been in general wards in the hospital and who have not been able to receive services appropriately. Therefore, we committed to doubling the number of mental health beds at Mount Gambier hospital. This is something which has been broadly supported by the community there, by the clinicians there. I was just in Mount Gambier last week, and they are certainly getting to work on the implementation of this, the planning of it, and making sure that we can deliver those services for the community.

Ms PRATT: Minister, can you then explain the process taken to ensure mental health services are being delivered to regional areas where they are most needed and where people are most at risk?

The Hon. C.J. PICTON: Increasing the number of mental health beds in Mount Gambier is a component of doing that, for sure, but that is not the only factor. There is clearly much more to be done. Clearly, the workforce issues that we talked about are more acute when we look at regional areas as well. Providing for the sustainability of large mental health facilities in regional areas has proved to be very difficult.

For instance, a long time ago under the previous Labor government, a mental health ward was built at Port Lincoln hospital. It is my understanding that it is still not commissioned, and that is largely because of workforce issues that have led to the unavailability of that being provided, including under the entire course of the previous government. Clearly, there are issues in terms of providing services.

One element that has worked successfully to provide services for country people is all the country local health networks working together to provide a number of services at Glenside that are dedicated to country people to make sure they can get access to services on a united basis across all those country local health networks. This is something that has recently undergone some expansion in terms of the intensive care beds that are being constructed at Glenside, which will be dedicated for regional mental health care services as well.

Ms PRATT: Minister, was a report developed to inform the election promise? I am certainly waving the flag for all regions in South Australia to receive funding for mental health. You mentioned the Port Lincoln site. Will the government consider recommissioning that site, and was a report developed to inform the decision on which regions were in most need?

The Hon. C.J. PICTON: Yes. I should mention as well that we have also made a commitment to Mount Barker hospital. There will be 12 mental health beds as part of the new hospital at Mount Barker as well, which does fit within our country health region. The other thing I would mention as well is that, as part of the government's response to the tragic death of Theo Papageorgiou a number of years ago—there is a Coroner's inquiry into that, which I tabled earlier this week—the government is implementing a review of regional mental health care services.

Full credit: I think that work started to be put in place before the election. That work is being led by an eminent mental health expert from interstate. The panel will be visiting regional areas across South Australia and providing advice in relation to how we can improve mental health care services to regional South Australians.

Ms PRATT: I would certainly welcome the panel visiting the Clare Valley, should that be possible. There is great work happening in all our regions. Can you advise when that review may be complete?

The Hon. C.J. PICTON: We are anticipating before the end of the year, but maybe it will be a few months earlier than that.

Mr WHETSTONE: Minister, there was a partnership between the former government and Atlases Australia, which published a population health profile for the regional LGAs. The report highlighted psychological distress, current long-term mental health issues and suicide rates in those regional areas. What are the government's plans to provide mental health services, beds and suicide prevention programs broadly in the regions of South Australia? You have gone to the major towns; not all of them, but some of them. Do you have any scope to go to other regional centres that are suffering the distress of mental health sickness and suicides?

The Hon. C.J. PICTON: I think you are asking a very important but slightly separate question to the previous questions, which were more about inpatient mental health care services. Obviously, there is a scale issue where we cannot provide them in every community, but what we do need to do is improve our outreach, our care for people, even if they live in small communities as well.

I think this is a key aspect in relation to our work in terms of suicide prevention, which I know you are interested in, given that you asked that the other day in the parliament. We will be very eager for the new Suicide Prevention Council to play an important role in how we can improve services, outreach, and suicide prevention for regional communities right across the state, no matter what their size.

This is also something that is important in relation to the work that is happening in relation to suicide prevention networks, which we absolutely support the continuing role of, working at a local community level in terms of the whole community working together, because these cannot just be SA Health coming in saying, 'This is what is going to happen to stop suicide.' This is the whole community working together and all services, all providers, everybody, doing their part as a community effort. I think we have seen those suicide prevention networks doing a great job in many regional communities in that area.

Mr WHETSTONE: You have just told the committee that suicide rates are much higher in other areas. Clare, Gilbert Valleys, the Riverland, Murraylands are 13 per cent higher than the average of the Mid North and Whyalla. Mount Gambier, which you have just put significant investment in, is part of regional South Australia's average. These other centres are 13 per cent higher yet receiving no funding or no support from your government.

The Hon. C.J. PICTON: I am not sure if the member is suggesting that we should not be investing in Mount Gambier, but I certainly do not support the connection that the member is making between an investment in an acute mental health care service and that needing to be decided on the basis of the suicide rate alone in that community. I do not think that properly understands the multifactorial issues that we are dealing with in terms of suicide prevention.

I think we have a lot of work to do right across the community. I think that suicide is an absolute tragedy that affects far too many South Australians, and I think the truth of the matter is that there are many people who unfortunately take their life who never interact with our mental health care services at all. So it is not just an SA Health led program, we need to involve the whole community in that effort in terms of suicide prevention.

That is the aim, that is the drive behind the work that was started by John Dawkins that has now led to the Suicide Prevention Act, which led to the Suicide Prevention Council. That is the work that we are keen to maintain, but we do need to make sure that everybody right across the state has access to appropriate and accessible mental health care services.

There are key challenges in terms of doing that in many areas of our state and there are key opportunities for us to consider in the future how we can improve those services for many people across the state. That is why this regional review that has been started into mental health care services is going to be very important.

Mr WHETSTONE: Just on to the new mental health community beds—

Ms PRATT: Before you do, can I ask a supplementary, Mr Chair, if I may?

The CHAIR: Yes.

Ms PRATT: Thank you. It is important enough, I think, just to wrap this up from a regional perspective. Minister, you might be aware of the Broken Hill Country to Coast Lifeline Connect centre, the only one in South Australia not-for-profit, which happens to be based in Clare, but I understand they are looking to expand their model. Is the government open to or considering or in negotiation with them to support that model to expand statewide?

The Hon. C.J. PICTON: I understand that Wellbeing SA is in some discussions with that branch of Lifeline in terms of the services run out of your electorate that provide a full range of regional services. I am not sure whether there have been recent discussions or not, so we will seek an update from Wellbeing SA and provide it.

I am very happy to have discussions with them. The volunteers who work in those services provide fantastic service through Lifeline. We know that Lifeline calls have been up significantly over the past few years, with impacts from the pandemic and from bushfires and other mental health concerns and pressures in the community.

Ms PRATT: Could you at least say whether those conversations with the agency have continued since the election?

The Hon. C.J. PICTON: I will take that on notice as well, but I am very happy to talk with them. I am happy if, representing your electorate, you would like to connect them, and we can organise a time.

Ms PRATT: I think you will find the member for Narungga and the member for Stuart are quite interested too.

The Hon. C.J. PICTON: Excellent.

The CHAIR: If you can loosely tie it back to budget lines and identify them, and I know we can speak very broadly, but just a little bit of focus.

Mr WHETSTONE: I refer to Budget Paper 4, Volume 13, page 60, mental health ambulances. How many co-responding mental health ambulances are currently operating and where?

The Hon. C.J. PICTON: I understand that the arrangements that were in place under the previous government are still in place; that is, there are essentially three services that operate for approximately 12 hours a day in the north, the centre and the south.

Mr WHETSTONE: What is the cost of the service, broken down by the LHNs?

The Hon. C.J. PICTON: We will have to take that on notice.

Mr WHETSTONE: I will move on to first responders, Budget Paper 4, Volume 13, page 60. What action is the government taking to protect the mental health and wellbeing of first responders within the state government services, such as police, ambulance and the CFS?

The Hon. C.J. PICTON: There are certainly actions being undertaken by other agencies, such as SA Police, the CFS and the MFS. I can speak to them broadly as a former minister in those areas, and I know they were key concerns of the chiefs and the commissioner in those areas when I was the minister and, likewise, in relation to SA Ambulance. I know that this is a key concern for the Ambulance Service and it is a key concern for me in terms of the impact of mental health that paramedics face.

There is work underway on how we can improve services for first responders through SA Ambulance. There is also work underway in terms of how we can provide more services that will help keep what can be quite unrelenting pressure off those first responders. We are regularly told by first responders, particularly ambulance officers, about issues such as not getting breaks and not being able to return to their home station, and that does have a cumulative impact; when you are going from one difficult job to the next, that definitely has an impact. In addition, there is also work at the Jamie Larcombe Centre. People will clearly be familiar with the centre in terms of veterans, but they are also doing work in terms of first responders as well.

Mr WHETSTONE: Further to that, how is the government ensuring the mental health and wellbeing of volunteers such as volunteer ambulance officers? We have talked about professional frontline services, but particularly in regions there are a number of volunteers—ambulance officers, CFS personnel in small country towns or communities—who are turning their neighbour over after a road accident or after an accident or injury, and that does have a significant impact on one's mental health.

The Hon. C.J. PICTON: You are absolutely right and that is why volunteers are absolutely connected to the services as well that SA Ambulance provides in relation to mental health and support. In addition to that, I think one of the key issues that we are facing is the number of volunteer stations which are seeing their demand escalate quite dramatically. That is why we are so committed that a very large proportion of our investments in additional ambulance officers will be based in regional stations, to make sure that we can ease some of the pressure on those volunteers as well.

Mr WHETSTONE: Is there a program that is available or is there a support service that the government is responsible for or is there some level of training or support services that these volunteers can go to?

The Hon. C.J. PICTON: There are absolutely services SA Ambulance provides that volunteers can go to and we will get the full details from SA Ambulance of those services and provide them on notice.

Mr WHETSTONE: Thank you.

Ms PRATT: Minister, I refer to Budget Paper 5, page 53. I may have that wrong as it refers to the Women's and Children's, but my question relates to, if you will indulge me, on 5 June 2022 the Sunday Mail report that a 17-year-old autistic transgender child had been turned away from multiple mental health services due to the complexities of their issues. How is the government ensuring mental health units for children are equipped to deal with complex issues such as autism and sexual health and identity?

The Hon. C.J. PICTON: I have to say that the mental health services for children is something that I have been particularly concerned by. I have met a number of times with the group Parents for Change that started up specifically in relation to concerns around these issues, particularly previously in my role as the opposition spokesperson and now as the minister.

That is why there is a number of key commitments for child and adolescent mental health care services: firstly, in terms of the commitment in the education portfolio in relation to 100 additional mental health and learning support staff in our schools; secondly, in relation to a commitment we have made for additional doctors, which will include mental health doctors at the Women's and Children's Hospital.

Thirdly, we have made a commitment for additional nurses, half of whom will be in terms of mental health at the Women's and Children's Hospital. The hospital has been working and I received an update recently in terms of the allocation of those mental health staff, and I believe one was likely to be designated in relation to LGBTIQ and CALD communities as well to assist, in particular.

Fourthly, we are providing additional investments in child and adolescent mental health care services and, fifthly, we have made a commitment that your budget line refers to that is in relation to the new Women's and Children's Hospital, which will have additional mental health beds that will be opened to provide for future capacity for care in that hospital as well.

Ms PRATT: Perhaps just to expand on that, what referral process then would be in place for children who are deemed to have needs that a particular service is not equipped to meet? It is a clinical question, perhaps.

The Hon. C.J. PICTON: Can I get more clarity on your question? You are saying, what happens when somebody is turned away from a service?

Ms PRATT: Yes, so for example, this young person who had complicated needs and was turned away. I understand that a multitude of services might exist but, really, what is the referral? It is a clinical question, but what referral process is there to meet their needs?

The Hon. C.J. PICTON: I think Dr Brayley has been looking forward to an opportunity to answer, so I might pass over to Dr Brayley to talk about some referral pathways.

Dr BRAYLEY: The Child and Adolescent Mental Health Service has been dealing with significant demand and that has increased due to the impacts of COVID on young people in particular. There are clear alternative referral options, for example, to disability services and options of follow-up referral to CAMHS's own services, but I think the question that is getting raised is: are the referrals being made when they need to be? This was a particular topic I was speaking about with Parents For Change yesterday. It is about understanding that, in terms of having the latest and most modern models for CAMHS, the strategic future for CAMHS, including for responding to the needs of people who have neurodevelopmental problems or children with autism spectrum disorders.

But also there is a capacity issue, the need for the Child and Adolescent Mental Health Service to expand so there are more options for therapy and follow-up available. So it is not all capacity. We are reviewing this. In fact, since earlier this year, our office has been looking at a number of children and young persons' cases to look at the services received and essentially this question that gets raised: should the young person, the child under 12, have been referred into hospital or had a CAMHS appointment or been referred to a disability provider? These are the sorts of things that we are looking at in this selection of individual case reviews. The summary report from that will be made public, so we will have some conclusions and recommendations.

I know that CAMHS themselves have followed up with a significant amount of improvement work, including looking at mobile models and of course looking at how to allocate new resources, both in the community—the practitioners—and in particular areas of need where follow-up and internal referral is required. So, in essence, the issue you have raised is one that is concerning families and users and is being followed up both in terms of practices and resource allocation.

Ms PRATT: Supplementary: as CAMHS expands, perhaps, is there accommodation or can there be an accommodation for a stronger working relationship with educators? It is a finite resource.

The Hon. C.J. PICTON: I think that is a very good point in that we need to make sure there is a strong connection between educators and our services. Clearly, I think there is a lack of service provision through both at the moment. We do not have enough support in schools for kids. That leads to more pressure on CAMHS, and they do not have enough resources as well, so that is why, through this budget, with investments in education and investments in CAMHS, we are looking to tackle both issues.

Mrs HURN: I refer to Budget Paper 4, Volume 3, page 13. I am keen to get an understanding as to what action has been taken to recruit additional child psychiatrists. There was a commitment to urgently recruit at least five and I am wondering where that is up to.

The Hon. C.J. PICTON: As we talked about before, over the four years we have committed to recruiting an additional five child psychiatrists and we made very clear that that is a difficult task. It is probably the most difficult workforce challenge we have set for ourselves, but it is very important, so we are committed to doing it. We have allocated $400,000 specifically, in terms of workforce planning in relation to this task, because it is not only child psychiatrists but also 10 child psychologists that we are looking to attract and get into our healthcare services through CAMHS as well.

The other key reason I was very keen to do this and have it as part of our election policies was the advice we had from the College of Psychiatrists, which was that clearly we have shortages of psychiatrists across the board, public and private, and one of the pinch points in terms of being able to train more psychiatrists is that they all have to do work in terms of child psychiatry, but we cannot do that because we do not have enough child psychiatrists, so it is a real catch 22 in terms of being able to train more psychiatrists right across the board because of the shortage we have in this area.

So not only will there be a benefit through getting more child psychiatrists on board but also that will enable us to increase the training through the college, was their advice across the board. We will be using that $400,000 to do specific workforce training and also in terms of what will probably be a global hunt in terms of trying to find good people to come and take up those positions.

Mrs HURN: So, to confirm, you are committed to putting on at least five over the next four years? I presume that, given the language was around the fact that it was urgent, it would be before the four years, but can you just provide some further clarity on that, and where will they be stationed?

The Hon. C.J. PICTON: These are five over the four years, and certainly we were clear that they would all work in the Child and Adolescent Mental Health Care Service team, which provides services right across the state.

Mrs HURN: Is there any guidance you could give as to how many may be brought on in which years? Given the language around the fact that it was urgent and this is an urgent matter, I do take the point that there is a global hunt on, as you described it, but I suppose, given that the minister used language that it was urgent, it does seem strange that it would only happen—really the indication you are giving is that it would be over the forwards, with no indication as to what is going to happen year by year, or at least what a goal is year by year.

The Hon. C.J. PICTON: We will provide, on notice, the breakdown over the forward estimates. I do not have the exact figures in front of me, but essentially it is not for all five that we are waiting until the last year. The funding builds up from now to the end of the forward estimates as we recruit more across the four years. I agree it is urgent; we need to start straightaway. If there was a plentiful pool of child psychiatrists available, we would likely be able to do that sooner, but we have set what we thought was a realistic target in terms of being able to do that recruitment to get to a position where we have more capacity in the system.

Mrs HURN: I would be interested to know—and you may need to take it on notice—how many vacancies there were for child psychiatrists before 19 March 2022. That would be interesting information to know.

The Hon. C.J. PICTON: I will take that on notice.

Ms PRATT: Budget Paper 4, Volume 3, page 49, the Flinders and Upper North LHN. I understand that a report into CAMHS on the APY lands was carried out by the Office of the Chief Psychiatrist. What was the conclusion of this report, and what implementations, if any, of the findings have there been?

The Hon. C.J. PICTON: Dr Brayley is happy to answer this question.

Dr BRAYLEY: Thank you very much. The report was completed at the beginning of December last year, and it has also been publicly released—it is available on the OCP website. The report has quite some detail in it, and it would be difficult to summarise that quickly, because there were 11 recommendations relating to the model, the staffing, the numbers of staff, how the CAMHS service would operate with other services on the land, and the question about lands based versus fly-in fly-out models of delivering the services. Our office was asked to undertake that review and that has then been followed up by the Women's and Children's Health Network and also other parts of the department.

There was a period earlier this year, during COVID outbreaks on the land, where there was slow progress, and I think that is understood. I have received reports recently about the response from the Women's and Children's Health Network to the recommendations and need to have further discussions with them because I am aware that there are concerns from Anangu about the absence of services on the land still. So the problem that was initially identified and led to our review is continuing.

I am also aware, from the Women's and Children's Health Network, that they have gone through an extensive planning process and have been working with bodies on the land, but nevertheless it is an area of concern that many of the issues that were identified in November last year when we did this review continue to exist and still need further action to resolve that.

The Hon. C.J. PICTON: Thank you to Dr Brayley. I will just add some comments in relation to this. This is a factor which we are very concerned about in terms of the service provision to the APY lands. What happened under the previous government in relation to the step-down of the services on the lands is certainly something that we were very critical of.

I know the Minister for Aboriginal Affairs has taken the very strong position that, in my opinion, led to the work that Dr Brayley and others have been doing in terms of trying to address these concerns in terms of provision. The mental health impacts on the lands are very significant and we do need services in place to make sure that people are cared for. This is something that I know both myself but also the Minister for Aboriginal Affairs are committed to doing everything we can to try to get these services back and to implement the recommendations of this report.

Ms PRATT: As a result of that report, are there identified vacancies now through CAMHS on the APY lands? What efforts are there to recruit and fill any vacancies? Are more child psychiatrists required on the APY lands, and what efforts will the government go to to resource that?

The Hon. C.J. PICTON: I will take those questions on notice, but essentially we do need more staff on the APY lands than what there are at the moment.

Mrs HURN: Minister, I refer you to Budget Paper 4, Volume 3, page 29. I am just interested to know if the government is aware of any hospital that has failed to obtain their accreditation in part or in full due to issues with their mental health services or have they had to take corrective action in response to these accreditation assessments?

The Hon. C.J. PICTON: I am not aware of that, no.

Mr WHETSTONE: On Budget Paper 4, Volume 3, page 40, eating disorders, what progress is being made in the development of the Paediatric Eating Disorder Service?

The Hon. C.J. PICTON: This is something where I am very eager to see accelerated progress from where we have been. You only have to look at a number of articles and media over the past few years to see where this project has been suffering a number of significant delays, fielding criticism from very noted experts in this field. Even Professor Tracey Wade raised concerns about the previous government's actions in relation to eating disorders. We need to do more in this area.

The project in relation to the eating disorder service at the Repat site was originally looked at under the previous, previous government, the Weatherill government. It still has not been resolved. We are in active consultation and working with Breakthrough mental health in trying to get this project over the line now to make sure we can establish these services and provide better accommodation for the services that need to be there to help young people. We know that there are a number of people who are not getting the care they need in very serious circumstances.

Mr WHETSTONE: Are you giving us any indication of when a facility like this, or like you have the interest in, will be built, or when it should be operational? ASAP, I presume. Can you give us a little bit more understanding of the urgency needed?

The Hon. C.J. PICTON: Yes, well, certainly more urgency than has been in place over the past four years, I can tell you that. Our work with Breakthrough is ongoing at the moment. I understand that we are looking at work to begin either later this year or early next year. If that can be brought forward, then I am very keen to do that.

Mr WHETSTONE: Yes—good thing we did not close the Repat. What evaluation process will be put in place to ensure the goals of this program are achieved?

The Hon. C.J. PICTON: Do you mean after it is built and established?

Mr WHETSTONE: Well, obviously you have the goals in the program to be achieved, but you need to have the ability to build the facility and get it operational. We need to understand if it is going to be another four years or something that you envisage would be built within the forward estimates. There is a lot of 'ASAP' and there is a lot of 'as soon as we can', but I just cannot see the urgency. I can understand your response to my question, but are you going to fill that with a delivery?

The Hon. C.J. PICTON: Well, certainly more urgency than there has been over the previous four years, where this project has been talked about and not delivered. I will get an update and provide on notice the estimated completion date, bearing in mind that, while we are supporting it, the construction of the project will be run through Breakthrough themselves.

Mr WHETSTONE: I move on to Budget Paper 4, Volume 3, page 66, Hospital at Home. Are Hospital in the Home services available for people with mental health issues?

The Hon. C.J. PICTON: Yes.

Mr WHETSTONE: Are there any plans to expand these services?

The Hon. C.J. PICTON: Yes. In fact, we have a commitment in the budget to expand Hospital in the Home services for mental health patients by the equivalent of 20 beds. I think that this is a really important measure to make sure we are providing not just inpatient hospital services but expanding our out-of-hospital services for patients in the community.

Mr WHETSTONE: Thank you, minister. Has there been any level of evaluation process in establishing the extra beds? How do we get an assurance that the goals of the program will be reached with expanded services?

The Hon. C.J. PICTON: I am sure you will keep me on my toes in future estimates in relation to this matter but, effectively, the question was: what was the driver behind doing this? It was our view that we put prior to the election that we needed more investment in mental health care, and that there were people who were missing out on mental health care, and that is why we decided to make this investment in additional out-of-hospital services. They will be run through local hospital networks, which will provide, as part of their quality and assurance framework, oversight of those services to make sure that they are safe and provide appropriate care, as well as have the oversight for all mental health services that are provided through the Office of the Chief Psychiatrist.

Mr WHETSTONE: Moving on to Mental Health Services Plan, Budget Paper 4, Volume 3, page 65. In the most recent Budget and Finance Committee hearing, the Chief Psychiatrist indicated that the Mental Health Services Plan is to be reviewed. What are the key issues necessitating that review?

The Hon. C.J. PICTON: I think it might be slightly putting words in the Chief Psychiatrist's mouth from reading the transcript of that. I stand to be corrected, but I thought he said it might need to be updated over time. Certainly, I would be working with him and with the department in terms of if there were updates that needed to happen, in terms of the Mental Health Services Plan, then we would do so.

I would again remind the committee that this is a plan that the previous government did not actually accept all the recommendations of. This was an unusual situation where you have a plan and a government response to a plan, so not all the initiatives in there were necessarily supported or funded. It was a very good initiative, it was a very good piece of work undertaken by Dr Brayley, then Commissioner Burns—and Jennifer Williams, Dr Brayley reminds me. I think I support what Dr Brayley said to the Budget and Finance Committee, that we may well look at updating that plan as time goes on.

Mr WHETSTONE: Who will undertake the review, and is there a time frame?

The Hon. C.J. PICTON: I am not sure I characterise it as a review, but this is under the purview of Dr Brayley, so this would be looked at by Dr Brayley and his team.

Mr WHETSTONE: Will there be any public consultation?

The Hon. C.J. PICTON: It depends on the level of work that is required in terms of what Dr Brayley and his team determine how significant the updates would need to be. What is very clear is that Dr Brayley and his team do a lot of work in terms of consultation with people with lived experience. We are very committed to doing that as a government. That is why we have invested in the lived experience leadership and action network for the first time to give a voice—a permanent body to fund a voice—for people with lived experience in mental health care. If we need to do significant updates to the mental health care plan, which I do not anticipate would need to be significant, we would certainly be working with people with lived experience as part of those discussions.

Mr WHETSTONE: I refer to Budget Paper 4, Volume 3, page 13, Mental Health Commissioners. Will the government be legislating to make Mental Health Commissioners a statutory role?

The Hon. C.J. PICTON: That is not something that we have formed a view on at this stage one way or the other. I have to say, it is something where the previous government have left this program a bit problematic in that we have Mental Health Commissioners who are part time who do not have associated resources attached to them, and certainly something they have raised with me is that they are concerned about definition and clarity in relation to their role.

However, I would make clear that this is something where we have underway at the moment a review of the Mental Health Act, which is being led by the South Australian Law Reform Institute. As part of the terms of reference for that review, we have asked that question in terms of what the role should be of the Mental Health Commissioners under the act and whether they should be legislated under the act, and I think it would be appropriate to see what the outcome of that review is.

Mrs HURN: I refer to Budget Paper 4, Volume 3, page 43. It is just an LHN question for the Barossa Hills Fleurieu. Can you outline what ongoing support is being provided for victims of bushfires in South Australia? Obviously, there was a lot in recent years, but what ongoing support is there for the ongoing trauma?

The Hon. C.J. PICTON: Yes, there has been support in terms of bushfire support, as the member says, and this I understand was a program funded under the previous government that has worked with the local health network, with the Office of the Chief Psychiatrist and with Wellbeing SA in terms of providing support for affected communities. Obviously, we need to now as well make sure that we provide ongoing long-term support for people who were affected, not just in a short-term measure. I know that our health services are working together on how we can make sure that we continue to provide support for people who are affected. I will take on notice to provide more detail in terms of specifics in relation to how that is being done.

Mrs HURN: That would be really helpful, thank you.

Mr WHETSTONE: I move on to Budget Paper 4, Volume 3, page 29, mental health triage. In your election policies, the Labor team claim that up to 60 per cent of calls to the Mental Health Triage Service are going unanswered. What plans do you have to address this? What plans do you have in place to ensure that calls do get answered?

The Hon. C.J. PICTON: This is of critical concern in terms of the Mental Health Triage Service in that we have seen significant numbers of unanswered calls under the previous government, as the member said. I believe the figures quoted were originally referenced from the Australian Nursing and Midwifery Federation, but I believe there are also other questions on notice from the previous Minister for Health and Wellbeing that have similar figures in terms of unanswered calls.

One element that we have made a commitment to is in relation to community mental health services, of which this is a component, but we are also doing work in terms of the future of the team that provides mental health triage services, and looking in terms of their accommodation, which has been an issue as well. I know that there is active work in terms of creating better accommodation for that service and making sure that we can improve the rate at which people are getting their calls answered, which is yet another important factor of not only providing better care, not only helping in issues such as suicide prevention, but also keeping pressure off hospitals and ambulances as well.

Mr WHETSTONE: We will move on to suicide prevention. Budget Paper 4, Volume 3, page 29: the SA Health incident reporting system shows an increase in inpatient suicide attempts in both mental and general health hospitals, or hospital units, since January 22. What advice have you received regarding the possible causes of the increase in inpatient suicide attempts? What came to light, particularly in the most recent Budget and Finance Committee earlier this month?

The Hon. C.J. PICTON: As you said, this is something that Dr Brayley raised in the Budget and Finance Committee: issues in terms of suicide attempts in hospitals over the past year or so. We have seen an increased number of suicide attempts in hospital, which is obviously concerning, and I know Dr Brayley is finalising his report into that matter, and that will be provided to me and to the government accordingly.

I think clearly, as Dr Brayley said to the Budget and Finance Committee, a key issue is in relation to whether COVID-19 restrictions may have played a significant role, but we need to do everything we can to make sure we do not see those rates lead to a permanent higher level of suicide attempts inside our hospital system. I know that our hardworking staff will do everything they can to prevent that, but I think it is very timely for Dr Brayley to be doing this analysis and I look forward to his recommendations to me and the government on what more we can do.

Mr WHETSTONE: You are looking down the track at what measures can be put in place, but what immediate measures can be put in place to reduce inpatient suicide attempts? We know that waiting for reports does take a lot of time. With an increased rate of suicide or attempted suicide, there must be something that can be done immediately.

The Hon. C.J. PICTON: The role of the Office of the Chief Psychiatrist is to investigate issues that are happening in our healthcare system or our mental health care system that are affecting people's mental health and to provide advice on issues that we can take appropriate action on. I know that our mental health care services will not be just waiting until that occurs but they will certainly be taking action to make sure they can do everything they possibly can at a local level to take action.

I think some of the leading factors that we are seeing, and certainly the analysis so far conducted from Dr Brayley, as he said publicly at the Budget and Finance Committee, are in relation to COVID-19 restrictions, mask restrictions and those sorts of things within our hospital network. It is a difficult balance because those measures are in place for very good reasons, to protect public health in vulnerable settings in our hospital system. To remove those to help one problem would only exacerbate another problem.

I certainly would not be advocating for a reduction in our COVID-19 measures, up until we receive the appropriate public health advice that it is safe to do so, but whether there are other measures that could be put in place to improve the wellbeing of people in our system is something that Dr Brayley is considering at the moment.

Mr WHETSTONE: You would be aware that in 2019 the former government launched a Towards Zero Suicide initiative, which focused on reducing inpatient suicides. What progress has been made towards the release of the implementation of the South Australian Suicide Prevention Plan 2022-25?

The Hon. C.J. PICTON: As the member would be aware, this is an aspect in relation to the Suicide Prevention Act, that we will have a plan under that act. We will also have a council. This is something that Wellbeing SA is taking responsibility for in relation to this plan. My understanding is that they are in the process of drafting a plan, but we will want to get the input of the council, once it is appointed, before finalising that plan and releasing it, rather than appointing a council and telling them what the plan is without them having the ability to have input into it.

Mr WHETSTONE: On the same reference, what progress has been made in implementing the Suicide Prevention Act?

The Hon. C.J. PICTON: As I think I said to the member in parliament the other day, a key element of that is in relation to appointing the council. That work is underway. There is also work in terms of regulation drafting, and that work is underway. There is also work in relation to the plan, and that work is underway. We anticipate that this work will be conducted, all to be completed within the next couple of months to enable that act to be commenced, with the regulations and the council in place to undertake its important work.

Mr WHETSTONE: Taking one step in front of that, under the Suicide Prevention Act there must be a register established. Can you shed any more light on the establishment of that register? What progress has been made in establishing that register?

The Hon. C.J. PICTON: Could we just check the budget line?

The CHAIR: That is a very good question. I have provided a lot of latitude, but I think the questions have drifted somewhat.

Mr WHETSTONE: Budget Paper 4, Volume 3, page 65, suicide register.

The Hon. C.J. PICTON: It is a good reminder that another element of the act, which is very important, is in relation to the suicide registry. I am advised that that has already been operating since late 2021 and could start before the legislation is in place. The registry has been developed between Wellbeing SA, the Australian Institute of Health and Welfare, the Coroner and the Office of the Chief Psychiatrist, and it commenced in December.

Mr WHETSTONE: I asked questions of you in the chamber during question time late last week in regard to the Advocate for Suicide Prevention. You shed some light on it, that it is coming and it will happen—sooner rather than later, we hope. What will be the make-up of that advocate and how will the suicide prevention council or committee be appointed? Will it be a member of parliament?

The Hon. C.J. PICTON: The appointment of the advocate is a responsibility of the Premier. I answered as best I could the other day; you might want to ask the Premier, in his estimates, specifically on his view on that. In relation to the council, that is more in my area of responsibility and, as I said the other day, we have had interviews underway in terms of members who have put their hand up. This was something where, prior to the election, ads went out for people to express their interest and that process is now underway with Dr Brayley, with Wellbeing SA and with one of the Mental Health Commissioners, who will be providing advice to cabinet in relation to the make-up of the council.

The act makes clear a number of ex-officio members of the council, one of whom would be a member of parliament who is not a member of the executive. Effectively, I think the idea was for it to be a government backbencher; therefore, I think the idea was that that person would also be the Premier's advocate. Hence, I think it would make sense for that position to be filled by the person who is the Premier's advocate.

Mr WHETSTONE: Do you have any concerns that, if it is a government backbencher, they might turn Independent and become Speaker or Deputy Speaker?

The CHAIR: Now we are getting right out of line. This has nothing to do with the budget. I think I have been very flexible. If you are happy to answer the question, feel free, but I am saying that this is not related in any tight sense, not even in a loose sense.

The Hon. C.J. PICTON: It is a good opportunity to remind members opposite of the members of their party who have left and become Independents. We have been very well served by two previous advocates of suicide prevention, the Hon. John Dawkins and the Hon. Dan Cregan, who is of course now the Speaker. Both later became Independents, but I think both did an exceptional job.

The third Premier's Advocate for Suicide Prevention was the Premier himself. After Dan Cregan finished in the role, the Premier, Steven Marshall, appointed himself as the Premier's Advocate for Suicide Prevention. Perhaps the concern was, as the member for Chaffey was saying, that there were a few too many people leaving the party and so it was better to keep that under wraps. I have no such concerns for the people on our side.

Mr WHETSTONE: We can finish that conversation in the bar. Budget Paper 5, page 12, MATES in Construction: I note that the government is providing funding to MATES in Construction to help prevent suicide. What other occupational groups have been identified as being at higher risk of suicide?

The Hon. C.J. PICTON: To be honest, MATES in Construction is under a different budget line that is not open at the moment, but I am happy to answer the question, nevertheless. There are particular workplaces where we do see high risk, and one has been construction. That has therefore led to MATES in Construction, which has been doing a fantastic job.

They had funding previously, but that was cut under the previous government. We are now reinstating that funding to assist them. I think there are other occupations where we see particular issues in terms of both mental health and suicide: one I am sure the member is aware of is the agricultural and viticultural sector, where farmers are at risk of suicide; the other that has been raised previously is issues in relation to first responders as well.

Mr WHETSTONE: Thank you for noting that primary producers are a significant contributor to suicide. Is the government planning to do anything to combat suicide in any other occupational groups? We note dentists and other professional groups have high levels of suicide or attempted suicide. Will the government highlight any of these other occupations and look at support programs?

The Hon. C.J. PICTON: An important part of the work the Suicide Prevention Council will be doing is looking at particular areas of South Australian society where we can best take action and where we can best direct resources that are going to make a difference. I certainly will be expecting them to pay close attention to areas such as primary production and regional communities as part of that work and in connection with local suicide prevention networks, as we have talked about earlier.

Mr WHETSTONE: I would like to move on to substance abuse, and I refer to Budget Paper 5, page 54. This allocation as an election cost provides community drug and alcohol rehabilitation beds in Adelaide, Mount Gambier and Port Augusta. What data does SA Health have on the current waiting times for rehab services in these areas?

The Hon. C.J. PICTON: I understand that for DASA-specific services, which service the metropolitan area, there is approximately an eight-week waiting time at present. Additional services being provided will obviously help to reduce waiting times and increase capacity in getting people into appropriate rehabilitation.

Mr WHETSTONE: Can you tell me if there are any longer waiting times in metropolitan Adelaide as opposed to country South Australia?

The Hon. C.J. PICTON: I will take that on notice.

Mr WHETSTONE: What service will be provided by the funding you have put on the table, particularly the significant funding for Adelaide and some funding for Port Augusta and Mount Gambier?

The Hon. C.J. PICTON: As part of our election, we have committed to $24 million for drug, alcohol and other drug rehabilitation beds in the metro area and the Port Augusta and Mount Gambier areas. They are the equivalent of 12 beds in Adelaide, four beds in Mount Gambier and four beds in Port Augusta. We will be engaging NGO services to help us provide these services.

We will be trying to get the best possible value for money in terms of the level of service that we can provide in those regions. When we go right around the state, there is clearly demand in terms of providing services not only for illicit drugs such as ice, etc., but significantly for alcohol services as well, which is something that probably does not get as much attention but which has a huge community impact, not just in terms of health services but right across the community. You only have to look at the impact upon domestic violence and other areas to see the impact of what not having enough rehabilitation and support services for people leads to.

Mr WHETSTONE: As I read it in the budget papers, Adelaide beds have the capital provided for the beds, but the regional sites do not. Can you explain?

The Hon. C.J. PICTON: Yes. We are looking to construct facilities within the metro area that will be owned by the government that we can then contract to providers to provide those services. We made a determination that that was an approach that we should conduct in the metro area. It may well be trickier to conduct that in the regional areas. Hence the funding was provided on a basis in the regional areas of a recurrent grant rather than any of it being in the capital component to do so.

Mr WHETSTONE: Thank you. I refer to Budget Paper 5, page 59. Minister, can you confirm when the drug and alcohol strategy will be released?

The Hon. C.J. PICTON: I understand work is underway on that by DASSA at the moment, and they are looking to have that complete and considered by government either before the end of this year or early next year.

Mr WHETSTONE: The member for Frome is over there instead of over here, and she would just love to have a glass of water and read out omnibus questions.

Ms PRATT: She would. I am ready to go, with your indulgence, Mr Chair.

Mrs HURN: I think I have the task of doing the omnibus questions. Everyone has fought me over this task, you might know.

The CHAIR: One day we will just sensibly table these things and not have to read them out.

Mrs HURN: That would be sensible. The omnibus questions are:

1. For each department and agency reporting to the minister, what is the total cost of machinery of government changes incurred between 22 March 2022 and 30 June 2022?

2. For each department and agency reporting to the minister, which administrative units were created, abolished or transferred to another department or agency between 22 March 2022 and 30 June 2022 and what was the cost or saving in each case?

3. For each department and agency reporting to the minister, how many executive appointments have been made since 22 March 2022 and what is the annual salary and total employment cost for each position?

4. For each department and agency reporting to the minister, how many executive positions have been abolished since 22 March 2022 and what was the annual salary and total employment cost for each position?

5. For each department and agency reporting to the minister, what has been the total cost of executive position terminations since 22 March 2022?

6. For each department and agency reporting to the minister, will the minister provide a breakdown of expenditure on consultants and contractors with a total estimated cost above $10,000 engaged between 22 March 2022 and 30 June 2022, listing the name of the consultant, contractor or service supplier, the method of appointment, the reason for the engagement and the estimated total cost of the work?

7. For each department and agency reporting to the minister, will the minister provide an estimate of the total cost to be incurred in 2022-23 for consultants and contractors, and for each case in which a consultant or contractor has already been engaged at a total estimated cost above $10,000, the name of the consultant or contractor, the method of appointment, the reason for the engagement and the total estimated cost?

8. For each department and agency reporting to the minister, will the minister advise whether it will be subject to the 1.7 per cent efficiency dividend for 2022-23 to which the government has committed and, if so, the budgeted dollar amount to be contributed in each case and how the saving will be achieved?

9. For each department or agency reporting to the minister, how many surplus employees were there at 30 June 2022, and for each surplus employee, what is the title or classification of the position and the total annual employment cost?

10. For each department and agency reporting to the minister, what is the number of executive staff to be cut to meet the government's commitment to reduce spending on the employment of executive staff by $41.5 million over four years and, for each position to be cut, its classification, total remuneration cost and the date by which the position will be cut?

The CHAIR: An excellent reading of the questions.

Mrs HURN: Thank you very much.

The CHAIR: With the conclusion of that and there being no further questions—and we accept the qualification that you have made in the past—I declare the examination of the portfolio of mental health and substance abuse completed.

Departmental Advisers:

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

Ms M. Curtis, Manager, Aged Care Strategy, Office for Ageing Well.

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

Ms K. Swaffer, Executive Office Manager, SA Health.

The CHAIR: We are ready to move to the portfolio of Office for Ageing Well. Once again, the minister appearing is the Minister for Health and Wellbeing. I advise that the proposed payments remain open for examination. I call on the minister to make a statement, if the minister so wishes, and to introduce advisers. I call on the lead speaker for the opposition to make a statement, if the member wishes. I call on members for questions.

The Hon. C.J. PICTON: Very briefly, we have maintained Lynne Cowan, Acting Chief Executive of SA Health. We are now joined by Ms Marni Curtis, who is the Manager, Aged Care Strategy and the Acting Director of the Office for Ageing Well. We continue having Jamin and Kris with us as well.

Mrs HURN: I will not buck the trend now by issuing an opening statement. We are happy to head straight into questions.

Ms PRATT: In regard to ageing well initiatives and the net cost of services summary, Budget Paper 4, Volume 3, page 13, can the minister provide information on any initiatives or actions associated with the ageing well strategy that have been budgeted in the 2022-23 budget and over the forward estimates period?

The Hon. C.J. PICTON: The Office for Ageing Well, while it does not have specific measures in the Budget Measures Statement, is continuing a range of its important work in relation to the strategy and its legislative responsibilities in areas such as adult safeguarding, which is also subject to a statutory review of its implementation. In relation to retirement villages, it has work underway on the review of the Retirement Villages Act that was undertaken. It also provides a range of important services in areas such as grants and also the Seniors Card program that it runs.

There is a whole variety of services that it runs. One area I would highlight in particular is the work that it does in terms of elder abuse. We had World Elder Abuse Awareness Day this week, in which we also launched a new campaign through SA Health to help prevent elder abuse and fight ageism, which has been running primarily through social media. I think it is another good communications campaign that has come out of the Office for Ageing Well.

Ms PRATT: I have a supplementary on that. Where our local councils often provide commonwealth home support services—and that is undergoing significant reform—they also rely on state government grants to support ageing well initiatives. Can you or the agency expand a little more on aspects of activities and initiatives from the ageing well strategy where there is very little reference to it in the budget?

The Hon. C.J. PICTON: I think what the member is looking for is some information in terms of the community grants work that the Office for Ageing Well does. The Office for Ageing Well provides $400,000 in community grants to support community organisations to deliver projects that promote opportunities for older South Australians to be involved and active in their communities and support South Australians to age well.

For instance, in 2021-22, the following community grants programs were run. Grants for Seniors enabled non-profit incorporated community organisations across the state to apply for funding for the purchase of goods or projects. Twenty-four different projects received funding of up to $150,000 for that. The Positive Ageing Fellowship Grants enabled community organisations across the state to apply for one-off ageing-specific grants of up to $40,000 for capability building projects, and five projects were funded through that for funding of $197,000.

There was an additional targeted grant of $50,000 provided to the Australian Centre for Social Innovation to develop ongoing coaching, mentoring and support to Positive Ageing Fellowship Grant recipients over the funding period to build the capacity of grant recipients and sustainability of project outcomes.

Ms PRATT: I refer to the same budget line and same reference point. Would it be likely that LGAs, local councils, can apply for those grants, or what portion of the net cost of services summary, if any, would be available to the local government sector to assist them with aged-care reforms?

The Hon. C.J. PICTON: In relation to the reforms, I understand that is a commonwealth matter that we are still waiting to be finalised. In relation to the local government grant support, we will take on notice in terms of that. I am receiving advice that they are eligible, but I am also looking at a number of the grants that have been provided which largely go to not-for-profit or community organisations as well, which I am happy to read out the list of. A lot seem to be in regional South Australia, I am sure you will be glad to know.

Ms PRATT: I refer to Budget Paper 4, Volume 3, page 22, Advance care directives. Can the minister please provide an update on the government's response to the recommendations of the review of the Advance Care Directives Act 2013 undertaken by Professor Wendy Lacey?

The Hon. C.J. PICTON: This is not necessarily under the Office for Ageing Well but broadly under the department, but I am happy to answer in terms of where this is up to. I understand that there is an oversight committee, which is overseeing the response to implementing the changes recommended under the Lacey review. I am sure the member will be aware that the previous minister introduced some legislation to help introduce some of the changes to the act that needed to be in place to implement the review. That did not finish before parliament was prorogued, so we will now need to reintroduce that legislation and debate it through both chambers to consider that, but there are some other non-legislative actions that are taking place as well.

I understand that reworking of the forms is part of that work. A team within the department is undertaking work in terms of how we can reform how the form works to help implement the recommendations of the review. This is a very important part of our architecture to have in place advance care directives. Certainly, we would like to see more people take up the opportunity to have an advance care directive in place, which is obviously helpful. It is not necessarily just an ageing question, but anyone at any point in their life should be able to put in place an advance care directive to make sure that at the end of life their views and their wishes are respected.

Ms PRATT: Moving on to the Retirement Villages Act, Budget Paper 4, Volume 3, page 20, highlights. What is the government's response to the review of this act? If the government has not formed a view, when do you anticipate having a public response?

The Hon. C.J. PICTON: The previous government undertook a review, I believe, off the top of my head, through Peak Consulting, of the Retirement Villages Act. I believe it was a statutory requirement that it had to take place. That has led to a whole series of largely technical changes that need to be considered in relation to redrafting and amendments to that act taking place. We committed before the election to implement recommendations from that review and to consider them in detail and to bring to the parliament a revised bill that would seek to update the act.

This is something where we will also continue to receive feedback from both sides of this equation, from people who are residents in retirement villages and also people who are the owners and operators of retirement villages. Often this is a challenge where we need to get the balance right in this regard. I think that my view will be that we need to likely have a further round of consultation once we have the measures drafted—whether that is an exposure draft or another form of consultation—to make sure that before we enact those changes we work through any unintended consequences that might be not thought through, or make sure that we get it right before it is considered by the parliament.

Ms PRATT: Moving on to the Adult Safeguarding Unit, Budget Paper 4, Volume 3, page 23. I refer to the final line referencing additional expenditure. Was the additional funding for the Adult Safeguarding Unit approved before the caretaker period?

The Hon. C.J. PICTON: Yes, that is right.

Ms PRATT: If that is the case, why was it included in the budget measures paper?

The Hon. C.J. PICTON: Because it was not in the budget until now.

Ms PRATT: Can you please explain what is the progress on the time frame for that review of the adult safeguarding legislation being undertaken by the South Australian Law Reform Institute (SALRI)?

The Hon. C.J. PICTON: The review date is 30 September 2022.

Ms PRATT: I am sorry, minister, I was distracted. Would you mind repeating that answer? My apologies.

The Hon. C.J. PICTON: The member for Schubert again?

Ms PRATT: Indeed. She will be schooled later.

The Hon. C.J. PICTON: The report on the review is due by 30 September 2022.

Ms PRATT: Would you anticipate an interim report then, given how close it will be?

The Hon. C.J. PICTON: I will not anticipate an interim report.

Ms PRATT: Is the Adult Safeguarding Unit on track to expand services from October 2022 to work with all adults who may be vulnerable to abuse?

The Hon. C.J. PICTON: I am informed that it is on track to meet that.

Ms PRATT: Is the department's additional promotion of the service ahead or around this date of expansion to ensure that all South Australians who may need this assistance are aware of the service?

The Hon. C.J. PICTON: This is something that is being worked on by the Office for Ageing Well at the moment: how do we communicate with stakeholders, with the public, to make sure that people are aware of that additional avenue for raising issues in relation to younger adults—put it that way—who will now be eligible for issues to be brought to the Adult Safeguarding Unit for appropriate action by that unit? This is clearly something where, as those additional staff come on board, there will be the capability to increase that awareness to the community.

Ms PRATT: Given you mentioned an effort to communicate, is any of the $1.2 million funding to be allocated for advertising or promotion?

The Hon. C.J. PICTON: I will have to take that on notice.

Ms PRATT: On the topic of the residential aged-care strategy, Volume 3, page 25, I refer to corporate and system support services. What progress has been made with the residential aged-care strategy for SA Health and the local health networks and what might be the next steps? What is the time frame?

The Hon. C.J. PICTON: Essentially, this is a lot of work that is being done on the implementation of reforms across the country in relation to aged care following the aged-care royal commission. This piece of work is being led through the Department for Health and Wellbeing, working with the six regional local health networks across the state, because we are a very significant, if not the largest, provider of aged-care services in the state, to make sure that we improve and implement the recommendations of that work.

A number of elements of work have been identified over the next 12 months to implement elements of that response—for instance, new models of care that need to be worked through, redefined roles and responsibilities, with the commonwealth under the National Health Reform Agreement that need to be negotiated, work in relation to what changes might need to be made to the Aged Care Assessment Program delivered by SA Health and reforms impacting aged-care services delivered by regional local health networks.

This includes casemix funding models, regulatory standards impacting workforce and service models, an increased accountability for providers and their governing boards, as well as reforms that impact workforce supply and demand, which obviously connects with the discussion we had earlier on pressure on workforce right across regional South Australia. Clearly, aged care is a connected and significant part of that.

Mr WHETSTONE: What is the expected impact of federal Labor's election commitments on aged-care staffing in relation to the workforce of SA Health and aged-care facilities?

The Hon. C.J. PICTON: Something that is being undertaken as part of this work is looking at what we will need to do in terms of changes in relation to the federal government's policy—the incoming federal government, as of a couple of weeks. That will be part of discussions we will be having with the federal government on how those reforms will be implemented and then working between the department and local health networks on what the changes will need to be to make sure that we are compliant and that we are implementing appropriate staffing in relation to what the federal policy will be.

Mrs HURN: Budget Paper 5, page 56: is the government committed to honouring the partnership with HammondCare to deliver dementia care services at the Repat?

The Hon. C.J. PICTON: Yes.

Mrs HURN: Fantastic.

Ms PRATT: Minister, I was just looking for a budget line for the Enterprise chemotherapy question. I will come back if I cannot find it. I will move on to aged-care accreditation, Budget Paper 4, Volume 3, page 25, corporate services. In the past 12 months, did any SA Health aged-care facility fail to attain commonwealth aged-care accreditation?

The Hon. C.J. PICTON: My advice is that all our aged-care facilities have accreditation under the scheme. There is one notice we are dealing with, which I think has been reported publicly, in relation to the Naracoorte Health Service and issues identified on inspection there. The local health network is taking action to implement recommendations for the aged-care services there and involving additional staffing being provided to that unit.

Ms PRATT: I might be seeking your indulgence on a budget line, and you may tell me this does not relate to the Office for Ageing Well. Rookie question, but I am jumping in. Budget Paper 4, Volume 3, page 16, the Enterprise Cancer Prescribing System. I relate this to perhaps an ageing clientele. It affects everyone and it is not anything to laugh about. Could you please update the committee on the Enterprise Cancer Prescribing System?

The Hon. C.J. PICTON: As the member has acknowledged, we are a little bit off the topic of the element of the budget that is open at the moment, but I am happy to take that on notice.

The CHAIR: We are nearly finished.

The Hon. C.J. PICTON: I will have to take that on notice and will get an answer for the honourable member. As the budget papers outline, the Enterprise Cancer Prescribing System has an estimated completion date at the end of next year, 2023. The total project is $25.1 million, of which $8.27 million is expected to be spent in this coming financial year.

Ms PRATT: We would be very happy if you would take on notice a supplementary question in regard to 21 SA Health facilities providing chemotherapy. Could you please take on notice the listing of those locations, by way of supplementary?

The Hon. C.J. PICTON: I will take it on notice.

Ms PRATT: I have an aged-care accreditation question. I know that we touched on that. How many SA Health aged-care facilities that are not subject to commonwealth aged-care accreditation were audited this financial year, and how many are planned to be audited in the coming financial year? This is Budget Paper 4, Volume 3, page 25, corporate services.

The Hon. C.J. PICTON: We will have to take the question on notice and provide a response.

Ms PRATT: Just picking up a legislative question, minister, and I will tie it to Budget Paper 3, page 23, the underlying health expenditure for the department. This is a voluntary assisted dying question: what is the current intended start date of the VAD legislation?

The Hon. C.J. PICTON: The advice to government upon us forming government after the election was that the expected date was going to be 31 March next year. That is of concern to both me and the Attorney-General, who obviously has been very keenly involved in this process having led the legislation. We have been asking for work that is headed up by the task force to come back to us with how we can bring that work forward and that if there are elements such as IT systems, etc., that we can utilise from other states to make sure that we can get this implemented as soon as possible.

It seems to me that there was a period after the bill passed, before there was substantial implementation of any work to get this started, that has led to a significant delay. We are now trying to play catch-up and get this work happening as quickly as possible, but in a safe and appropriate way.

Ms PRATT: On the matter of the new older persons mental health unit—I am happy to be told that it does not relate, but I am talking about Budget Paper 4, Volume 3, pages 14, 16 and 34—the budget papers outline that the government will continue the implementation of existing investing initiatives, including the new Modbury Hospital older persons mental health unit. Does the government intend to expand the number of beds delivered in this project from 20 to 24?

The Hon. C.J. PICTON: Essentially, what we are doing is implementing what the previous government was doing, which was moving the inpatient mental health care beds from Modbury to Lyell McEwin and then the Lyell McEwin older persons mental health beds to Modbury. In addition, we are creating a new ward, which will be the new replacement for inpatient mental health beds at Modbury as well. So essentially what was going to happen under the previous government but in addition a new ward on top of that, and that new ward will have 24 beds in it.

Ms PRATT: Does the government still plan to deliver on its election commitment to rebuild and expand Woodley House?

The Hon. C.J. PICTON: Yes, the new ward will be the new Woodley House.

Ms PRATT: When will that construction and delivery of 24 beds take place?

The Hon. C.J. PICTON: I think these are the same beds we talked about in the mental health section earlier. I think we are a bit off topic of the Office for Ageing Well. The time frames are as we talked about earlier.

Ms PRATT: What is the government doing to combat ageism and age discrimination?

The Hon. C.J. PICTON: This is absolutely something which is very important in terms of the work for the Office for Ageing Well. This is clearly an area where people do face significant discrimination for their age, which is illegal but still happens. One element that we have launched this week is a new campaign about ageism. The statewide Tackling Ageism campaign was launched just this week and will run until the end of July to raise awareness that ageism takes away older people's rights and can lead to elder abuse.

This is predominantly running, as I said, on social media, but the Office for Ageing Well is committed to tackling ageism as part of its work to safeguard the rights of older South Australians and create age-friendly communities where people remain active and engaged as they age. This is also clearly something that will be considered as part of the review in relation to the Ageing and Adult Safeguarding Act that is being undertaken by the South Australian Law Reform Institute.

Mrs HURN: How long do you think the advertising campaign will go for, minister?

The Hon. C.J. PICTON: As I said, it will run until 27 July.

Mrs HURN: Is there any room to extend that at all?

The Hon. C.J. PICTON: That is not the current plan, but obviously we will consider in the planning for future advertising campaigns whether there could be an extension of that or a new campaign down the track. That is something that would be considered based on the success of the current campaign.

Mrs HURN: I go to Budget Paper 4, Volume 3, page 20, in relation to the Retirement Villages Act of 2016. Is the government considering changes to the statutory buyback provisions?

The Hon. C.J. PICTON: As I said, we are going through a process in terms of considering what the recommendations of the consultant's report that we have received are, and other feedback that we have received as part of the response to that report that is being considered, and it is likely that we will go through a further round of consultation before presenting a bill to the parliament. No decisions on any particular matters such as that have been made at this point.

Mrs HURN: So you are not ruling out any changes to the buyback provisions?

The Hon. C.J. PICTON: I am not ruling them in and I am not ruling them out. I am saying that we are taking the report, we are considering that, we are considering feedback from a whole range of stakeholders, and we will conduct further consultation before we bring a bill to the parliament.

The CHAIR: Thank you, we have now come to the—

Mrs HURN: Just in relation to—

The CHAIR: I know you were just getting warmed up and I know you would like to stay here all night, but I now have to draw you to a close. There being no further questions, I declare the examination of the portfolio of Office for Ageing Well completed. The examination of the proposed payments for the Department for Health and Wellbeing, Wellbeing SA, and Commission on Excellence and Innovation in Health are now complete.

Having said that, I would like to thank all the members for the very measured tone during this estimates hearing. I would like to thank the public servants for all the solid work they do leading up to estimates. I will even thank the minister for his comprehensive answers to questions. I also thank the parliamentary staff, including the parliamentary security that has had to sit up there just about the whole of the day. Good on you.

At 18:32 the committee adjourned to Monday 20 June 2022 at 09:00.