Department for Health and Wellbeing, $5,922,190,000

Commission on Excellence and Innovation in Health, $6,865,000

Preventive Health SA, $32,685,000

Chair:

Mrs R.K. Pearce

Membership:

Mr Fulbrook substituted for Mr Odenwalder.

Ms Hood substituted for Ms Thompson.

Hon. D.J. Speirs substituted for Mr Teague.

Hon. D.G. Pisoni substituted for Mr Basham.

Minister:

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

Departmental Advisers:

Dr R. Lawrence, Chief Executive, Department for Health and Wellbeing.

Ms S. O'Brien, Deputy Chief Executive, Strategy and Governance, Department for Health and Wellbeing.

Ms J. Formston, Deputy Chief Executive, Corporate and Infrastructure, Department for Health and Wellbeing.

Ms J. TePohe, Deputy Chief Executive, Commissioning and Performance, Department for Health and Wellbeing.

Ms L. Tuk, Manager, Executive Services and Correspondence, Department for Health and Wellbeing.

The CHAIR: As the duly elected Chair of Estimates Committee B, I welcome you back to today's estimates committee hearing. 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 lead speaker for the opposition confirm that the timetable for today's proceedings, as previously distributed, is accurate?

The Hon. C.J. PICTON: Yes.

The Hon. D.J. SPEIRS: Yes.

The CHAIR: Thank you very much. I remind members that 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 lines of expenditure in the budget papers and must be identifiable or referenced.

I also advise that, if the minister undertakes to supply information at a later date, it must be submitted to the Clerk Assistant via the Answers to Questions mailbox no later than Friday 6 September 2024. Members unable to complete their questions may submit them as questions on notice for inclusion in the assembly Notice Paper.

The rules of debate in the house apply in the committee. Ministers and members may not table documents before the committee, but may supply them to the Chair for distribution. I will allow both the minister and the lead speaker for the opposition to make opening statements of about 10 minutes each, should they wish.

The Hon. C.J. PICTON: Thank you very much, Chair, and congratulations on your election as the Chair of this committee. I will make some brief opening remarks. Firstly, I will introduce my advisers. Firstly, Dr Robyn Lawrence, the Chief Executive, Department for Health and Wellbeing; and deputy chief executives, Ms Sinead O'Brien, Ms Judith Formston and Ms Julienne TePohe; and also Ms Lauren Tuk, who is the Manager of Executive Services and Correspondence in the Department for Health and Wellbeing.

Two years into the term of our government and the 2024-25 budget delivers a further $2.5 billion investment in health, highlighting our continued focus on delivering the government's commitment to improve ambulance response times, improve access to our hospital system and give South Australians the best health care possible.

The latest funding boost means that in its first three budgets this government has delivered $7.1 billion in additional funding for the health system over the forward estimates. This investment includes:

$30.2 million over two years to build 56 new beds across The Queen Elizabeth and Lyell McEwin hospitals, providing more hospital beds for South Australians living in the western and northern suburbs;

$24 million over three years for three brand new ambulance stations at Marion, Two Wells and Whyalla;

$23.5 million over two years to introduce an electronic patient care records system to SA Ambulance Service, enabling paramedics to transmit patient data in real time to hospitals and speed up admissions, rather than the current paper-based process;

$17.1 million over four years to expand renal dialysis in the northern metropolitan area, providing an additional 21 chairs and supporting an additional 84 patients;

$15.2 million over three years to manage the current tuberculosis outbreaks across South Australia;

$11.5 million over four years to support the Port Pirie emergency department upgrade and provide for a multiprofession simulated training and development service. This brings the total capital investment for the Port Pirie hospital upgrade to $20.6 million;

$10.7 million over four years to expand the Clinical Telephone Assessment service, enabling SA Ambulance to employ 16 more paramedic telehealth clinicians; and

$5 million over four years to fund a range of programs to support youth mental health services, including an expansion of the Child and Adolescent Virtual Urgent Care Service, additional mental health workshops, and support for carers and families of those with eating disorders. This is in addition to the beds, services, doctors, nurses and ambos that are already being delivered across our health system, funded in previous budgets.

In April 2024, we officially opened 20 fast-track beds at Flinders Medical Centre. It is part of our commitment to open more than 600 beds across the system, including 280 by the end of next year, to deliver better health care for South Australians. Of course, that number has now grown, in this budget, to well over 330.

We will shortly be opening 52 new beds at The Queen Elizabeth Hospital as part of the $314 million clinical services building. This site will feature a 50 per cent bigger emergency department, 12 state-of-the-art operating theatres and a new rehabilitation unit, all designed with thorough engagement with health professionals and the community who use the hospital.

A 48-bed expansion to support the growing population in Adelaide's north is taking shape, with construction on track to be complete in coming months. The $47 million project at Lyell McEwin will deliver two new 24-inpatient wards. We have also broken ground on the new mental health facility at The Queen Elizabeth Hospital, the new Women's and Children's Hospital site in Thebarton and the expansion of Noarlunga Hospital. Construction is also set to begin on the 98-bed tower at Flinders Medical Centre, providing a huge boost to care in the southern suburbs, and we have already broken ground on the expansion of the Margaret Tobin Centre for additional mental health beds at Flinders Medical Centre as well.

While we acknowledge that there is still much, much more work to do, it is pleasing to see that ambulance response times have improved significantly since this state government was elected, with 72.5 per cent of priority 1 cases reached on time (within eight minutes) in April 2024 compared to 50.3 per cent in April 2022. The target of course is 60 per cent. Also, 66.7 per cent of priority 2 cases were reached on time (within 16 minutes) in April 2024 compared to 34.3 per cent in February 2022—the best response times in three years. The improved response times are despite having more than 1,027 more ambulance transports to Adelaide metropolitan hospitals compared to the year before—an increase of 8.3 per cent.

Our government remains committed to doing everything possible to address ramping in our hospitals, ensuring South Australians receive the urgent care they need. Fixing the ramping crisis is our number one priority, and we are taking action across every front to deliver this with a comprehensive plan to address every aspect of blockages that leads to patients waiting longer on the ramp and in the community for an ambulance.

We are investing in health initiatives to meet demand pressure, ease pressure on hospitals and address ramping. This includes, as I said, increasing the capacity of our system by adding 600 more beds and increasing our workforce by already having recruited 1,400 additional health workers, full-time equivalent—above attrition—since coming to government. This includes 691 extra nurses, 329 extra doctors, 219 extra ambos and 193 extra allied health workers.

In February 2024, more than 300 graduate nurses were recruited to work at the Central Adelaide Local Health Network, which was its largest graduate nurse intake ever. These recruits are among 832 new nurses and midwives employed to work at hospitals across the state this year, compared to the standard annual recruitment of 600.

We are also partnering with the federal government to roll out the single employer model across the state. This will allow rural generalists and general practice trainees to be employed by SA Health as a single employer for four years while they complete their training. We have delivered on our commitment to open three 24-hour pharmacies. All of these initiatives build on the significant work in our two years of government, including the significant investments in our first budget.

I put on the record my very sincere thanks to the thousands of clinicians, allied health professionals and other staff who do an outstanding job across SA Health, day in and day out. As a government, we demonstrate in this budget that we are listening to what is needed across the health system to improve the care for South Australians and improve the environment for our staff. That is why we are making this $7.1 billion investment since we came to government. I thank the committee for having us today.

The CHAIR: Thank you very much, minister, and I see the member for MacKillop. Leader of the Opposition, would you like to make any remarks?

The Hon. D.J. SPEIRS: I thank the public servants who have been involved in the preparation—I know that much work goes on behind the scenes to ensure that the minister is appropriately prepared, and I thank them for that.

The CHAIR: I advise that the proposed payments are open for examination. The portfolio is SA Health. The minister appearing is the Minister for Health and Wellbeing. I call on the Leader of the Opposition.

The Hon. D.J. SPEIRS: I refer to Budget Paper 4, Volume 3, page 35, which covers off on performance indicators, particularly with regard to these questions, the performance indicators around elective surgery. Minister, as of today how many patients have now had their elective surgery cancelled as a result of the Code Yellow that has been declared for our hospital system?

The Hon. C.J. PICTON: The budget paper the member refers to is in relation to the Central Adelaide Local Health Network specifically, obviously not all of our—

The Hon. D.J. SPEIRS: Yes, that is correct.

The Hon. C.J. PICTON: I will answer the question, if that is okay, member for Black. This is in relation to the Central Adelaide Local Health Network specifically, but while I was asked in relation to the current incident management approach that SA Health has in place cross the system, I am happy to answer more broadly than the budget line in which we have been asked.

Three weeks ago, the chief executive of the department put in place incident management protocols, otherwise known as a Code Yellow, based on the demand we were seeing in the system, and the fact that we were seeing very significant presentations in terms of COVID, flu, RSV and other respiratory illnesses. At the same time, we had significant numbers of staff who were ill at that time, which was placing significant pressure on hospital throughput, with very high utilisation of all our general medical beds and all of our intensive care beds across the system.

Part of those measures were to put in place suspensions of our elective surgery work for non-urgent cases. These were some of the category 2s and all of the category 3 cases, to prioritise emergency department presentations and also the urgent elective surgery that needed to be conducted across the system, that being category 1 cases and some category 2 cases. As of last Friday, 90 per cent of those operations that were suspended have been lifted.

The current cancellations are only in the range of about 10 per cent, and that is for metropolitan hospitals only and only for those non-urgent cases where there is expected to be a hospital stay of multiple days. Currently, metropolitan and peri-urban hospitals are able to continue with their overnight—otherwise known as 23-hour—surgery, as well as same-day surgery, and country hospitals are able to continue with no restrictions in place at all in terms of their surgeries.

That has seen what were high numbers of deferrals a few weeks ago reduced to very small numbers of deferrals now. As of yesterday, through that whole period there have been 657 cancellations since 31 May. That compares to, for example, in the system yesterday 212 elective surgery operations being completed. That highlights that we are seeing the elective surgery numbers significantly bounce back across the system, although there are still some cases, within a very limited cohort of categories, that are seeing deferrals.

The Hon. D.J. SPEIRS: Minister, was that figure of 657 across all LHNs or only for central?

The Hon. C.J. PICTON: I was very generous and, despite you asking about the Central Adelaide Local Health Network budget line, that is the figure across all LHNs.

The Hon. D.J. SPEIRS: I am happy to ask you now if you could give a figure breaking down for each, so for Central Adelaide Local Health Network, Budget Paper 4, Volume 3, page 35; for Northern Adelaide Local Health Network, Budget Paper 4, Volume 3, page 36; for Southern Adelaide Local Health Network, Budget Paper 4, Volume 3, page 39; and for Women's and Children's Health Network, Budget Paper 4, Volume 3, page 41.

The Hon. C.J. PICTON: We do not have a breakdown on that figure, we just have a figure for across the system, but we will endeavour to locate that and provide that on notice.

The Hon. D.J. SPEIRS: On the same budget paper, referencing CALHN as a headline network and seeking generosity in terms of the information that you give, minister—although, again, I can go through the other references if you would like—how long does SA Health anticipate that the patients who have had their elective surgeries cancelled will wait to have them rescheduled, and do you have a rough timeline as to how that will occur?

The Hon. C.J. PICTON: All of our local health networks will be working hard to make sure that those operations are rescheduled as soon as possible. There will be a variety of different cases and a variety of different circumstances that will need to be worked through. Some of those may well be able to be rescheduled relatively quickly, particularly where country hospitals have a significant amount of capacity available to conduct those and can reschedule them quite quickly. Some of those, obviously, are same-day operations, such as cataracts, and some are multiday surgeries that require a significant amount of planning and preparation.

Obviously, it needs to be balanced with other urgent cases that may pop up as well. But I think the thing that I would really want to make sure is clear and communicated well to the public is that somebody who has had a deferral in terms of their elective surgery does not lose their place in the queue. They will stay at the top of the queue to receive their elective surgery and our local health networks, our clinicians, our surgeons will be working to try to reschedule those as soon as that can happen.

The Hon. D.J. SPEIRS: Do you anticipate that you may need to call another Code Yellow internal emergency in the next 12 months?

The Hon. C.J. PICTON: Code Yellow is a standard term which is used across Australia. There are different codes, different colours for a variety of different circumstances. A Code Yellow, as the member has noted, is listed as an internal emergency and there are a variety of different circumstances in which that may well be considered.

I think it would be very difficult for any minister, any politician of whatever political persuasion, to rule out that such a circumstance might not need to happen in the future. Those emergency management protocols, for a whole variety of different reasons, are in place to make sure that the system can respond when it needs to, and can do so in a coordinated way, following appropriate emergency management protocols, which is what is in place at the moment.

The Hon. D.J. SPEIRS: In relation to the current system-wide Code Yellow, has a Code Yellow ever been called for this length of time before?

The Hon. C.J. PICTON: I would have to take that on notice in terms of going back through the history books, but what I can say is that in terms of elective surgery cancellations there certainly have been elective surgery cancellations issued on a statewide basis before, most notably through the course of the past four years. I believe under the previous government, when the member was in the cabinet, there were about a hundred days of statewide elective surgery restrictions in place.

That is obviously very significant and caused issues in terms of backlog that we are still trying to catch up from. That was obviously before we had COVID in South Australia, and we were not having any flu cases in the system at all. We have seen a lot of extra demand since then, and that is why these protocols have had to be put in place, at the same time that we are building hundreds of additional beds to make sure that we have the capacity we need, so that we can see both emergency cases and also continue to see these elective surgery cases, without the need for cancellations or deferrals to happen.

The Hon. D.J. SPEIRS: When do you anticipate that all restrictions or measures put in place by the Code Yellow will be lifted?

The Hon. C.J. PICTON: It is impossible to give an exact estimate in terms of that, but I can assure the house and the committee that this is being reviewed on a daily basis by not only Dr Lawrence but also Mr Wayne Champion, the incident commander for the current incident, and by the broader team, in terms of making sure that, firstly, our restrictions are as small as possible. Obviously, we have already taken action in terms of making sure that some 90 per cent of those elective surgery restrictions have been lifted.

I suspect that we will see further easing of those restrictions before we see an easing of the broader Code Yellow incident management response, because that also enables us to implement and to work on a number of measures that are happening across the system to try to address the flow and blockage issues that are causing significant what is called access block in emergency departments, where we see patients who have been treated by emergency department teams in an emergency department bed waiting for an inpatient bed. We need inpatient bed capacity to be able to do that.

A lot of the actions being taken at the moment, while obviously elective surgery is getting the most attention, there are behind-the-scenes actions being taken, and I would particularly highlight things such as country repatriations. We have, on a daily basis, often more than 500 patients in our metropolitan hospitals who are country patients, and we are trying to get as many of those who can be safely looked after in their local country hospital as possible—obviously, it is not only better for those country patients to be closer to home, it will also help free up metropolitan hospital bed capacity.

The Hon. D.G. PISONI: The same budget line, minister.

The Hon. C.J. PICTON: Sorry, which one is that?

The Hon. D.G. PISONI: That is Budget Paper 4, Volume 3, pages 20 and 35. Are you able to advise how many patients have contracted COVID in public hospitals in South Australia in the last financial year, and how many of those patients have died with COVID?

The Hon. C.J. PICTON: I will take that on notice but certainly the advice I have received in relation to this matter is that it is quite difficult to determine when somebody has caught COVID. While there may well be a positive test that is conducted within a hospital, in many cases it is hard or impossible to determine whether that was contracted within the hospital system or whether it was contracted in the community before somebody presented at the hospital.

I will say that what has been very clear through the course of the past four years is the importance of infection control, and one of those key measures relates to single rooms in hospitals. If you look at the Royal Adelaide Hospital, this is a hospital that was designed with a pandemic in mind. Single rooms, infection control, the ability to turn on pandemic mode for air conditioning and other related plant and equipment has meant that, firstly, they were deemed at the beginning of the pandemic as the COVID hospital.

Before the borders closed, when we were expecting mass infections at that stage, that was going to be where the vast majority of infectious people were going to go because it had that superior infection control available because of the way the hospital was designed. Compare that to Flinders Medical Centre. It is our second major hospital in South Australia, but it is a very old piece of architecture now and the majority of those beds are in four-bed bays. That makes it very difficult in terms of being able to deal with a respiratory infection and we see blockages.

The advice I have received on a regular basis is that one of the issues they face in terms of access block from the emergency department into wards is that they regularly have people who require a single room in the hospital, but they are obviously in short supply. This is one of the reasons why in the expansion of the Flinders Medical Centre, which is progressing, there will be an uplift in terms of the number of single rooms in the hospital, which will give us greater flexibility in terms of being able to treat patients who have respiratory infections or are infectious who need to be in a single room so they do not infect other people in the hospital.

So while there are very careful measures that are taken to try to make sure that patients do not infect each other, when you are dealing with a virus such as COVID that is obviously difficult in a hospital that was not designed with the same modern infectious protocols as one that has been designed in the past decade.

The Hon. D.G. PISONI: Can you advise as to whether patients with COVID ever share a room with patients who do not have COVID in the hospital system?

The Hon. C.J. PICTON: The advice I have is that that would be very unlikely or certainly not done knowingly. Obviously, COVID is a condition that people do not necessarily always know they have until they receive a positive test. Our hospitals work with their infectious disease specialists to make sure they have appropriate protocols in place.

As I said, one of the issues at the Flinders Medical Centre is when you have people coming into the emergency department who have COVID or other infectious respiratory illnesses. There is a lot of work that will take place to try to make sure they can find them single rooms to go to and that is one of the issues that causes access block and therefore delays for other patients. I am very happy to take on notice the exact protocols that are in place across our major hospitals.

The Hon. D.G. PISONI: Another part of my question was: how many people have died with COVID in the hospital system?

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

The Hon. D.G. PISONI: Another question I have relates probably more to page 13, key agency outputs. How many incorrect administrations of drugs and incorrect drug doses have been reported in the public hospital system in the last financial year?

The Hon. C.J. PICTON: Sorry, member for Unley, page 13? Is that what you are saying? Ministerial office resources and workforce summary?

The Hon. D.G. PISONI: Other health services for the South Australian community, health promotion and education, statewide public hospital and community health services.

The Hon. C.J. PICTON: Which budget paper are you looking at?

The Hon. D.G. PISONI: I am looking at Budget Paper 4, Volume 3, page 14, sorry.

The Hon. C.J. PICTON: That clears it up. Sorry, maybe if you can repeat the question, member for Unley.

The Hon. D.G. PISONI: The question was: how many incorrect drug administrations or incorrect drug doses have been reported in public hospitals in the last financial year?

The Hon. C.J. PICTON: We will take that on notice. We do not have the detail with us, but I would say that there are longstanding protocols in place across our public hospital system in terms of medication errors to make sure they are appropriately followed up and appropriately notified, but also so we can learn lessons where they have occurred to make sure the same error does not occur again.

This is, of course, one of the reasons why successive state governments have invested such a significant amount of funding in terms of what is now known as the Sunrise EMR, previously known as the EPAS, which we have rolled out to almost all hospitals across South Australia, which will be a significant achievement within the course of the next few months.

One of the rationales behind that was that one of the issues behind medication management was that hand writing paper notes obviously had a number of issues in terms of making sure that the correct doses were issued. So between having better digital records, between making sure that there is appropriate work by our clinical teams but also the work that SA Pharmacy do at their end to make sure they are dispensing the correct medication to meet the orders that are put in place, there is a lot of work that happens across the system to try to make sure that medication errors are reduced as much as possible.

Of course, in a system as large as SA Health, with hundreds and hundreds of thousands of patients being treated every year, there will always be some times when errors occur and, where they occur, they need to be appropriately followed up in relation to our safety learning system and other protocols.

The Hon. D.G. PISONI: While you are coming back with the information, can you advise the committee if any of those errors led to deaths and how many there were?

The Hon. C.J. PICTON: Sure.

The Hon. D.G. PISONI: Can you do that?

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

The Hon. D.G. PISONI: You cannot come back with that? You have to take on notice as to whether you can come back, or you will come back with that figure?

The Hon. C.J. PICTON: I will take your question in relation to the number of deaths on notice.

The Hon. D.J. SPEIRS: Thank you, minister. I refer you to Budget Paper 4, Volume 3, page 26, which is the costs relating to the Clinical System Support and Improvement section of the budget papers, the costs table on page 26 being the reference point for the following question. Minister, will you release a copy of the direction that the SA Salaried Medical Officers Association alleges has been orally conveyed to doctors, mandating that SAAS offload at 180 minutes and that SAAS patients were to be preferentially offloaded over patients in the waiting room?

The Hon. C.J. PICTON: Obviously, this follows up a question that the member asked me before in parliament. I am not aware of an exact direction that the member refers to. I do know that there has been work by the incident management team in relation to making sure that there are appropriate protocols in place where there have been very long-ramped patients and to make sure that action is taken, including by escalating to the chief executive to make them aware of the issue.

The advice I have from Dr Lawrence is that there has been no direction in relation to preferencing people who are on the ramp for treatment above people in the waiting room, other than to say that we already have a very longstanding policy in place, which is for patients of equal clinical standing—i.e. if both are categorised as a category 3 patient, for example—then the patient should be offloaded from the ambulance before the patient in the waiting room.

Obviously, we had a previous allegation that was raised in relation to this issue, firstly by Dr David Pope, President of the Salaried Medical Officers Association, and followed up by the Leader of the Opposition himself. Following those allegations, I commissioned Professor Keith McNeil and Professor Bill Griggs to look into those claims that were made. Those claims were alleging that clinicians had been ordered to preference patients from the ambulance ramp ahead of those patients in the waiting room and that had led to deaths occurring.

They looked into this matter. They provided a report which has been released publicly. They did not find evidence to support the allegations that were made. They did raise a number of recommendations in terms of how the preferencing and the allocation of patients and the priority of patients across the system should be put in place. When that occurred, when we received that report, I asked Professor McNeil to chair a working group of clinical representatives and union representatives, including the doctors, the nurses and the paramedics, to guide our implementation of that work. That implementation, as I was briefed just the other day by Professor McNeil, has been going well.

There has been very constructive engagement from all the parties in terms of putting in place those appropriate protocols, and that is shortly to lead to a number of improvements to be made, firstly in terms of an update of that policy that we put in place across the system in line with their report, and secondly in terms of making sure that there is awareness in the emergency department of clearly being able to see not only the demand in terms of what is currently in the hospital but also SAAS community demand, to make sure that the appropriate decision-making can take place, thinking about patients wherever they are in the system, including those calling 000.

As Professor McNeil has explained to me, the way that we should be looking at this matter is to say that what is called a MET call within a hospital system, which is a widely acknowledged term by doctors, should be regarded the same whether it is a MET call in the hospital, in a ward, or a priority 1 patient coming into the waiting room or on the ambulance ramp, or a priority 1 patient calling 000. We need to be able to make sure that we are responding to those patients quickly, because it is a key safety issue that needs to happen across the system.

The other thing that I would say is that there is a difference between offloading and treatment. What we have seen at the Lyell McEwin Hospital is a huge amount of work that has happened in the past six months to put in place offload bays that have led to a reduction of ramping at Lyell McEwin Hospital but not a prioritisation of treatment of those patients. So we are making sure that we can offload the ambulances, but then the appropriate decision-making is therefore put in place, making sure that the right patient is the next one to get treated based on the clinical priority.

That obviously addresses the SAAS community demand and makes sure that they can see those cases in the community faster, but it also makes sure that patients can get the appropriate care that they need, based on the clinical priority, no matter which way they came into the hospital, because we have that valve of the offload bays, or what you could otherwise describe as a waiting room for SAAS patients within the Lyell McEwin Hospital.

I know that there is work being done by other hospitals to examine ways in which similar mechanisms could be put in place, and similar mechanisms are in place in many major hospitals across the country as well. Of course, this is one of the features that has been built into the design of the new QEH emergency department as well, to allow more offload capacity to happen at that hospital, but we are looking at it elsewhere across the system.

The Hon. D.J. SPEIRS: Minister, you talked about a directive or a protocol, and you mentioned that the chief executive had put in place a protocol where she is advised if a patient has been ramped for more than three hours. I understand that protocol was put in place on or around 7 June 2024. Can you advise how many times that protocol has been triggered or used?

The Hon. C.J. PICTON: Just to correct, it is not the CE of the department who is being advised; it is CEOs of the local health network who are being advised. I do not have the exact number of times that has been enacted, but obviously there are times, unfortunately, when patients do, in our current demand, have prolonged waits. I think that everyone would want to make sure that the people who are running our health services are aware of that issue and are making sure that appropriate steps are being taken.

Critically, I think the key point here I would like to raise is that it is not just about the emergency department; it is also about escalating that to the rest of the hospital. If you have a situation where you have an emergency department that has half of its bays full of patients who do not need to be there because they need to be in an inpatient ward and you have lots of patients still waiting to come in, the action that a CEO is likely to take is going to be making sure that the rest of the hospital can step up and make sure that those patients can get into other beds in the hospital faster to free up the emergency department capacity.

I think there is a very key understanding of how these issues connect across our hospital system by Dr Lawrence, by Mr Champion, by the chief executives of the hospitals, rather than a particular finger being pointed at the emergency department. This is obviously why we need additional beds in the system as well, to make sure that we can meet that capacity and free up the EDs.

The Hon. D.J. SPEIRS: I just have a little supplementary on notice on that question. Minister, can you provide us with a breakdown by LHN, by CEO, of how many times they have been notified under that protocol or directive? Can you take that on notice?

The Hon. C.J. PICTON: Yes.

Mr ELLIS: I have a thread of three questions, minister. The first one is on Budget Paper 4, Volume 3, page 42, which talks about the target:

Complete concept planning and commence construction of new Women’s and Children’s main hospital works.

It is undoubtedly a wonderful target to have. I just wonder, with such a significant amount of money, whether there was any work done on alternate uses and the effect that they may have had; for example, and selfishly—I will call it $3 billion, but I know it is not quite the right number—if that were spread over the regional hospitals, what effect that might have on ramping in the city, etc. Were there ever any alternate priorities that were considered with such a significant allocation?

The Hon. C.J. PICTON: Thank you very much, member for Narungga, for the question. Obviously, I know his deep commitment and advocacy in terms of regional hospitals and particularly the hospitals in his electorate. I would make a couple of points, firstly in relation to the Women's and Children's Hospital. This has been a commitment of successive state governments since 2013 to see a new Women's and Children's Hospital put in place. But through a variety of reasons too lengthy to mention without soaking up the entire time here, it has been put off, and we are only now seeing that action starting on site now. Obviously, we have gone through a process in terms of the site selection, which is enabling us to build a hospital that is going to meet the long-term needs of South Australia.

The second point I would make is that in a state such as South Australia, to have a Women's and Children's Hospital, that is always going to be the quaternary centre for women and children across the state. It is good on the Scrabble board: quaternary. That means that it is not just patients from around the local area who go to the Women's and Children's Hospital but patients around the state. Obviously, that sometimes comes with inconvenience for people who have to travel, but we cannot establish those levels of specialty of services everywhere. In fact, many of the patients who go to the Women's and Children's Hospital come from the Northern Territory, Broken Hill, Mildura, etc. Therefore, it is important not just as a local city project but as a state project to see that hospital delivered.

Thirdly, when you look at the priorities in terms of health expenditure, I think investing in terms of our young people has to be seen as a priority. The current Women's and Children's Hospital is a very constrained site, a mishmash of old buildings, that makes any expansion on the existing site difficult. Hence the desire has been there for the past 11 years to see that moved to the biomedical precinct on a brand new site with modern facilities.

Having said that, I do not think it is an either/or. I do not think it is building the Women's and Children's Hospital or investing in regional health services. I can advise that we have seen a significant increase in terms of what we are spending per annum in terms of capital works in our regional hospitals. For instance, in 2021-22, which was the last financial year of the Marshall government, I am advised that the total capital expenditure for the country capital works in the budget was $34 million—$34 million for all our country hospitals. That has increased this year. In this year's state budget, I am advised, $166 million is now being spent on country capital works. That is a huge uplift, some 388 per cent of that original sum. So there is more being invested in country capital works.

I know that the member has additional priorities that he would like to add to that list, and we will continue to engage with him and the Yorke and Northern Local Health Network in relation to those additional requests and needs that his community has. But we are seeing more and more invested in our country hospitals.

Mr ELLIS: Just a perfect segue: do you know if the Yorke and Northern Local Health Network has submitted plans to Infrastructure SA for an upgrade at Wallaroo, for feedback? If they have, what was the response?

The Hon. C.J. PICTON: I know that they have been working on plans in relation to Wallaroo for some time. I am not sure—Ms Formston is checking whether plans have been submitted to Infrastructure SA for consideration. I know that certainly there has been work done by the Yorke and Northern Local Health Network in looking at all of its major hospitals, obviously particularly Port Pirie, which we have highlighted as the biggest hospital in the region (I know that is a sore point for the member for Narungga). We are investing in the upgraded emergency department, and this budget contains additional funding for that. I know that they are also doing work in terms of planning and consideration for the future of Wallaroo Hospital as well. My advice is that plans have not been submitted to Infrastructure South Australia.

Mr ELLIS: For my final question on this, I refer to the same budget paper but now on page 57, where it talks about, in the targets for next financial year, establishing a Rural Doctors Program, something that is very eagerly anticipated in the community. In budgets past there has been an allocation for the appointment of three full-time salaried doctors to be employed by the public health system at Wallaroo Hospital. I understand that it is impossibly difficult to fill those positions. Is that money now off the table? Have we given up—perhaps justifiably—on trying to appoint those three full-time positions?

The Hon. C.J. PICTON: It is a good question. The way that health budgeting works, essentially, is that while we receive our allocation from Treasury for our operating funding, our local health networks will be funded from a combination of activity funding and also block funding grants. Then, through our devolved model that was introduced and legislated by the previous minister, the local boards oversee their own local budgets.

I am very aware that the Yorke and Northern Local Health Network in previous years—I think this was before I was the minister—under their previous executive director of medical services, had ambitions to have a number of what we call FACEMs (Fellows of the Australian College of Emergency Medicine) or emergency department doctors based at the Wallaroo Hospital who would be within the Yorke and Northern's own local health network budget that they had determined through their activity funding. They then found that impossible to fill, and there have been a variety of different locums who have been used in that service.

The latest advice that I have received in my discussions with Yorke and Northern is that they have made some progress, I believe, in terms of making that emergency department medical coverage more stable. I would have to check the exact details, but I understand it is a combination of better engagement with local GPs and also some level of better stable medical coverage, on either an employment or even a more stable locum basis than what they had. I am happy to seek the most fulsome update in relation to that.

I think the big opportunity that we have now is to have in place a pipeline of doctors who will be able to be trained in regional South Australia and be able to work for both us and primary care during the course of their training. What we have seen in the Riverland is that that has bolstered the medical coverage of all their hospitals in the Riverland region. It has made the rosters more stable and it has reduced their locum usage as they have brought more doctors in. The ambition for us now is to roll this out across the state and for that to happen everywhere. It is not going to happen overnight. This is going to be a significant project over a number of years, but we need to start as soon as possible to build that pipeline of locally trained doctors.

If you look through the Yorke and Northern region, there are already a number of sites where significant training of GPs takes place and I think they will be able to be bolstered through this partnership. I would particularly highlight that the current executive director of medical services, Dr Meyer, in Yorke and Northern has been excellent in terms of rebuilding relationships with general practice, and that is essential to making sure we will be able to properly implement this program and see that pipeline developed.

The Hon. D.J. SPEIRS: I refer to Budget Paper 4, Volume 3, page 39, which covers off the finances of SALHN. A safety report to SafeWork SA was issued by SASMOA in March this year. It stated that corridor care, which is being utilised during periods of high demand, was 'clinically unsafe'. Will SA Health continue to utilise corridor care?

The Hon. C.J. PICTON: I thank the member for his question. My understanding is that these were measures that Southern Adelaide Local Health Network put in place to manage their demand. They were staffed beds that were used, beds that were not people left without care or supervision but had nursing staff in place, but they are no longer being used. Concerns were raised about that practice with the chief executive, Professor Kerrie Freeman, who then made a decision to cease their use.

I am not aware of any proposals and am certainly not considering anything along those lines, except to say that we are very serious in terms of what capability we have to increase the capacity of our emergency departments to be able to safely, with clinical care, off-load patients, as described before and as has been deployed successfully at the Lyell McEwin Hospital over the past few months.

Ms PRATT: Thank you, minister. A bit of change of pace, if we may: Budget Paper 4, Volume 3, page 47, PATS. It is not too tricky—it is a small field and a big book, but there is a statistic missing. I am going to reference the year 2021-22, but if the growth rate of that financial year 2021-22 to 2022-23 was 6.4 per cent, and if we applied that to this financial year, then projections should be closer to 41,000, as opposed to this budget line that says 40,500.

Given the pressure on the country health system, where we are seeing more patients travelling to the city for acute care, do you consider that that number of payments will be adequate? Given the increase, given the projections, do you consider that amount of payments, 40,500, to be adequate?

The Hon. C.J. PICTON: Thank you for the question. It is good to get a question related to the budget papers. Gold star to the member for Frome for that.

Ms PRATT: It only took me three years to work it out.

The Hon. C.J. PICTON: The first thing I would say is that PATS is a very important scheme, and we have taken action to bolster it by doubling the fuel subsidy within the past year, or slightly longer than that. We are seeing demand, obviously, in terms of people using PATS. The figures, as I understand them, advised in relation to what is in the budget paper there in terms of a projection, is our best estimate.

Every year, the PATS team, which form part of the RSS, the Regional Support Service, that sits under the Barossa Hills Fleurieu Local Health Network umbrella, will make an estimate in terms of what they believe the future demand on PATS will be. It will be very much determined on what the demand is and what applications are put in. This is not a capped scheme. There is not a certain number of claimants or claims that can be made and then we stop providing payments. This is an uncapped scheme, so if people meet the criteria then they will receive payments irrespective of what that estimate in the budget papers is.

Ms PRATT: Minister, there are two members behind me who I am sure are just as interested in this particular field as I am. On page 47, there is not enough information.

The Hon. C.J. PICTON: You are not referring to the member for Unley.

Ms PRATT: He is not sitting behind me, so I am not. When we look at the activity indicators for PATS, there is not a lot of information to go on. I take your point that it is not a capped scheme and so it is responsive and reactive as the claims come in. But if you can say, what is the operating budget for payments and administration of this scheme? I note that it sits within the Barossa Hills Fleurieu LHN and RSS are responsible, but can you speak to the specifics of the operating budget for claims and administration?

The Hon. C.J. PICTON: I can indeed. In 2022-23, the expenditure budget for PATS was $10.997 million, and then the budget that we had for 2023-24 was $11.482 million. That currently I have listed as our estimated result; however, I suspect that is because we are not at the end of the financial year yet and there will still be work done to determine what the actual estimated financial result for PATS is for this financial year.

The current budget that Barossa Hills Fleurieu has aligned to it for next financial year at this stage is $11.769 million. However, of course, I preface that by saying, as per previous discussion, it is a scheme in which people make claims meeting the criteria, so the best analysis, the best predictions are put in terms of what the claims are likely to be. I am advised that between 2021-22 and 2022-23 we did see a significant increase in terms of claims. Compared to 2021-22, there had been a 14.74 per cent increase in claims received.

The advice I have received is that is because of an increased activity within the scheme. Because of the increase to the fuel subsidy—we had that doubled from 1 January 2023, so it is a little bit off by saying 'in the past year' as it was 18 months ago—and also additional positive exposure to the scheme, we have seen an increase in that demand in the scheme.

There was also an increase of 16.26 per cent in approved claims due to an increase in overall claims being submitted that within that year saw a 28.5 per cent increase in expenditure through the program. Obviously, part of that was the increase in payments that we were making for the doubling of the fuel subsidy as well.

Ms PRATT: It is pleasing to hear that there has been perhaps a greater awareness and take-up where necessary. What is not pleasing is to hear from people statewide when their payments are delayed. Can you explain why there are reports of consistent delays in payments to individuals, and not just individuals but service providers—I do not want to name them generally, but NGOs which are in receipt of those overnight accommodation payments, if you like. The answer I am seeking is an explanation to repeated reports of delays in payments.

The Hon. C.J. PICTON: That is another good question. The member for Mount Gambier raised in parliament maybe six months ago a question in terms of delays that his constituents were experiencing for PATS at that time. At that time, I followed up with the PATS team and was advised that they had some staffing difficulties at that stage, but they added additional staff to make sure that they could get on top of what they were facing as the backlog.

Obviously, as has previously been discussed, PATS has been facing an increase in terms of their demand, particularly as there has been an increase of awareness and also an increase in the rebate that has been provided too. My advice is that that has helped to reduce the length of time that the claims are taking to be processed. Currently, I am advised that the processing time frames are around five weeks from the submission of claims, and obviously work is still continuing to see if that can be reduced any further.

The member raised a question in relation to a significant NGO. I think I know who she is referring to, but I will not name them. What I can say is that PATS have met with that NGO within the past month—or slightly longer than the past month, 17 May—and are working with them to try to streamline processes and other supports for the provision of accommodation subsidies to address what I think they were encountering in terms of some significant bureaucratic issues in receiving their payments.

Ms PRATT: That is very pleasing, minister. Just on delayed payments and the five-week average I think you are pointing to, is there a target that RSS would be aiming for that is a lot less than five weeks? I say that because there is a cost-of-living crisis and people in the country are out of pocket because they know they have put their paperwork in and they have calculated what they would be getting in return, and they would be waiting in anticipation.

The Hon. C.J. PICTON: I do not have that in front of me. I believe I previously said to the parliament when there were questions about this in terms of what they would be seeking, but I would have to go back and check Hansard. If that is not already provided to the parliament in the Hansard I am happy to go back and look at what their exact target is. In my head I have that their target is usually four weeks, but I do not want to mislead the parliament so I will check that.

Ms PRATT: Alright, thank you. Finally on PATS, in terms of the overnight accommodation there is much commentary. Every country MP understands the impost for individuals travelling. With the Code Yellow we heard about a number of patients travelling to the city who had arranged their accommodation, only to find they were out of pocket and did not have the surgery. What reform or what plans and consideration do you make, minister, to review the overnight accommodation to increase it to a much more appropriate commercial rate?

The Hon. C.J. PICTON: Obviously, we are sympathetic in terms of people who have to travel to Adelaide for their treatments, and that is why the PAT Scheme exists, to help them. The changes that we have made in the past year have been the most significant changes that have been made in terms of PATS, I believe in the past two decades, including the doubling of the fuel subsidy from 16¢ to 32¢ per kilometre for eligible appointments from 2023 onwards. In addition, all Kangaroo Island residents are now eligible for a ferry subsidy when travelling to the mainland, which was not the case previously. Also, prosthetic orthotic treatment is now eligible when treatment is performed by a registered Australian Orthotic Prosthetic Association member.

There has also been, I am advised, a number of other changes that have been made in the past three years, including the eligibility of Airbnb and other accommodation options. There are always going to be additional requests and suggestions in terms of how the scheme could be expanded or improved. They will continue to be under consideration by the government in terms of both future budgets and future decisions that could be made. These are very significant increases that we have seen in the past couple of years and the most significant, I think, in the past two decades, but we will always consider other options or other suggestions in the future.

Mr McBRIDE: Budget Paper 3, page 107, the 2024-25 expenditure for the Naracoorte hospital is said to be $4.6 million. Can the minister explain what this money will be spent on?

The Hon. C.J. PICTON: We are just checking.

The CHAIR: Can I just confirm the budget paper?

Mr McBRIDE: It is Budget Paper 3, page 107. If I have it wrong, I will find another one.

Ms PRATT: Budget Paper 4, Volume 3, page 16 will get it done.

Mr McBRIDE: It must be Budget Paper 4, Volume 3, thank you.

The Hon. C.J. PICTON: The team are furiously checking to see if we have further information.

Mr McBRIDE: I have another question while you are doing that, if you want, minister? I can ask you another question to make it easier.

The Hon. C.J. PICTON: I can talk just off the top of my head—

Mr McBRIDE: Sure.

The Hon. C.J. PICTON: —about the Naracoorte hospital all day. Naracoorte hospital, as the member knows very well, is a hospital that has been long overdue for a very significant upgrade. It is what I would best describe as a hodgepodge of a hospital. There are bits and pieces all over the place and very outdated infrastructure and the community quite rightly have advocated that they need an upgrade.

One of the decisions we took in putting our election proposals together for the last election was, when repurposing what was previously planned as a $662 million basketball stadium, as we would call it, or people would call it an arena otherwise, to repurpose at least $100 million of that funding into country hospitals and $8 million of that was therefore allocated to Naracoorte hospital. We made it very clear at the time that that was only ever going to be stage 1 of what needed to happen at Naracoorte hospital because, clearly, there is much work that needs to happen at that hospital.

The team since then have been working very hard in terms of the planning of those works, making sure they address some of the urgent needs at Naracoorte hospital but also making sure they keep in mind the future planning that is required across that site to make sure we do not do something now that will cause us issues later.

In addition to that, as the member well knows, we were able to achieve $1 million in extra funding in last year's budget for additional planning on that site, which is now being utilised for two purposes, firstly, in terms of the future planning of Naracoorte hospital for other stages that need to happen and, secondly, to make sure we have in place clinical service planning for the other hospitals across the Limestone Coast Local Health Network, apart from Naracoorte and Mount Gambier. It has been partly because of the very strong advocacy from the member for MacKillop that that needs to happen.

In terms of the $8 million allocation, there are a number of vital, urgent upgrades that need to happen. At the top of my mind on that list is always the lift that has been an issue and has been broken down for some time at Naracoorte hospital, but the major service improvement will be in terms of works we are doing at the emergency department. The emergency department in recent years has moved location at Naracoorte hospital into more the centre of the hospital, but it is not really a fit-for-purpose environment or set-up where it is at the moment, so those works will be happening.

Judith has found some more information. There was an investment strategy agreed with Naracoorte Area Health Advisory Council and the Limestone Coast Local Health Network to upgrade the emergency department and provide infection control and compliance upgrades and priority engineering service upgrades of the hospital. Works are due to proceed to a tender for a general building contractor shortly. Electrical works are underway in a separate package of works and a full scope of works are anticipated to be completed in the middle of next year.

Mr McBRIDE: I have another question for you and this time I will try to get the paper numbers correct. It is Budget Paper 4, Volume 3, page 57, right at the bottom, the Limestone Coast Local Health Network, where it talks about activity indicators. In this shaded line it has a 2022-23 actual of, I believe, $15,784,000 and then there is at least a $1.2 million reduction for 2023-24, estimated and projection. Reading on, in 2024-25, which is what we are talking about here today, no doubt, we are not even back to where we were in 2022-23. Can you help me, minister, understand why we are at least $1 million down over last year and we are still not back to where we were in 2022-23 in budgeted figures as what they call activity indicators?

The Hon. C.J. PICTON: Thank you very much for your question. In the detail of the National Health Reform Agreement and our national funding mechanisms, there is an arrangement called NWAU. An NWAU is a national weighted activity unit. Everything that happens within hospitals that are activity-based funded is given an allocation in terms of how many NWAUs it is. For example, a made-up figure for a hip operation might be five NWAUs.

An NWAU has a weighted basis that is set by IHACPA, which is the independent pricing authority across the country, and they determine what the price of one activity unit is and therefore the price of all activity that happens across our hospitals. Therefore, there will be allocations and estimates that are made and real results in terms of where activity happens across different hospitals.

As the member has noted, we have what is projected to be a reduction in terms of the NWAU, and that could be for a combination of different reasons. It could be because fewer patients have presented or it could be because they have presented with less complex matters or it could be that they have presented with entirely the same things but the weighted units have changed in terms of what the NWAUs are.

Obviously, the combination of all of the NWAUs for all of the LHN will be part of the determining factor in terms of which will be the overall budget for an LHN. Clearly, Limestone Coast are projecting that they have had a reduction, but they may well have an increase in terms of some of their block expenditure as well. We can see their estimate in terms of their expenses, despite a reduction in NWAU, has actually gone up substantially as well.

Julienne TePohe, who is the deputy chief executive and who looks at our commissioning process and all of these weighted units, is busily looking to see if we have an answer in terms of why there is projected to be a reduction in terms of the NWAU of Limestone Coast. If we can get that, we will bring back some more information.

Mr McBRIDE: I have one last question. This one refers to Budget Paper 5, page 38, sustainable and efficient health system. The top of the paragraph states, 'This initiative provides $1.577 billion over the forward estimates.' Looking at the operating expenses in the graph and chart above it, it states that in 2023 there is minus $334 million being estimated, which I think makes up the $1.577 billion when you go across the years from 2024-25, 2025-26, 2026-27 out to obviously beyond the forward estimates of 2027-28.

Minister, can you give some explanation around this $1.5 billion? Is this just a federal initiative to recognise inflationary costs? Are these extra costs something that we are hoping to rein back in, or is this an explanation of some sort of efficiency process, because it always talks about the national average efficiency? They say 'significantly increased'. Can you tell us how we are travelling in this area, minister, and what these figures actually mean, and is there any way of saying we are doing well, or are we doing badly?

The Hon. C.J. PICTON: I think the short answer is that, right across the country, post COVID, the cost and efficiency of health services everywhere has gone up. As you said, there is the National Efficient Price, which is set by IHACPA, which has seen the latest estimates that have come out from them projecting a significant jump in terms of the National Efficient Price because all hospitals everywhere have become much more expensive to operate.

There are a number of matters in the budget that the Treasurer has kindly addressed for SA Health, firstly in terms of an increase in activity that we are seeing but also in terms of an increase in the cost of what we are facing in terms of delivering health services. That is a combination of a whole range of different matters that we are facing, not only inflationary pressures but staffing pressures as well, having to have additional staff in place, some of which we are still addressing, to be frank.

Regarding the sustainability of the budget when we came to office, I think the health expenditure in the year that we came to office was in the approximate range of about a billion dollars more than what was being budgeted for. In successive budgets, we have been addressing the shortfall and making sure that we can address new activity coming into the system and also making sure that we can appropriately budget and make sure that we can meet the needs and the costs of actually delivering those services.

I am advised that if you look at the 2023-24 budget pressures, clearly you have unprecedented demand for services across the hospital and health system, necessitating innovative solutions to address short-term capacity constraints, particularly while new beds and services the government has committed to come online. There is also an increase in staffing requirements to address additional demand for hospital and health services.

Of course, health service full-time equivalent staffing is estimated to increase substantially in the budget papers. Whilst new staff are being recruited, workforce shortages have been experienced, requiring usage of agency nurses and locums in many health services, and obviously particularly in regional areas, as well as recruitment costs to attract new staff, and also increased costs associated with inflation at record levels.

All of those factors combined have led to increased inflationary costs in terms of SA Health. Obviously, our goal is to be at the National Efficient Price. I do not think since that process has been in place—for, I think, over a decade now—South Australia has ever been operating at the National Efficient Price, but we are still aiming to do so.

The CHAIR: Thank you very much, minister. I understand the member for Narungga has one more question before we turn to the member for Torrens, who has been waiting patiently.

Mr ELLIS: Very patiently. I have one question about ambulances. I refer to Budget Paper 4, Volume 3, page 61, specifically the performance indicators, which list the goals and achievements in terms of response times. They seem to be limited only to urban centres. Do we measure response times at regional centres? That might give an indication as to how the volunteer model is holding up out there.

The Hon. C.J. PICTON: My understanding—and I will correct this on notice if I am wrong—is that while we say 'urban centres' that is not just the metropolitan area. There are a number of built-up regional areas across the state that are included in our response time figures. Separately, we do have a metropolitan figure that we report as well, and that is the figure that we report on as part of our regular monthly reporting that we committed to, releasing those figures on a monthly basis. But my understanding is that in relation to these figures here, where it talks about urban centres that does include some of the more significant regional centres across the state.

Mr ELLIS: And the less significant?

The Hon. C.J. PICTON: Obviously, SAAS monitor their response times everywhere, but it becomes tricky when you have very long distances to cover in some of the call-outs, much longer even than in your electorate, member for Narungga, some of the Far North or West Coast cases, etc. How do you appropriately categorise those in a way which is meaningful and statistically comparable, when a particularly long call-out case hundreds of kilometres away would skew the stats? I think that would be what SAAS would say in terms of their difficulty of doing that.

I have been to the emergency operations centre and sat for many hours with the team watching what they do. The regional dispatches do an incredible job. While the metropolitan dispatches are looking at a small grid and a high number of cases and that can be a very stressful job, obviously it can also be very stressful in terms of making sure that we can get ambulances across very wide, large distances across the state.

I know the crux of your question is also in terms of volunteerism in terms of SA Ambulance as well. I think it is fair to say that over a number of years that has been a challenge. There are a number of pieces of work that are being done to try to address that. We have had a new advertising campaign that has been rolling out this year to try to attract more ambulance volunteers to the service.

Another piece of work that the chief executive officer, Rob Elliott, has been working on, with my encouragement, has been one of the things I have heard a lot about from meeting with SAAS volunteers in my visits across country South Australia; that is, the training program that we put people through is very arduous. It can be significantly off-putting for people. Even people who want to do it, when they see what is involved in terms of just doing the training, it becomes a barrier for them to do so.

So I think Rob agreed, when he looked at the detail in terms of what was being asked now, and is undertaking a piece of work in terms of making sure—obviously, we want people appropriately trained, but we do not want them to be undertaking an unnecessary level of training either.

Ms WORTLEY: I refer to Budget Paper 4, Volume 3, page 32, line 1, Program 2: Health services. Minister, how are barriers in secured aged-care placements for older long stay patients and people awaiting NDIS assistance impacting hospital capacity?

The Hon. C.J. PICTON: Thank you very much, member for Torrens, for your question. This is a huge issue for us. One of the issues that we have seen, as we see increased demand coming through the front door, is it has been very hard to get people through the back door, particularly to aged care. There has always been in the system some level of barriers of discharging people to aged care, particularly for complex patients, but that has become so much worse in the past couple of years.

I think this is a combination of factors, including the fact that there has rightly been a big focus in terms of improving the quality and standards of aged care, particularly following the royal commission, but a resultant factor has been that aged-care providers are now having to adjust their risk tolerance in terms of who they will allow to come into their aged-care homes, which has meant that there are many people who are very difficult for us to place in terms of aged care.

These are people who are medically ready for discharge who are still in our hospital beds waiting for discharge. That, therefore, leads to bed block, that leads to ambulance ramping and that leads to long waits in the emergency department because we have people in our beds who no longer need to be there. Of course, this is not good for our older patients either. Older patients should not be in hospital any longer than they need to be. It can lead to worse outcomes if they are stuck in hospital for a long time. So there is a lot of work that is being devoted to this.

I will give you an example of the statistics: in August 2022, there was an average of 88 patients per day in our metropolitan hospitals waiting care placement for beds. They were well enough to be discharged but were waiting for placement in an aged-care facility. That was a lot of beds back then, just a couple of years ago, and that was a key barrier in terms of our system with those 88 patients, but that has risen substantially since then.

As of last week, we had 163 patients in our metropolitan hospitals who were stuck waiting for an aged-care placement. That is an increase of 75 patients, almost double the number of patients of just less than two years ago, which highlights the problem we have. Combine that with people stuck waiting for NDIS, you have basically a Modbury Hospital equivalent of our system, which is people waiting to leave the system and get out.

Throughout 2023-24, patients waiting on aged care have represented the largest proportion of patients' delayed discharge in the hospital system. That has a big impact upon our system. This is something where all states and territories are particularly concerned about this impact. Further to the member for MacKillop's question, it adds to cost in the running of our health services and it adds to the delays for people getting care.

Last week, we had a meeting of health ministers. All health ministers took a step that has not been seen for many years, which was an open letter, signed by all state and territory health ministers, raising concerns about a number of federal factors that are impacting the running of our hospitals at a time of significant demand right across the country. One of those was this: the barriers for people waiting to get out of aged care and calling on the commonwealth to take action to make sure that they can have programs that can assist people to get out of hospital and to support people into aged care.

There are a number of things that are being worked on. I would certainly highlight that and thank the federal government for their work in terms of the Strengthening Medicare package that they have delivered, or are in the process of delivering, which will see some help for us in helping to address this. The most significant part of that package for us is $35 million, which is going into the geriatric flying squad. This will deliver specialist geriatric outreach services for older patients transitioning into aged care or to prevent an avoidable admission.

This is a program that New South Wales has been trialling for some time, where we can give aged-care providers more confidence that they will be able to take patients from our hospital system because they will have some level of support from geriatricians and other doctors and nurses within SA Health—that they will not just be left on their own with potentially some more complex patients. We are hopeful that that will help to increase the risk tolerance of our aged-care providers and help to significantly reduce that number of 163 patients and ultimately free up more beds and free up more capacity for other patients who need it.

The other thing that we have been doing is really stepping-in in terms of addressing what is another federal issue of primary care access for people in aged care. There are a lot of issues where it is very hard for aged-care providers to access GPs as well, making it easier to send somebody to hospital in an ambulance than to get a GP. So what we have rolled out is our SA Virtual Care Service, which we have made available to all aged-care providers in South Australia. They can speak to one of our doctors, nurses or paramedics in our Virtual Care Service directly, and that has seen a reduction in terms of the number of ambulances that go from aged care to our hospitals. That is because of the work that the doctors, nurses and ambulance officers in the Virtual Care Service have been able to provide in keeping people in place.

That might mean that, after that consultation, we could then send out a mobile X-ray to that person the next day, for example, rather than having to take that person to hospital. For somebody in aged care, hospital can often be the worst possible place, particularly taking old and frail people away from their home to be in a busy emergency department or busy hospital wards rather than receiving some help in their own home.

We are hopeful that these measures will help to address this, but we are still calling for more action from the federal government because this is a significant handbrake on our system, and a very similar situation is happening right across the country in terms of the people who are waiting very long times to get discharged from hospital.

Ms PRATT: Minister, I refer to Budget Paper 4, Volume 3, page 27, commissioning targets, dot point 1:

Continue to build self-sufficiency in regional areas to ensure patients can access high quality services.

I am interested in upgrades announced for the Clare Hospital at a cost of 4.5. Can you confirm if that budget upgrade cost has blown out, and how is the difference going to be found or sourced?

The Hon. C.J. PICTON: I have received advice from the deputy chief executive that we are absolutely still committed to the delivery of that project. Significant planning work has been done, both through the department and through the Yorke and Northern Local Health Network. This will upgrade particularly the CSSD, which is the sterilisation area of the hospital, to meet the appropriate national guidelines that are in place for all hospitals.

Obviously, Clare is a significant site where surgery happens, and we want to make sure it meets the appropriate guidelines to deliver safe and quality care. That will be funded from annual programs. I do not have an exact updated cost estimate, but we will provide that on notice if there has been a change in terms of the costs the member mentioned.

Ms PRATT: Thank you, minister. Is the project delayed, and can you provide some updates on when it will commence and when it will conclude?

The Hon. C.J. PICTON: The advice I have is that we are in the process of procuring the team to deliver that work, so we will have more to say about that very shortly, including when work will be likely to start and be completed once the team is on board—i.e. the construction team—and we do that in conjunction with the Department for Infrastructure and Transport in terms of the procurement work that will occur.

Ms PRATT: I have a question about the Mount Gambier upgrade. The reference is Budget Paper 4, Volume 3, page 16. What is the cause of the delays to the Mount Gambier hospital upgrade?

The Hon. C.J. PICTON: I am not sure I accept the premise of the question, in that we are still progressing with that. I have not received any advice that we are off track in terms of having that project completed by the end of next year. It is certainly a very important project for the government. There are three components to the project: firstly, an expansion of the emergency department. Mount Gambier emergency department is a very busy regional emergency department that sees a large number of patients, and having additional capacity in the emergency department to meet that need in the community, particularly while there are significant barriers in terms of people being able to access primary care in the Mount Gambier region, is needed.

Secondly, there are additional mental health beds, so a six-bed mental health subacute unit will be expanded. Mental health has been a significant impact in terms of demand increase over previous years at Mount Gambier, and this will give quite a big boost in terms of its capacity for mental health patients.

LastIy, a two-bed drug and alcohol unit, known as detox beds, was first raised with us by Substance Misuse Limestone Coast, which has been advocating for many years to improve drug and alcohol services in the Limestone Coast. Following their advocacy, we made election commitments for that but also for additional drug and alcohol rehabilitation beds, which I believe are now in place in the Mount Gambier region. The substance abuse beds, the detox beds, will be the first of their kind outside of the metro area in South Australia. There is a lot of work happening between the Limestone Coast Local Health Network and Drug and Alcohol Services South Australia to ensure they can be delivered.

I am advised that the tender for a general building contractor has been completed, and construction works are due to begin within weeks and involve a staged delivery of the subprojects, which are on track to achieve practical completion towards the end of 2025. The idea that that is off track I certainly disagree with.

Ms PRATT: Budget Paper 4, Volume 3, page 55, the Limestone Coast Local Health Network, targets, fifth dot point, 'Evaluate and action the recommendations from the Radiation Therapy Feasibility Study report'. When will the Radiation Therapy Feasibility Study report be evaluated with actions and recommendations, and will recommendations be made public?

The Hon. C.J. PICTON: We have not received that report. I certainly have not received that report. The latest update I had from the Limestone Coast Local Health Network is that the consultants who are undertaking that feasibility work have been consulting with the community. They have provided some initial advice to the Limestone Coast Local Health Network governing board, but they are still in the process of completing their final report. It certainly would be my intention that we would be releasing the findings and recommendations from such a report when it is received.

Ms PRATT: Would you expect the community action group, that have been advocating for radiotherapy services, to get a briefing from you or the agency ahead of the report being released?

The Hon. C.J. PICTON: I think they have been very key partners in terms of the project. There are a number of very strong community advocates who are very passionate about improving services through their own personal lived experience. The Limestone Coast Local Health Network, on my encouragement, have tried to involve those community patient advocates as part of the process. In fact, I believe at least one of the representatives was part of the panel which made the assessment in terms of who the best contractor was to deliver this project.

No doubt, when the report is received, it will have to be considered by the board. No doubt, we will want to have a look at it from the department and government perspective as well, and then there will be work done in terms of making sure that we can release it, and I am sure part of that will be providing appropriate briefing to the members of the advocacy group.

Ms PRATT: I am also referencing Budget Paper 5, page 38, in reference to the regional Integrated Cancer Consult Suite. Does it follow then, where the feasibility study is not complete, the evaluations have not been completed, and it is not publicly facing, that the $4.3 million or $2.8 million (depending on which budget line you look at) that is federal funding was originally allocated to fund a regional radiotherapy centre, and so is that money quarantined and, if not, why not, given the feasibility study report is ongoing?

The Hon. C.J. PICTON: We will take a step back. That funding was, as you say, allocated many years ago to radiation oncology in the South-East. There was then a decision made by the previous Marshall Liberal government and the previous Morrison federal Liberal government to not proceed with that project, to rule out delivering that project. I am not aware of what the process was that led to that consideration but that was the decision that was made at the time. I know members to my right like to pretend that that did not exist, but that was what happened.

When we came to government, that decision had already been made. The Limestone Coast Local Health Network at that stage, with that decision already made, were working on: could they use that funding for something else? They had worked up a plan to deliver increase in terms of cancer care in the Limestone Coast. That is what they had therefore allocated that funding to do, following that decision that was made under the previous government.

We have now made the decision to undertake a feasibility study in terms of the potential for radiation oncology, to get the experts to give us the advice, what would need to happen, what is feasible for that to occur in the Limestone Coast. We are asking, 'Was the decision that was made by the previous Liberal government wrong?' essentially. We will receive that report. We will, as I say, make the findings and recommendations of that report public and everyone will have the opportunity to have a look at it.

I have made it very clear that we will not spend that $4.3 million of what was then the revised plan for the use of those funds until we see that report. I think that is an appropriate and fair thing to do. So there is no intention for us to sign contracts for the delivery of that revised plan that was worked on after the cancellation of that project by the previous Liberal government until we see what the revised feasibility study says.

Ms PRATT: Thank you for the history lesson. Just to clarify what the minister is saying now, where my question was about quarantining, the minister has undertaken a commitment not to spend any more of the $4.3 million until the feasibility study has concluded?

The Hon. C.J. PICTON: Correct. I have said that publicly already, yes.

Ms PRATT: Continuing with country hospital upgrades and country hospital commitments, if you like, I have a question about the Barossa hospital. Has the site for a new Barossa hospital been determined, and when will it be purchased, noting that $5 million has been set aside for the 2024-25 year?

The Hon. C.J. PICTON: Yes, that is correct. Funding was set aside, I believe, in the 2021-22 budget for purchasing land for a future Barossa hospital. That money is still in the budget, and I have not received advice in terms of a particular site being selected for that purchase at this stage. It is something that is being worked through between the Department for Health and Wellbeing's infrastructure unit and the Barossa Hills Fleurieu Local Health Network in terms of the appropriate consideration of that purchase.

Ms PRATT: The new Barossa hospital full business case has completed Infrastructure SA's gateway to assurance review process. Has the report been finalised and presented to state cabinet yet and, if not, when do you expect to have it? In terms of the capital cost, has that been determined and, if so, what is it?

The Hon. C.J. PICTON: My understanding is that that report is going through the appropriate consideration by Infrastructure SA. It is also something which is a cabinet document and is being considered by cabinet as well, and therefore, obviously, I am not going to reveal the contents of that.

Ms PRATT: Budget Paper 4, Volume 3, page 33, in reference to continuing the progress work to establish the Bragg Comprehensive Cancer Centre. My question is: what progress has been made with the Bragg centre in the consideration of utilising new technology other than proton therapy to improve patient outcomes?

The Hon. C.J. PICTON: I think it is worth separating the two things out. They both have the name 'Bragg' associated with them so it is certainly very understandable that they get mixed up. There is the Australian Bragg Centre for Proton Therapy Research (otherwise known as the ABCPTR) and that is a wholly-owned subsidiary of the South Australian Health and Medical Research Institute (SAHMRI), and that is the body which it is proposed will deliver proton therapy services.

Completely separate to that is the Bragg Comprehensive Cancer Centre (otherwise known as the BCCC). That is being funded through a commitment that was made, I understand, by both major parties at the last federal election, to provide $77 million towards that project to establish the BCCC. That was not to deliver a project to deliver proton therapy, that was to deliver a comprehensive collaboration of services for cancer across the state. It involves everything from the treatment of cancer to the prevention of cancer.

There has been a lot of work done with other partners, both within the health system but also with external partners such as the Cancer Council and the Hospital Research Foundation, but obviously our clinicians within the health system in terms of what the best use of that $77 million is. There is still work underway in terms of making sure that we can get the best bang for that buck before we will put that plan to the commonwealth government and start to receive those funds that we expect will come via SA Health to deliver that.

The proposition that was originally determined and the business case that was originally done, I think four or five years ago potentially, for a comprehensive cancer centre essentially argued that, unless we have an ability for our cancer services to better connect, to better collaborate and to better stand up on the national stage, that will impact in terms of our ability to receive grant funding and further our research and our standing on the national stage. That is essentially what it is.

It will I think in many ways be a network that happens between people who are operating on different sites, so there is a lot of activity that is occurring between universities, hospitals and on different campuses. To have people being able to be brought together with some common goals and some coordination is ultimately the direction we are heading. I know that Dr Lawrence, who has been very involved in working through the plans for this, has been very keen to make sure we establish it in a way that is going to be sustainable into the long term as well.

Ms PRATT: I have a supplementary on that. Minister, thank you for expanding on how the word Bragg is used in two different contexts. With some latitude, in relation then to the ABCPTR, my final question in response to that is: as an anchor tenant of the Braggs Building of the Bragg Centre, with five levels taken up, what efforts have you as minister taken separate to the Treasurer to meet with industry suppliers in an attempt to offset costs of this asset and maximise the location to restore our aspiration to the world? There is an opportunity to source or negotiate with different suppliers separate to the Treasurer. What role do you take as an anchor tenant?

The Hon. C.J. PICTON: I am sure you would understand that I do things in collaboration with the Treasurer, not separately to the Treasurer.

Ms PRATT: Indeed.

The Hon. C.J. PICTON: Certainly, the lead for proton therapy has sat with Treasury since the previous government and even before that my understanding is it sat with DPC, but Health obviously is very much involved in discussions with Treasury in terms of the future of proton therapy and the future of that building as well. As you say, there was an agreement that was signed, I understand, under the previous government by Treasurer Lucas, or not personally, for the South Australian government and ultimately Health to take up a number of floors of that building, which was one of the ways in which the government signed up that enabled that building to be constructed in the first place.

We are obviously delivering on that contract that was signed under the previous government and the department has moved in the previous couple of months a significant number of public servants into that building to utilise the space that the department signed up to in terms of that contract under the previous government.

In terms of other discussions in relation to proton therapy in relation to the building, we are very much in harmony and working side by side with Treasury and the Treasurer in terms of that. There is not a separate line of negotiations that Health is undertaking on its own.

Mr FULBROOK: I refer to Budget Paper 4, Volume 3, page 13, workforce summary. What was the total number of redundancies offered and accepted via voluntary separation packages this financial year?

The Hon. C.J. PICTON: Thank you very much for the question. I think it is very important that we look at the redundancies of staff within the health portfolio because there has been a very remarkable change that has occurred. A few years ago, we were seeing huge numbers of redundancies of health staff and that has significantly changed in the past couple of years. One of the commitments we brought to government was that we would end redundancies of frontline healthcare workers.

Remember, these are not healthcare workers who are just leaving. These are people who are having redundancies where positions are being abolished. We do not believe, particularly in an era of high demand on our healthcare services and patients having difficulty accessing care, that we should be making our frontline healthcare workers' positions redundant. But that was not the approach under the previous government.

So in this financial year, 2023-24, my advice is that there were only two TVSPs offered and accepted. One was an admin person and one was an other health portfolio staff, so not clinicians, not doctors, not nurses, not scientists. That compares with the four financial years of the previous government when, I am advised, over those four years there were 549 packages accepted. They included 228 nurses and midwives, 46 scientists, 22 allied health professionals and four medical officers. That is a very significant level of redundancies for frontline healthcare workers in our system over those four years.

The highest numbers we saw were in 2020-21, 98 nurses and midwives redundant and, in 2019-20, 114 nurses and midwives redundant. These were years in which we were facing the COVID pandemic. Right across the world people were expanding their healthcare workforces, getting ready for that. Here in South Australia we had redundancies being offered and accepted for frontline healthcare staff.

So this is a very different approach that we are seeing now. Now we can see through our workforce statistics that we have increased our healthcare staff by over 1,400 clinicians, 691 additional nurses, 326 additional doctors, more allied health workers, more ambos. These are full-time equivalent staff above attrition.

I thank the member for his question. I can assure him that there is a very different approach now happening and that the redundancies we previously saw of frontline healthcare staff have ended.

Ms WORTLEY: I refer to Budget Paper 4, Volume 3, page 13, workforce summary. How is the government ensuring that there are sufficient medical system graduates to meet the workplace needs of our health system?

The Hon. C.J. PICTON: Thank you very much, member for Torrens. This is something we have raised on the national stage because we are concerned in terms of the impact on the medical workforce of the number of doctors being trained in this country. We are hiring more doctors. Every other state and territory health service is hiring more doctors. We need more GPs, but we are not training more doctors through our universities than what we were previously, not to a sufficient level to meet the need.

Adding to that, with the doctors who are retiring versus the doctors who are coming into the workforce, we are not getting one for one, because people coming into the workforce are working much more flexible, family-friendly hours than many of the people who are retiring. So while we are seeing increased demand for healthcare services, we are not seeing a one-for-one replacement let alone meeting that gap in terms of future demand.

We are very reliant in terms of overseas recruitment for our healthcare staff and there is a lot of work being done to make sure that we can improve the pathway and make it as easy as possible for people who have the requisite skills to avoid long bureaucratic delays to be able to come into the country, but what I am advocating for and would like to see is the federal government take action to lift or remove its caps that it has in place on the number of medical school students that we see in Australia.

There are hundreds, if not thousands, of people around the country who try to become doctors every year, who have the smarts, the know-how, the compassion to become doctors, but they cannot get places. Many of them end up doing other degrees like health sciences or paramedicine or a whole range of other things, with a hope to try to get into medicine down the track, but we need to increase the number of medical students who are being trained in this country.

In 2024, there are expected to be 344 students graduating from South Australia's medical schools: Flinders University and the University of Adelaide. In 2017, I am advised, we saw the same number of students graduating from our local medical schools, so there has been no uplift in that time. Over the past decade, there has been some increase across the country, but we have not seen that in substantial numbers in South Australia.

If you look at the graduates who have come out of medical school in South Australia, last year 342 came out of medical school. Of those, once you take out the international students, who obviously are not capped, 261 of those were what is called commonwealth-supported placements. These are Australian students who have support to get through—261 graduating last year. In 2017, there were 286, so we have actually gone down compared to where we were five years prior, at a time when we need to be substantially increasing.

I do give credit to the federal government, in that they have given Flinders University an additional 20 places as part of a plan to establish a regional medical school, and that is welcome. Yesterday, the chief executive and I were meeting with Flinders Medical Centre in relation to their plans for those places, but we need to see more than that, not just here but around the country, to meet the needs, to make sure we have enough for hospitals, to make sure we have enough for private practice and, importantly, to make sure we have enough for GPs, and to try to reduce our over-reliance in terms of international doctors in the future.

This is one of the matters that was raised by all health ministers when we wrote an open letter last week where we called on the government to lift restrictions on the number of medical school places in Australia, to build a local workforce and enable young Australians to pursue a career in medicine. It may not pay dividends in the time that I am the health minister, but it certainly will in future years, to have that benefit of those doctors coming into the system while we face an ever-growing ageing of the population.

Otherwise, the only thing that we are going to be able to do is to do more and more overseas recruitment. We have a good opportunity at the moment, and we are having some success in the fact that the UK's National Health Service is in a very difficult state and they pay their doctors a lot less than what we pay our doctors. That has led to a number of doctors moving to Australia and to South Australia, but we cannot rely on that forever. We need to make sure that we are growing our own, and that is why I call on Minister Jason Clare, who is the Minister for Education, to lift this cap and see more doctors trained in our country.

The Hon. D.J. SPEIRS: I refer to Budget Paper 4, Volume 3, page 46, which covers off on the costs associated with the Barossa Hills Fleurieu LHN. Within the statistics for that LHN, the percentage of patients attending emergency departments who commenced treatment within clinically accepted time frames declined from 92 per cent to 69 per cent this year. What are the reasons for what is a very significant decline?

The Hon. C.J. PICTON: I certainly noticed this as well in the budget papers and asked for an explanation from Barossa Hills Fleurieu of those changes. I am advised that one of the issues in terms of this, they believe, was likely related to a data issue. BHF implemented the Sunrise EMR at all their sites during this financial year. I am advised that the administrative task of clinicians when they click 'commence treatment' was not consistently followed and there was not a consistent administrative definition of when treatment had commenced. The ED clinical teams now have an agreed definition of when treatment is commencing, and education on the new EMR system is continuing.

I am also advised that BHFLHN experienced an estimated 11.5 per cent increase in presentations across their EDs throughout the year compared to the year prior. This is based on the 10 months of available data so far this financial year. It represents about 50 per cent of the year on growth in regional presentations across the system. Obviously, BHF also support our metropolitan hospitals when they are facing demand. Clearly, they need to lift their performance. Hopefully, a lot of that is in relation to a data issue, but we also need to make sure that those performances lift while they are facing that significant demand.

I think three big things that are obviously going to help are the three emergency department upgrades happening in the Barossa Hills Fleurieu. Mount Barker emergency department has opened, which is providing excellent services to the Mount Barker region. Very recently, we have seen the Gawler emergency department open as well, and that had a big uplift in the number of beds as well, and we have just started construction on the Southern Fleurieu Health Service new emergency department at Victor Harbor. All three of those emergency departments were seeing very high numbers of patients in a small area. They are now going to have a much bigger capacity to see patients.

The CHAIR: Thank you very much, minister. With the allotted time having expired, I declare the examination of the portfolio of SA Health completed. Thank you all very much for your efforts.

Sitting suspended from 15:31 to 15:45.

Departmental Advisers:

Dr R. Lawrence, Chief Executive, Department for Health and Wellbeing.

Ms S. O'Brien, Deputy Chief Executive, Strategy and Governance, Department for Health and Wellbeing.

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

Ms L. Prowse, Executive Director, Mental Health Strategy and Planning, Department for Health and Wellbeing.

Ms M. Bowshall, Interim Chief Executive, Preventive Health SA, Department for Health and Wellbeing.

Ms L. Tuk, Manager, Executive Services and Correspondence, Department for Health and Wellbeing.

The CHAIR: Welcome back, everybody. We are now up to mental health and substance abuse, with 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 he so wishes, and to introduce his advisers.

The Hon. C.J. PICTON: I think we have a number of the same team, but I will also introduce Dr John Brayley, who is the Chief Psychiatrist, and Liz Prowse, who is the Executive Director for Mental Health Strategy and Planning.

The CHAIR: Thank you. I call on the lead speaker for the opposition to make a statement, if she so wishes.

Ms PRATT: Thank you, Chair, and thank you, minister. I have no opening statement but just an opening comment as we wade through the health session this afternoon. Minister, I noted in the previous session that we took about five questions on notice, but the opposition are yet to receive the questions on notice responses from the previous estimates session last year. If we can have it noted that that is information the opposition would dearly love to get. That is my opening statement. I refer to Budget Paper 4, Volume 3, page 28 or page 22. I will read from page 22, regarding the bilateral schedule. There is a dot point in targets stating:

Continue work implementing the state government’s commitments under the Bilateral Schedule on Mental Health and Suicide Prevention.

There was a health minister's communiqué on 19 April, where it was stated that there was an agreement to hold a dedicated session with mental health ministers in the future. When does the minister anticipate the national psychosocial committee will conclude the national estimates of unmet needs, given that it was expected by March this year? When will that meeting take place, and what will the minister be calling for?

The Hon. C.J. PICTON: My advice is that the committee the member refers to is the responsibility of the commonwealth. While we have released and received our Unmet Needs report, there is a federal one that has been in the works for some time. It is impossible for us, I think, to give an accurate explanation in terms of what the commonwealth's time frame will be in terms of the consideration, finalisation and release of their Unmet Needs report that they are conducting across Australia. Obviously, as per any of these measures, we will cooperate constructively with the commonwealth in relation to that.

The other aspect that the member raised in her question was in relation to an agreement that health ministers have made to have a special meeting in relation to mental health. My advice is that that is likely to be at our August meeting of Health Ministers Meeting. While in South Australia, under both myself and the previous minister, Minister Wade, mental health has sat combined within the health minister's portfolio as the Minister for Health and Wellbeing, it is about half and half between other states, where some states have it as a separate portfolio with a separate minister under the same department.

There was an original suggestion from the Royal Australian and New Zealand College of Psychiatrists that we should have a special meeting on mental health. That was something that was considered by ministers at our Brisbane meeting that we had and we agreed that would be a good idea and we would include those ministers not part of the Health Ministers Meetings but who have responsibility for mental health as part of that meeting. My understanding is that that is going to be planned for the August meeting.

Ms PRATT: Would that meeting set likely to be in August, and the federal minister has made comments in the past that his observation is that the mental health system in South Australia and nationally is certainly under pressure—can the minister pre-empt what some of the shared priorities of that meeting might be that would benefit the state? South Australia's agenda going forward to that meeting, what might that look like?

The Hon. C.J. PICTON: I think that is a good question. I think there are a number of different things that we will continue to raise on the national front and they really align with the other issues that we have been raising for health more broadly.

The first is in terms of primary care and making sure that people can get good access to mental health primary care when they need it. This is obviously increasing pressure on general practice in terms of the number of mental health patients they are seeing through general practice, while facing burdens in terms of general practice workforce across the country, so I think the more that we can, through the federal government's Medicare programs, will assist in that area.

The second is in relation to workforce: all aspects in terms of mental health workforce. I am particularly concerned, and have been since I took on this job, in relation to the psychology workforce. I brought together all the, for lack of a better word, key stakeholders in relation to psychology and we had an all-day meeting on this probably six to nine months ago to work through the issues in relation to psychology in South Australia. We are now working on a specific psychology workforce plan for South Australia. That is really focused on SA Health. There is a much broader piece of work that needs to happen.

There are a huge number of students who go into undergraduate psychology degrees. Universities will say, 'Come and do a Bachelor of Psychology.' But this teeny, tiny, little number of people get through to get their Masters and actually become a psychologist. I think that is bad for the health system and it is bad for other systems that need psychologists as well. I think it is unfair on those people who are promised that they will have a chance of being a psychologist when the chances are very much against them to do so. I think workforce is a big issue that we need to address across the country. They are some of the key issues that we will be raising when that meeting happens.

Can I add to that as well: the other big piece of work that is underway is in relation to the NDIS and foundational support services. We had an agreement from national cabinet last year in relation to health, NDIS and foundational support services. Obviously, I know that the member is very interested in unmet need and this potentially will be very helpful in terms of addressing unmet need across Australia for a range of people who do not get into the NDIS, but particularly in this discussion for people with psychosocial mental health conditions who need support.

There is work underway, currently being led by Minister Rishworth, in terms of designing what the scheme for foundational support services will be between the states and the commonwealth. A key part of that will be that psychosocial support to address that unmet need. I think a key other part of the puzzle is going to be the negotiations that are happening in terms of the future of the NDIS, which is important to health and mental health ministers as it is to disability ministers because obviously it is a way that many people with mental health conditions are able to receive ongoing support through the NDIS.

That is something that South Australia and all the other states and territories are actively engaged in trying to make sure that we reach a good outcome there that will be good for people overall, and I think that will certainly be a subject of discussion at that meeting as well.

Ms PRATT: I am sure the sector will welcome that the NDIS is a complicating factor when it comes to psychosocial support services, but there is also a piece of work to understand how to fund psychosocial services beyond the NDIS. Budget Paper 4, Volume 3, page 27, dot point 5, starting 'Increased access to psychosocial services'. My question on that dot point is: what does increased access to psychosocial support services look like where it is via an emergency department assessment pathway?

The Hon. C.J. PICTON: I am going to ask Sinead O'Brien, deputy chief executive, to explain more about that topic.

Ms O'BRIEN: There are a number of components in relation to this. A significant one is that the Mid-Year Budget Review allocated $8 million over the next five years to support the adult metro LHNs, particularly when people are coming towards the emergency departments. This is enabling the NGOs to provide inreach services so that these consumers can be supported to be discharged rapidly, they get wraparound care for up to two weeks and during that time we find more sustainable ways to support these consumers in the community. In addition to that we obviously have the Urgent Mental Health Care Centre as well, which is another pathway for people who can be directed from the emergency department.

Ms PRATT: Thank you, you read my mind. In the Mid-Year Budget Review I believe it stipulated that half a million had already been allocated or spent. How specifically would the remaining budget be spent over the forward estimates?

Ms O'BRIEN: The initial budget that has already been expended is because the service was able to commence very quickly, because we had significant pressures within the RAH and CALHN. That service commenced a couple of months ago and the next service will commence wrapped around the Northern Adelaide Local Health Network, particularly the Lyell McEwin Hospital, so that will be rolling out in a few months, and later the next service will be rolled out for the Southern Adelaide Local Health Network.

Ms PRATT: In response to that answer, are there specific programs or service delivery titles that capture what has just been explained?

The Hon. C.J. PICTON: While we are trying to find the exact breakdown of those programs, just touching on this focus in terms of unmet needs and psychosocial programs, I can give you some updated figures for both expenditure we have had and also projected expenditure we are likely to have, according to the 2024-25 budget. As no doubt the member will know, in terms of state commissioned psychosocial programs, there was a reduction between 2018-19, when $32.7 million was expended. That went down, through cuts that were made, to $26.4 million in 2020-21. That was a 19 per cent cut over that time.

Since we have come to office we have increased the expenditure from state commissioned psychosocial programs from $29.7 million in 2021-22. That has gone up to $38.3 million that is likely to be expended this financial year. Our estimate for next year's financial expenditure will be rising to $42.2 million. That represents a 42 per cent increase over those three years in terms of psychosocial state-funded programs since this government came to office, obviously following where there was previously a 19 per cent cut.

We do not have a very helpful way of describing it, but can I just explain what we have tried to do with this additional funding. There are two things that have happened simultaneously. One is that we undertook a project of redesigning how those programs were expended and recontracting the provision of our psychosocial programs under new contracts. Through that process, we have been able to derive better value and have been able to reach more people in terms of the redesign of those projects.

In addition to that, we had that additional funding through the Mid-Year Budget Review, and that has enabled a number of programs to take place. One, as Ms O'Brien referred to, is in relation to the additional funding that is going to help people upon exit from the Royal Adelaide Hospital in particular as a starting point, where we know that people who are leaving the emergency department potentially might be at risk in the future. To have some wraparound supports for them upon discharge, in a very quick manner, we think is very important. That has been contracted to UnitingSA to deliver that program.

The other element of what we are doing in terms of that additional funding being put in place is focused on kids. One of the areas in the Unmet Needs report where there was a highlighted need for additional expenditure was specifically in relation to children, so there is a focus on that in terms of that additional funding as well. So the combination of all those measures—the redesign, the recontracting and those additional programs—we are expecting will be able to deliver approximately another thousand people being helped through that program, which obviously does not completely resolve unmet needs but goes some way to addressing unmet needs.

As well, as I said, the big piece of work that is being undertaken at the moment that we are obviously contributing to, with our colleagues in the Department of Human Services taking the lead, is in relation to foundational supports being undertaken on a national basis, because no-one should think that this unmet need is a South Australia specific issue: this is right across the country. It follows a whole range of the programs that used to be in place, like the PHaMs program that was in place for carers and mentors across the country, which was stopped when the NDIS came into operation or shortly thereafter. Therefore, there needs to be national action, and obviously there is that national report that is coming in relation to unmet need.

Ms PRATT: Minister, that is quite a comprehensive coverage of how the government argues it is investing in psychosocial services through redesign. If you were to calculate the total spend currently, then, on psychosocial services based on those answers, what would that figure be?

The Hon. C.J. PICTON: As I said in the previous answer, this financial year we are spending $38.278 million. We expect that will be the total expenditure on psychosocial services, and that is an increase from when we came to government. The 2021-22 expenditure was $29.69 million, and we are expecting that next year the budget is increasing even further to $42.2 million. That is an increase over those three years of 42 per cent.

Ms PRATT: Given that public commentary, including from the key stakeholder, the Mental Health Coalition, calling for full investment of the Unmet Needs report, we in this room know that that total is $125 million. The state's split is somewhere around $62 million. Would you argue, then, that on those projections, on those increases, the next financial year is going to be $40 million? Is that the government's pathway to meeting its share of funding the Unmet Needs report?

The Hon. C.J. PICTON: It is a combination of factors. We have obviously increased our expenditure on psychosocial services by 42 per cent since coming to government. I think that is a pretty big percentage, whichever way you look at it. But I think that what we are undertaking in terms of that work in relation to foundational supports is critical in terms of addressing unmet need for people not just here in South Australia but across the country. Part of the agreement at national cabinet was in relation to state and commonwealth shares of that expenditure that will be in place and that work that is being led through Minister Rishworth and, with the disability ministers and DHS, but obviously with health inputting into that.

The other thing is that this is connected to the work that we are doing in terms of the National Health Reform Agreement as well. All of that and the delivery of those foundational supports will be critical in terms of meeting unmet need.

Ms PRATT: I have a final question on psychosocial, minister. Just going back to the commonwealth responsibility, the national psychosocial committee was set to conclude its report in March. It is now June. When do you anticipate that the national report will be released?

The Hon. C.J. PICTON: I would not make an estimate in terms of when the commonwealth will release the national report. I do not have information to signal that one way or the other.

Ms PRATT: I will move on to the topic of the Urgent Mental Health Care Centre. I will be referring to sub-program 1.2 for the Chief Psychiatrist. What has been the reliance of the agency senior medical practitioners (SMPs) for covering shifts?

The Hon. C.J. PICTON: As the member would know, the delivery of the Urgent Mental Health Care Centre in the city is a contract that we have with Neami and as part of that contract they have certain criteria that they need to deliver, including appropriate workforce, and one of those components is appropriate medical workforce.

It is obviously a matter for them in terms of the employment that they have of those medical staff. I am advised that our understanding is that they do employ psychiatrists at least part-time, but they likely also will use locum medical staff as needed to fill the requirements that they have. I probably should have talked about this in our previous discussion about federal reform as well. Psychiatry workforce is another key issue. It is one of the key priorities that we have highlighted through the work of the Kruk review in terms of international recruitment as bringing more appropriately trained psychiatrists into the country because every state needs more psychiatrists.

We are also working with the Royal Australian and New Zealand College of Psychiatrists on a state workforce plan, but I think, clearly, part of that needs to be national action as well. The other component that I would mention is, obviously, yesterday we had the opening of the new northern Medicare Mental Health Centre as it is now called, which is a really exciting development for people in the northern suburbs. We have seen the Urgent Mental Health Care Centre in the city for some time and now a similar centre is available for people in the northern suburbs.

We are having a discussion there about their use of psychiatry. They have engaged some psychiatry to assist their service, but what Minister Butler was saying was that they have made provision in their budget at a federal level that will enable greater use of telehealth services for these Medicare mental health centres around the country to be able to use telehealth for psychiatry as well. Certainly, Sonder, which run that service, thought that that would be a great ability for them to increase their psychiatry availability through the service.

Ms PRATT: On that then, just jumping around a little bit, but it is related to the same service if you like: how does that 16-bed Crisis Stabilisation Centre at Elizabeth compare in its services, its access hours and its treatment to the Urgent Mental Health Care Centre on Grenfell?

The Hon. C.J. PICTON: I will just explain. They are two different things.

Ms PRATT: Sorry, I will just clarify that in reports about that announcement it looked like the access hours are different; they are not 24.

The Hon. C.J. PICTON: Sure, so just to explain, there are two different things. The northern Medicare Mental Health Centre that opened yesterday is one of the initiatives under our bilateral agreement with the commonwealth, and has been contracted to run with Sonder, and is available at a site now in Elizabeth. Separately, but connected to that, we have the Crisis Stabilisation Centre, which we have now finalised plans for, and will hopefully soon start construction of, which will be operating opposite the Lyell McEwin Hospital, so on a separate site.

That site will have 16 beds available for behind the scenes, and the intention has been that the front door of that is the northern Medicare Mental Health Centre that will be run through an NGO, currently contracted to Sonder, and then behind the scenes we will have the 16 beds that will be available, so it will be a much more beefed up version, for lack of a better term, than the Urgent Mental Health Care Centre, which obviously does not have inpatient capacity to it.

The northern Medicare Mental Health Centre, which opened yesterday without the beds on that different site in Elizabeth, has extended operating hours, but not 24/7 like the Urgent Mental Health Care Centre. It is a bit similar to what was initially in place for the Urgent Mental Health Care Centre when it first opened, so extended hours on weeknights and also available through the weekends as well. Obviously, we will monitor demand of that, and whether that is appropriate, and whether there will need to be changes to that over time.

Ms PRATT: Minister, you mentioned on radio yesterday in response to this announcement that 'more are set to come'. I am quoting you, but I will be guided by you now on whether you meant more stabilisation centres or Medicare mental health centres, but my question is: can you provide those locations? Sorry, you referenced 'more are set to come to the regions', so can you provide those locations and a timeline?

The Hon. C.J. PICTON: Yes. I will go off the top of my head. If anyone can find me the paper, then I will read it. Part of the bilateral agreement between the commonwealth and the state is that there is a whole series of centres. These were previously called Head to Health centres, and have now been rebadged.

The Mount Gambier centre is already open, to my understanding. There is one to be in Port Pirie. There is one to be in Mount Barker. There is a specific Head to Health centre focused on young children to be based in the Bedford Park area, and there is also a specific Aboriginal and Torres Strait Islander Head to Health or Medicare Mental Health Centre that will be set to open. We are planning for a city location for that in all likelihood. Together with the Urgent Mental Health Care Centre, that becomes quite a network of different alternatives to emergency departments across the state.

In addition, obviously we also have the Safe Haven site, which has been operating in Salisbury, and there are a number of regional sites that have been operating, including in Port Pirie as well, set up by local health networks, so I think that we are starting to see more and more options for people to go to places other than emergency departments for mental health distress.

Ms PRATT: Of those regional and peri-urban locations that you just listed, and that one in the city, I am just interested in the provider, given there are a few players in this space. We know the Urgent Mental Health Care Centre on Grenfell Street comes under the auspice of Neami, and Sonder is the Elizabeth announcement yesterday. Those regions you just listed off would be provided by which NGO?

The Hon. C.J. PICTON: They obviously have to be appropriately contracted. The advice I have is that the Mount Barker Head to Health will be operated by an NGO, Summit Health, which people in Mount Barker will be very familiar with. They operate a significant number of health services in the Mount Barker region. That will be commencing in the second half of this year and funded through the bilateral. It will have urgent mental health support for people aged 16 and over. Sonder is running the northern service and we are still working through, I think, the Aboriginal and Torres Strait Islander service and also the kids' service as well.

Ms PRATT: Bedford, which the member for Elder referenced, would already be contracted?

The Hon. C.J. PICTON: No, the children's service that will be in Bedford Park is still to come; that has not been contracted yet.

Ms PRATT: And Port Pirie?

The Hon. C.J. PICTON: I do not think that is contracted yet. The advice I have is that the Country SA Primary Health Network will be running the contracting for the Port Pirie centre. We do not believe that has happened yet.

Ms PRATT: It is a tricky path to follow. We were talking about the Urgent Mental Health Care Centre when we drifted to the northern announcement, so I am just returning to my set of questions, still part of sub-program 1.2. My previous question was about the SMPs and workforce, and I take your point that some workforce questions that might follow will be known to Neami and not yourself, but is the minister aware of how many shifts have not been covered this year?

The Hon. C.J. PICTON: That is not something that we would have information about. Neami have a contract with us in which they need to provide certain information, but I suspect that the information we set in the contract is largely related to the outputs rather than the inputs. We would be much more interested in terms of the patients that they are seeing, the outcomes they have, etc.

Ms PRATT: Would the minister know whether the centre is still allocated 50 full-time equivalents, or has that allocation changed?

The Hon. C.J. PICTON: I do not think that we would have that information.

Ms PRATT: Again, these are questions that are around outputs and activity statistics, if you like, of the centre, and I am interested to know the average wait times for guests upon presentation to the Urgent Mental Health Care Centre.

The Hon. C.J. PICTON: The advice I have is that there is a very negligible wait, if at all. The model that they run with peer workers sees in the scheme of around 20 patients a day, up or down depending on the day. Across 24 hours that obviously is very different from the number of patients who are coming into, for example, an emergency department. That means that it is very accessible for a peer worker to be able to see somebody as soon as they start coming into the centre and, therefore, there are negligible waits for people. That is another reason why we certainly would encourage as many people as possible to go there.

Ms PRATT: I would agree with that. Last year in estimates I asked how this service would be promoted, and there was agreement at the time, I believe, that a promotional campaign would be run. What resourcing has been allocated for communication and promotions to GPs and the mental health triage to increase that awareness?

The Hon. C.J. PICTON: There was a campaign that Neami ran. Neami conducted that campaign as their campaign, not through the state government. We will see if we can find the details in terms of the exact expenditure they made on that campaign.

Ms PRATT: I ask because there is an operation report from this year that states: 'It is acknowledged that the Urgent Mental Health Care Centre may need to be continually promoted to ensure the service is front of mind for potential referrers. There is a relatively small number of referrals that do come directly from GPs in the mental health triage service.' With that feedback, given that it is a service that is provided by Neami, what opportunities are there for the government and for the department to lean into—promoting, advertising, resourcing—for creating awareness to GPs, primary care and the mental health triage service?

The Hon. C.J. PICTON: I think it is a good question. Certainly, we are very keen to promote alternatives to emergency departments, hence we were very supportive of the work that was done within the past financial year through Neami to promote the Urgent Mental Health Care Centre and to try to get more people to go there rather than emergency departments.

There has also been work done, I understand, through our local health networks to make sure that information is available in our emergency departments so that people can get there. The other thing that I have been trying to make sure that SA Ambulance highlights is to try to increase the awareness through SA Ambulance of the ability for ambulance patients to be able to be taken there, because we see a very small number of SA Ambulance patients who go to the Urgent Mental Health Care Centre.

We obviously in the past 24 hours have launched a new campaign in relation to avoidance of hospital. Despite the comments from the Leader of the Opposition, which I totally reject, the premise of the campaign is to try to encourage people, if they are unsure about where to go, to speak to Healthdirect. The ability to speak to Healthdirect means you then will be able to speak to a nurse who can give you excellent advice in terms of the specific options that might be available for you in particular circumstances, and that is obviously both physical health and also mental health. Obviously, the Urgent Mental Health Care Centre is something through which people can find out information.

As we see more alternatives to the emergency department for mental health become available, then I think that that increases our need to highlight those. I do not think that we would do that in a way which highlights just the Urgent Mental Health Care Centre in the city alone, particularly now that we have a similar service operating in the northern suburbs as well and are soon to have one in Mount Barker, at the very least, in the Greater Adelaide catchment—although obviously Mount Barker does not regard itself as part of Adelaide—and then with other services to come as well. I think that then starts to necessitate us turning our campaign attention specifically in this area to promoting those as a range and a network of services that could be available for people.

The other element that I think we would want to have as part of that would be the commitment that we have made in this state budget to expand the Child and Adolescent Virtual Urgent Care Service, otherwise known as CAVUCS, to cover mental health services as well. We want to promote that service to parents as something that is available for them.

It has always been something of concern to me that there are so many phone lines in mental health. We are doing work in terms of could there be a consolidation of different phone lines. If we are able to achieve that, then that would necessitate a campaign to alert people to that single point of entry that we would be encouraging people to do as well.

Ms PRATT: Minister, do you know how frequently the Urgent Mental Health Care Centre releases an operational report? Is it monthly?

The Hon. C.J. PICTON: We receive a monthly report.

Ms PRATT: Does the minister receive a report?

The Hon. C.J. PICTON: I have seen, on a very ad hoc basis, a couple of them, but I do not receive them every month. They would go to the relevant area of the department that manages the contract. There have been times in which I have been interested in terms of the number of people who go to the Urgent Mental Health Care Centre, and I have been provided with information from those reports. As I suspect the member might agree, I think that there is scope to increase the number of people who go there, particularly as we see mental health demand on our system be a significant issue.

Ms PRATT: Are they public facing?

The Hon. C.J. PICTON: I do not believe so. Obviously you have one, so they cannot be that confidential. I think as part of their contract with SA Health, which I suspect predates this government, they have to provide them to the government on a regular basis. They are not secret either; I am not worried that you have a copy of them. They ultimately minimise information.

Ms PRATT: For clarification, the copy I have received was requested through Budget and Finance, so that has been shared by the department, and I think they are very valuable reporting tools. My question is, if they are not public facing, what access can the parliament have? Are there legislative or regulatory requirements for that to be tabled, and what access does the opposition have beyond Budget and Finance to read them?

The Hon. C.J. PICTON: There is a variety of different mechanisms that you have at your disposal. You could always write and ask. You could ask for information through the parliament. You clearly have already been successful in requesting that information through a parliamentary committee and have been provided, no doubt promptly by Dr Lawrence's team, with that information.

Ms PRATT: No doubt.

The Hon. C.J. PICTON: There is also the Freedom of Information Act availability. That would be, I would not have thought—far from me to judge a potential freedom of information request. It is likely that would not be seen as commercial in-confidence information and exempted from the FOI Act. I suspect that there might be a number of ways that you could have access to it.

Your sort of suggestion in the question of whether it should be legislated that it be tabled on a monthly basis, that is up to you whether you would like to introduce a bill for that purpose. It is probably, I think, maybe a little bit over the top when there might be other avenues for you to obtain the information that you are seeking.

Ms PRATT: The independent review into the care of Shaun Michaels Dunk raised issues of information sharing between the Urgent Mental Health Care Centre and the RAH. Does that centre now have access to SA Health clinical information systems such as CBIS, CCCME, Sunrise EMR and The Oasis as per recommendation 2 of the review?

The Hon. C.J. PICTON: This was obviously a really shocking case that concerned the whole South Australian community and as soon as it happened I asked Dr Brayley to commission an independent review in terms of the circumstances of this case.

Obviously, this is also before the courts and the last thing I would like to do is to do anything which would impact it in terms of that court case and a successful prosecution. But after carefully considering advice, we were able to release the findings and recommendations of that report publicly, which we did, and we have accepted all of those recommendations that have been made, including the one referred to in relation to the Urgent Mental Health Care Centre. That was obviously one of the places where treatment was received in the lead-up to what occurred.

The recommendation, as the member says, is that there should be better connection between the different datasets. My understanding is CBIS is now available to access to the Urgent Mental Health Care Centre. Following the receipt and release of the report, I have asked Dr Lawrence and Dr Brayley to oversee the implementation of all of those recommendations. The access to the other systems is being worked on under the auspices of that oversight from Dr Lawrence and Dr Brayley working with Digital Health to make sure that we can make that connection work. I understand that work is currently underway.

Ms PRATT: In regard to that, if you can say, has the service level agreement between the RAH and the Urgent Mental Health Care Centre been finalised and why, according to the interim review, is it limited to read only for the Urgent Mental Health Care Centre staff? I am happy to read clause (c), but recommendation 2 in regard to those system states, 'Enable read only access to SA Health clinical information' for the Urgent Mental Health Care Centre.

The Hon. C.J. PICTON: My understanding is that the steering committee overseeing this has just had its second meeting. The work is underway in relation to all of those recommendations, including what was recommended in a memorandum of understanding between the Royal Adelaide Hospital and the Urgent Mental Health Care Centre and we will make sure that that happens.

In relation to the read only access, the advice I have is that that is still being worked through as part of that project with Digital Health, understanding that these recommendations were only received not that long ago. There is work very expeditiously being done on them, but there are obviously some technical IT issues we will need to work through to make that happen.

I would say in relation to the Urgent Mental Health Care Centre and its relationship to the Royal Adelaide Hospital that something I was concerned about from the beginning of this project was the procurement methodology here, which was that it was set up through a process whereby there was a competition between NGOs and the Central Adelaide Local Health Network in terms of who would deliver this project. The Central Adelaide Local Health Network put in a bid and was ultimately unsuccessful and in hindsight—well, I mean, foresight as I was concerned about it at the time—it is not an approach that I would foresee in the future.

I think that we should be working in partnership with our local health networks either to commission them to undertake services or, alternatively, for us to work together in terms of who would be commissioning services and contracting with them, rather than making them compete for them. I think that, clearly, we need to get to a better position of cooperation between the Royal Adelaide Hospital and the Urgent Mental Health Care Centre.

I do not want to attribute blame to anybody for this, but I think, clearly, that has not been the case to date, and I think there is a huge scope for better cooperation between those two very important services in the city.

Ms PRATT: In relation to the steering committee that you referenced, they have had their second meeting. Can you provide details of who is on that steering committee, the name of the steering committee and when they meet or how frequently? So if they have met twice, when is the next one?

The Hon. C.J. PICTON: It is called the Plympton Incident Steering Committee and it is chaired by deputy chief executive, Sinead O'Brien. It has the Chief Psychiatrist on it. It has representatives from LELAN, the Lived Experience Leadership and Action Network, representing people with lived experience. It has a carer representative on there. It has a number of clinician representatives on there. It also has representatives from Neami on there to work through all these issues. As was mentioned in the previous answer, it has met two times already.

The CHAIR: I will just pause for one moment. The member for MacKillop has a question.

Ms PRATT: I have one more question about the steering committee.

The CHAIR: Yes, no worries.

Ms PRATT: In relation to steering committees, on 30 April I asked a question in the house about another steering committee: the Mental Health and Emergency Services Steering Committee. The question was when had it had its most recent meeting? Are you able to provide that answer now?

The Hon. C.J. PICTON: I certainly did not have that information to hand, I admit, when you asked me in the house, but now I have Dr John Brayley to hand who, if not organises those committees, certainly sits on them. I will ask Dr Brayley to explain in more detail.

Dr BRAYLEY: The emergency services memorandum of understanding steering committee is a meeting that I chair and our office supports. It has in attendance people from police, ambulance, local health networks and the Royal Flying Doctor Service, and it centres around the operation of the act and how our services link and work together. Part of the concerns of that committee have been how we respond to the needs of people who might have high levels of need, complex needs, and the committee overarches a range of local liaison groups where emergency services meet regularly and look at how they work together.

The last meeting was on Tuesday, and we were talking further about how we can have even better links for people to be able to identify people's circumstances of concern that the services are communicating well about. There was also discussion about a large meeting that police and our office are convening in late August that is looking at the topic of drug and alcohol and mental health and will have police in attendance, mental health, drug and alcohol and lived experience. This is going to be quite a large forum that we are convening.

Also discussed at that last meeting was a suggestion that you had made about whether general practitioners should be part of that MOU meeting and the strengths and benefits of doing that, but also contrasting that to the purpose of these agencies meeting together to get their own systems working was discussed and the conclusion was that it would be good to be engaging primary care and to be able to invite primary care to the meeting to discuss issues and responses, but not necessarily make primary care a full member of the meeting.

Ms PRATT: I note that the steering committee met on Tuesday. I was interested to know prior to Tuesday when it had last met given that the MOU stipulates that meeting should occur quarterly. I am interested to know how often and on what dates the committee has met in the last 12 months, and would the Plympton steering committee consult with the emergency services steering committee? Given the distressing events that we have seen referenced through threatening behaviours in our community, and first responders are involved, do you see a link between or a requirement for the Mental Health and Emergency Services Steering Committee to be reflecting on and reviewing how recent incidents have been responded to by first responders?

The Hon. C.J. PICTON: I will ask Dr Brayley to provide information.

Ms PRATT: And—apologies, Dr Brayley—minister, will you take on notice, if you cannot provide it now, how frequently the steering committee has met for the 12 months?

The Hon. C.J. PICTON: We do not know if he is going to be able to answer it or not.

Dr BRAYLEY: My recollection is that the previous meeting had occurred in that quarterly cycle, so it would have been in March, from memory. I actually had a competing event at that meeting and Assistant Commissioner Scott Duval kindly chaired that meeting in my place. We can confirm the dates of previous meetings.

There are a number of situations that, obviously, police are aware of and our office is aware of, and all of this informs the work of our committee. It is a bit difficult to talk about individual cases in a public forum because that then might be saying something that could reflect on the criminal trial process, but all of this information is feeding into the considerations of that committee. I am a linking person, of course, and some of the people who are on the committee—there is LHN membership from mental health but also emergency departments, so there is some overlap with the Plympton incident steering committee as well. This will all work together.

Another topic that we did consider on Tuesday was the types of recommendations about additional changes to the Mental Health Act that we might make to the minister, because that has been the minister's request for that to be considered based on the information that we have been receiving.

Ms PRATT: A final question on that thread: how soon after the Plympton incident did the Mental Health and Emergency Services Steering Committee convene?

The Hon. C.J. PICTON: We will take on notice the exact date but I think the member rightly knows, through the auspicing of that committee, that it meets on a quarterly basis. The Chief Psychiatrist has already outlined that he believes it was in March that it met, and then obviously it has met this week as well.

Mr McBRIDE: I refer to Budget Paper 4, Volume 3, page 22, Sub-program 1.2: Chief Psychiatrist and Mental Health Strategy. I am trying to get an understanding of the chart where it talks about the 2024-25 budget and it clearly highlights a $12 million increase in income between 2023-24 and 2024-25. It also talks about a $13.8 million increase in expenses in that same period. The reason I want to ask this is that we were fortunate enough to be shown over in Warrnambool in Victoria what they call WRAD, which stands for Western Regional Alcohol and Drug, an alcohol and drug addiction type facility which seems to be able to stand on its own two feet and not need Victorian state government help.

My question to you, coming back to those two figures of $12.4 million and $13.8 million, is: do you have any understanding, with the help that is alongside you—and maybe you do not even need it—of what part of that is state government funds and what part is federal funds? If the state government is needed to help in the mental health arena over and above what the federal Medicare system does, why is that the case? How can we get more facilities out there based on the federal system, rather than having to depend on you as a state health minister, around mental health and drug addiction?

The Hon. C.J. PICTON: There is a bit to unpack there. Firstly, in terms of the budget papers and the income—and remember, this is just the branch of the department that looks after mental health—the income is projected to increase. At the top of page 23 it explains that the increase in income is because we have signed a new bilateral agreement with the commonwealth that sees us receive income to deliver a number of the services that we were talking about in answer to the question from the member for Frome earlier. These are very specific services that will be commissioned by the department.

The vast majority of the services that we deliver, of course, are not through the department; they are through the local health networks and sit within the budgets of local health networks through the budget papers as a combination of mental health and physical health services being delivered. In fact, the member may be very pleased to know that the advice that I have is since we have come to government all of our country local health networks have seen an increase in terms of mental health staff across the system, including in the Limestone Coast, which has seen an increase from 32 to 48 mental health staff, full-time equivalent. That is an increase of some 49.7 per cent that they have had just in those two years between 2021-22 and 2023-24.

I have very low-level awareness of the service in Victoria that the member speaks about. My understanding was that it did receive funding from either state or federal governments, but we would need to properly look into that. Obviously, I am supportive of any service that does not require government funding to operate, but I know that the vast majority of services that do operate in the drug and alcohol space in South Australia do receive either state or federal government funding of some description.

The Medicare system predominantly is a system which funds services directly delivered by doctors. That obviously covers a small subset of where drug and alcohol services, or even mental health services, are provided, but a lot of services fall outside of the Medicare Benefits Schedule and hence require in that case, and in the case of most of our services, specific commissioning by our local health networks or contracting with non-government providers or for-profit providers to be able to deliver services.

For instance, regarding the additional drug and alcohol services that we are delivering across South Australia we have talked about commissioning two detox drug and alcohol beds in the health centre in Mount Gambier, but we have also put in place additional drug rehabilitation, community residential rehab facilities that have been contracted through the NGO Uniting Communities.

There is a whole range of other services that are contracted through the federal government, either directly by them or through primary health networks, and one of the issues that we have been raising with the federal government is that a number of those services have been on short-term contracts, so that people have not had continuity in terms of whether they are going to continue or not. We have had a number of rollovers of those, and obviously those service providers would like to see more continuity and certainty in terms of those contracts to be able to plan better for the future. I am very happy to discuss further the Victorian model that he has looked at.

Mr McBRIDE: In regard to the drug and alcohol presentations on ramping—and I do not care which ramp we are talking about in South Australia—is there any understanding of the percentage of patients who present on a ramp who can be solely defined as substance abuse due to drugs and alcohol? Is there an awareness of that sort of figure and percentage?

The Hon. C.J. PICTON: It is complex, because I think that there is a large degree of crossover between people who have particular different conditions. There will be some people who will have drug and alcohol issues who will also have physical health issues, and there will be some people who have drug and alcohol issues who will have mental health issues. People who do not have either a mental health issue or a physical issue with a drug and alcohol issue, who are presenting at emergency departments either as walk-ins or via ambulance, I suspect are low, but I am happy to take that on notice and get further information in terms of what numbers of those we are able to identify.

I would say that this is an issue that we are paying particular attention to, particularly at the Royal Adelaide Hospital, and it connects to some of the work that we were talking about before in relation to the member for Frome's questions. It is something I know the Chief Psychiatrist and Sinead O'Brien, the deputy chief executive, have been engaged in in terms of looking at how we can best manage people with substance abuse issues, particularly in the Royal Adelaide Hospital, where, above odds, we see a lot of these cases coming.

There is a large degree of crossover between those substance abuse issues and mental health issues. This is obviously the hospital where we see the largest degree of bed block for people waiting for inpatient beds for mental health. So I think it is an area of work that we can see improvements in.

Mr McBRIDE: If I may just pick up on that, minister, one of my love affairs I want noted—not love affair in the sense I love the problem—is a solution I heard from Westmead Hospital in Sydney, where I was talking to a couple of medicos from there. I asked them, 'What would you do to solve the ramping issues at the Westmead Hospital in Sydney?' They said they would draft off every mental health and substance abuse patient down another line.

It would look something like a health remand centre that would be able to cater in a nursing mental health way specifically, so two things occurred: you had the resources around everything that mental health and drug addiction and alcohol poses, which can be quite difficult at times, and, secondly, it freed up the ramping system in our hospitals for all the other medical-type issues. You have already used the words 'bed block', and I know that it becomes really difficult with security and these sorts of things. When you think along those lines, it certainly gives an opportunity for better outcomes.

Moving on, you talked about the 32 to 38 new staff. One of the things the Victorian model really did point at was that they were looking for trainee psychologists and psychiatrists that clearly fell under the Medicare system. I am thinking, if you were to pick up counsellors, then they probably do not fall under the Medicare system and then they would have to be financed by the state system.

Correct me if I am wrong; I am seeking clarity and a question here too. Of the 32 to 38 new staff, were all those new staff medically trained to fall under the Medicare system—and that is fine if they do not or do. On top of that, I would not mind asking: does the minister himself and his department here help put psychologists into the education system as well?

The Hon. C.J. PICTON: Okay, there are a few things to unpack there. Firstly, in terms of the increase in staff that we have seen in the Limestone Coast Local Health Network, it has gone from 32 to 48, so an increase of 16. They would be a combination of different categories of employees, and I suspect a very small proportion, if any, is of medical staff. We have a lot of allied health in mental health. We have a lot of nursing in mental health. I do not have the specific breakdown, but that is my presumption in terms of what would sit underneath those figures.

As we were talking about before—I am not sure if you were here—the psychiatry workforce is a problem right across the country. That is why it has been identified as one of the priority areas for recruitment fast-tracking internationally, and so there has been a report done by Robyn Kruk, who used to be the head of New South Wales Health, of fast-tracking processes safely to bring specialists into the country, and psychiatry is one of those priority professions where we will be doing that.

In terms of the Medicare Benefits Schedule, when a doctor sees somebody in a public hospital, we cannot access Medicare. The presumption under the health agreements that have been in place since Medicare came into operation is that that is something which is funded under the public hospital funding agreed between the federal government and the state government, and there is not an additional ability to charge Medicare.

There is a whole level of complexity that would definitely take up the remaining time available to talk about private practice arrangements, and that is an area that psychiatrists are able to utilise and do utilise in South Australia. I think there have been some arguments made that, perhaps more than in other states, they utilise that, and that is when they are able to access Medicare Benefits Schedule payments—but for public work you are not allowed to.

In terms of the psychology workforce, separately, that is another area of concern to us. Where we can help is in offering placements for psychologists. If there are more placements then arguably the universities could have more places for masters students, to allow a larger pipeline. There have been a number of changes that have been made over the past five years or so, in terms of the pathway for people to become a psychologist, that have reduced some of the on-the-job training-type pathways. Those changes have been made to try to improve professionalism or clinical skill, but that has made even more workforce issues. That is of concern to me and, I suspect, to all the other health ministers around the country.

The federal government have taken some steps in terms of increasing the funding that they are giving to universities to create places and training pathways for psychologists. We are looking at what more we can do in terms of creating more on-the-job clinical placement positions for psychologists within SA Health, and that is being done as part of the work that we are undertaking in terms of our own SA Health psychology workforce plan.

Ms PRATT: I return to sub-program 1.2. Minister, under the Code Yellow, what number of country mental health patients on involuntary treatment orders have remained in country hospitals for more than 24 hours, requiring the level 1 treatment order to be reviewed by video rather than in person?

The Hon. C.J. PICTON: The team were clearly following question time and, when you asked this yesterday or the day before—

Ms PRATT: I reframed it. It was poorly worded.

The Hon. C.J. PICTON: That is alright. They have endeavoured to try to find the answer for you. They have not been able to do so, but I have already taken it on notice in the house. There are a couple of things to say on it. One is that there are clearly a number of those patients who are intoxicated and who are not suitable for transport, so there is a clinical decision that is made in terms of whether they are able to be transported or not. Part of the consideration has to be the safety of the RFDS, SAAS, MedSTAR or whoever is going to be involved in facilitating their transfer. It is hard to separate out who has been waiting because of an operational capacity reason, which I guess is the angle of your question, versus who has been waiting because of a clinical reason or a safety reason, based on that person.

The other thing to say is that the advice that I have from Dr Lawrence is that there is likely to be very little or zero impact upon that issue because of the Code Yellow in itself—that is likely to be an issue, ongoing, for some time. Obviously, we will see if we can find it, but the data is unlikely to be different in terms of Code Yellow from what we have seen other times.

Ms PRATT: If I can share then, in good faith, the advice I have been given is that, under the Code Yellow, separate to transport complications, there were country mental health patients presenting to EDs who were admitted to hospital and who remained in hospital longer than they would normally. They were declined, or not given compliance, to transfer patients to rural and remote, due to the Code Yellow. If the minister can take that advice?

The Hon. C.J. PICTON: Dr Brayley would like to comment on that.

Dr BRAYLEY: We can certainly follow up the specifics of that concern. When I have been attending various system teleconferences to give advice and also to give advice to the commander, there has been a change in country transfers, but that has been a change to their destinations in Adelaide. Previously, with air transfers, when people came in, they would all go to the Royal Adelaide, but with the Code Yellow approach those transfers are being shared between Flinders Medical Centre, the Royal Adelaide and the Lyell McEwin.

I know from past modelling, and in fact predictive modelling, that this has a positive impact at the Royal Adelaide in particular. So it does mean that there could be country people who have gone to those other EDs and then gone to the rural and remote or stayed at those local hospitals, but that change would be the destination. In terms of the other observation that you are reporting, we can check on that.

Ms PRATT: I am happy to provide information out of session. I am interested in the broader implications on the country health system because of the Code Yellow and what pressures are on nursing staff, in particular, at a country hospital, who are not necessarily clinically trained in mental health, where any patients have remained at a country hospital longer than they would normally.

It has been reported that there were patients through Yorke and Northern. There may have only been one and I make allowances for my source as well, but if that were a directive that the Code Yellow meant that rural and remote had to keep its beds open to support RAH admissions, then was there a pressure statewide?

Dr BRAYLEY: That can be looked at. At the meetings that I was at, there was certainly some pressure for air transport to the extent that at times land transport was being used instead. I observed those sorts of delays, but we will check for the other ones as well.

Ms PRATT: Thank you. Is Dr Brayley saying that is going to be taken on notice for further information?

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

Ms PRATT: Budget Paper 5, page 39, the youth mental health support funding of $5 million: to what extent will these funds be available to support young people in regional South Australia, noting you have made previous comments today on investment in regional mental health services, but in particular youth?

The Hon. C.J. PICTON: This is in relation to CAVUCS?

Ms PRATT: My question is: in relation to the youth mental health support, the funding of $5 million in the government's budget, to what extent would those funds be available to support young people in regional South Australia?

The Hon. C.J. PICTON: There are a number of components to that $5 million investment, the largest of which is an expansion to the Child and Adolescent Virtual Urgent Care Service (CAVUCS), which currently is available for children who have physical health issues. It has been successful and something that we have expanded and made permanent in the previous budget. Now the proposal is to expand that in relation to mental health services as well. That will be available to anyone across the state.

I believe when CAVUCS first started there was a geographic location restriction on it, but that, I believe, has long been lifted and it is available for people across the state. Certainly, a lot of the feedback that has been very positive about CAVUCS has been coming from regional areas.

The other components of the package were in relation to particular supports and trainings that we will be providing, both for parents who have children with mental health concerns and also eating disorders. We will be undertaking contracts with service providers to be able to deliver those packages.

To the extent that we can reasonably achieve within those contract negotiations, we would like to have regional locations as part of those. That would be a standard approach we would undertake as a department when we contract for services, but I would not want to premeditate the final contracts we get in place, other than to say that would certainly be our hope.

The Hon. D.G. PISONI: I will take you to page 25 of Budget Paper 4, Volume 3, dot point 5, the 24/7 pharmacies. What was the criteria that you used to award the contracts for the three 24-hour pharmacies, two of which were Chemist Warehouse and one was National Pharmacies?

The Hon. C.J. PICTON: We are in the session on mental health and substance abuse, and we do not have the appropriate advisers here covering that, which would be in the portfolio session that has already closed. I would say that an open tender was available. People were able to bid for that and it was a process managed, I understand, under the Office of the Chief Pharmacist, who made the evaluations and decisions in terms of which pharmacies were selected.

The one clear thing we set as a government from our election commitment was that we wanted one in the northern suburbs, one in the central Adelaide area and one in the southern suburbs as well, and that has obviously been achieved as part of this project. The feedback has been overwhelmingly positive from people utilising these services. They have been very well utilised across all three sites. Chair, I know that your local service in Salisbury has been particularly well utilised, with some of the strongest numbers.

I think in a world in which people are now accessing general practice through a variety of different online and telehealth means, they can get sent their scripts at all hours of the day. They have not had the ability to physically obtain them and this enables them to do that. But also, pharmacists can provide a whole range of other health advice. Particularly now that we have expanded the role of pharmacy, and I know that the member for Unley was involved in the committee that helped us with the work in terms of UTI prescribing, with that now in place cross the state, as well as access to the pill, all those things are available through these 24-hour pharmacies, 24 hours a day, which is just another way people can avoid having to go to an emergency department if they do not need to.

The Hon. D.G. PISONI: Minister, were you aware that Chemist Warehouse had to back pay $3.5 million for underpayment of staff? The Australian Journal of Pharmacy reported, as well as commercial press at the time in 2016, that after paying back almost 6,000 of its workers more than $3.5 million, Chemist Warehouse entered into a compliance partnership with the Fair Work Ombudsman. In other words, the Fair Work Ombudsman was so concerned about the underpayment that for three years they monitored the work Chemist Warehouse did in paying its staff.

The discount brand, which includes a network of 350 retail pharmacy businesses, was audited by the Fair Work Ombudsman, following concerns raised over non-payment of wages. Under the compliance deed Chemist Warehouse would have to engage an independent auditor to assess compliance with workplace laws for the three years of the deed. Were you aware of that before you awarded those two contracts to Chemist Warehouse?

The Hon. C.J. PICTON: I will take the member for Unley's word on what he has read into Hansard, but I again reiterate that this procurement was managed by the Public Service in line with appropriate Public Service procurement guidelines—

The Hon. D.G. Pisoni interjecting:

The Hon. C.J. PICTON: —sorry, if I could just finish—in line with the procurement guidelines set through Treasurer's Instructions and elsewhere, and it is not something in which ministers would interfere in terms of which business is selected as part of that procurement. If any business is working with government or not working with government, the expectation would be that they comply with all workplace laws, that they comply with every requirement in terms of paying their employees appropriately. If they do not, then there are obviously appropriate mechanisms in place through both the federal system or the state system to make sure that that should happen.

The Hon. D.G. PISONI: But does the underpayment of wages—

The CHAIR: Member, the minister has been very gracious about answering these questions, but I do remind you to stay within the examination of the portfolio we are in at the moment.

The Hon. D.G. PISONI: Is the underpayment of wages a disqualification for getting a government contract in the Department for Health?

The Hon. C.J. PICTON: As I said, the procurement guidelines that are set across government have been complied with.

The Hon. D.G. PISONI: Can you bring an answer back—

The CHAIR: Member, you have been warned. Are there any questions in relation to the portfolio?

The Hon. D.G. PISONI: Can you bring an answer back to the committee, minister, as to whether that is a disqualification for awarding a contract?

The Hon. C.J. PICTON: I have answered the question.

The Hon. D.G. PISONI: So you are not—

The CHAIR: Are there any questions in relation to the portfolio?

The Hon. D.G. PISONI: —going to bring an answer back. You have not answered the question. You said you did not know.

The CHAIR: Member, are there any other questions in regard to this portfolio?

The Hon. D.G. PISONI: Are you doing the omnibus ones, Penny?

Ms PRATT: The estimates committee omnibus questions are:

1. For each department and agency reporting to the minister, how many executive appointments have been made since 1 July 2023 and what is the annual salary and total employment cost for each position?

2. For each department and agency reporting to the minister, how many executive positions have been abolished since 1 July 2023 and what was the annual salary and total employment cost for each position?

3. For each department and agency reporting to the minister, what has been the total cost of executive position terminations since 1 July 2023?

4. 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 since 1 July 2023, 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?

5. For each department and agency reporting to the minister, will the minister provide an estimate of the total cost to be incurred in 2024-25 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?

6. For each department or agency reporting to the minister, how many surplus employees are there in June 2024, and for each surplus employee, what is the title or classification of the position and the total annual employment cost?

7. 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 and, for each position to be cut, its classification, total remuneration cost and the date by which the position will be cut?

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

What savings targets have been set for 2024-25 and each year of the forward estimates;

What is the estimated FTE impact of these measures?

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

What was the actual FTE count at June 2024 and what is the projected actual FTE account for the end of each year of the forward estimates;

What is the budgeted total employment cost for each year of the forward estimates; and

How many targeted voluntary separation packages are estimated to be required to meet budget targets over the forward estimates and what is their estimated cost?

10. For each department and agency reporting to the minister, how much is budgeted to be spent on goods and services for 2024-25 and for each year of the forward estimates?

11. For each department and agency reporting to the minister, how many FTEs are budgeted to provide communication and promotion activities in 2024-25 and each year of the forward estimates and what is their estimated employment cost?

12. For each department and agency reporting to the minister, what is the total budgeted cost of government-paid advertising, including campaigns, across all mediums in 2024-25?

13. For each department and agency reporting to the minister, please provide for each individual investing expenditure project administered, the name, total estimated expenditure, actual expenditure incurred to June 2023 and budgeted expenditure for 2024-25, 2025-26 and 2026-27?

14. For each grant program or fund the minister is responsible for, please provide the following information for the 2024-25, 2025-26 and 2026-27 financial years:

Name of the program or fund;

The purpose of the program or fund;

Budgeted payments into the program or fund;

Budgeted expenditure from the program or fund; and

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

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

Is the agency confident that you will meet your expenditure targets in 2024-25?

Have any budget decisions been made between the delivery of the budget on 6 June 2024 and today that might impact on the numbers presented in the budget papers which we are examining today?

Are you expecting any reallocations across your agencies' budget lines during 2024-25; if so, what is the nature of the reallocation?

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

What South Australian businesses will be used in procurement for your agencies in 2024-25?

What percentage of total procurement spend for your agency does this represent?

How does this compare to last year?

17. What protocols and monitoring systems has the department implemented to ensure that the productivity, efficiency and quality of service delivery is maintained while employees work from home?

18. What percentage of your department's budget has been allocated for the management of remote work infrastructure, including digital tools, cybersecurity, and support services, and how does this compare with previous years?

19. How many procurements have been undertaken by the department this FY, how many have been awarded to interstate businesses? How many of those were signed off by the CE?

20. How many contractor invoices were paid by the department directly this FY? How many and what percentage were paid within 15 days, and how many and what percentage were paid outside of 15 days?

21. How many and what percentage of staff who undertake procurement activities have undertaken training on participation policies and local industry participants this FY?

The CHAIR: With the allocated time having expired, I declare the examination of the portfolio of Mental Health and Substance Abuse completed.

Departmental Advisers:

Dr R. Lawrence, Chief Executive, Department for Health and Wellbeing.

Dr C. Lease, Executive Director, Health Protection and Regulation, Department for Health and Wellbeing.

Ms M. Bowshall, Interim Chief Executive, Preventive Health SA, Department for Health and Wellbeing.

Ms L. Tuk, Manager, Executive Services and Correspondence, Department for Health and Wellbeing.

The CHAIR: We will move to Preventive Health and Public Health, with the Minister for Health and Wellbeing. I declare that the proposed payments remain open for examination. I call on the minister to make a statement, if he so wishes, and to introduce his advisers.

The Hon. C.J. PICTON: I will be very quick. I retain Dr Lawrence, Chief Executive of SA Health, and I am joined by Dr Chris Lease, who is the Executive Director of Health Protection and Regulation for the Department for Health and Wellbeing, and also Marina Bowshall, who is the Interim Chief Executive of Preventive Health SA, and I am retaining Lauren Tuk, who is the Manager of Executive Services and Correspondence.

Just as a brief opening, I want to explain that when the Premier created the new ministerial position of the Minister for Seniors and Ageing Well that obviously took the 30-minute slot that we had here. The first estimates draft I saw had this disappeared and I thought that that would no doubt raise concern that we had reduced the time for me to be examined by this worthy committee, so I thought let's add it with this important area of public policy. So for these officers, I am to blame that they have to be here on a Friday afternoon.

The CHAIR: Indeed. I call on the lead speaker for the opposition to make a statement, if the member so wishes.

Ms PRATT: I would just like to take this opportunity to thank the minister, the house, parliamentary colleagues and public servants for the three sessions that we have currently sat through, including the previous session. Not getting an opportunity to farewell them, I do that in their absence, and I welcome the new team late on a Friday afternoon.

They are two important topics, minister, Preventive Health and Public Health, and we have 30 minutes ahead of us to examine the budget. I refer you to Budget Paper 5, page 36, regarding the additional renal haemodialysis services in northern Adelaide. Where in the northern metropolitan area will those additional 21 chairs be located?

The Hon. C.J. PICTON: I think that we are really probably back on the first topic in terms of public hospital services in talking about dialysis. I do not think that really falls into preventive or public health through any sort of standard definition; however, I am happy to answer the question. I will indulge you. We know that there is a need for additional dialysis chairs across our system. We are utilising a high number of patients receiving dialysis in the private system as well as trying to juggle as many patients in the public system as we possibly can.

We know that the northern suburbs both has a significantly growing population and also significant health disparities that make it a target area where we need to increase dialysis provision. We are very thankful that the Treasurer has made available that funding in the budget for dialysis. There are still options being considered in terms of where that additional dialysis capacity will be established, but one of the options that is being considered is whether to build a facility at Lyell McEwin Hospital to deliver it, but we are also considering whether to commission or contract a provider that could provide those services.

Ms PRATT: Minister, if you will make allowances for yet another year of me interpreting how the different budget lines open across different sessions and, I guess, my interpretation of preventive health, which is why I am interested in asking questions about renal dialysis, I understand that it does not fit within the budget line that has brought your public servants today, so thank you for answering that question. I am going to ask this question, whether you are going to indulge the answering of it or not, just because—just because it is Friday afternoon.

The Hon. C.J. Picton interjecting:

Ms PRATT: The line of questioning around haemodialysis really has come from a meeting that I had with the Aboriginal kidney action group, and I am noting on page 64 of Volume 3 continued implementation of the Aboriginal Health Promotion Action Plan, and the plea that was coming from the room, from nephrologists, from dialysis nurses and people living with kidney failure was the importance of investment in dialysis chairs and the absence of them in country health, and then the gap that they see in accessing transport.

I have told you a story. I have not asked you a direct question, and I relate the government's investment into renal dialysis as an element of preventive health, which is where I was coming from, so my questions relate to the status of the SA renal dialysis plan, and further consideration for investment in dialysis chairs in country health. If there is anything there that the minister is inclined to pick up, I would be grateful.

The Hon. C.J. PICTON: Sure, I am happy to. I think, when we think of preventive and public health, we think of the stage well before somebody gets to dialysis. I think dialysis is well regarded as treatment, not that it is not important but, as you know, I have very rarely relied on the advisers in answering my questions, so I am happy to answer anyway. In terms of country dialysis, we are very aware that there is more need for dialysis across country areas as well, and I know that there is a number of country LHNs that have been exploring to what extent they can expand their current dialysis provision.

I know off the top of my head that Yorke and Northern are looking at ways in which they can expand some of their current dialysis units. Certainly, Barossa Hills Fleurieu has been looking at that as well and, as part of works underway in the Southern Fleurieu Health Service at Victor Harbor, I think there are opportunities where we may be able to expand dialysis chairs there, and these would be relatively small-scale developments that could be undertaken to add some particular chairs. But clearly, when it comes to metropolitan Adelaide, we need a much bigger uplift, and that is why we have prioritised the Northern Adelaide Local Health Network for these 30 dialysis chairs, both because there is an existing need and also because we know that it is going to be a growing need in the years ahead as well.

There has been a lot of work done between the clinicians and also the department to try to track where we think the estimated growth is going to be, and I think for many years we have probably been behind that curve. We need to sort of try to jump ahead of that curve in terms of dialysis provision, and these 30 additional chairs will be a big help.

Ms PRATT: Thank you very much. Perhaps if we take a step back, can I ask for an update on the conclusion of Wellbeing SA and the transition to this agency, Preventive Health SA, and in terms of the outcomes or the KPIs and the priorities of Preventive Health SA? What are the differences and what is the status currently of this new agency as it flexes up?

The Hon. C.J. PICTON: I might add a few comments and then I will ask Marina to expand a bit in terms of where things are at. What we wanted to do was to have a dedicated prevention agency. While I certainly appreciated the work that was done by Minister Wade in setting up Wellbeing SA, my concern was that it was focused on a range of things that were not necessarily prevention, and it did not have all of the prevention elements as part of it.

There were, for instance, Priority Care Centres, My Home Hospital, and the at home community services that we provide, all sitting within Wellbeing SA, which you would not define as prevention, and, on the other hand, there was not a whole range of key prevention tasks such as smoking, vaping, alcohol and other drugs campaigns that were sitting within Drug and Alcohol Services South Australia (DASSA).

What we have done is a reform that has brought parts of DASSA into what was Wellbeing, to become Preventive Health SA. The service delivery outlets that were in Wellbeing SA have moved into the department and, underneath that, one of the executive directors in Dr Lawrence's department is now running those programs. I think that has actually helped better connect them with some of the local health networks, in my view. There has been work done in consultation with staff in terms of those movements of staff both into the department and also from DASSA into now Preventive Health SA.

Marina has been working in terms of consulting with her staff about making sure that we have the best possible structure for that organisation, to mean that we have the best delivery in terms of outcomes. The other element is that we have re-established a full-time Mental Health Commissioner as well. That is connected to Preventive Health SA, although it retains independence in reporting to me as well.

The other additional element that we have underway is work with an expert committee, chaired by former federal health minister Nicola Roxon, to work on the drafting of legislation that we will be bringing to the parliament this year to legislate for Preventive Health SA as a permanent organisation. That is the summary. I might ask Marina if she wants to say anything more, or does that cover it?

Ms BOWSHALL: That certainly covers it in regard to structural issues. I will say that it has been quite a significant change for staff over the last several months and they have been exceptional in continuing the great work of prevention for the state. There was significant work in the tobacco and vaping space, recent work around alcohol and pregnancy, cancer screening, and working with Aboriginal community-controlled organisations on cultural determinants of health grants, so quite a vast array of work that is continuing to operate to the benefit of the state while we are going through these structural changes.

The bill that has been drafted by the advisory council is currently out for public consultation to, again, get further input and feedback from the community to make sure that we are designing an agency that is fit for purpose and reflecting the needs and the desires and aspirations of the community.

Ms HOOD: I refer to Budget Paper 4, Volume 3, page 64, Sub-program 3.2: Preventive Health SA. How is the government tracking against the targets of the South Australian Tobacco Control Strategy 2023-2027?

The Hon. C.J. PICTON: Our Tobacco Control Strategy outlines our commitment to reduce tobacco smoking and e-cigarettes or vaping use to improve the health and wellbeing of South Australians. A key target of the strategy is to reduce daily smoking prevalence (15 years and over) from 9.8 per cent down to 6 per cent by 2027.

Preventive Health SA, responsible for overseeing the strategy, have contracted SAHMRI to analyse the prevalence of smoking in the South Australian community against the first year of the strategy. While the results show that the 2023 smoking prevalence of people aged 15 years and over has marginally increased to 8.7 per cent from 8.1 per cent, based on the 10-year trend the strategy target for daily smoking prevalence of 6 per cent is still on track to be achieved.

What is concerning, though, is the results that we are seeing about vaping. This is new data that we have not yet released but we are releasing from today. In 2023, 6.7 per cent of respondents aged 15 years and over reported currently using a vape or an e-cigarette compared with just 3.6 per cent in 2022. That has almost doubled just in the space of one year. Particularly concerning was that amongst 15 to 29 year olds current vape use has gone from 8.4 per cent in 2022 to 15.1 per cent in 2023. That is a huge increase of our young people taking up vaping in just one year, and for the first time a greater proportion of those aged 15 to 29 currently used e-cigarettes than smoked.

This increase in e-cigarettes is of increasing concern to me, to the government and to our public health experts, and we are very passionate about tackling it here in South Australia. Of course, there are significant health impacts of the substances involved in those vapes: all sorts of ingredients that are found in disinfectant, weedkillers, poisons—the sort of things that you do not want to have in your lungs. But what is particularly concerning is the high amount of nicotine in these products that is seeing our young people become hooked on nicotine very quickly and in a way that is very hard to shake. We also know that the impacts of vaping include nicotine addiction, breathlessness and symptoms of nicotine poisoning such as vomiting, nausea and diarrhoea.

We are committed to taking firm action in this response. The first thing I would say is that within the next fortnight there will be a bill before the federal parliament that Minister Mark Butler is bringing. It has the support of all state and territory health ministers around the country, including the Liberal government in Tasmania, to make sure that we can take action in relation to vaping. We want to see that passed. I hope that the Liberal Party here and the Greens party here will certainly call on their federal counterparts to support that legislation to take action on this, to make sure that we can only have vapes available where people have appropriate health authorisation through pharmacies, not on every street corner.

We are also taking action as a government to invest in this budget in enforcement, to make sure that as these laws come in we can actually have proper enforcement of them. This is a $16 million investment, as well as that money being used to make sure we can better enforce the increasing rise of illegal tobacco across our community.

We are also investing in terms of making sure we have new campaigns running, including a new campaign that has just started in the past few weeks with young people's voices speaking directly to them in terms of the impacts of vapes and making sure that message gets loudly heard by our community. I am very concerned about these statistics that we are putting out today and I think it really highlights why this is the moment we need to take action on this issue.

Ms PRATT: Following on from that, my own communities of Clare and Balaklava are very worried about smoke shops that have popped up, where it is strongly suggested that vapes are being sold. Some of those smoke shop proprietors are asking for customer mobile phone numbers in case they get shut down. What can country communities do to fight this scourge and to report their concerns where they see this practice happening?

The Hon. C.J. PICTON: It is a good question. One of the reasons why we have put this in place not through the Department for Health but have taken the approach of now embedding the enforcement function within Consumer and Business Services is they obviously have a much more focused element in terms of enforcement and in terms of current liquor licensing provisions, etc.

To go from a couple of people in our health department to what will be a quite significant team of these additional staff within CBS will give us the ability to make sure that there are people inspecting premises not only in metropolitan Adelaide but also across regional South Australia. Obviously, that sits under Minister Michaels, but has the strong support of our team. I know Dr Lease and Professor Spurrier have worked very closely with CBS to make sure we are transitioning those elements of our legislation and giving them the appropriate enforcement powers to make sure they will be able to take action.

At the moment, there is a provision where people can make reports to SA Health and there is an SA Health website where people can report information. That will no doubt transition to CBS receiving that information, but I would encourage in the meantime before that is established for anyone to still make those reports to SA Health through the public health website.

Ms PRATT: Just on that, because I am aware of people who have done that, can you speak to the department's response to those online reports and what action was taking place and is current in this transition? What happens next?

The Hon. C.J. PICTON: Our SA Health team, which has been, as I said, really just a couple of people, undertook a blitz last year and seized a significant number of products at that time, but there was a real limit to what a small number of people in the Department for Health can do, particularly given that a lot of these pop-up businesses have been run through, we believe, links to organised crime.

We obviously connect with other services, whether that be the police, whether that be the federal police, whether that be the taxation office or border force in relation to these matters as well. No doubt that is what the Consumer and Business Services team will do as well.

This transition is coming online over the course of not that long. I think it is from 1 July when CBS take on that funding and some of that legislative responsibility in relation to the tobacco and e-cigarettes act, but we will still be active and we will still be receiving reports and taking what action we can. I think it is very clear that an absolute increase in that resourcing was needed and that is what this budget is delivering.

Mr McBRIDE: I refer to Budget Paper 4, Volume 3, page 64. In regard to this new program, will preventive health cover off on community health, Country Connect or community nursing and will that be part of this new preventive health arena or is it going to be kept separate?

The Hon. C.J. PICTON: The short answer is no. I think it is worth defining what we mean by preventive health, which is really at the very early stage of the continuum. Other services, such as community nursing and primary care, are absolutely very important and they will continue to be run through our local health networks across the state. Obviously, other primary care services are also run through the federal government.

But this is about how can we stop people becoming sick in the first place, whereas a lot of those programs are about how we can keep people with a chronic disease or who are ill healthy and out of hospital, which is absolutely vitally important as well. We are really trying to move the needle a lot further in terms of what action we can take to help people stay healthy so they do not need any of those other services to begin with.

There has been a lot of work done in a short time by Marina and her team looking at all of those levers sitting with the one agency in terms of being able to take action and where the best place is that we should be taking action. Obviously, we know there is a big impact from smoking still in our community and an increasing one from vaping. I think that will always be a focus, but I think we see the increasing risk of obesity and overweight people in our community and the impact that has on their health and that is going to have to be a significant focus as well.

Mr McBRIDE: Supplementary: minister, how will you measure the success of this new preventive health initiative? In particular, if you were not fortunate enough to be the next minister for health in the next government and there might be a new minister with a new emphasis or a new government, how would they not throw this away to the sidelines and say, 'What a waste of time this was'? You could easily say, 'No, here we have some facts and figures and these are the changes we obviously saw and these are the benefits we got from this new initiative.' I am just wondering how you are going to measure that success?

The Hon. C.J. PICTON: It is a really good question, because some of the measurements of success of these sorts of initiatives happen over decades and some of them are very hard to determine. You cannot run an alternative scenario of a state without taking action on preventive health to see what would happen either, so it is difficult to measure.

There are certainly measurements that we can take of the benefit of individual programs, individual campaigns that we might run. For instance, if we run an anti-vaping campaign, as we are doing at the moment, we will conduct research on that to see did it resonate with people, has it led to some people changing their behaviour, etc., but the longitudinal benefits over a long period of time are obviously what we are trying to achieve as well. So you have to have an eye on both things: the success of particular measures, but also are we turning the needle on those longer term issues as well?

There has been a very long-term program over decades that SA Health has run where we do a survey and ask people a whole series of questions about their own health, and that gives us good longitudinal measurements in terms of people's weight and wellbeing, and even mental health wellbeing, through that survey. That is one of the ways that we can measure whether things are on track or off track. You raised a good point in terms of this is one of the reasons why I want to legislate this as well, because I think that we should put the marker in the ground and say, 'As a parliament, we think that this is important, and if a future government, future minister, wants to get rid of it, we will have to come back to the parliament and argue why that is the case.'

The Hon. D.G. PISONI: This relates to your highlights page on page 25. You raised this matter earlier of UTI and availability now of antibiotics from pharmacists without a prescription. How many pharmacies are offering the service?

The Hon. C.J. PICTON: Particularly given that there is limited time—and this is, again, a question on pharmacy that should have been dealt with in the first two hours of the estimates session—I will take that question on notice.

The Hon. D.G. PISONI: It is community health, is it not; preventive health and public health?

The Hon. C.J. PICTON: A treatment for UTI is a pharmaceutical issuing of a medication that I would have argued would be in the first session. I am happy to take the question, but there might be questions that people have on preventive and public health and for matters that the advisers are here for.

The Hon. D.G. PISONI: Okay, if you are happy to take that question on notice, are you also able to—

The CHAIR: That was in previous sessions. Do we have any questions regarding the current portfolio?

The Hon. D.G. PISONI: He answered the question; he is going to bring it back. I would like you, if you are able, to bring back the number of individual dispenses that have happened in this period at the same time.

The Hon. C.J. PICTON: Sure.

The Hon. D.G. PISONI: You raised vapes earlier. What was the process of pharmacies being the only place where vapes could be issued? I have been made aware that pharmacists are not terribly happy about having to deal with it. There are other alternatives to giving up smoking: patches and gum, for example. What is the evidence that vapes are actually a medical process?

The Hon. C.J. PICTON: Nicotine is a drug. This is something which has been worked through between the federal government and all the states and territories. Marina is our representative on that group which meets to consider these matters. Ultimately, this is legislation which is currently before the federal Senate and has been proposed by the federal government, but to answer on behalf of the federal government, I believe the consideration was that it should be seen as just a smoking cessation device, not as something that is going to be attractive and not as something that kids are going to want to take up, but something that you should have to have a healthcare practitioner endorse for you as needed for smoking cessation.

The best mechanism that we would have to dispense a product through such a mechanism where there are health checks applied to it would be through our community pharmacy network across Australia. There would be particular requirements around that: it has to be in plain packaging, it has to be very limited in terms of tobacco or menthol flavours and it has to comply with requirements around not advertising or showing those products. So it would be very limited compared to what we currently see in vape stores.

The Hon. D.G. PISONI: Is there peer-reviewed evidence that vaping can assist somebody to quit smoking?

The Hon. C.J. PICTON: I think there are a lot of differing journal articles about this.

The Hon. D.G. PISONI: I am asking for peer-reviewed evidence.

The Hon. C.J. PICTON: I understand the question, member for Unley. There are documents and there is peer-reviewed evidence that points to a variety of different evidence in terms of smoking cessation. I think that there is a lot of advocacy from public health experts that they do not advocate vaping as a smoking cessation device necessarily, but there are some people who are advocates that it is a good smoking cessation device. The determination that has been made from the federal government in proposing this legislation is that these products should be made available as smoking cessation devices, but only for that purpose, and that is what is currently before the Senate.

The CHAIR: The time allotted having expired, I declare the examination of the portfolio of Preventive Health and Public Health completed. The examination of the proposed payments for the Department for Health and Wellbeing, the Commission on Excellence and Innovation in Health and Preventive Health SA are now complete. Thank you very much to everybody for your participation.

At 17:46 the committee adjourned to Monday 24 June 2024 at 09:00.