HEALTH CARE BILL

Second Reading

Adjourned debate on second reading (resumed on motion).

(Continued from page 1315.)

Mr VENNING (Schubert) (16:09): I rise to contribute to the debate on the government's Health Care Bill. The bill proposes to reform the governance and administration structures of South Australia's health care system. Really, it is not so much about health care; it is more about health administration change. The bill's proposal to abolish existing hospital boards in country areas and replace them with health advisory councils, hereafter known as HACS (that is a rather ironical way of putting it), will spell the beginning of the end of the many country hospitals. This proposed wind-down of country health would rate as one of the most important issues that I have dealt with in my many years here, and is of serious concern to me, because these hospitals are the lifeblood of our communities, particularly the more isolated, smaller communities.

I have made many speeches in this house over the years in support of our hospitals, especially our country hospitals. In the last six to eight weeks I have vamped up my comments in support of the status quo. For the record, I have five hospitals in my area (Angaston, Tanunda, Mannum, Mount Pleasant and Gumeracha) with three boards operating. I have had experiences serving on a hospital board. I served on the Crystal Brook Hospital Board for approximately six years as the council's representative. I know how the community supports its hospital, and Crystal Brook is just fantastic.

The government reduced the eight regional hospital boards across the state early in its term of office, and I supported that. It was a level of bureaucracy that we did not need to have—and it really was. Why then, minister, are we putting it back in this instance? Having local hospital boards replaced by health advisory councils, which would report directly to the state government and minister, will be disastrous for this state's health system. This bill will only result in a centralised, massive bureaucratic mess and will not provide better service for patients and communities. Mr Deputy Speaker, you can be assured of a poorer performance and it will cost more—much more. Why are we doing this is the question. Is this legislation necessary? Why change something that has worked so well for so long and means so much to so many people?

The most important thing in regard to health care is that the services offered are delivered in ways which best help local people. They know who they are. What better way to achieve this than by having in place local hospital boards which have some real authority and can make decisions about what happens in a given hospital? This issue is one on which the government and the opposition are poles apart, and that is for philosophical and basic reasons. If management decisions are made closer to the people being affected by them, ultimately, a better quality of decision making will result. The Minister for Health said last year in a ministerial statement:

These new governance changes will streamline decision-making and ensure that we have an integrated health system for the future and give a strong voice to community members and clinicians.

This is what is happening now under the current system. Why change it? Why change the structural arrangements of our health system when it is already delivering the goals outlined by the minister? The government claims that this bill will result in a more unified health system for South Australia through the integration and coordination of services. Rubbish, I say. This is a long-term plot spanning over 20 years, as the shadow minister very capably put in this house yesterday, for health bureaucrats to increase their control of the health system—a long-term goal. They have always wanted to control it; they never have, and here is their big opportunity.

I have to say that those two words: 'integration' and 'coordination' set off alarm bells in my head. It sounds like a lot of political palaver for what we really know the government wants to happen. It seems that this government's real plan is to slowly dismantle country hospitals by limiting the services they offer, take away the control and input that locals have via the removal of their hospital boards, and, therefore, force rural residents to travel to the city to obtain adequate health care and relevant services. Ever since Don Dunstan's electoral reform, country people have been losing out on the provision of government services. Equity—

The Hon. J.D. Hill interjecting:

Mr VENNING: The minister said 'democracy is a bugger'; they are his words, sir, not mine. There is fairness and equity. I believe governments have obligations to serve all communities. If you could only do it on the one-vote/one value policy, there would be a lot of people out there who would not get any services at all. The government has the responsibility to offer minimum services to people, and they are not even getting that.

This bill is yet another kick in the guts to country people, and highlights the citycentric approach of Labor. I am somewhat concerned that there has not been more public reaction or uproar about this legislation and what it will do. I have attempted to beat this up via public comment and press releases in my local media, but it seems that many of the stakeholders have given up and accepted the inevitable. I spoke to a doctor who is well known to me, and I was not happy with his response. He said 'What's the use?' And he was a person who should have known better, and I am very concerned about that. I am not prepared to give up.

Under the draft bill, country communities will continue to have a voice through a local health advisory council. However, their influence on real decision making will be limited and the real responsibility will be transferred to the Department of Health. Under the current Health Act a minister cannot easily sack or remove a local hospital board; under this new act the minister can, very easily. Is this just a halfway house to total oblivion? How many of our country hospitals will this affect? The Blyth hospital is totally gone; it was a wonderful facility but Labor shut it, and I wonder what will happen after all this. I was a member at the time Labor shut Blyth; it was an excellent facility but, boom, it was shut—and I have never forgotten that.

I have not given up, and I will not. This is a most important issue; it will go before the other place—and I hope the government will appoint the Hon. Nick Xenophon's replacement before it gets there. Or is that part of the plot? The upper house can prove its worth here and represent the important, oppressed minorities in South Australia.

The state Labor government says this bill has come about due to the rising cost of health care, and that the increasing demand for and complexity of health services inevitably mean that communities will have a relatively less central role in maintaining and controlling their assets, but can still have a role in the planning of appropriate services. Part 4 of the bill deals with Health Advisory Councils (HAC) and the Country Health Community Assets Authority. Clause 18(2) of division 2—Functions and Powers—provides that:

...a HAC must, in the performance of its functions, take into account the strategic objectives (including any health care plan or plans) that have been set or adopted within the government's health portfolios.

In other words, you will do as you are told. It also provides that:

Subject to this act, a HAC has the power to do anything necessary, expedient or incidental to performing its functions.

So now, to meet rising costs, we are to have these new health advisory councils (the HACs) which, at the end of the day, will be nothing more than councils who are directly responsible to the minister—in other words, the minister's HACs. Do rural communities not know their needs better than some bureaucratic outsider? Of course they do. In a letter I received from the Minister for Health he stated that, 'Overwhelmingly, country hospital boards and communities support the local retention of hospital assets.' Well minister, you got that right.

This can hardly be considered surprising. Of course country hospitals and communities support the local retention of assets. It is their people, their auxiliaries, who have worked hard over the years to raise funds to provide assets for their local hospitals; why should they relinquish control? In most cases they built them, gave the land for them, and have helped in their governance ever since—and some of them are over 100 years old. The way it is currently is that the community has ownership of the hospital and therefore they support it personally and financially. Many people make a bequest to 'their' hospital or donate money, and most hospitals have local auxiliaries that raise money for 'their' hospital. All this would be lost if you take away local management; local ownership will be gone. The minister is silent; I presume he agrees with me. If local hospital boards cease to exist—

The Hon. J.D. HILL: I rise on a point of order. The member for Schubert is accusing me of having a particular opinion because I did not interject upon him. I think that is disorderly and it is also dishonest.

Mr VENNING: I withdraw—

The ACTING SPEAKER (Mr Koutsantonis): Order, member for Schubert! You cannot infer opinions other than your own.

Mr VENNING: I apologise to the minister; it is just that he was silent and I was a bit provocative in what I said. I hope he will pick that up in his reply. It is about whether the auxiliaries will survive when you take that individual ownership away. If local hospital boards cease to exist then the locals will no longer have a say in how hospital funds, that they have helped raise, are spent. Surely the state government can understand that this would cause a lot of money that flows into hospitals to dry up, especially as the hospital loses its identity.

The form of health care system proposed by the Rann state government will simply result in the minister running all hospitals, including those in the country, from his office in Adelaide. This will ensure that the decision-making process is taken further away from where the service delivery is, inhibiting the growth and development of local hospital services. This bill seeks to do nothing more than deliver ultimate and total control of our health service to the minister and the government—the bureaucracy. The local health service would gradually be perceived as just another government service impeding any community involvement.

What is happening at the moment is that even very minor decisions have to be referred to the director's or minister's office. Such decisions or problems get logged there and never dealt with; as a result the issue remains unresolved, staff morale decreases and a bad situation gets worse. The result of this is that South Australians have the longest elective surgery waiting list ever recorded in the history of this state, the worst emergency response times in the whole country, and the lowest elective surgery and mental health funding per capita in Australia. If this is the Rann state government's idea of a healthy hospital system I have to say that South Australians deserve better.

Under the scheme proposed by the Rann Labor government, the performance of health services at regional and local levels will not be published; it will be kept secret from South Australians. The new health care bill states that 'the aim is to provide a prosperous, environmentally-rich and culturally stimulating state which offers its citizens every opportunity to live well and succeed.' By centralising health care services and management the government is achieving exactly the opposite. Each area is different, and that is why a local approach is the best way to treat these issues. This will all come to a halt under the new system—another questionable brainwave of the Rann government.

I see local involvement as a real positive; when you keep management local you get the best value for your dollar. There has been much criticism of the Rann state government, saying that direct funding hospitals via community hospital boards will add another level of political bureaucracy to the current health system. This is just plain nonsense. Local hospital boards are already in place and have been for a long time. Minister Hill says that South Australia must 'have a strong health system that can take responsibility of delivery of health service to all the people in the country, not rely on the goodwill of local volunteer boards'. How ungrateful! Keeping hospital management local has proved over the last 80 years to be the most efficient and community friendly system. It is clear that the bureaucrats want greater control, but boards comprised of volunteers are there for the benefit of their local hospital, their local communities, and do not have any other motive.

For the health minister to say that it would be adding another level of bureaucracy to the health system is absolute garbage—and, worse, to say that it will create inefficiencies is grossly hypocritical. We do not need to be reminded of his latest attempt at creating an efficient system, namely, the NRM review, the principle of which I supported. However, burgeoning government bureaucracy has killed it. I know that the minister had every good intention, but now what we see is a system totally out of control with the bureaucracy taking it over and killing it. In regard to the health care service, the Minister for Health said:

...one of the things that people have said to me is that there is far too much bureaucracy.

Well, one has to ask: who is running this state's health system and who has put this bureaucracy in place? None other than his government. I cannot accept this backward step, which again depicts that this government is interested in maintaining only large regional hospitals—similar to its direction on education in smaller schools. The current hospital board system can deliver and has been for decades. Bureaucracies, empire building, increased costs of service and over-servicing is what will result if the current boards are dismantled. If management is local and funded externally, by either the state or federal governments, I am totally confident that all taxpayers will get better value for money and people in country communities will get a better standard of health care.

Bringing an end to the local management of hospitals runs counter to the Rann state government's stated desire to encourage local community involvement through the proposed health system. I do not believe that the Rann Labor government's plan for health advisory councils will ever be a suitable replacement for local hospital boards, which are made up of locals, not boffins in Adelaide attempting to micromanage the whole state health care system. This plan is just another example of this government's incompetence and ineffectiveness in managing this state's health care system. It is government ideology overshadowing commonsense. The fact that the country health budget for this financial year has been cut by over $35 million is one of several concerns and even more reason why we should resist the hijacking of our country hospitals. With cuts like this already made to country health services, what will happen if the minister and government gain absolute authority?

The pool of budget allocations for country health is proof of the minister's contempt for health services outside Adelaide. The last thing country people need now in this time of drought is any concern over the future of their local hospital. I pay the highest tribute to the various local hospital boards across South Australia. Their work ought to be rewarded, not wiped out. I will never compromise on my position to fully support individual hospital boards made up of members of the local community. I ask: what happens to the land, the real estate? I know that the government is moot on this matter and has locked it up in various areas, but I am still very concerned because this real estate belongs to the community. The land is usually donated by local people and money is put in by local people, so it really belongs there and it should always be guaranteed to stay there. I give my full support to the federal government's proposal of retaining local management of country hospitals by maintaining the boards currently in place and not implementing boards of city hospitals currently managed by bureaucrats.

And what about the Barossa Hospital? I mention that because we are still waiting for something to happen. For all the years of pushing, the priority is unknown. It is an absolute disgrace. I believe that the federal government has a good opportunity to fund this hospital because the state government never will. If it is able to do it in Tasmania the federal government should be able to do it here. The only way to achieve that result for the Barossa Hospital is to have it externally funded. This Labor government at the last state election said that no hospital board would go—sacked, or anything else. Remember that, minister? Well, what is this? Where is the truth and the commitment? The love and care given by my constituents to country hospitals is appreciated. The level of service given in often antiquated facilities is just fantastic. It is now time for us to stand up and be counted and to support our families and our communities.

I put on the record my desire to support all country hospitals and to keep the management local, to encourage local funding, to promote community ownership of the hospital and to recognise the performance and service delivery, not condemn it forever. This is a prime example of a government which does not understand, which is not close to the subject and which is dumping on people legislation they really do not want. In terms of some of the legislation coming through here, over the years I have been in this place I have often thought, 'Well, why are we doing this?' If it is not broken, why fix it? Are people asking for this legislation? Who is asking for this? I will tell you who: the minister's department. The bureaucrats want this. They do not want these boards in country areas to have any power at all. How dare they have any say at all! After all, they do raise the money and, over the years, their record has generally been pretty good—not always, but generally pretty good.

I am sure that a minister with clout and respect could always go out—and this minister has visited my hospital—and talk about the problems he may see, and I have no problem with that. I am very concerned. This bill has been coming for sometime. I thank the minister for the public consultation period, which I think is straight and honest. I appreciate that. As I say, he is still one of my favourite ministers. There are not many over there anymore. He has certainly blotted his copybook on the NRM, but it was not him. He gave a commitment to me, but he was moved on. That is always the thing: you bring something in with a good minister and then the minister is moved on. You get a dud minister and you end up with a real problem, as we have got with NRM; and we could have it with this when the minister moves to high office in a year or two. I urge the house to support all South Australian hospitals and oppose this bill.

Ms BREUER (Giles) (16:30): Country South Australia has a vast diversity of geography and cultures. Approximately 429,000 residents live in 1,200 cities, towns and hamlets across an area of 983,000 square kilometres, and I point out that about 500,000 of those square kilometres are in my electorate. In response to the Generational Health Review, the government identified governance reform as a priority to improve the management and operation of the health system. The doom and gloom coming from members opposite is quite incredible. I have been listening to some of their arguments and discussions, and I am amazed at what they are coming up with. In May 2006 a country health conference, attended by 260 delegates made up of regional and local board members, hospital staff and other stakeholders, spent two days discussing the best way to govern the public health services in South Australia.

The general view reached by the delegates was that if Country Health is to work as a fully integrated service system, changes would have to be made to local governance arrangements. This was decided at that conference. You cannot write off 260 delegates at a conference. There has been significant support from the country for the proposed changes in the bill, and again I say that I am not sure where members opposite are getting their message, but I certainly am not hearing what they are hearing.

For the country region many important functions of the existing boards will be maintained—we will not lose that—and delivered through the Country Health SA board and the local health advisory councils. The health advisory councils will continue to undertake an advocacy role on behalf of their communities, so we will not lose that. Also, they will be able to provide advice on planning and service issues in their local area to the minister and also to Country Health SA and the chief executive of the Department of Health. So, I do not see what the problem is. That will not be changing.

The members of the health advisory committees will be drawn predominantly from the local community to ensure that the voice of the community is well represented on that health advisory committee. We will not be losing that local touch that we have in country areas. For many years it has been a status symbol in country regions to be on the hospital board. People like to say they are on the hospital board. If they are running for local council it suits them to say they are on the local hospital board or they have served on the local hospital board. It can be a status symbol for them.

Mr Pengilly interjecting:

Ms BREUER: Also, very often those local hospital boards over the years have been stacked by various governments to make sure that they are favourable to the current government—

Mr Pengilly interjecting:

Ms BREUER: —and I know that Labor and Liberal governments have done that.

Mr Pengilly interjecting:

The ACTING SPEAKER: The member for Finniss is warned. The member for Giles.

Ms BREUER: Thank you for your protection, sir. They are being very rude. The Country Health SA board will continue to provide advice to Country Health SA and to the chief executive and the minister. The bill does not change the arrangements for commonwealth funded aged care facilities and accommodation bonds, and the retention amounts and interest will continue to apply to the benefit of that facility. So any warnings about aged care facilities in hospitals is not true.

Historically, governments at the local level grew out of a traditional community participation model, with members volunteering their time to fundraise and support their local hospitals, and there have been some wonderful examples of that over the years. I know in my own city of Whyalla this has been the case for many years, and they have done a wonderful job over the years. However, over time, the governance responsibilities of local health boards have substantially changed and the issues that require determination have increased in complexity, and this has resulted in concern about the responsibilities that have been placed on those local health boards.

To make country health services safer, more accountable and sustainable in the long term, there is little doubt that the health services must operate as part of a modern, integrated system, one that is large enough to provide common mandated quality and safety standards, consistent policies and corporate systems, and sector-wide career opportunities for those people working in the hospitals. It is no longer a little world; it is a big world now. There is a global picture. We want better health outcomes for country residents in line with the recommendations of the Generational Health Review. We need a new system, and the new Health Care Bill establishes the legislative foundation on which to build the new system of health care.

We heard a number of issues cited by members opposite. There are a number of examples of boards spending beyond their budgets without approval. Issues with financial management have occurred over the years. With the dissolution of the seven regional boards and the establishment of Country Health SA, processes have been implemented to assist with the management of financial issues. I served on the aged care board many years ago, and there were many issues dealing with finance, and I know that the hospital board had considerably more. I would not like to be dealing with those issues in our current times. There have been examples of boards approving staff positions and filling them without the funds available and where boards have not complied with commonwealth legislation in their use and management of funds held in trust.

I am sure most of these incidents have not been deliberate. It has been through ignorance and not understanding, and beyond the scope of their capabilities. There are two examples where bequests have not been used consistent with their terms, and one led to a successful challenge and the loss of a bequest worth nearly $750,000. Another situation required the health unit to seek Supreme Court approval for changes to the way the funds are used. In both instances, the Department of Health has had to intervene after the event to resolve the matter. These financial issues are beyond the capabilities of people to manage nowadays on those hospital boards—you are talking about volunteers giving up their time.

In terms of clinical issues, there is a variable approach across Country Health sites in relation to clinical governance and safety and quality matters, and an example of this was the breakdown of the colonoscopy cleaning and disinfection practices at the Riverland regional hospital which potentially could have resulted in cross-infection to other patients. Patients were required to be tested and retested for any cross-contamination, and it no doubt caused them considerable worry. There were many reports at the time in the newspapers. It would be very frightening for people in situations such as this. The minister had to instruct the board to cooperate with the review into the procedures of cleaning and disinfection of clinical equipment by the Communicable Disease Control Branch of the Department of Health.

There are also concerns with the management of medico-legal risks, because some boards have little or no involvement or comprehension of their roles in this area. One example particularly was close to my electorate at the Wudinna health service. In 2005 the board of the Mid-West Health service, which has responsibility for the running of the Wudinna hospital, commissioned a clinical review regarding a number of allegations which centred around difficulties between nursing staff and the general practitioner at the time, Dr Du Toitt, who was then resident in the area.

An independent review heard from individuals who raised many issues in relation to performance, behaviour management, clinical assessment and treatment. The review team found a lack of appropriate and sound leadership and management practices over a number of years and recommended corporate governance training for board members, annual board performance development plans and performance reviews for all executive and management staff. The review found that the medical and nursing care did not meet contemporary standards at that time, although the situation was not serious enough to place lives at risk—but this was a serious issue. Of course, there was some hostility after that—and the member for Flinders was quite vocal about some of this—but it was an incident which highlighted that the board was not the able to handle the situation.

We have also had issues with procurement processes in hospitals. The most notable was the failed contract negotiations with Gawler obstetricians, which resulted in a breakdown of relations between the doctors and the health service. Protracted negotiations with the two private specialists saw the board making decisions which were outside their delegations. A review was undertaken by the Department of Health which found:

a lack of clearly defined processes for negotiation;

the GHS board did not know that, due to the value of the contract, a tender should have been undertaken or a tender waiver sought;

the board allowed the GHS chief executive to withdraw from the contract negotiations;

the deputy chair of the board subsequently took a more 'hands on' role in the contract negotiation process, which is normally considered outside the role of a board member; and

recommendations of the review included a centralisation of contract negotiations process. The new Health Care Bill will allow greater authority in this area.

Delays in pursuing a tender for medical imaging services at one hospital resulted in an extension of the existing provider's contract without due processes, leading to the intervention by Country Health SA to ensure the continuation of an essential service.

The recruitment and retention of staff is a major issue for our country hospitals. There are many examples of difficulties associated with GP recruitment and negotiating contracts in country locations. I know that, in my own town of Whyalla, with its population base, we should have approximately 22 GPs and I think we have 14. The Whyalla hospital has been negotiating for well over two years now to get a local resident physician but has not been able to pursue it. This is a major issue for country hospitals. Difficulties in recruiting and retaining medical staff in country locations is not unique to South Australia. Some examples on the public record include the South African specialist who was recruited from New Zealand, arrived at the Mount Gambier hospital, changed his mind and returned to New Zealand on the next available flight.

A very sad case was that of Dr Singh who was recruited to Wudinna from India and who left within a week. That was particularly sad. I read an article written by Dr Singh. He was frightened; he was terrified; he did not know where he was. His family was frightened. He had come from a major city in India which had millions of people and arrived in Wudinna (which has a population of between 300 and 500 people) and thought that he was on the edge of the earth. He could not cope and no support services were provided to help him. A director of nursing hired by the Lameroo community fled before a welcoming party was held. An ongoing issue for us in country hospitals is being able to keep people.

Another thing that has happened in our country hospitals has been the lack of quorums. Increasingly boards have found it difficult to achieve the constitutionally required number of participants for board meetings and annual general meetings. I think this is a reflection of the amount of input and work that is required from them and perhaps that feeling of being overwhelmed when some board members realise how much control and responsibility they have. For example, in 2005-06, eight country health services failed to achieve a quorum for their AGM, which is the most important meeting for the year. These included services such as the Barossa, Ceduna, Millicent and Penola health services.

I believe that this new bill will provide a service for us in the country that we have not seen before. I am very happy that Whyalla will be one of the four centres of excellence for country health, because I believe that we do serve a large hinterland and we will be able to serve those people well. I am very pleased about this.

Before I sit down, I pay tribute to my local hospital, the Whyalla hospital, and the work that goes on there. Before my mother passed away with cancer last year, she spent a considerable time in the hospital I have to say that the care she received at the Whyalla hospital was outstanding. The nurses were very supportive to us as a family, as well as to my mother. The medical services were excellent. Again, we had a situation where, because of doctor shortages, we saw a number of doctors attend my mother. I was able to experience first hand the issues with doctor shortages and a high turnover of doctors.

We will have some major problems in future years in country hospitals. Many of our country hospitals no longer provide obstetric services and that is generally because we are unable to get obstetricians and anaesthetists in country communities. I would hope that we can continue to maintain some of these services in country areas, but I am quite fearful that, over the next few years, we may find that all country women will have to come to Adelaide to have their babies because of health professional shortages in those areas.

I look forward to the new structure. I certainly support this bill. It will be a wonderful thing for country people and I believe that, despite what the opposition says, there is not a lot of opposition. Most people are sensible and see that this is the way to go. It will provide better services for us in the future and I congratulate the minister on his foresight.

Mr PENGILLY (Finniss) (16:44): I also rise to make some points regarding the government's Health Care Bill, which I oppose. Quite frankly, after some time in this place, you start to wonder why on earth they do some of these ridiculous things and, in this particular case, I could not agree more with my colleagues on this side of the house. Unfortunately, the member for Giles says that she has not heard too many complaints. I suggest that she drives around the country and chats to people. In particular, I would like to place on the record in due course my regard and respect for the efforts of the boards of the two hospitals in my electorate, the Kangaroo Island general hospital (now known as the Kangaroo Island Health Service) and the South Coast District Hospital at Victor Harbor.

I picked up on the comments made by the member for Giles, with respect to the fact that some board members saw this as an opportunity to gain social status in the community. Let me tell the member for Giles that, in the 16 years I have spent on health boards, at both unit and regional level, I never encountered people going on the boards or into local government so that they could become status symbols. The fact of the matter is that they went onto those units and put their hands up for regional boards to provide service to the community in the best spirits of the volunteer ethic. I think that is an absolute slap in the face for those people across South Australia.

Mr Goldsworthy: It's an insult.

Mr PENGILLY: It is quite insulting and rude, as my friend, the member for Kavel, said. I would also like to express my thanks and appreciation to the former minister for health, the Hon. Lea Stevens; the member for Little Para. As regional chair, I had a lot to do with Lea Stevens, and I thought that she had a firm grip of reality: she was not in cuckoo land, where we are now. The fact of the matter is that minister Stevens (as she was at the time) recognised that the Menadue report really did not add up and was not in the best long-term interests of South Australians and, in particular, South Australian country health.

Former minister Stevens actually listened to what the regional chairs had to say. She took us into her confidence and she had enough trust in us to be able to talk to us about the problems surrounding country health in South Australia and take it on board. I have deep respect for Lea Stevens. She listened, she observed and she took note. There was no hint of arrogance about her, which was terrific. So, I place on the record my appreciation of the efforts of the member for Little Para during her term as the minister for health. Obviously, she was under a good deal of pressure with respect to a number of issues, but that is always the case whether someone is the minister for health or the minister for whatever; it goes with the job.

I was involved in health when the Menadue report was being prepared. Members of the communities with which I was involved at the time put forth their thoughts freely. Mr Menadue ultimately produced his report, which was basically put to one side, the Hon. Lea Stevens was put to one side, and we now have the Menadue report.

I would also like to mention what a great performer Mr Jim Birch was when he was CEO of the health department. Jim Birch had come through the country health system; he had been there for many years. He was very fair and equitable, and he also did not have any arrogance about him; he would listen to people. I think it was a sad day when Jim eventually gave up and moved on to other fields. I saw him in Goolwa just recently, and he looked about 15 years younger, and a much happier man. So, CEOs of government departments may well take that on board.

Ms Breuer interjecting:

Mr PENGILLY: Thanks for your help, member for Giles. I am not going too badly. I would like to talk about the two hospitals in my electorate. I will first talk about the South Coast District Hospital, which is at the core of health service provision on the south coast. I would particularly like to recognise the efforts of the chairman of the private board, Mr Kevin Howard, and the chairman of the public board, Mr Brenton Hutchison. Both are deeply committed to the South Coast community and, indeed, are widely respected in the community, and they are wringing their hands over what is now proposed with respect to that health service—and, likewise, board members who have been there many years, who have been phenomenal on that board and have put in sterling service.

One person whom I would like to mention in particular is Mr Adrian Lush of Inman Valley. Mr Lush served on the board for a long time (along with many others, of course), and he always had a profound interest in what was going on and a profound understanding of the health needs of the south coast. I now want to talk about Kangaroo Island general hospital, of which I am very much aware, having been born there, along with the member for Bragg.

Ms Chapman interjecting:

Mr PENGILLY: It does not seem that long ago since we were born there; but we were born there.

Mr Pederick: Just like yesterday!

Mr PENGILLY: Yes, just like yesterday.

An honourable member interjecting:

Mr PENGILLY: I hear what the minister is saying, but I have a feeling that the member for Bragg might have been born before me. I am not sure. The Kangaroo Island General Hospital has a proud record of service to the island community and, indeed, as has been mentioned by other members, is very much at the core of that community's interests and funding.

Ms Chapman interjecting:

Mr PENGILLY: Dr Mary McHugh? No, she did not deliver me—Bunty Burnell, I think. The current Chairman of the Kangaroo Island board, Mark Warren, at the annual general meeting a couple of weeks ago, spoke of his concern about the unknown nature with respect to where the hospital and the health service were going under these proposed new arrangements. I restrained myself from making any utterances, knowing that I would have plenty of opportunities to do so in this place.

They really do not know what is going on. Health units around South Australia have invariably had problems from time to time. I think it is most unfair to blame the boards for those problems because, as I have discovered during my term as regional chair, in particular, quite often the mistakes are made at the administrative level and are only brought to the board's attention when it has to go and clean up the mess, which is most unfortunate—that is not to say that that happens with all of them. It is just a fact of life that all our instrumentalities are run by people, and people invariably make mistakes. Sometimes they do not have the correct training and they get in deeper than they should and, unfortunately, just cannot cope with what is going on.

I feel that I should mention one person who was on the Kangaroo Island board who is now deceased: Mr Don Brown. He was the chairman of the Kangaroo Island hospital board for 17 years and provided sterling service. The hospital went through a great period of change while he was there. So, I acknowledge the late Mr Don Brown. I attended innumerable functions with him and, in fact, I succeeded him as chairman of that hospital in the early 1990s. I worked with some fantastic people who were on the board at the time. I worked with a few who probably struggled to understand what it was all about, but I think that is part of the learning process that people who get onto local health boards have encountered. Indeed, that happens when you get into local government. You find that when you get into these things if you do not have a grip on what is going on, you are on a steep learning curve and it is hard to pick it up for some people.

I turn to the business of hospital auxiliaries and the sterling work that they have done. I have a great fear that these auxiliaries are going to wring their hands in despair and disappear because for years, as I think the member for Schubert inferred a while ago, people have regarded these units in country towns as their own. The auxiliaries and the community rally around to work and to raise money in order to put more facilities and more equipment into the hospitals. I can see that disappearing because I do not think they will have any inspiration whatsoever to continue doing that. I think that the government has made a fundamental catastrophic blunder in doing this.

These health advisory councils (HACs) are going to be creatures of the minister and the minister will put on who he likes. He may well say that they come through from the communities but we all know what happens when ministers go to appoint boards or councils: they put on people who are ethnically clean, so to speak—

The Hon. J.D. Hill interjecting:

Mr PENGILLY: That's all right, minister; you can have your turn again in a minute to wind up. I do not agree that these HACs are going to be much at all. They are socialism gone crazy. Advisory councils are a good way of saying that people can stand up there and have input and that they will be totally ignored. I thank the volunteers on the auxiliaries for their work and for what they are doing now. I hope that they will continue and I hope that the communities will still rally around. In due course, I do not think they will.

I would like to mention briefly the regions that were dissolved. In my case, our region was phenomenally successful, and I know that some of the regions were not. But the region I was chairman of for a number of years—namely the Hills Mallee Southern Regional Health Service—was outstandingly successful and I attribute much of that to the administrators that we had at the time and, in particular, the regional general manager, Mr Kevin Eglinton, whom we appointed and who stayed throughout. He is an outstanding fellow. He is immensely gifted and broad in his views and his perception of what should happen. He was always ably assisted by Mr Rick Brandon. I worked very closely with those two gentlemen, along with a number of the regional managers around that Hills Mallee Southern region during my time on that board.

I cannot speak highly enough of the efforts of Kevin Eglinton and Rick Brandon. We always had our moments. If you do not have the odd row or dispute over things, you are not really achieving very much. So, from that side of it, I place on the record for ever and a day my thanks to those two fine gentlemen, the other staff and board members with whom I served over a number of years on the regional board.

I am very concerned that what is going to happen under this act when it comes into operation is that we are going to return to the bad old days where the glass tower in Hindmarsh Square is going to be bulging at the sides with people running around and filling out forms and not accomplishing anything. That is my chief concern. This has happened before. There was a widespread cleanout of the ‘glass mahal’ and that involved a lot of dead wood disappearing over the years and getting back to the core of actually doing something for health in South Australia.

I think now that with this debacle that is going on in the house at the moment with this Health Care Bill all you will see is more and more people working in Hindmarsh Square, running around and filling out forms. Health care, particularly in regional and rural South Australia, is going to be put under immense pressure. I do not think it is the answer; I never have. I think it is foolhardy and most disappointing. I think that the people of South Australia have been absolutely conned with this bill. I think it is a nonsense.

I look forward to the day when we sit on the other side of the house when, once again, we can fix up another mess like we did with the State Bank and God knows what else. What the government has done, in my view, with this bill is that it has forgotten the fundamentals. It all about people, and people have been forgotten. I think that the mandarins that run around on the top floor of the health department building in Hindmarsh Square would not know what people look like, quite frankly. All they care about is numbers and power and things such as that.

It is with a great deal of disappointment that I see the ultimate demise of boards. Earlier on the member for Schubert talked about the federal government’s idea of maintaining boards in hospitals in South Australia, and I fully support that as one who has been a member of a board for a long time and who has put in a lot of hours. I know the value of boards and I think that what is happening is damned stupid quite frankly. The Prime Minister is on the right track coming out with that statement.

I think it is a sad day in South Australia when country hospitals and those in the metropolitan area are going to be screwed by this bill. We will have people sitting in that glass tower in Hindmarsh Square calling all the shots and riding roughshod over everybody. I hope they do not treat them as arrogantly as I am led to believe they have been lately. I think it is just a dreadful step backwards for South Australian health. We are going to wear it whether or not we like it.

The people have been forgotten. Over the next couple of years, I will be casting a fairly close eye over what happens and how people are treated. I tell you this: I will only have to get messages about ill treatment by administrative staff or senior bureaucrats and, believe me, I will be naming and shaming them in this house. They will wear it because what they propose is absolutely, totally and fundamentally wrong. It is just stupid and out of touch. It lacks the common touch and forgets all about people.

Mr HANNA (Mitchell) (17:00): I speak today in relation to the reforms to the health sector that the government is bringing into parliament. I have followed the debate about health care reform over the last few years. There was great promise in the Generational Health Review, led by Mr Menadue a few years ago. I am not sure that all the ideals of that review have been achieved, but this legislation is part of the process of implementing that review.

One of the most significant changes is to abolish the hospital boards; we will now have advisory panels to represent the interests of consumers. I acknowledge that, to some extent, there is a need for ministerial control of the hospitals and other health care agencies because, ultimately, the minister of the day will be politically responsible for what happens in the health care sector, so I can understand the government's reasoning. It remains to be seen how well these advisory panels will work. In my view, it will certainly be important to retain a healthy (pardon the pun) consumer representation on those panels.

The experts, including doctors, surgeons and all variety of health professionals, sometimes lose sight of what it looks like from the other end of the stethoscope. The interesting thing in terms of health care in the electorate of Mitchell is that I am receiving a lot more phone calls about dental care than probably any other aspect of health care services. From time to time, I receive calls complaining about waiting times at the Flinders hospital. Indeed, I had to take a family member to the Flinders hospital last year. I forget how many hours it was before a proper diagnosis and admission, but it was probably a couple of hours before they saw a doctor, let alone receive diagnosis and treatment.

So, I certainly feel for those who are ill and wait for hours to get proper medical attention. It does still happen. Perhaps it is inevitable that it happens sometimes, but one would hope that we are constantly improving emergency care services at Flinders and in our other hospitals. I know that the doctors, nurses and other staff work extremely hard. At times, they are called upon to work above and beyond the call of duty, but still the demand seems to overwhelm them at times, and that is when the government has to take responsibility for the deficiency.

A related issue to hospital waiting times—and I mean waiting times at the emergency department, for elective surgery and so on in public hospitals, such as Flinders—is the continuing delivery of community health care. For years I advocated the need for a replacement for the Clovelly Park Inner Southern Community Health Care Centre, and I was very pleased when the GP Plus centre at Marion was announced. I was not pleased about the name, and I have conveyed my thoughts about that to the minister. I do not think that there is anything wrong with calling it 'community health care' if it is health care in the community, that is, away from the major institutions.

The other problem with the name is that it has caused some aggravation with the 24-hour GP clinic next door, which assumes that a GP Plus clinic will have GPs competing with its private sector services. I have had some reassurance from the government that that will not be the case, but I have to say that the anxiety remains. It will, of course, be of tremendous benefit to the local community to have a range of non-urgent treatments provided by the GP Plus centre at Marion—perhaps kidney dialysis, counselling of various sorts, minor procedures that can be handled easily and do not require an overnight stay, and so on. We have yet to see how that will shape up. The government has taken a good initiative in building a modern, up-to-date community health care centre, even though, in Marion, it is not called a community health care centre.

I return to the issue of dental care because I really do have a significant number of calls from people, mostly pensioners, who are not happy with the service. From people on the age pension to whom I have spoken about this, I hear that it is not unusual for them to pay up to half their weekly income on a visit to a private dentist. So, to receive timely treatment from the Bells Road dental clinic at Somerton Park is of tremendous value to them. Members of parliament have a fairly healthy pay packet and, if we had to pay $1,000 each time we went to the dentist, we might give more thought to how to make dental care more affordable. So, when we think of old age pensioners paying perhaps up to half their weekly income on a dental bill, it helps us to realise how significant that sort of amount is.

A number of pensioners I have spoken to have been in pain, but have been told that they have to wait many months—perhaps more than six months—to get dental care at the Somerton Park clinic. The alternative is that they go to a private dentist and pay accordingly. In some cases, the clinic has been able to subsidise visits to private dentists, but, as I understand it, at the moment, that funding has run out; so, it is the luck of the draw to some extent.

I can understand that, with the substantial and growing demand for dental care for those who cannot really afford private dental care, there should be some triage or some ordering of the priorities for people who wish to attend the Bells Road clinic. My understanding is that, really, if you do not have some pretty significant swelling or uncontrollable bleeding, you will not be seen urgently. There are a number of people with fairly significant and sometimes painful dental conditions who have to simply put up with it for substantial periods of time. This is clearly an area that needs to be addressed by the government. I recognise that, under previous ministers and under the current health minister, there have been real increases in funding for public dental care. Clearly, the demand is still growing faster than the supply of those services.

The other matter about which I want to speak, while I have the opportunity to speak about health care, is the GP shortage. In the Marion area, as I have said, we have a 24-hour medical service with a number of GPs, and there is generally not a problem in getting in fairly quickly to see at least one of those GPs, even if it is not the preferred doctor. In my southern suburbs—Sheidow Park, Trott Park and Old Reynella (soon, I will be looking after Reynella as well)—there is a shortage of GPs. It is quite astonishing that, in the Marion South area—that is, in the southern area of the Marion council district—there is approximately one doctor for every 2,200 people. The national average is one doctor to 1,400 people, I am told. So, we have a shortage of GPs which is actually more severe than in many country areas, and, yet, often it is in the country areas where we hear about a shortage of GPs, the need to subsidise GPs to move to those areas, and so on.

There is, I suppose, an answer to that. The government could always say, 'Well, those people in Trott Park can always drive over the hill to Marion, or they can drive down to Noarlunga,' but it is not always as simple as that. I do have a number of single car households in Sheidow Park and Trott Park. Quite often, one parent, perhaps the father, for example, is out at work—it may be shift work—and the mother might be left at home with one or two children. When it is essential to get to a GP in a fairly short time to check out a stomach problem, a continuing headache, a vomiting session, or something like that, it is no satisfaction to be required to get on a bus and get there by public transport, or to get a taxi, which the family cannot afford. That is a real issue, and I think the government needs to work with the federal government to address it.

In conclusion, I recognise that this government has taken some positive steps in health care reform. I appreciate the continuing commitment to community health care. There are some gaps, particularly in public dental health care, but I have no problem with the legislation that is today being dealt with in parliament.

Mr GOLDSWORTHY (Kavel) (17:12): I am also pleased to make a contribution to the legislation before the house—the Health Care Bill 2007. I understand that one of the key planks of this legislation is the dismantling of the current country hospital boards, which have served the communities so well over many years back through the generations, and which are being replaced by what will be called health advisory councils. I want to commence by commenting on the outstanding contribution that country hospital boards have made to their local communities. They are made up of community-minded and community-spirited people who have worked tirelessly for their local communities in volunteering their time to the service of their local community through the hospital.

I note the remarks from the member for Giles in her contribution. The honourable member stated that she has not received any real opposition or any real negative comments from her community in relation to the abolition of these boards. Well, it is a rhetorical question. Why would she? Part of the government's master plan is to renovate the Whyalla Hospital into one of these big, super-duper regional hospitals. So why would the member for Giles receive any negative comment, given that the majority of her electorate includes the town of Whyalla? As I stated, her electorate will have a new, big, flash regional hospital built there.

It is my opinion and also that of a number of people in my electorate, that what has happened over the past months and years is that those representatives of the local community who have sat on hospital boards have really been worn down by this whole process to a point where they have basically said, 'Oh, well, what's the point? The government's going to do what it is going to do. We're just going to hope for the best. The way the legislation will pan out is that our communities will hopefully not be negatively affected.' I think that the opinion of those people in my local community in the Adelaide Hills is that they have been basically worn down to the point where they have run out of the energy needed to argue against the proposed legislation. The bureaucracy and the government have just steamrolled through the process, and we see the legislation now before us.

Abolishing hospital boards means that the role of volunteers in the community will be significantly diminished. Other speakers (particularly members on this side of the house) have given quite accurate critiques on how the government may well be able to influence the health advisory councils that are to be formed. It really diminishes the role of volunteers, and we have seen that in some other areas of legislation which the government has brought to the parliament and which has, unfortunately, been passed in this and the other place—and I will give some examples of that in due course.

I have two hospitals in my electorate of Kavel: the Mount Barker District Soldiers Memorial Hospital and the Gumeracha District Soldiers Memorial Hospital. The structure currently in place is that the Mount Barker hospital has its own board while the Gumeracha hospital and the Mount Pleasant hospital have the one board that oversees the operation of those two hospitals. One board administering and overseeing the operation of both Gumeracha and Mount Pleasant hospitals has worked very well, and the community has been extremely satisfied with the way those hospitals have operated. Similarly, the Mount Barker hospital board has also administered the operations of that particular hospital extremely well. I would like to take this opportunity to congratulate and pay tribute to all those outstanding members of the community who have worked tirelessly and selflessly for their communities for the contribution they have made to those hospitals in my electorate.

As the member for Finniss highlighted, you could say that this is socialism at its best (if you want to take that angle) or at its worst. It is about centralising control, and we have seen it in other areas of legislation that this government has brought to the parliament. A striking example of that was the establishment of the natural resources management boards, where the role of volunteers has been diminished and these huge monolithic bureaucracies created that are questionable in their achievement of any outcomes in managing natural resources within the state. The current Minister for Health was the minister for environment and conservation at the time that legislation passed through the parliament, and I think it was to the credit of the Liberal opposition that it moved hundreds of amendments to try to knock that piece of legislation into some semblance of order.

Another example is the establishment of the South Australian Fire and Emergency Commission (SAFECOM). The opposition strongly believes that the role of CFS volunteers was diminished in that whole restructure. It wanted CFS volunteers to actually have a position on that board, but the government vehemently opposed that and the CFS Advisory Council (as I think it is called) is now hooked onto the side giving some advice to the board, but it depends whether or not they want to take any notice of it. These are striking examples of how this government is centralising control, showing the true colours of its socialist agenda. It is social engineering at its worst or best that takes away a significant contribution from the community through the volunteer sector and places it with a government department and bureaucrats. Government members can argue all they like, but that is the reality. It is disempowering local communities and centralising control in what will be an enormous bureaucracy called Country Health SA.

I would like to continue my remarks in relation to part of the so-called master plan (and there is a big question mark over that title) that the government has for restructuring the health services in this state. We have seen its major announcement in terms of building the new hospital at the City West precinct (the so-called Marjorie Jackson-Nelson hospital) and also its announcements in developing Whyalla, Port Lincoln, Berri and Mount Gambier as large regional hospitals, and I want to give an example of how that will not service the regional districts. The member for MacKillop highlighted that in a speech he made to the house last week, I think, in relation to a motion moved by the opposition. He cited the example of a mother who lived at Cleve (an inland town on the Eyre Peninsula), who was not able to avail herself of any services for the impending birth of her child

She had to travel to Whyalla or Port Lincoln. No postnatal services were available at the local health service. No doctor, from my recollection, was able to give any postnatal treatment to this lady. This particular lady, who lives and works with her family in the middle of Eyre Peninsula, had the inconvenience of travelling some distance to seek medical help. Whilst on the surface the redevelopment of these regional hospitals might be attractive, the manner in which the services will be delivered to those communities that are removed from these regional services is a serious issue.

That takes my focus to one of the fastest-growing regions in the state, the Adelaide Hills, of which I represent a reasonable proportion. We see that the state's population in itself is not growing significantly. I know that part of the government's Strategic Plan—or some such thing—is to grow the population to two million people by whatever the target might be—2050 or whatever the airy fairy target is. At the moment we are not seeing the population growing to any real extent in the state; however, what we are seeing is significant growth in the population in the Adelaide Hills.

A recent announcement is that the Plan Amendment Report of the District Council of Mount Barker has been approved, and we will see at least 1,000 new homes built within the Mount Barker township. That is a significant population shift from around the state, presumably from the Adelaide metropolitan area. If the state's population is not growing but you can see a population shift into the Adelaide Hills, my understanding is that one key recommendation of the Menadue report is that you deliver health services to where the population is.

What we are seeing is a population shift into the Adelaide Hills, and 1,000 new homes. So, arguably, there will be 5,000 new residents in the Adelaide Hills based in and around Mount Barker. But what are the government's plans for improving the health services at Mount Barker Hospital and the Adelaide Hills Community Health Service? Tell me that, minister? I wrote to the minister several months ago—probably a year ago now—asking that question.

The Hon. J.D. Hill: What was the question?

Mr GOLDSWORTHY: What plans have you in place to meet the needs of the growing population in and around Mount Barker? Obviously the minister is not aware that this letter was written, but to his credit he instigated a report into that issue. That report and review has been carried out, and I have it here with me. It is entitled 'Great Expectations'! ‘A Review of the Pressures Impacting on Delivery of Health Services to Mount Barker and Surrounding Districts’. It is quite voluminous, minister. I was able to obtain this report through freedom of information, and it contains some quite interesting facts, figures and recommendations. There are 17 recommendations—

Ms Chapman interjecting:

Mr GOLDSWORTHY: No, none have ever been implemented. However, this document refers to another document with which I have not been furnished and which is called 'the extract'. I understand that the extract also has some quite interesting information. I was disappointed that my FOI request really was not completed in the way I requested. I asked for all documents, files and reports in relation to the review on service pressures in the Mount Barker district. I would have thought that all files, reports and other documents would have included the extract. I will look to FOI for that document. As I said, this document refers to the extract, and I will make an FOI request for the extract so that we have, perhaps, a clearer understanding of what the recommendations may be.

In terms of the pressures on health services in the Adelaide Hills, particularly at Mount Barker and the surrounding districts, as a result of the growing population what we need is an integrated health service. We need an expanded GP clinic. We have got a GP clinic which caters to patients outside normal consulting hours and which is located within the Mount Barker Hospital buildings. I understand that that was as a consequence of the federal government's providing the required funds to enable an after-hours clinic. I think the clinic is open until 9 or 10 pm. Really, what we need is an expanded service of the current facility, and there is ample area. I think that the total hospital site is about four or five hectares and, perhaps, only two-thirds or even half that area has been built on. There is open space for further infrastructure development.

Another part of integrating the health services would be building some specialist consulting rooms. The information I have received from people in the district is that specialists would be more than happy to come and consult with patients in those rooms. So, it is my wish that the head of Country Health SA, Mr George Beltchev, takes notice of this report entitled 'Great Expectations'. That title in itself says something, that the district has expectations—great expectations—of the government and Country Health SA. I will be keenly interested, and so will the community, in what services will be delivered as a consequence of this report. As I said, I congratulate the minister for initiating the report, but I certainly hope it is taken notice of and not just filed on a shelf somewhere in an office to collect dust, because that is the risk we run.

So, if the government ignores the contents of this report, it is not facing up to the reality of the situation. I could speak about other issues in relation to that particular matter. I know I am digressing here, Mr Speaker, but transport infrastructure needs in the district are being ignored. If the government and the bureaucracy and the department is fair dinkum, honest and open in their attitude towards delivering an improved level of health service to the Adelaide Hills and surrounding districts, they have to take notice, and a considerable amount of notice, of this report and implement the recommendations.

Mrs PENFOLD (Flinders) (17:32): I speak on behalf of the constituents in my vast electorate of Flinders who, once again, are the victims of this government's citi-centric mentality—a government who, even today, admitted that 250 jobs will be removed from the region back to the city on another similar efficiency upheaval, with no understanding that one job lost in the country has a multiplier effect of at least six times, effectively leading to the loss of around 1,500 jobs in regional areas. A job lost in the city means the person gets another job in the city, whereas a job lost in the country means that they and their family have to leave, thereby affecting the whole regional economy. The Labor government, whose ethos is supposedly based on social justice, has again thrown justice out the window to favour itself with the metropolitan bureaucracy. We continue to hear rhetoric about the importance of the country regions and the value of the thousands of regional volunteers and how much they contribute to our state, but now, with one broad brush stroke, this government tells us that our volunteer board members really are not up to it, they do not cut the mustard, and they certainly are not intelligent enough to give proper governance to our hospital system.

Certainly, let us make volunteers feel good because they can go on an advisory board to provide advice to the minister about what is needed in their area, but it is only the minister and city-based bureaucrats who will be making any decisions. In fact, the board members will be gagged by the government from making any adverse comments to the very people they are supposed to be representing. It is laughable that these advisory boards will supposedly have access to the minister. What does that actually mean? Based on experience with the way government bureaucracies work, the minister will be even more removed from access to the people on the ground. But then, cynically, one must remember that it is the minister himself who will be appointing his HAC members, so perhaps we should expect some Yes Minister stalwarts who will not question the government bureaucrats or lobby for the local community. Heaven forbid that we have people who might rock the boat or expose shortcomings.

The gagging of customer advocacy groups under this government with withdrawal of funding continues (look at Consumer SA, Respond SA and the Australian Aiding Children Adoption Agency), as does the gagging of departmental employees, my most recent example being the government scientists who are not allowed to publicly comment adversely about the proposed Whyalla desalination plant. Even the press is being gagged wherever possible, with the Sentinel newspaper and ABC journalists in the last few days being advised that they could not attend SA Water consultation meetings being held across my electorate. It was 'invitation only' to what should have been meetings open to the public. One of my personal assistants and his partner, who did apply for an invitation, did not get a response and did not know that the meeting was being held. I suspect they were weeded out as undesirables.

I am sure this government would be happier with all South Australians living concentrated in the confines of our City of Adelaide, using the super-efficient super hospitals and super schools or, at the very most, living in the regional cities. Everyone else is just a huge inconvenience. But, of course, the government does not want to do away with our volunteers, because who else is going to continue to privately fundraise to help keep services in the region, man the phones and the ambulances, not to mention the home support and transport services, and keep people in the bush earning the taxes and paying the charges and endless levies needed to support city bureaucracies? People in regions do not complain for complaining's sake. We do contribute significantly to this state's coffers. However, we are increasingly becoming more and more ignored.

Smaller country hospitals have been omitted from South Australia's Health Care Plan 2007-16, leading to the assumption that these hospitals are of no concern to the Labor state government, which actually appears to be planning for their demise. As the Lower Eyre Health Service stated, 'Generalities stated within the plan about country South Australia and, in particular, about smaller community hospitals in rural areas have meant that limited details are creating concerns about the implications of the entire health care plan.'

These concerns and assumptions are reinforced by past Labor action when previously in office. Labor made a start of downgrading country hospitals, but such was the outcry that the plan was suspended. In the meantime, we had a Liberal state government that supported and strengthened country hospitals and retained acute care services. A state government that governed for the whole of the state was greatly appreciated, and is being sorely missed. It is an indication of what would happen under a Labor federal government.

Small country hospitals that have been established through the tremendous sacrifice of those living in the district in order that their communities could have localised health care on Eyre Peninsula are clustered together to help gain further efficiencies. They work together in an integrated process of management and delivery that reduces wastage and management costs, but that is not what Labor really wants. Labor wants control, just as tyrants and dictators seek absolute control. Now, with the new hub concept, only Port Lincoln, Ceduna (some time in the future) and Whyalla are to be upgraded to provide services for the Eyre Peninsula region. Even then, will the state government really provide the funds needed?

In Port Lincoln, many services are now inadequate. The dialysis service does not even provide for the local need, with people having to go to the city. There are no resident psychologists and, even with a local gaol, no forensic psychologists. Mental health across the region, with the drought, is at crisis point. Many of the small regional hospitals elsewhere in the state are private hospitals, and I am beginning to think that this is the only way in which we will be able to keep adequate health services in our regions, particularly if the federal government will provide some help; otherwise, they will become aged care homes. The federal government has already provided the Wudinna and Tumby Bay hospitals with the funds to build properly equipped modern health centres.

I personally thank all the volunteers who have served so faithfully and well on hospital boards and auxiliaries. The work they have done for nothing in the country will have to be paid for in the city under Labor's empire building.

The Chairman of the Generational Health Review, Mr Menadue, is quoted in The Advertiser as saying:

The long-term solution must be to get people out of hospitals and develop alternative areas of care in terms of super clinics that can attend to minor surgeries, minor accidents, and a whole range of services.

However, without acute care hospitals and doctors, there is no trained person and no equipment to attend to minor surgeries, minor accidents and other matters. Mr Menadue's use of the words 'super clinics' shows his aim quite clearly—an aim that has been adopted and is now being pushed by Labor, since it fits with its party's ethos of controlling everything. Super clinics will not exist in the bush, and the outcome will be a drop in health care as people try to treat themselves, which often has disastrous results, rather than seek medical help that is hours away. We already have a higher death rate than those fortunate enough to live in the city, and this bill will only compound the problem.

This is the state of health delivery that this government is trying to put forward as an advance. It will not meet the current challenges and demands of health—at least, not in the country—which is one of the claims made by the government with respect to the necessity for the changes. On Eyre Peninsula, we already have an excellent system of home and community care, which is funded by state and federal governments. A comment was made to me that the city just does not have the volunteers to provide the kind of service that we are able to provide at a minimal cost in the country, where every dollar is stretched far beyond what is the case in metropolitan areas.

This bill shows yet again that Labor cannot be trusted. It is yet another example of Labor's deceitfulness in making public statements along one pathway while planning the opposite action. The government's health reform documents, which were published in June 2003, stated: 'There will be no forced closure of local boards in country South Australia.' Not only is closure on the agenda, but the total abolition of local boards is the aim of this government—and, dare I say, the complete abandonment of small country hospitals for the delivery of acute health care, including obstetrics.

Small country hospitals have worked together cooperatively in management and service delivery for many years. Each country hospital is a centre for its respective district, providing a mantle of safety to that particular region. I use the phrase 'mantle of safety' deliberately. It is a phrase that was used by the Reverend John Flynn to describe his vision for what became the Royal Flying Doctor Service, bringing health care to remote and isolated Outback South Australia. This is happening at a time when, because of the hub system proposed, retrieval of patients back to the bigger hospitals will be needed more than it ever has been since the small hospitals were first built. These retrievals are mostly carried out by way of fixed wing aircraft on Eyre Peninsula, and the local hospitals have to pay for them. I ask the minister: who will pay for them now? At the briefing we were given, the bureaucrats were unable to tell me. I do not think that they would have been aware that the cost is not covered (as are helicopter retrievals close to the city) by the government through the emergency services levy.

It has been proved many times over that the most effective, efficient—and, in the case of health, safe—management, is where decisions are made as close as possible to the action. This government's blinkered and inflexible move to centralise everything is a recipe for poor service delivery at the coalface, inevitable waste and mismanagement through the layers of bureaucracy and, ultimately, a reversion to a Third World standard of health care delivery for those who live in the geographic majority of the state. With the increase in mining activity, it would seem to be commonsense that our country hospitals and health services should be maintained and increased, not slashed to non-existent. The Lower Eyre Health Services submission on the Health Care Bill to the Minister for Health states: 'Limiting the effectiveness of any region through eroding its health services has significant implications for the future survival of these regions.'

The government has failed to state how a unified single public health system will improve the coordination and integration of services in country South Australia. Government bureaucracy is noted for its poor financial performance. This lack of financial performance cannot be laid at the feet of departmental heads and staff, since they are constrained by a great many (often petty) rules that they must obey and, of course, the minister, or ministers, who also have a big say in the management. Local boards know about the increased costs of time, travel, training, freight and recruitment in country areas. However, the 'one size fits all' scenario is this government's requirement.

Certainly, this bill gives the minister great control, which may be exercised against the advice and commonsense of departmental officers and local knowledge. In fact, by the time the various councils and committees are set up, more of the scarce health dollar is likely to go into administration located in the city than is now the case. The sweeping changes in governance issues are not being put in place to save money or to deliver better health care but only to fulfil the Labor Party's culture and goal to centralise and control and, ultimately, to eradicate freedom.

The changes to the ambulance service again demonstrate the city-centric, limited outlook of the Labor government and ministers. It is obvious that they look at ambulance services as vehicles being driven by paid personnel over sealed streets to transport people from home to hospital, or to attend accidents—which, again, occur on sealed roads. Country ambulance services are provided by volunteers: no volunteers, no ambulance. Volunteers undergo training, giving freely of their time and expense, to gain accreditation for their communities at no charge. Driving in all weather on unsealed country roads for hours, not minutes, requires expertise that drivers do not always have and, therefore, it presents dangers not found on sealed roads. A driver unused to corrugations, for instance, can easily overturn a vehicle, and this happened to a Swiss couple on an outback South Australian road and the couple and their infant were killed.

The recent fatality that occurred on the unsealed Wirrulla to Glendambo Road outside of any council area was attended by Streaky Bay's volunteer ambulance service. They had to drive to the accident, deliver first aid, then drive back to Ceduna Hospital with the victims and then back to Streaky Bay before returning to their homes or place of employment, a distance well over 40 kilometres.

Emergency services work and train together, each appreciating the skills and responsibilities of the various services. This close working relationship will not be enhanced by the proposed changes; however, it may be put in jeopardy by an extended chain of command. It is easy to see why Labor does not want local boards of health since this would erode their control, but it is the seamless delivery of health care that boards provide, including links to the areas that are seldom written into law. One of these areas is the contact between the public, the health services of the hospital, ambulance or whatever, and the decision makers.

The local board is the primary point of contact between consumers, carers and the community and the local health service. The proposals for advisory councils do not adequately pick up this role. It has been recognised for decades that the advances in medical science mean that no government can ever fund health so that every procedure or treatment that can be done scientifically can be paid for. In other words, choices about what is done and where the health dollar will be spent have to be made.

Therefore, it is more imperative now that the hospital auxiliaries and support groups continue their volunteer work and fundraising activities. Port Lincoln hospital is classed as a regional hospital, yet fundraising is essential. A local doctor in Port Lincoln paid for an expensive machine out of his own pocket so that he could treat his patients. This is not an isolated incident. Hospital boards are being duped into becoming fundraisers rather than the local linkage between consumers, carers and the community with the responsibility to maintain and develop local priorities.

The current strong connection between the hospital board and the community spills over into the greater support for volunteer ambulances, St John's, the CFS and the SES services and the like. Local contact encourages residents to volunteer for their health services. Overall, this bill is another example of Labor's ability to increase bureaucracy and the number of public servants required to administer the bureaucracy in the city with a corresponding decline in the number of workers at the coalface. Our state and our people deserve better.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (17:48): I thank all members for their contribution to this debate thus far. I intend to make some statements which I think will probably take me 20 minutes or thereabouts, so I will seek leave to conclude my remarks after the dinner break.

I start by saying that the major contributions made by members opposite relate to the provisions in the bill to change the power and the name of the country health boards, so the majority of what I have to say relates to that. I put it on the record that this bill is about more than just the governance arrangements associated with country hospitals. This is making contemporary health legislation in South Australia and, of course, it deals with the ambulance services and a whole range of other matters.

I say to the house and to all those reading Hansard that the government comes to this legislation not with a political agenda in the sense of a party political agenda nor with an ideological agenda—that is, that we are somehow socialising the health service—far from it, in fact. We come to this legislation and the health portfolio with the agenda to make our health services sustainable and to make them integrated in order to provide assurance in relation to health care in South Australia wherever you happen to live.

I could sum it up by saying that we want a safe, affordable and complete health care system in South Australia and that very much derives from the work that was done by John Menadue who produced the Generational Health Review for us. We want a health system which is safe so that, when people go to a hospital or a health clinic somewhere in our state, they can be assured of getting the very best service with the minimum risks associated with the provision of that service. We want it to be affordable, not only to the individual—and that is certainly a key factor, and the member for Mitchell raised the issue about dental health care—but also affordable to the state.

We know now in South Australia that the cost of the provision of health care services through the public system in South Australia is growing about 8 to 10 per cent a year (that is about twice the rate of the revenue basis of our state) and we know that by somewhere around 2030 to 2040 our entire state budget will have to be spent on health if we are to continue providing the same kind of level of health services in the same way that we currently do. That is not sustainable and it needs to change.

It needs to change in a couple of ways. First, we need to have a much more efficient and effective system in place to provide health care in the best possible way so that we can get the best bang for our buck. The second thing we need to do is change the focus of our health services away from the provision of acute services to the provision of primary health care and, particularly, prevention. A whole lot of strategies are in place through the GP Plus health care system which is aimed to that end. This legislation is not about all of our health reform package but it is a significant part of it, particularly as it relates to governance.

I want to refer to the issue of the country health boards, the matter which has caused the greatest amount of concern for members opposite. I would hope that they would actually think about this and listen to this. We do not want to get rid of community advocates associated with local country hospitals, far from it; in fact, we want to strengthen their role.

What we want to do, what I want to do and what the government wants to do is make sure that we have better systems in place to manage four key areas that are currently the province of the local boards. They are: first, safety and quality issues, or safe performance of health care; secondly, financial management; thirdly, employment situations; and, fourthly, contracts. I will give some examples of where the current system has failed and failed people in country South Australia quite badly.

Before I get into that, I say one other thing about the new health advisory councils proposed by this legislation. The reality for members of country health boards at the moment is this: they go along to a meeting, they are elected to the board, they serve a period of time, and they attend the hospital for a meeting on a regular basis (usually once a month or so). They receive reports from the general manager of the hospital and from other officials. They look at the budget, they make a range of decisions, based on advice from the CE of the hospital, and then they go back to their homes. The chair would probably be more actively involved, and there would be a secretary, a treasurer or other key members of the board who would have greater involvement.

Effectively, that is what they do: they receive reports from the hospital, from the people responsible for the day-to-day management of the hospital, and they say yea or nay. They operate very much in the way school council members operate: they meet the principal, they look at the budget, they get advice about particular programs, they express their opinion in relation to a number of things, and then they go home and come back in a month's time. In the proposals I have before the house, the real changes will be negligible because all those things I have described will continue to be the experience of people on the health advisory councils. They will go to monthly meetings, they will receive reports and the budget, and they will get advice about the overall policy framework. They will be able to have input into what they think the strategic direction of the hospital should be, they will have input into the grounds and they will have input, in particular, into the selection of the senior staff. All those things will stay the same.

The reality for individual members of health advisory councils will be just the same as it is for those who are currently on the boards. The only difference will be that the statutory responsibility they currently have for the management of the hospital when things go wrong will be removed from them. We will have a system in place so that that responsibility will, ultimately, end up with me as the responsible minister. The minister of the day is the person who comes into the house and is answerable for things that go wrong in our health system, and I think it is appropriate that that is the case. At the moment, in relation to country health, the individual boards are responsible for things that go wrong.

During debate, a number of members on the other side raised issues of concern about things that were not as they would like them in country hospitals. In fact, I think that the member for Kavel and a number of others raised the issue of the provision of birthing and other services at the Cleve hospital as an example of something that was not working. I say to that member: that is part of the system we currently have, where we have a local board. The local boards are responsible for all those things and, clearly, they are not able to manage them because they just do not have the resources or the capacity to try to deal with those kinds of complex issues in a modern health system. The system I propose will help provide a system-wide approach of dealing with those complex issues. It does not necessarily mean that every hospital will get everything it wants, but at least we will have a system in place where there is some clarity about what you can expect and what can be delivered.

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: Thank you for your protection from some of my colleagues, Mr Speaker.

Mr Venning: Rabble!

The Hon. J.D. HILL: I would not use that word, but you might. Another general point I make before going into some of the detail is that a number of members opposite said that this is the government trying to centralise the management of the system. That is not the case. The existing regions will continue. There will be a central northern region, a southern region, the children's, youth and women's region, and there will be a country health region. Those regions will still be the decision-making bodies. At a hospital level, at an individual unit level, there will still be managers who will make decisions at that level. There will also be clinicians who will make decisions of a clinical nature in hospitals, in wards and in surgeries on an individual basis. That is not changing at all. We are not centralising the process. What we are centralising is the responsibility. The buck has to stop with the government, and we need a system in place to ensure that that is the case.

In the Generational Health Review, John Menadue identified the need to re-orient efforts to prevent illness, provide greater primary health care and reduce the emphasis on acute care in hospital services. In relation to country health services, he found that there was considerable duplication of effort, with separately funded planning, advisory and governing bodies which made decisions about health which had little impact on improving health outcomes. We dissolved the seven health regions last year and created Country Health SA, which brings together the administrative elements of the seven country regions with the administrative element that was in the Department of Health. Effectively, we have taken out a layer of bureaucracy in the management of country health.

We have also announced expanded health services in four country hospitals: Whyalla, Port Lincoln, Mount Gambier and Berri. Surprisingly, a number of members commented on that decision in a negative way. I would have thought that the provision of more services in the country would have been welcomed. The decision to expand services in the country does not mean that just those hospitals will have expanded services. What we would like to see is those hospitals become locations from which doctors, who are based in those locations, can travel to other hospitals and nearby regions and provide services on a regular basis. For example, an orthopaedic surgeon may well be based at Whyalla who can travel to other towns and, on a regular basis, provide surgical assistance to those communities through those local hospitals, if there is sufficient demand and sufficient capacity to aid patients in the recovery stages.

So, rather than taking services away from country hospitals and putting them into major country hospitals, we want to take services out of the city and put resources from the city into the country to expand the capacity in those country regions. The new Health Care Bill is the next step in creating greater integration and coordination of services across rural areas, with common standards and policies for its safety and quality, common corporate systems and the equitable distribution of resources based on population need.

[Sitting suspended from 18:00 to 19:30]

The Hon. J.D. HILL: I was going through some notes which reflect upon the reasons for the government introducing this bill, and I will go through them reasonably rapidly. There are a number of things that I want to put on the record and then there are some comments I want to make which respond to statements made by other members, and I will go through those relatively quickly, but I do want to get them on the record.

The new Health Care Bill is the next step in creating greater integration and coordination of services across rural areas, with common standards and policies for safety and quality, common corporate systems and the equitable distribution of resources based on population need. We need consistent mechanisms to work with rural doctor organisations, local government and the federal government so that we can attract the best doctors, nurses and allied health workers to staff our country hospitals. Gone are the days, I believe, of stand-alone hospitals run by volunteer boards. Health is far too costly, too complex and too important for that.

We know that many of the boards have done a terrific job, and I do commend them and advocate hard for their communities, but things have changed and moved on. We cannot afford to let our country health system continue in the way that it is being run at the moment. Local community members will continue to play a vital role in health, advising me and the Department of Health on the priorities for the local area and shaping the services needed.

I will just pick up a couple of points made by members opposite, who may not have had a chance to read the draft constitutions which I have tabled. I think there is a misunderstanding amongst some members opposite that the minister of the day will be selecting members of the health councils. That is not the case. The majority will be elected by the local community, similar to the way boards are now elected. The local doctors will have a rep, the local government will have a rep, the staff will have a rep and the local member of parliament will also be able to participate or have a rep, in much the same way that secondary school councils have parliamentary representation.

That will give local members of parliament a very strong role to ensure that the HACs do their job and are not denied access to knowledge and information. In addition to that, the minister of the day will be able to appoint three persons. That is similar to the powers that the minister currently has in relation to at least some of the boards. At the moment, the boards have a whole range of constitutions, so this will, in fact, standardise the constitution, but the majority of members will be chosen by the local community.

I will look at some of the issues that have come to my attention over recent years in relation to individual country boards. I have to say that we have 40 or so country boards in South Australia at any given time, most of them probably doing a pretty good job, but there are occasions, too frequent to ignore, where individual boards have not done a good job. I will go through some of those examples. The member for Giles, I think, highlighted the fact that there have been a couple of occasions recently (in the last 12 months) which have resulted in bequests not being used consistently with the terms of the bequest, and that has led to successful challenge and the loss of the bequest, worth nearly three quarters of a million dollars on one occasion. The other required Supreme Court approval to change the way the funds are used. That highlights, for me, the need to ensure that the financial management systems are system wide, rather than just specific to individual hospitals.

In relation to clinical governance, there has been an inconsistent approach across many country health sites. The example of the Riverland hospital where colonoscopies were done on something like 200 people without the piece of equipment (the colonoscope) being properly cleaned, was the result of a failure at the hospital level. I went and spoke to the board about it and, of course, they were very upset about it. I said, 'It was your responsibility to ensure this happened.'

Two things had happened in that case: one, the best practice protocols about the management of inspections of systems had not been complied with, so for 12 months the mistake had not been picked up because those protocols were not being followed; and the colonoscope itself had not been cleaned properly because the staff in the hospital had not been trained properly. That was clearly a responsibility of the individual board. Fortunately, nobody had AIDS, nobody had an infectious disease which could be passed on, but we could have had a disaster where 200 or so people could have been seriously affected.

There was another example at Wudinna, where all sorts of allegations regarding nursing staff and the resident GP came up. The review, as has been said before, found a lack of appropriate leadership and management practices over a number of years and recommended corporate governance training for all board members, annual board performance reviews, and performance reviews for all executive and management staff. These are examples where local boards just did not get it right and problems occurred. It is no good for members opposite to come here, as they did in relation to the Wudinna case, asking questions of the minister of the day and accusing the government of failure, when it was precisely the structure that we have in place which meant that the minister of the day was not responsible. It is to address those kinds of issues that I have introduced this legislation.

In the case of Wudinna, medical and nursing care did not meet contemporary standards at that time. There are other examples of country hospitals not having in place proper drug protocols for morphine dosage and administration. A coroner's inquest into the death of one patient recommended that all hospitals be sent copies of the morphine administration protocols used by the RAH, and that was done, of course, in July last year. In relation to the recruitment of staff, there are many examples of difficulties that boards have faced in recruiting and negotiating contracts with staff.

At times boards have not understood their corporate roles and responsibilities, and this has resulted in some boards negotiating outside of government policies and delegations. We all know about the Gawler obstetricians at the Gawler Health Service. That was just an appalling situation. I do not blame exclusively the Gawler Health Service. I think that, with the regional board and the department itself, there were problems at all levels. I think there was a confusion of responsibility that produced those problems.

We have had examples at the Mount Gambier hospital where a South African specialist, who was recruited from New Zealand, arrived at Mount Gambier hospital, changed his mind and returned to New Zealand on the next available flight. There is another case of a doctor who was recruited at Wudinna from India, and left within a week. The director of nursing hired by the Lameroo community fled before a welcome party was held. These are examples of recruitment and management of staff. They are issues that I think need to be managed at a departmental level.

Another example involves poor contract negotiation, which led to the delay in pursuing a tender for medical imaging services at a large major country hospital. It almost led to the hospital being without an imaging service. Because of its frustration at the delays in managing the contract, the company involved was about to set up a new service in the town, which would have meant that the hospital was excluded.

The department found out about it, and we intervened and fixed it up. I spoke to the chairman of the board, and he said, 'Well, we weren't told by the general manager', and that is precisely the point: boards are not necessarily hearing all these things. If we had had a strong management structure in place, that general manager would have had to report to somebody in Country Health, and there would have been supervision.

I want to make sure that major contracts, employment, financial management, and safety and quality issues are all managed at an appropriate level; that is, at Country Health SA level, not at individual board levels. The Health-Care Bill will give greater authority in those areas. Those areas are crucial to the management of the health service and to the delivery of better health services for people in the country. The existing arrangements for those examples that I have given have been disastrous for country communities. In every case, it is the state government through the Department of Health that has had to intervene and fix a problem that has occurred because of the decisions that were made at the local level.

I now refer to some of the particular issues raised by the deputy leader and other opposition speakers. The deputy leader raised questions about increasing the powers of the chief executive and the minister. I advise the house that it was the Hon. Dean Brown, who was the then Liberal minister for health, who transferred the powers of the Health Commission, under the Health Commission Act, to the minister and the chief executive of the department, leaving the commission with residual functions around standards of public and environmental health. Effectively, the Health Commission has been gutted as an organisation for quite sensible reasons. I do not criticise Dean Brown for doing this: he did it for very good reasons.

He also amended the Health Commission Act to give the minister power to direct incorporated hospitals and health centres, and there are very complex provisions in the act to do that. He recognised, as has every health minister in recent years, including minister Armitage, that the current system is not working and needs to be improved.

There are clear and strong community expectations that the Minister for Health be accountable for the public health system, as I have said many times. The buck stops with me. I come in here and get to answer the questions. We would have an absurd position if one took seriously the existing arrangements where I deferred every question back to the board and said that I was not responsible for that as there was a board in place. That would be the outcome if Prime Minister Howard had his way.

In addition, the bill provides for transparency and accountability if the minister uses the power to transfer services or property assets, or to dissolve or amalgamate HACs. These mandated requirements include consulting with HACs, as prescribed in regulations; be satisfied the community is being consulted; have prescribed grounds for dissolving or amalgamating; require remediation before transferring property; and give two months public notice in the Gazette before transferring property.

It was the Statutes Amendment (Public Sector Employment) Act of 2006, passed last year, that gave powers to the chief executive to employ and allocate staff. Largely that issue has been managed and this act brings it into line with those provisions. There has been a lot of talk about the bureaucracy. The total staff employed within the health sector is just under 27,000, of which 711 (or 2.7 per cent) are in central office, so there are a relatively small number of central office bureaucrats. It is interesting that the opposition—

Ms Chapman interjecting:

The Hon. J.D. HILL: I am just about to get to that. It is interesting that the opposition criticises the health system for having too many bureaucrats yet, when we try to centralise the services, as minister Wright is attempting to do, we get criticised for taking public servants out of regional areas: you cannot have it both ways.

The second issue I refer to is the Health Performance Council. The deputy leader indicated that the HPC would be relying on data provided by the department, which could be skewed. She also indicated that the HPC would not be independent, because it would be supported by the department rather than having the ability to employ its own staff. The Health Performance Council will be provided with the same data the department provides for national reporting purposes, including the commonwealth Department of Health and Ageing, the Australian Institute of Health and Welfare and Australian Bureau of Statistics, and it conforms to national processes and standards.

The Health Performance Council has two or three main roles, one being to provide me with advice that it chooses to give me about issues of the day and another is to provide me with advice about issues on which I ask it to provide me with advice. For example, I would want regular advice given to me about the provision of services, particularly for Aboriginal people, particularly around children and birthing. We need an independent view on that, regularly looking at it and goading us into action. The service itself might provide information on any other service. I am sure the Minister for Mental Health would want regular advice on mental health issues.

In addition to doing those things as part of its regular ongoing role, it would also provide every four years a state of health report for the parliament as well as for the government. That could be akin to the State of the Environment Report that the EPA produces every five years for the parliament. I chose four years so there would be at least one every parliamentary term.

The purpose of that will be not just about the state of the Department of Health but the state of health of our citizenry, covering public, private and all sorts of institutions. It would give us information about how many babies were born underweight, how many children died within the first 12 months—all the statistical information about South Australia and how it relates to our State Strategic Plan. It will be a very useful guide to allocating resources and developing our strategies for the future. It will be used in the same way by government departments as the State of the Environment Report is used.

There was an issue about advice provided by health advisory councils. A HAC will provide advice in the same way that boards have currently been doing. They can come directly to me; there is nothing in between them and me if they choose to use me. In addition, and as I have already said, there will be a local member of parliament or their representative on there, so they have a background way of getting information into parliament if they choose. The bill does not in any way change the value in input of this advice. According to its constitutional rules, a HAC can advocate or promote the interests of its community and provide advice on the provision of health services, programs, issues, priorities, plans or other matters referred to it by the minister or the CE.

The principles outlined in clause 5 explicitly require health services to take into account the needs of people living or working in the country and to engage with the community in the planning and provision of services. It is the advice of HACs in the country regions that will be a primary mechanism to enable service providers to work with the community to ensure that they can apply these and other principles drafted in the bill, and the model constitution tabled in the house enables a member of parliament, as I have said, to be on it. I encourage members to look at those provisions.

The member for Goyder stated that volunteers would be less likely to participate, given that the HAC would no longer own or control the assets. I think that is inaccurate—in fact, I believe it is more likely that we will get people involved—and at this stage I seek to table a document that details all the AGMs held in the period 2005-06. It is a purely statistical document that names the hospitals, the meeting quorum, the actual attendance at the meeting, and who was eligible to vote.

It is worth highlighting that out of the 44 boards, eight failed to get a quorum at their last AGM—and that is where quorums are in the region of 12 to 18 or thereabouts. Another half a dozen or so just barely reached their quorum. I think it would be fair to say that in very few of the boards were there large attendances.

The ACTING SPEAKER (Hon. P.L. White): I ask the minister to clarify whether he wants to incorporate that information into Hansard.

The Hon. J.D. HILL: Yes, I would like to do that. I seek leave to have this information inserted in Hansard without my reading it.

Leave granted.

Annual general meeting information re country health units incorporated under South Australian Health Commission Act 1976

The Hon. J.D. HILL: Ironically, the one board that had a rather large attendance was the Port Lincoln Health Service, which had 46 in attendance while their quorum was 15. The Port Lincoln Health Service is probably the most enthusiastic of all the boards in favour of the reforms that I am making—and I would just like to bring that to the attention of the house.

I believe that taking the burden of responsibility off the boards will allow people to be more enthusiastic about participating in the HACs and allow them to focus on things that communities are best able to do, and that is to do the work that volunteers like to do in country health—support the hospital, raise funds, participate in planning for the site, advocate for their hospital, help select the CE, and those kinds of things (which I think I have outlined before).

I have made the point previously that regions will be maintained under the legislation; we are not actually getting rid of regions, we are just getting rid of the boards that operate within the regions. So it is not centralisation of decision-making: decision-making will still be made at a regional level and at individual unit levels. What will be in place will be a network or system of responsibility links so that the individual hospital or individual health unit is linked to the region, the region is linked to the head office, and the head office is linked to me. So there is a clear chain of command and a clear chain of responsibility, which is vital.

There were various other references made which I will not go through, other than that regarding private hospitals (and the deputy leader made a large point about private hospitals). This bill, with the amendments we are making, is about the public health system: it is not about the private health system. Despite her claims that we are trying to take away the boards and private hospitals (which is not the case), we have no intentions in relation to private hospitals whatsoever.

I merely make the observation that the provisions in the legislation have been around for some time. They probably need to be looked at in the future, but there is no particular agenda or plan to do anything in relation to private hospitals. If and when we do go through the process of amending that legislation, we will do it as a result of close discussion and consultation with the private health sector.

The deputy leader also referred in passing to the number of injured hospital workers. She made the claim that the number had quadrupled over the past three years. I forgive her for making that claim. Unfortunately, it is an incorrect claim. The honourable member was basing it on an article that was in The Advertiser. The data in The Advertiser in 2006-07 was for hospital performance in both registered and private self-insured arenas. The hospital injury number in 2003-04 (which was the first group) did not include the public sector. The first set of figures was the private sector and the second set was both sectors. Obviously, those figures could not be compared.

New claims numbers for public sector hospitals over the past four financial years are: 2003-04, 1,203; 2004-05, 1,195; 2005-06, 1,188; and 2006-07, 1,198. It is a relatively steady performance. There is a slight decrease by a couple over that time so it is trending down. The total health portfolio new claims for the past four financial years are: 2003-04, 1,873; 2004-05, 1,868; 2005-06, 1,719; and 2006-07, 1,768. It is a decline of about 6 per cent over that time.

Finally, the deputy leader talked about the government's commitment to funding the health system. Between 2003-04 and 2005-06, the Australian Institute of Health and Welfare estimated that total health expenditure in South Australia increased by $830 million (14.2 per cent). If we take the last budget into account it is over $1 billion. The state's share has increased by $306 million (20.6 per cent) and the commonwealth's share by 14.8 per cent. In relation to public hospitals, the total expenditure in South Australia has increased by $310 million (20.5 per cent). The state's share of this has increased by $221 million (29.9 per cent) and the commonwealth's share has increased by 11.5 per cent.

The total health expenditure per capita in 2005-06 was $3,912—4.1 per cent above the national average and higher than anywhere except the Northern Territory—which is contrary to the figures the deputy leader brought to the attention of the house. The increase in expenditure which the state provided (over 70 per cent) was necessary to meet the increasing demand on our health system. Emergency department attendances increased by 5.8 per cent in 2005-06, total separations increased by 4.2 per cent and elective separations increased by 7.2 per cent.

An additional $38 million had already been provided for the period 2006-07 to 2009-10 to increase the level of elective surgery activity. In 2005-06, South Australian hospitals were efficient, with the lowest average cost per casemix adjusted separations in Australia (10.8 per cent below the national average). I do not want to suggest that our health system does not need work—it certainly does. This legislation is part of the government's plan to reform, strengthen and better integrate the health system.

Finally, in relation to Country Health, I think the member for Schubert said that there was a cut of $35 million. In fact, the 2007-08 budget of $560 million represented a $55 million increase on the 2006-07 budget. Some savings are required in Country Health, but they will be ploughed back into Country Health for bureaucracies; and, also, we will be getting funding for aged-care beds from the commonwealth (which I understand it is prepared to do in many cases) rather than from the state.

A number of other things were said by various members and I will quickly go through them. In particular, a number of members spoke about their local hospitals. The member for Finniss spoke about local hospitals and how outraged they were. The honourable member mentioned particularly the South Coast District Hospital. I am advised that the chair of that hospital spoke to one of my staff this week and said that the board supports the creation of incorporated HACs to manage assets. He said that they wanted a more informed and timely consultation process and that they support the concept in principle of health reform and regard the bill as progress. I am also advised that the chair of the Kangaroo Island Health Service chose not to make a submission, and indicated that if he had concerns he would have voiced them to me, as the minister, during my recent visit to KI.

The member for Flinders also made some comments about health services. I am advised that the chair of the Eastern Eyre Health and Aged Care Service advised us that she supports the bill now that it provides for incorporation. Her only concerns relate to the future service role but she understands that that is not a matter for the bill. The chair of the Lower Eyre Health Services indicated support for incorporated HACs, wants to select the chair for the HAC, and wants the minister to consult with the local community before changes are made, which we have done. They want the incorporated HAC to hold assets, which we have also done. Mr Tim Scholz, chair of Mid West Health which covers Wudinna, said, I am told, that the bill resolved all specific concerns regarding the role of the HAC and control of assets, the ministerial subcommittee, and supports the bill.

In the case of the member for Schubert, I am advised that the Barossa Allied Health Service generally supports the reforms to the bill but wants HACs incorporated to hold assets. It wants members to be elected by the community, and for the health care manager to be obliged to support and interact with HACs. It indicated it did not want fundraising incorporated in the role of HAC. We picked up all those issues. I am advised that the Northern Adelaide Hills Health Service (which also covers the electorate of Schubert) is also supporting the bill.

As the minister, I spent an enormous amount of time consulting with the various representatives of the existing boards, as did the department. We have had a number of meetings. I set up a focus group, which represented a range of people from various country boards. They self-selected: they were not chosen by me. We worked through the details of their concerns, and I am pleased to say that I think the overwhelming majority of the people are satisfied with the direction we are taking. Many of them are enthusiastic, some less so. Only three or so boards of which I am aware are openly opposed to it. The great concern for many was that the assets should be held by the local board, and we have set up the system in such a way that the incorporated health advisory council will own those assets and will have absolute control over how those assets are used.

I think we have worked very hard to make sure that the local board members have had proper consultation and have had a strong opportunity to have a say. I am very confident that the balance of the legislation picks up their concerns and will provide them and people in country South Australia with a much stronger health service over time. I commend this bill to the house.

Bill read a second time.

Committee Stage

In committee.

Clause 1.

The Hon. G.M. GUNN: I refrained from making comments during the second reading. However, in relation to the short title, this is an opportunity clearly to put my views on the record. Having listened carefully to what the minister had to say, I was very happy to see the regional health boards removed, because I did not think they played any significant role. However, I am very passionate about the role of local communities and I think under this legislation there is a lessening of their influence, and I think that is disappointing. I also think that a pretty hard sell has been done by the bureaucrats to bring people around and get them to accept this proposal, from my information.

Further, we know that administrators do not like local people being involved, just as ministers and heads of departments do not like backbenchers. They are a nuisance: they ask questions, they talk, and they express their views. However, that is democracy, and democracy is also about having decisions made as close as possible to where services should be delivered. If you have local people involved with a considerable amount of authority, they will vigorously stick up for maintaining their services. No matter what is said here, if I were a wagering person—and I am not—I would say that within 10 years there will be a lot fewer services at rural hospitals than there are today, because there will be attempts to centralise and rationalise them under the guise of improvement.

So, I hope I have made my point clear: I do not agree with these changes. I was totally in agreement with getting rid of regional health boards, and I attended some of the meetings when the story was being broadcast about amalgamating hospital boards. I know that one bureaucrat got terribly cross with me and he said to me after the meeting, 'You have an iron fist covered with a velvet glove.'

The Hon. J.D. Hill: What, he did?

The Hon. G.M. GUNN: No, I had, about what I had to say at the meeting. I said to him, 'That's just because you don't like what I had to say. I had more people on my side than you had at the end of the meeting.' They agreed with me when I told them they would lose services, and that is what is happening. So, minister, I sincerely hope—I will not be here in 10 years' time, and people will probably say that is a good thing, but I want to—

The Hon. J.D. Hill: Lloyd Hughes' record is there to be broken.

The Hon. G.M. GUNN: Well, someone else can break the record. There are only five people who have been elected 12 times to this place; I am one of them, and I do not intend to be the odd one out and go one more. I think that I have probably—

The Hon. S.W. Key: You must have been a baby when you were first elected.

The Hon. G.M. GUNN: I was full of energy and vitality, and came here fresh faced. I came here because of bureaucrats, and I suppose I will still be fighting them when I finish, because of those nasty experiences I had as a young person which I have never forgotten.

So, I sincerely hope that these provisions are not used to downgrade local facilities and local decision making. During the next 2½ years I intend to take a very close interest in what is going on in the hospitals in my area. I recall that some years ago the people in power (the bureaucrats) told one of the administrators at my hospital that he was not allowed to talk to me as a local member, because they would make a decision that the locals did not want; the locals would come to me and I would ring the minister and have the decision overturned.

The people concerned were really angry. Of course, the moment they gave that instruction, the person in question could not get on the phone quickly enough to tell me, and I went to the minister again. I sincerely hope that we are not going to have this imposition from a great height by Sir Humphrey Appleby, or one, two and three, because the minister would know, as a former minister for transport, how one of the CEOs tried to gag people from talking to members of parliament.

One of those characters we had to put up with sent a fax saying that they were not allowed to talk to people like me. The funny thing was that, within two minutes of that fax being sent, one came through on my fax machine. When I read it back to him at a meeting of the Economic and Finance Committee, he did not like it very much, but that was the end of that. I hope that this bill is not used to curtail free speech.

The Hon. J.D. HILL: I thank the father of the house for those comments. I will make some observations about what he said. I will try to give him some assurances—and, in part, I share the concerns he has—that the system I am trying to set up is to do not what he is suggesting. The first point is that I thank him for his support of the abolition of the seven regional boards (which he gave publicly), and I agree with him completely. The second point is that, if one looks at the services in rural South Australia now with the current arrangements with the existing boards compared with 10 years ago, there are fewer services in parts of rural South Australia, particularly in the area of obstetrics.

That is not driven by the government's arrangements that are in place. That is driven, in part, by the availability and willingness of doctors to work in particular communities. A number of members have raised concerns about Cleve and the fact that the obstetric service is no longer available. That is not something over which the hospital board, Country Health, the department or the government has any control, because the provision of health services in country South Australia largely is driven by the private sector funded by the commonwealth government through the provision of GP specialists. If they choose to leave, or if they are given a bigger office somewhere else, they will leave.

I am not saying this about the guy from Cleve, but I do know that a corporate health provider who runs the corporate GP clinics based around Sydney and Melbourne—there are fewer of them in South Australia—is offering country doctors $500,000 to buy their practice and take them and their provider number and put them in a GP clinic in one of the inner city areas, because they cannot get doctors either. They are going around offering bribes. How can a rural community face that and deal with it? There is just no way they can. There is no way we as a system can deal with that either. A whole lot of things need to be changed, and that gets into the state-commonwealth relations.

One thing of which I am sure, member for Stuart, is that, if we have the model we are proposing not only through this legislative change but also by developing a country health plan, we may not be able to provide birthing in every community that wants birthing, but we will have a pretty clear idea where we can have birthing, what support systems need to be put in place and how it can be managed into the future so that it is sustainable. At the moment, every individual hospital is responsible (and has been historically) for selecting, choosing and getting staff. Often, when one hospital is short of a doctor or a nurse, they advertise and they pinch the person from a hospital down the road which then has to advertise for staff. There is this multitude and a never-ending series of appointments and recruiting processes.

We are doing all that at a central level now. It makes sense to have one ad saying, 'We need a doctor here, here and here and a nurse here, here and here.' We want to manage that not only through country health as an entity so that we can try to fill the gaps where best we can but also by the provision of extra services through four or five general hospitals—Whyalla; Port Lincoln; Port Augusta, to a certain extent, especially in Aboriginal health; the Riverland; and the South-East.

We want to build up a team of doctors and nurses who are specialists in those areas and who can not only provide the bulk of services at that location but also provide services where appropriate and where possible at adjacent networked hospitals. For example, a specialist surgeon might be at any one of those towns, but they could then travel to other communities.

I was recently in Ceduna, and I met one of the doctors from Ceduna who travels to Whyalla—or he might have been in Whyalla and he was travelling to Ceduna; I cannot recall. He provides a peripatetic sort of service. We want to see more of that and, if we can build up those four hospitals where greater medical services are provided, we know we will attract more doctors and a better range of services. We will also be able to train more doctors and get more country kids to train in country locations. We are more likely to get doctors who will want to work in the country.

That is the theory behind this. I recognise that there are many aspirations in all this, and one cannot guarantee anything. There is nothing more certain than that over the next 10 years country health will change. However, we want to make sure that that change is carried out in a planned, managed way, so that we can maintain the maximum amount of health outcomes and services that we can.

In terms of the boards being answerable to the ministers, I just make the point to the member for Stuart that, under the new model, he will be on every single hospital board in his electorate if he chooses to be, and he will hear exactly what is said around the health advisory council. There will be reports from the CE and the doctors. He will know intimately about any of the issues and be able to raise them in this parliament or in any other context.

So, if you like, that is the government taking a risk by trusting that the system will work in a transparent way. We have it with schools, and I do not see members of parliament misusing that right or responsibility. We all go to our schools as often as we can, or we appoint people to go there. In the same way, members of parliament will have direct representation on those HACs. So, if it is not working, I would expect members of parliament to tell me or raise it in the public arena so that the issues can be addressed.

Ms CHAPMAN: Given the government's objective to establish in this bill a unified single public health system, and the importance of its being integrated and being a model that, in the restructure the minister has identified, will therefore be a better health outcome, why did he not deal with a 20 year old piece of legislation, which also relates to the health of South Australians and which is under his jurisdiction, namely, the Public and Environment Health Act 1987?

The Hon. J.D. HILL: As the member knows, that is a separate piece of legislation, and work is being done on it. I would expect, in 12 months or so, to bring to the parliament—and, before that, to the attention of the public—the proposed changes to that legislation. We will go through a proper consultation process. The member is right: that act also needs revision.

Ms CHAPMAN: An explanation was given in the minister's second reading speech as to why he did not proceed to review the private hospital licensing legislative process which, as I understand it (and I have not checked it word for word), has largely been lifted from the SA Health Commission Act and placed in this bill, to apply until such a review takes place. He has added more recent comments since my contribution to the effect that there is no agenda on the part of the government in that process, other than the fact that it is part of a licensing process within legislation that is 30 years old and, therefore, needs some review.

However, he also said that he did not want to introduce issues in relation to what it was necessary to reform in that area (to use his words), because it would confuse the matter. Even if there is no sinister or adverse agenda for private hospitals, what prompted the minister to indicate to the house that there were reforms he had in mind, but that he did not want to confuse the matter?

The Hon. J.D. HILL: The provisions in this legislation are about the public health sector, and that is what we have been focusing on, because that is ultimately what I am responsible for. I have no ambitions—we have no policy, in particular—in relation to the private sector, except in one regard, in that we want to cooperate with the private sector. It seems to me that, in a whole range of areas, it makes sense to cooperate with the private sector—not just the hospital sector but also the aged care sector, pharmacies and the like. I want to see us work more closely with that sector, particularly so that we have an integrated delivery of services to people who might cross between sectors—people who go to private pharmacies and private doctors and end up in public hospitals, private nursing homes and sometimes in private hospitals.

So, to be able to work across all of those sectors in a cohesive way makes sense. We would want to do more training of our staff in private hospitals. They are the beneficiaries of the public training system, and I think they would welcome, in many cases, the participation of trainees in the provision of their services. If there is a capacity for research, or networking the research processes in public with the private, I would like to see that. Of course, there is the opportunity for some services to be delivered through the private sector when the public sector does not have the capacity, whether it is equipment or surgery space and the like. So, I am quite open about that; we need to cooperate together.

However, I have no agenda or particular issues in relation to the way in which the private sector operates now. I merely make the observation that the legislation is 30 years old, so it is probably time for it to be looked at in terms of making it contemporary. However, that is not to say that there is any agenda, and I want to assure the operators of private hospitals that I have no agenda in relation to them. We have no time frame for reviewing the legislation; it is just something we recognise that needs to be done at some subsequent time.

Ms CHAPMAN: I will come to the question of submissions, then. Whilst you make the comment, minister, that that is something that can be dealt with down the track, and you have reaffirmed that there is no negative agenda on the part of the government in relation to the private sector, you did see fit in this bill to introduce as a new item amongst your areas of responsibility (and this will be discussed further in clause 6) 'to promote a positive relationship between public, private and other health sectors'. Whilst I do not doubt that it is an objective you want to incorporate in the bill, it seems rather unusual that you would start out with what your new objective is going to be but not review that sector. In any event, we will see what happens in relation to that issue. In relation to the submissions themselves, some of which you referred to in the second reading explanation and some in your response, a number of the submissions are published on the website. I ask the minister: why it is that only some and not all of the submissions were published before this debate?

The Hon. J.D. HILL: I asked for all of the submissions to be published. We felt that the institutional ones (that is, from a public board or public entity) could be published without seeking approval. In the case of submissions from individuals, we asked them whether they would object to their submission being published. Most said yes, but I gather that a few said they did not want their submission published. I guess it is something for future reference for me that, in seeking submissions in the future, we should ask the people in advance whether they are happy to have their submission published. However, we wanted to get all of the submissions out on the public record, where the biddees were happy to allow it, and I gather that was pretty well most of them.

Clause passed.

Clause 2.

Ms CHAPMAN: I thank the minister for providing that information. However, I indicate that on our search of the website we found that the minister has made reference to some of the submissions, particularly in his recent response, of current boards and area boards of hospitals that have not been published on the website. So, I am disappointed that the minister has given a direction but, from our assessment, that direction has not been complied with, other than in the case of submissions from individuals. The opposition clearly respects their request for privacy in that regard. However, the opposition has not been able to locate some of the submissions the minister has referred to.

The Hon. J.D. HILL: I inadvertently misled the member. We asked all of the organisations as well; and the majority said yes. Some did not get back to us and some, I think, said no; there might have been one or two who said no. However, our intention was to put everything on the website. The information I gave during my response was not based on formal submissions. After all this process, I asked my staff, in the past week or so, to phone all the boards and get advice about what their current views were, and I did this as an informal record for my own purposes, and I conveyed some of that information. I summarised it by saying that I think the majority were reasonably comfortable, some were quite enthusiastic, and a handful were dead opposed, which is what you would expect, I guess, in relation to any change.

The ACTING CHAIR (Hon. P.L. White): Deputy leader, if your question is on clause 2, the commencement of this act, you may proceed.

Ms CHAPMAN: The commencement of the act, of course, is all of which passes; hence, I will be asking some questions about how that is going to be effected. I ask the minister firstly: how long after the passage of this bill is he proposing the commencement of this act and, in particular, have all the regulations been drafted and are they ready to support this legislation?

The Hon. J.D. HILL: Our intention is not to commence until at least the middle of next year, and I have given an undertaking to all of the boards that we will do that. I particularly wanted to do that for country health because we are going through the process of developing a country health plan and I thought it was sensible and appropriate that the existing boards should maintain their responsibilities and powers during that process.

The regulations have not been produced. I have tabled some draft constitutions, which are still subject to final negotiation with the boards, but we think we have got them pretty right. Of course, the regulations cannot be drafted until after we have got the legislation through, because there is always the possibility (particularly in the other place) that the legislation may be different when it comes out of the parliament than when it went in.

Clause passed.

Clause 3 passed.

Clause 4.

Ms CHAPMAN: In respect of clause 4, which sets out the objects of the act, one of the proposals is to dispose of the boards. In fact, it is the repealing of the SA Health Commission Act and its death which will be the feature of the conclusion of the current boards' powers upon proclamation, which you have indicated will be no earlier than 2008. Will the boards continue to have authority to maintain an employer/employee relationship, as they currently enjoy (notwithstanding the legislation which came into effect on 1 April), until the time of the conclusion of the boards, or will they just continue in their form without that power?

The Hon. J.D. HILL: The legislation, as you know, which I think was passed last year and put into action this year, assigns all staff now to the CE, who then reassigns the staff back to the body from which they came. The CE assigns whoever works for the Port Lincoln Hospital to the board of the Port Lincoln Hospital, and we are not intending to change that. There will be no interim arrangements.

Ms CHAPMAN: In the submissions that have been put, particularly by a number of country boards, the question of achieving these objectives is one where they have taken a different view as to the capacity for that to occur, given their abolition. A few of them have put forward a number of concerns about that matter, and I think the objective, particularly subparagraph (b), relates to the services that you are making available across the state for South Australians.

The Balaklava and Riverton District Health Service, for example, say that they support in principle the intended repatriation of patients to country SA for their medical needs wherever possible and conducting elective surgery closer to the homes of country residents. They specifically said that they do not support the abolition of local boards but, if they have to have the health advisory councils, they want them to be incorporated. No doubt, that is a theme, as the minister has acknowledged, which came through loud and strong in the consultation period.

This group raised the theme, which has been espoused sometimes by the minister in the house and at other times by Mr George Beltchev in a number of these consultations, that the government's objective is to provide services in the country which will allow it to relieve the high demand in metropolitan hospitals and to provide a service closer to those in the community. Indeed, a very significant number of country residents undertake procedures and medical treatment in metropolitan hospitals, about which they do not have any choice in many instances.

This is the category we are talking about when we say that they could elect services, if they had the services available in the country. From my understanding, the provision of those services is at a cost of about $100 million a year, so we are talking about a significant amount for services for which, if available in the country, patients could be repatriated back out there to use the Balaklava example.

They support that but, of course, Balaklava is a long way from Whyalla, Berri, Mount Gambier or Port Lincoln, which are the locations of the four hospitals that have been identified to be enhanced to provide these extra services. I ask the minister how he proposes that the people in this Mid North area can expect to be part of that transition for which they have indicated their support.

The Hon. J.D. HILL: I thank the deputy leader for that question. We acknowledge the common sense of the propositions. The practicalities, of course, will depend very much on where people live, what is wrong with them and what is the best transport connection. All I can say is that at the moment country health is going through the development of a country health plan to try to give us some guidance about the best way of managing these things, and it will occur over time.

We will not suddenly flick a switch and all of the services that are currently provided to country people in the city will be provided in the country. We will obviously have to recruit and it will be a bit of a piecemeal, patchwork quilt type of approach, but the long-term strategy would be to have four substantial general hospitals in the country with a broad range of services, which I think I have defined in public in the past, and then to have those services linked to other hospitals and other health providers in order to make available the services where appropriate.

Mr Venning: More across the state, all right?

The Hon. J.D. HILL: Yes, but the point I am making is that at the moment they are all concentrated in Adelaide. If, for example, I see a specialist who flies a light plane and he travels from Adelaide on a regular basis to a country hospital and provides some surgical procedures from Adelaide, that is fine, but it is not necessarily the most efficient way of doing it. We want to have those surgical teams based in the four regional hospitals in order to be able to provide services within those hospitals which can then travel from those hospitals into other country areas so that you build up a network of health services in rural areas.

Clearly, in the most remote parts of the state and in other parts of the state—and Balaklava may be an example; I have not looked at that in detail—it may be difficult to do a lot of that. It also depends on the capacity of the people working in those hospitals to manage the recovery of patients who have received treatment. For example, a surgeon might be able to come from Whyalla to work in a smaller town like Cleve and be able to provide services there on a regular basis (once a month or so), and he might be able to perform particular operations but, if we do not have the skilled nurses there and appropriate GPs to manage the recovery process, there is not much point putting a surgeon out there to do it, so you have to have a team around it.

This is the process that we are going through now. As I said, we are leaving the boards in place until we have articulated what that is. We want to be open and honest about this: it will require some thinking through, and we are going through that process now. This bill does not go into the detail: it sets up the philosophical and legal framework for the things that we want to do. I am just giving you some colour about the direction in which we are heading. How that will eventually be articulated will, of course, depend very much on a whole range of factors, including—and especially—the planning process that we are currently going through.

Mr VENNING: I appreciate what the minister just said. I will give you a true-life scenario of two hospitals: Port Pirie and Crystal Brook. Crystal Brook is where I come from, and I know the hospital well. It is a brilliant hospital. When the member for Little Para was minister, she opened a wing of that hospital. The facilities there are fantastic, yet it is 36 kilometres from Port Pirie. The member for Little Para knows this, because she was there. She has her name on the wall there, and you, minister, might get your name there if you are lucky.

The Hon. J.D. Hill: If I'm good, you were going to say.

Mr VENNING: If you're good. The minister just told the house that, under regionalisation, all the impetus and energy will be going into Port Pirie because it is a larger hospital. Crystal Brook is just 36 kilometres away but, through local support and very good local doctors, it provides a brilliant service. The facilities are fantastic. My mother just passed away in that hospital, and I cannot speak more highly of it. A lot of people from Port Pirie actually come down to Crystal Brook to have their babies, and it works very well. But, under your scenario, minister, how is Crystal Brook going to survive? All the doctors will support the hospital and keep it as it is, but what if the direction from the top is, 'Hang on, you're too close to the larger regional hospital. We will put the money and the emphasis into the regional hospital. You'll just have to provide aged care services, and that's about it'?

The Hon. J.D. HILL: This is all hypothetical. We are developing a country health plan, and I would point out that Richard MacKinnon, who is the doctor at Crystal Brook—

Mr Venning: He is my doctor.

The Hon. J.D. HILL: Well, he is a terrific doctor, not that he has given me service. He is a terrific person and I am sure he is a terrific doctor.

Mr Venning: Blunt.

The Hon. J.D. HILL: He has been blunt to me, too. He is a member of the Country Health SA Board—I put him on that board. I visited him in his surgery—

Mr Venning: I didn't know that.

The Hon. J.D. HILL: Yes. I visited him in his surgery and I visited the Crystal Brook Hospital. I am aware of the services and, in many ways, it is an ideal country hospital. It is very close to Port Pirie, so that does raise issues about what services should be in which hospital. I cannot tell you what sort of plan will occur for that particular region, but I can tell you one thing: Richard MacKinnon is going to be very much involved in the development of that plan, because he is on the board. I am very optimistic that Crystal Brook will be an important part of our structure. It may well be that the two hospitals will work more closely together so that certain things happen at Crystal Brook and certain things happen at Port Pirie; I do not know. I have not thought about it as a particular example. I am just saying that we will think through the issues.

Port Pirie was not the one that we identified as providing a more general hospital service. Down the track, we might have additional hospitals, but it was not that hospital. We want to build up the four hospitals by putting more capacity in there so fewer country people have to go to the city. We are not saying that they have to go to the country. The member for MacKillop suggested that people would rather go to Adelaide from Millicent than to Mount Gambier. Well, some might, and they can still do that; we are not compelling them to go to Mount Gambier, but others may have family and friends in Mount Gambier and find it a better option.

We want to put more capacity and do more training in the country so we can have more doctors, allied health workers and nurses coming out of those hospitals. Then those people who work in those four general hospitals can also be mobile and provide services elsewhere.

It is about developing a plan. At the moment, we do not have a plan. We have 40 or 50 hospitals all trying to survive and do what they can for their community. Lots of good things happen, and we do not want to lose that innovation, but it is not a plan: it is haphazard. You are lucky if you live in Crystal Brook because you have terrific services but, if you live in another country town, where the GP has decided to leave, it is terrible. That is not a good way of running a service. We want to have a planned service.

Ms CHAPMAN: I think the submissions have made it very clear to you, your departmental representatives, and certainly to the opposition, that they strongly oppose the move to abolish boards. They are particularly keen to retain a relationship with and involvement in the selection and employment of their staff and to have a major decision-making role in the services they provide and in relation to the assets which, given the bill now before the house, are irrelevant for the purposes of the discussion, because you have given the option for those to be retained.

I think that you could not have a clearer message than that from the Bordertown Memorial Hospital Board, for example. It has sent petitions to the parliament and put submissions in writing about its objection. This is a hospital which, apart from Keith and Murray Bridge, provides health services on a major freeway into Victoria. It provides accident and retrieval and other services for many people passing through, not just their local regional residents.

I am sure that you are mindful of the position of the District Council of Elliston, which is quite opposed to the government's model and even put up a model of its own. It is very strong on the loss of identity. That hospital plays a major regional role in the provision of care of the aged for the whole of the West Coast, and it has excellent facilities for people with dementia. We have submissions from Streaky Bay that make it abundantly clear that, in their role as a country hospital board, and in relation to the involvement of the hospital in the community itself (it is a major employer and the like), they have very grave concerns not only about the changes to the boards but also about the fact that, in their opinion, the advisory councils would be toothless tigers, to use the description in the submission. They made their position very clear.

The Repatriation General Hospital also made it very clear to your predecessor, the former minister for health, and the Premier that it wanted to remain independent of the proposal to amalgamate boards at a regional level. Not only was it exempted from that requirement at the time but an undertaking was also given in this parliament by the Premier, and indeed statements were made by the former minister confirming and supporting that. Even through this process, it is allowed to survive. From what I understand, for a public hospital it is the only board that will survive in this state.

So, if it is good enough for the Repatriation General Hospital to keep its board, when it has asked to maintain its independence, why is it not good enough for the communities in the regions? Unless they have some bad medical record or something of the kind (and they certainly give assurances to me that they provide an excellent service to their communities), they should be allowed to keep their board, just as the Repat Hospital has, so that they and any other board or community that have expressed that request can be added to the schedule as well.

The Hon. J.D. HILL: I will go through the issues as I recall them. In relation to the health advisory councils (HACs), the questions were: what powers would they have, or would they be toothless tigers and the like; and would they be involved in the selection of staff? Under the draft constitution, the health advisory councils will be involved in the selection of senior staff. Obviously, they will not be involved with every person who is employed in the hospital. I doubt whether they are now. I am sure that most of those things are delegated to the general manager, and that would continue to be the case. The senior staff, the senior personnel in the hospital, the Health Advisory Council, would be involved in that decision.

They will own the assets. That was one of the big issues that a lot of the boards were most concerned about, that property which was owned by the community, and often in many cases donated by local farmers or local community groups, should be retained by the community. I have absolutely no problem with that. I did have a different device for doing it which would have produced the same result, but I guess that may have been seen to be a little bit too remote from the individual communities, so I was happy to go back to creating incorporated bodies wherever they were wanted. I think in practically all but two or three cases they wanted incorporated bodies, and I would expect that over time some of those boards will say, 'Well, we would rather the Country Health Board acted as a trustee for us'. As long as we have certain protections we would be happy with them running it, because there are some advantages. You do not have to have annual reports and all those audited processes.

In relation to the Repat General Hospital, the member is correct: the Premier and I, and previous ministers, have given an undertaking to the board, and particularly to the veterans, that they will not have that responsibility taken away from them unless they choose. I guess the reason they are separated out is that they are veterans. They represent veterans and they have a particular view about health service delivery, and we have honoured that commitment because of the special nature of the people. However, the legislation does provide a mechanism for the veterans' community, if they choose, to get rid of the board and become part of the Southern health region. I would expect that over time that will be seriously considered by the veterans.

Under the legislation we will establish an unincorporated health advisory council at a state level which will provide advice to the department and to me on veterans' affairs issues. I think that will provide a very satisfactory mechanism for veterans to have a say in the provision of health services. You need to remember that probably fewer than 50 per cent of veterans would now use the Repat hospital. They tend to use private hospitals or their local public hospital, wherever they happen to be based. So, to have a central state-based health advisory council on veterans' affairs possibly would offer them a better option in terms of getting their voices heard. I am not putting any pressure on them, but I believe that over time it is likely that they will consider being incorporated in the general structure.

The member then said, 'Well, you have allowed it for them, why not allow it for everybody?' If I did that, I would not end up with a system approach; I would end up with exactly what we have. I have given ample reasons why we need to change. The broader reason is that we need to have a system rather than a whole series of institutions. Secondly, I have given examples of a range of country hospitals which have got into trouble in terms of the contracting of services, employment, financial management and safety and quality issues. As the health minister, it is my responsibility, under the existing legislation, to ensure that all of the system is managed to a very high standard. Currently, the legislation does not provide me with the tools, it would not provide the member opposite with the tools, and it has not provided any other minister with the tools, to adequately do that job.

Time after time ministers have come into this house, on both sides of politics, and been asked questions about things that have happened in hospitals. It would be ridiculous for the minister of the day to say, 'It is not my responsibility. It is the responsibility of the Bordertown board. Go and ask the chairman there why a particular event happened.' Of course the minister of the day is responsible and, if you are responsible, you must have the mechanisms to make sure that you know what is going on and you can manage a situation before it becomes a problem. This is about creating a better health system for country people. I say to you that it is not out of any political ideological desire I have; it is about trying to make the system work better.

Clause passed.

Clause 5 passed.

Clause 6.

Ms CHAPMAN: The notable additions to the functions from the previous legislation relate to emergency ambulance services, for reasons which are clear from the contribution, and the promotion of a relationship between public, private and other health sectors. In relation to the latter, how often do you presently meet with representatives of the private sector to ascertain what they are doing to promote this positive relationship between the three?

The Hon. J.D. HILL: I meet periodically with various members of the private sector. I have visited private hospitals, I have met with people representing private hospitals, insurance companies, pharmacy organisations, aged care providers, a whole range of bodies such as the Cancer Council, and others, but there is no systematic approach in place. That is what I have asked the department to do some work on: to provide us with a platform where we can all come together. My goal is to produce a compact or a charter, or something of that order, where all the providers of health services in South Australia and allied services can come together with a common set of goals. That could include groups such as SACOTA, the AMA, nurses, and all of these other advocacy groups, if you like, or groups that represent particular people who work in health—a broad range of organisations which are involved in health care delivery. My goal is to get us all together, organise a set of agreements about where we will work together and what we can do to work together, and then have a regular set of ways of engaging.

We would need to talk with all those folk about how we would do that, but that would be very sensible. I think it would be very helpful, particularly in the achievement of public health goals. For example, let us take issues of obesity. Everybody is concerned about obesity. All of those organisations have probably made statements about obesity. All of them would have ideas and, possibly, programs in relation to obesity. Pharmacies might be doing certain things, private hospitals might be doing other things, and the AMA might be doing something else. It just makes sense, if we are all interested in this, to see how we can work together to have a campaign which would operate in all those in areas of activities. So, if we are going to promote healthy eating, it could work in all those institutions at the same time. That is a goal that I have, and I am very keen to sit down with all of the groups who constitute the private sector in health, and see if we can develop a common platform to work from.

Ms CHAPMAN: I am pleased to hear that, minister, because there is nothing stopping a continued consultation, whether informal or formal, if the objective is to develop a greater and better health outcome for all of the South Australian community. But, in saying that, is it your commitment in including this function that you will formally meet with them, and when you do review a particular area of health significance, you will consult with the private sector, which obviously plays an integral role? Let me just give you an example.

We received Monsignor Cappo's report on the review of mental health services in South Australia, which is obviously a very significant health service both in public and private arenas. One of the comments in his report was to identify certain sites that provide mental health services by the private sector, namely, Adelaide Clinic and Fullarton Private Hospital, to name just two that I can think of that neighbour my electorate. And that is good. He went on to say that it is important to understand what services they are providing, to be able to identify the needs of the development of the Glenside Hospital site, or other community mental health services. That all seems logical. The problem is that I am informed that, when the minister conducted his review, interview and assessment, he did not even contact Ramsay Health, for example, the owners of the private sector for provision of services for mental health in this state. That was a recent example of the fact that what the minister is saying, which sounds admirable, appropriate and encouraging, is not actually being translated out in the real world. If we are going to deal with identifying what is important, for example, in the redevelopment of Glenside Hospital, and identifying what services we need to pick up, we clearly need to know what on earth is going on in the other services, so I am pleased to hear that.

Do I have the minister's assurance that in undertaking this function he will ensure there is consultation with the other sectors and that there will be a formal invitation to these people to have meetings with the minister of the day, and not just in a response situation, which the minister has said he is doing by attending facilities, answering inquires and dealing with insurance companies?

The Hon. J.D. HILL: I made plain that there are informal connections and I would like to make it more formal. We are working on a set of propositions that we can then put to members of the institutions in the non-government sector. I have raised the issue at a number of meetings where I have spoken and the feedback I have received every time I have made that statement has been very positive. I think the private sector would welcome that and it can help create a platform where various groups can interact. I meet regularly with a whole range of organisations.

It is clear that there is not as healthy an interaction between the public health sector and elements of the private health sector. I meet pharmacy groups regularly, and particularly did so during the construction of the legislation. We do not necessarily interact with pharmacists on a regular basis on a whole range of things, but it may be a sensible thing to do. The public health campaign springs to mind. It would be sensible for us to have a strong relationship with nursing homes, particularly over prevention of primary health care service provision. I met recently with a group from a private nursing home who advocated some strategies whereby we may be able to work closer together. I give a commitment to working in a way so as to create a platform or place about a set of ideas and strategies where we can get better cooperation between the public and private sector, which makes sense for everybody.

Ms CHAPMAN: The notable omission from the minister's functions, which appeared in the SA Health Commission Act, are the provisions of section 15(1)(m), which ensures that people live and work in a healthy environment. I wonder why it has been deleted.

The Hon. J.D. HILL: I will take some advice, but I would have thought that it is covered in objects of the act under paragraph (b), which is 'to facilitate the provision of safe, high-quality health services and focus on the prevention and proper management of disease, illness and injury'. That probably covers the field, does it not?

Ms CHAPMAN: That is in the objects. As the objects are set out, we then go through the principles and the functions for the minister the chief executive follow through as to who gets the job to do it. Until the passing of this legislation, it is the minister's function and that is what is being deleted. Has it been transferred to someone else or is there an explanation as to why it is not there?

The Hon. J.D. HILL: I do not think there is any particular reason. If the honourable member would like to move to have it reincluded, I would be happy to accept it.

Ms Chapman: There may be a good reason why it is not there.

The Hon. J.D. HILL: Well, there is no particular reason. I think we believe that the language currently in the act covers the field, but I am happy to have a look at it between now and the other place, if the honourable member likes, to see whether it has been omitted for some unforeseen reason. If it has, I will put it back in. It may well be that, given its focus on environment, that element is covered in the Public Environmental Health Act which was introduced subsequent to the Health Commission Act, and it may be that that act is considered to be the one that deals with that particular policy area. However, as I said, I am happy to have another look at it and, if it make sense to include that omission I will happily put it back in.

Ms CHAPMAN: I appreciate that, because the Public Environmental Health Act had its predecessor, which was the Health Act of 1935-1975. So, it had its own origins; it is not as though it was peeled off. Hopefully that can be clarified.

Clause passed.

Clause 7.

Ms CHAPMAN: This clause introduces the functions that will now apply to the chief executive. I suppose it is fair to say that it is the area of his or her proposed functions, and the significant expansion of the role, that has attracted a number of comments by me (on behalf of the opposition) during this debate. I also think it is fair to say that, apart from some of the redefining here, a large portion of what has been published in this clause is consistent with the powers the chief executive has already. Like you minister, his or her direction power is restricted insofar as it relates to any direction that concerns the clinical treatment of a person. This is part of section 29C of the current act, and it restricts ministerial directions basically from interfering with services provided, assets or staff employment.

Given his or her more expanded role, particularly regarding the overall management, administration and provision of health services, essentially he is the employing authority for the whole 27,000-odd employees in the health department to whom the minister has referred, and they are all accountable, either directly or, in the case of the ambulance service, through their chief executive officer, to him.

The chief executive already has a very significant role, and one of things that occurred during the consultation process for this bill is that, as opposition health spokesperson, I have corresponded with the chairs of the health services and hospitals, both public and private. I particularly refer to my communications (of which there are quite a lot) to country board chairs—some by letter, some by fax and some by email. As the minister may be aware, the most recent correspondence I forwarded to the attention of the chairs of the hospitals was intercepted by the chief executive, and he wrote to me saying that he considered information that I had communicated to the hospital boards was inaccurate, and he had therefore directed the hospitals to which the correspondence had been forwarded not to pass that correspondence on to their board.

I will not go into detail about whether there might be a breach of federal law in relation to intercepting correspondence, but it is a matter of such seriousness that I have raised it with the Speaker of the house. There is a fundamental protection for people in the community, especially when we are consulting about laws which affect them and which are being made in this chamber, to freely correspond with any of us in this parliament in order to ensure that their views are expressed and that their communication is not interfered with. Minister, did you direct the Chief Executive or authorise him to intercept that correspondence and issue the direction that my correspondence not be forwarded on?

The Hon. J.D. HILL: Talk about long bows! I am not aware of the circumstances to which the honourable member is referring. If she had raised this matter with me outside this bill, I could have sought advice. As we are dealing with this bill I cannot give her any information whatsoever. All I can say is that under the provisions we are putting in place she, and anyone else, can write to health advisory council chairs, and what they choose to do with the letters they receive will be up to them.

Ms CHAPMAN: I thank the minister for his answer because it highlights exactly the problem that I have put to the parliament on this matter; that is, things are going on in the minister's department about which he is not told. I suggest that they are very serious matters in relation to conduct. The minister might have a view about the issue, if he had been briefed on or informed about it. Copies of correspondence from me to the Speaker of this parliament have been forwarded to the minister's chief executive, and he is telling the parliament that he knows nothing about it. I am not suggesting that is inaccurate in any way, but it highlights the point about what is going on out there which the minister does not know about and which the chief executive has not seen fit to tell him about.

That is of great concern, and that is why the opposition is strongly opposed to handing over more power to the chief executive in this type of situation. It is dangerous enough already. It ought to be a matter of concern to the minister rather than his handing over more power to run what is now to be the overall management, administration and provision of health services. It is simply not enough to say, 'But the law says he is ultimately accountable to me.' That may be so but, if the minister does not know what is going on and he is not told about it, how can he reasonably be expected to act upon it?

That is the difficulty. When it is all placed in one person's hand, there are no checks or balances (which we have currently) by being able to understand the existence of other processes, by having checks and balances involving those who are otherwise supervising other people in the department. At this stage the structure is established, which is all the way up to the top to the chief executive, and the minister is sitting out there on a limb. I indicate to the minister that we will be opposing this clause.

The Hon. J.D. HILL: The deputy leader, with all the drama she can muster, is making an allegation. She says that I don't know. Well, there are 27,000 employees in the health system. No-one knows what everyone is doing all the time. That is impossible.

Ms Chapman interjecting:

The Hon. J.D. HILL: If the member was so concerned about this alleged breach, why did she not raise it with me at some other time?

Ms Chapman interjecting:

The Hon. J.D. HILL: Why?

Ms Chapman interjecting:

The Hon. J.D. HILL: You might consider it to be a matter of great moment. If you raised it with the Speaker, I am not sure what processes you are going through. I will tell the deputy leader the things I am most concerned to hear about. I am not concerned about the spat between the deputy leader and the chief executive. What concerns me is when I find out that a particular hospital board failed to sign a contract with the provider of an imagining service, which meant that the hospital may not have an imagining service into the future and that the lives of people in that community will be potentially at risk because of the failure of the board to deal with the issue. The board did not know. That is what concerns me.

What concerns me is when I find out that a couple of hundred people have had colonoscopies and the machinery used was not properly cleaned. I find out after the event, and that is what concerns me. That is where I want certainty. If the deputy leader is alleging that individual public servants have done something wrong, a range of procedures are open to her to do deal with them. One of them would have been to raise the matter with me. She chose not to raise it with me, and now she gets offended or upset because I do not know about it. I will seek information, but I will not make any comment about the allegation until I have sought further advice.

This legislation is about providing a proper chain of command and a proper chain of responsibility. It is important that the chief executive has appropriate powers to do the job that is required of a chief executive, in the same way that a chief executive of any other government department has similar kinds of powers in order to do the job that we require of them.

Ms CHAPMAN: While we are on the centralising of the power of the chief executive, the minister identifies illustrations of either some omission or act by a board that has potentially resulted in a health risk, and he has detailed a couple of examples. What about the example of the minister's department being notified two years ago of a person who was HIV positive and who was having unsafe sex with members of the community? Your department was informed but you claim that you had not been told about it until recently—I think about Easter this year. You then acted on the information.

That is exactly the same situation. You can raise criticism and cherry-pick some little events where there has been some potential risk because some hospital board has failed to sign a contract or follow a protocol, but what about your own department? There is no difference. There can be mistakes, there can be negligent acts and there can be consequences when a board negligently fails to undertake its duty. In the example I have just used nothing happened other than the fact that an inquiry has been conducted to try to make sure it does not happen again.

There has not been any consequence in relation to the person or persons in your department who may have been responsible for that which we now know may result in negligence claims in relation to the victims—and that case actually had victims, unlike the situation where a local board has not signed a document and possibly put people at risk because it has not entered into a contract. There is a very real example in your own department where nothing has happened, and you are trying to tell us that you need to have a unified single system under one person who has already failed to deal with something right under his nose, and you want to give him more power.

The Hon. J.D. HILL: Again, the honourable member is drawing a long bow. The relevance of that question to the legislation is tenuous at best. Before I answer that, I will provide more information to the committee in relation to the matter the honourable member raised previously. One needs to be very careful in addressing statements made by the deputy leader because she does not necessarily give all the facts.

The deputy leader said that the chief executive intercepted a letter she had sent to the board. In fact, I am advised that the deputy leader sent a letter to the chief executive of the department and asked him to send it to the various boards. When he received that letter he chose not to do that because it contained inaccuracies, some of which may have been slanderous, defamatory.

In particular, she made claims about the role of the chief executive of Country Health, which were untrue so he, quite properly, wrote back to the member, corrected the errors and referred the matter to her.

Ms Chapman interjecting:

The Hon. J.D. HILL: As I said, Madam Chair, the claims made by the deputy leader always have to be tested very carefully because she often is prone to exaggeration when it comes to her statements about the behaviours of others, and I have seen that repeatedly in this house.

In relation to the matter about HIV/AIDS, it is true that the department's management of this case was not at the standard one would have expected. The person who was responsible at the time is no longer working with the department.

Ms Chapman: He's in someone else's department.

The Hon. J.D. HILL: He is not in someone else's department.

Ms Chapman interjecting:

The Hon. J.D. HILL: The member once again makes claims which are not true. He does not work for a health department at all. He works outside the health department in New South Wales, as I understand it, so he is not subject to any control that the health department or the government of South Australia may have. If there are legal actions pursued by some of the alleged victims of the person who had HIV, that is up to the courts to resolve. I think just generally I would say to the member, and to all members, that ministers in their day-to-day business do not know everything that goes on. It is a bit like the vice presidents of America—you know what you know, you don't know what you don't know, and you know what you don't know—and all those kinds of things. Not everyone—

Ms Chapman interjecting:

The Hon. J.D. HILL: Well, the trouble with that interjection is that it is inaccurate because the boards of individual hospitals do not know what is going on. The trouble is that the CEs of the hospitals do not have anyone to whom they are accountable other than the boards. So, if the boards do not know what is going on—and how would they, because they only meet once a month—

Ms Chapman interjecting:

The CHAIR: Order, the deputy leader!

The Hon. J.D. HILL: —then if no-one is pursuing the interests of the hospital and no-one is supervising the individual managers, there is no supervision at all, and there are potentially disastrous problems, which I have highlighted.

In relation to the HIV case (and I am not sure how it is relevant to this particular legislation because the powers in relation to that are not affected whatsoever, as understand it, by this legislation), that matter has been dealt with appropriately. There was a review and new procedures have been put in place and, of course, it has highlighted issues at a national level because a lot of the protocols that were being followed in South Australia were, in fact, nationally agreed protocols that had been put in place by the former Liberal minister for health at the national level, Dr Wooldridge.

The committee divided on the clause:

AYES (24)

NOES (10)

PAIRS (10)

Majority of 14 for the ayes.

Clause thus passed.

Clause 8 passed.

Clause 9.

Ms CHAPMAN: This commences the clauses to facilitate the establishment of the health performance council, which is a new initiative of the government. Essentially it is to consist of 15 persons appointed by the Governor on recommendation of the minister. They are to have a high level of knowledge and expertise, represent diversities within South Australia's community and have such expertise, skills and qualifications as will enable them to carry out those functions. They are to consult with bodies, report to the minister, give him high level advice, etc.

On behalf of the opposition, I have made our view clear; that is, no matter how brilliant are those people appointed by the minister, clearly this minister can obtain a high level of advice from the 27,000 employees he has to choose from within his department who have access to all the data and reports which we have listed. To create another body under the pretext that this will provide some great panacea of advice to the parliament which is independent and which will provide some guidance about the current performance of health services in Australia and assist us in our deliberations regarding the direction of future health services is pointless. It has no foundation and its independence will be severely hampered by the fact that the very people from whom it is supposed to be independent—namely, the department—will comprise the secretariat that supports it.

It will have no separate budget to select its own staff, and it will have people from the department who are allocated to provide a service who have a commitment to the other master, which is the chief executive. They will be drawing on the data that they already have available to them, which a special data unit in their own department produces.

We have raised these matters, and our concern is that there are also myriad other people in the community who already represent the diverse interests. The Australian Medical Association, for example, is an important advocacy body, which obviously has as its membership those in the medical world to provide advice. I have no doubt that, from time to time, it obtains advice (as it should) from the Australian Nursing Federation, which would give available data and advice about the services that that very valuable part of the health industry provides. My question is: given that the minister will have this new health advisory council, will he still retain Dr Chris Cain as his adviser on health matters?

The Hon. J.D. HILL: That is a ridiculous question. The answer, of course, is that I do not have Chris Cain as a medical adviser: he gives advice to the department.

Ms CHAPMAN: One of the things that are coming out of the functions is that the chief executive will not be giving the minister performance advice any more. That has come out of his functions, because there will be this health performance council. Is the minister saying to me that the adviser whom he has appointed to help the department—that is, Dr Cain—in relation to medical matters will go to the chief executive (or someone else in the department, perhaps, but let us assume it is the chief executive)? He does not have that role now; that is for the health advisory council—or will he get it from both? If the minister says, 'I would expect that I would still get some advice from the chief executive, because of the other relationship we have with respect to the functions and accountability in relation to him,' and if the health advisory council advises him to go in direction A and the chief executive advises him to go in direction B, which one will he take?

The Hon. J.D. HILL: Despite all the rhetoric, and the sound and fury, the member made a reasonably sensible point in the question; that is, it is potentially the case that the department and the health performance council will give me different advice. That is a good thing; that is why we are setting it up. I point out that the health performance council will give the government and the parliament broad advice about the state of health in South Australia, not on a day-to-day basis but on a longer term basis. It will also have responsibility to investigate issues which I would refer to it and which it may decide of its own volition to investigate. That is outside anything that the department may be doing.

I thought it was important that we had an external body to do this. This is very consistent with what John Menadue recommended. He recommended that there be an independent body to provide advice to the government on how the reform process was proceeding, and I think that is a very sensible thing. So, one of the things that the health performance council will do is to give advice on how that is going.

I think it is important for the department's sake to have an external body looking at how it is going; it puts pressure on them to perform at a higher standard. I refer the member to paragraph (g) in relation of the chief executive's responsibilities, as follows:

(g) to provide advice to the minister in relation to the operation or administration of this act, the provision of health services within the state, or the protection or promotion of public health within the state;

So, clearly, the chief executive has responsibilities as well. However, I as minister, and any subsequent minister, will now have a second source of information, which will be high level information provided by a specially chosen group of people who are specially skilled, who will be able to review the performance of the department and the performance of health generally. That is to the good, I would have thought.

Ms CHAPMAN: The health performance council is to provide an annual report, as the minister has indicated, and a four-yearly report which will provide much more information, with a review of the future direction of health services, which all sounds good. Is it the case that the current performance indicators and commentary in relation to those matters will no longer be contained in the annual report of the chief executive and, if it is to be included in the annual report, will it therefore be included in both reports, bearing in mind that this information and data is all collated by the department?

The Hon. J.D. HILL: No; the department's responsibilities will continue as they are. The health performance council will be an independent body that will be established to give me and the parliament separate advice on the health performance of the department and the health performance in our state. The member is confusing the two sets of responsibilities. It is a different body to give independent advice not just to me but to the parliament. I would have thought, from an opposition point of view, this is rolled gold, because the parliament will get advice from an independent body on how the government and the department are going in delivering health services. This is a greater level of scrutiny and a greater transparency than has ever existed.

Ms CHAPMAN: At present, the chief executive provides an annual report and, in fact, regional boards and even individual units currently provide reports. We currently have 50 or 60 of these reports going through this parliament each year, and those reports provide information about the performance in relation to the particular area of responsibility. I assume that under this new arrangement only the chief executive will provide a report because these other organisations will no longer be required to provide one.

In relation to any overlap, is there anything we currently get in performance and commentary reporting—usually an explanation for a large increase in the number of required surgical or elective procedures, or a big change in employment levels, or a high level of claims and those sort of things—in the chief executive's annual report or, currently, by officers at the lower level? Can I have an assurance from you, minister, that, no matter how well the health performance council program is ultimately carried out, there will be no reduction in the information that is currently reported to the parliament through the chief executive's report and those other reports we currently get?

The Hon. J.D. HILL: I thought I had answered that question, but I will try again and perhaps explain it by way of analogy. At the moment, the chief executive reports on an annual basis, through me, to the parliament on the operations of the health department in financial terms, yet that does not stop the Auditor-General every year going through that and making comments upon the performance of the health department in regard to its financial performance.

What this body will do is address the performance, from an outsider's point of view, of the health department and all its ancillaries in relation to all the issues I have already described. It will not be taking away from the CE his obligations to report to me on his perceptions of the performance of the department similarly to the way he currently does, and each of the other hospitals created under this legislation will have a similar requirement. They will all report in the way that they do now, but there will be an additional level of reporting by the Health Performance Council which is analogous to the level of scrutiny that is provided by the Auditor-General. It is an outside view, looking in, on the health system; it is not less, it is more.

The committee divided on the clause:

AYES (23)

NOES (10)

PAIRS (10)

Majority of 13 for the ayes.

Clause thus passed.

Clause 10.

Ms CHAPMAN: Of the new members of the HPC, which is some 15 persons, can the minister tell me what is the budget that is proposed to pay for this new council annually and how much are each of the members going to be paid?

The Hon. J.D. HILL: I cannot advise the committee of that because the legislation is yet to go through. It will be a modest amount. We will seek advice in terms of payment of individuals from the Public Service Commissioner who assesses those matters, but no budget has been set as yet. It will be a modest amount.

Ms CHAPMAN: How many staff will be allocated to service the HPC?

The Hon. J.D. HILL: All I can say to the member is that it will be a modest provisioning. Some staff will be associated with the HPC. We have not worked through the detail of this at this stage. It will not come into effect until the legislation is proclaimed which should be in the next budget year, so we will start thinking about the cost of this legislation once it is through. Other elements may have costs which we will need to take into account. The expectation I have is that this will be a relatively modest amount. I am happy to give the information once we have made that determination.

Clause passed.

Clauses 11 to 13 passed.

Clause 14.

Ms CHAPMAN: This clause proposes that the HPC may, provided it has your approval, minister, or, if relevant, a responsible public sector instrumentality, make use of staff, services and facilities of an administrative unit or other public sector instrumentality. I am not quite sure I understand that. Is there some body other than your department that is going to be required to submit material if requested by the HPC and, if so, who?

The Hon. J.D. HILL: The advice I have from parliamentary counsel is that it is just a standard provision. It could be the minister and, if not the department, it could be a statutory authority. For example, something like the IMVS or another research facility could allow the body to use a room or get access to whatever services they may wish to provide. It is really to empower other bodies to help the HPC rather than in reverse.

Ms CHAPMAN: Is this to facilitate an obligation on behalf of basically any other organisation which might receive government funding in relation to health to cooperate with requests, with the proviso that you have agreed? They cannot just ring up the IMVS and say, 'I want the whole of the last century’s data on some contagious disease.' You have to be able to approve the extent of the information they might seek or the costs and so on. Is that the way it would work?

The Hon. J.D. HILL: I do not think it is to do with information provision: it is to do with access to facilities and staff. For example, I could say the body could use the boardroom on the ninth floor, which is close to my office, for the purpose of holding their meetings or provide staff to carry out research or, alternatively, the IMVS, for example (or another statutory body) could say, 'We have a staff officer here who would be ideal for the sort of research you want into epidemiology’ (or something to that effect) and they can make that staff member available on their own initiative. So, it is really to provide resources from a range of public sector unspecified sources just for flexibility's sake.

Ms CHAPMAN: How often is it proposed that the HPC will meet?

The Hon. J.D. HILL: I refer the member to schedule 1, which gives the authority to the HPC to determine its own meeting schedules.

Clause passed.

Clause 15.

Ms CHAPMAN: The health advisory councils are the new bodies, Mr Acting Chair, as you would be aware by following this debate and being riveted by it. You would have a full understanding of what new roles this group will have across the state when we abolish all the boards. Apart from the repealing of the SA Health Commission Act—which comes later in this bill—it is this clause, and a couple that follow, that really put the nail in the coffin of boards and conclude the death by a thousand cuts that they have endured so far. The boards that currently exist for the metropolitan region health services are the central northern, southern, children's and women's health, and the like. There are three of them and, currently, they are paid members of boards.

The board positions that currently provide the overall management of the policy making and reporting responsibilities—which include reporting to parliament—are paid positions. Mr Ray Griggs is the chair, and he has half a dozen others who are currently on the central northern board which meets monthly. They are paid positions and, of course, they have support from the regional chief executive. I cannot think of the current chief executive. Dr David Panter occupied that position last year but he has moved on. The current chief executive's staff provides executive support to the regional metropolitan health board. In its case, it has responsibility for $1 billion of spend out of a $3 billion budget, so it is a pretty big one. My understanding is that there will be health advisory councils for these regions. Will these regional positions in the metropolitan area continue to be paid positions?

The Hon. J.D. HILL: I think the question was: will the metropolitan regions have boards associated with them? Is that the question?

Ms CHAPMAN: Yes, will they have HACs?

The Hon. J.D. HILL: Maybe, maybe not. We will think through the best way of doing it. This is like a toolbox provision. There certainly will be incorporated HACs in relation to the country health units. There will be a country health board; a HAC associated with volunteer ambulance officers; a HAC associated with veterans; and there will be flexibility in relation to other unincorporated HACs. I think it is highly likely, but there may well be more than one HAC associated with the regions. For example, there might be a HAC associated with each of the individual health units in the northern area. I am not saying there will be, but that is a possibility. I think it is likely that there will be at least one, but there could be multiple HACs. They will not be paid bodies, as I understand it.

One of the things that Menadue said very strongly is that those who deliver health services are very skilled at the delivery of these services. They are not necessarily very skilled at involving consumers (patients) in a whole lot of decisions.

The typical way governments have gone about addressing issues such as this is to create a board and put on it representatives of consumers. That is one way of doing it. What I want to happen through this process is that the whole system becomes conscious of the needs of the consumers of the services (the patients) and the carers of the patients. For example, we have set up clinical networks, which are networks based around particular issues, such as cancer, renal problems and so on. On those networks are doctors, nurses, allied health workers and representatives of consumer groups. Those groups work together to work through what the service plan ought to be for that particular area of health speciality.

That is one way we can involve consumers; HACs are another way. For example, in a big area such as the north, there may be a number of these groups that give advice to the region on how it can best meet the needs of the community. I cannot anticipate at this stage what they will be, but I anticipate that there will be some. To make sure that the department is properly consulting with communities and involving patients, carers and so on, the health performance council will have as one of its tasks the monitoring of how effectively and really they are doing that. So, it is not just paying lip service to it. It is a complex set of arrangements that are being put in place to achieve that kind of outcome, and the HACs are a tool that will be used to achieve that.

Ms CHAPMAN: Wherever the HACs may apply, are they also able to meet whenever they like and set their own arrangements? I will come to the constitution and the set of rules later.

The Hon. J.D. HILL: The draft constitutions, which I tabled yesterday, have provisions in relation to both incorporated and unincorporated HACs. From memory, I think they state the frequency of meetings, and they might have some minimum standards but, of course, the HACs would be able to meet more frequently if they so chose.

Ms CHAPMAN: I will come to the constitutions and the set of rules that apply, subject to whether they are incorporated or not incorporated, as they are referred to in clause 17. I appreciate that the minister has tabled these; I had a quick look through them, but I could not find any obligation with respect to them. As I understand it, the health performance council, which will have obligations to report to the parliament, can meet whenever it likes. It will be paid, but the HACs will not be paid. They do not have any obligation to provide anything other than advocacy and advice on request, having read the constitution template rules by which they will be bound. Apart from having a role to manage assets, if they elect to become incorporated they will have a financial report to give you about the management of those assets—once a year, from memory. Is it your understanding that they will have an obligation to meet at a certain frequency?

The Hon. J.D. HILL: I am relying on the fact that that would be in there; however, if it is not, we will correct that. These are draft constitutions. I would expect that there will be minimum meeting provisions; that is, they must meet at whatever frequency it is. Section 28 on page 14 of the constitution for the incorporated HACs provides that the advisory council will hold at least four ordinary meetings in any 12-month period, and these meetings will be held at regular intervals. I imagine that there would be a similar provision for the unincorporated ones.

The unincorporated HACs are really replacing what is in the current Health Commission Act, and they are called 'ministerial advisory committees'. The minister can set up a committee on anything, for any purpose and without any rules. There is a variety of ministerial advisory committees that we have at the moment. I would expect that some of them would merge into HACs. The capacity is also there to have a time-limited HAC. So, if we were looking at a particular issue, stem cell research, for example, I might want to set up a HAC for six months to give some advice about that and then it just stops operating. It is really just replicating what is already there. They are powers already under the existing act and they are called ministerial advisory committees, and now they are called health advisory committees.

Mr WILLIAMS: Minister, is it not the case that the health advisory committees (HACs) are only there as a sop to try to get us through this process of disbanding the boards, which have some real power? We have stripped them of power and we are putting in place a supposed advisory committee. How can the parliament be convinced that these advisory committees will have any real teeth at all, or any real purpose? In considering your answer to my question, I draw your attention to the Occupational Health, Safety and Welfare Act, under which your government, back in 2005, at great pains, established the SafeWork SA Advisory Committee. On my reading of the bill before us, and of the act, and reading the debate when that committee was established, it is a similar sort of process.

Your colleague the Minister for Industrial Relations at the time argued vehemently that this was a very important committee and set out how it was to be established, the terms and conditions of the office, etc., how they would hold their meetings and, indeed, the functions and powers of the committee. Earlier this year it came to my attention, as shadow minister, that one of the very important functions of that committee, and the thing for which your colleague the Minister for Industrial Relations argued vociferously, was that it would give him advice on matters. One of those matters involved grants in the OH&S area, yet it came to my attention that your colleague had actually established a grant to his mates in the unions of $3  million, which the advisory committee (which was specifically set up to advise the minister on these sorts of issues) had not even heard of and was never asked about and on which it never had the opportunity to advise.

Is this not really just a sop to the health community, and particularly those people who have given thousands of voluntary hours to help our system work—those people who have worked on hospital boards—to try to convince them that you are going to be listening to the community? Your colleague the Minister for Industrial Relations, by his very demonstration earlier this year, has shown that the committee established under the Occupational Health, Safety and Welfare Act is just not worth anything. Its functions may not be there; it is just a waste of the parliament's time and of the time of those people who have been appointed to that committee, because the minister in that case chose not even to discuss that very important matter with them.

The Hon. J.D. HILL: I move:

That the sitting of the house be extended beyond 10:00.

Motion carried.

The Hon. J.D. HILL: Before the break, the member asked me a question about HACS and whether they are a sop. I would say to him that they are not a sop. There are two kinds of health advisory committees (HACs) that we are creating under this legislation. One, which I just referred to in answer to the question from the deputy leader involves unincorporated health advisory committees, and they replace the ministerial advisory committees, which are currently extant. Ministers use those to a greater or lesser extent, depending on their own inclinations and the policy initiatives that they wish to pursue.

The incorporated health advisory councils, which are associated with individual health units, or clusters of health units, which will replace the boards, will have particular powers, responsibilities and functions under the legislation; so, they are not a sop. In particular, the incorporated health advisory council owns property and assets on behalf of the community, and has particular responsibility to manage that property. They have particular responsibility in the selection of senior staff of the hospital. They have the responsibility to meet on a regular basis with the senior staff, the CEs, and so on, to go through issues such as the budget, planning, the grounds, and those kinds of things.

In many ways they are analogous to the responsibilities that a school council would have in relation to the running of a school. They do not choose the curriculum, and they do not hire and fire the staff, but in every other way they are involved in the planning and the decision making about how a school should operate. The health advisory council will be the same in relation to the hospital. In addition, of course, by the nature of their membership, they will bring together in a community the medical practitioners in a town, the staff of the hospital, local community groups, the local council, the member of parliament, and up to three appointments that the minister should choose to make.

There will be a very good forum for the discussion of health issues and strong capacity for advocacy. As I have pointed out on a number of occasions now, the local member of parliament can be a member of that board. The local member of parliament or his or her representative, by participating on a regular basis, will be very aware of the issues and will be able to raise concerns if those issues are not properly addressed.

The committee divided on the clause:

AYES (24)

NOES (10)

PAIRS (10)

Majority of 14 for the ayes.

Clause thus passed.

Clause 16.

Ms CHAPMAN: I refer to the health advisory councils. Assuming they exist, the minister sets them up and they are a useful tool in ensuring that we have advocacy and the view of the community is maintained in a link with the minister. How often will they meet with the minister?

The Hon. J.D. HILL: As they need to. There will be something like 50 or 60 of these things. I do not propose to meet with them regularly, but I would expect with country health advisory councils that there would be annual or biannual conferences of members. We have had a couple with existing boards since I have been minister. I have met with them in that forum and I would expect it to be instituted on a regular basis. The advisory HACs I would meet with on an as needs basis.

Ms CHAPMAN: One of the most concerning aspects for the opposition is that, assuming they are operational and meeting with the minister as required, notwithstanding how important they are (and the minister has reaffirmed this to the parliament), in giving this advice the minister can get rid of them if he wants to. Specifically, the provisions of this part require that, if the minister thinks that a HAC should not exist and it does not agree with the minister's view (that is, it wants to exist), even if it holds assets the minister can get rid of it, provided he demonstrates in writing that he has consulted with them, given his reasons for wanting to get rid of them, and a mediation process with a moderator has taken place. I understand that this process commits the minister to genuinely listening to their view and being required to get it. The minister can decide he does not want them, and he is then able to refer that area of responsibility into another HAC.

Given that I have seen nothing here that requires the minister to put the matter into a HAC next door, if the minister did not want to keep Streaky Bay, for example, in the West Eyre Peninsula regional HAC (even if they wanted to be there) he may think they would be better placed in Ceduna, even though they were not very happy with that, and may even ultimately decide to put them with Mount Gambier, Port Augusta or Port Lincoln. In implementing a decision to dispose of a HAC that the minister does not want to exist any longer, what is the intention in terms of ensuring it is absorbed into a geographically neighbouring HAC?

The Hon. J.D. HILL: It is always a balancing act between flexibility and certainty, as well as the use of arbitrary power. The health department and I, through negotiation with the current boards, came up with that set of words to provide what we all thought was a reasonable compromise. If a health unit decides to amalgamate with another health unit—and they do this all the time; it has been happening under the current boards, and that is a good thing—some mechanism is needed to allow that to happen, and that is the mechanism that we believe will do that.

If I, or any other minister, were to use that power arbitrarily without proper consideration then there is a mechanism to allow that matter to be adjudicated through an independent mediator. So, there is a process in place to ensure that that power is not used in any unfair or unreasonable way. You would only do it if it were to aid the provision of health services; not just as some arbitrary act to include Streaky Bay with Mount Gambier, as the member suggested.

Clause passed.

Clause 17.

Ms CHAPMAN: The minister presented to the parliament yesterday a template for the constitution and rules, and I thank him for that. Essentially, this is some kind of precedent constitution or rules and it is my understanding that, under this clause, these will have to be adopted—or is it the case that these are just provided as a guide with which they can prepare themselves? I am not quite sure whether this is to be enforced or whether it is just a helpful guide.

The Hon. J.D. HILL: The proposal is a model which we would expect the HACs to use as a starting point. They may wish to make variations, depending upon local circumstances, and I think that, with my authority, those variations can be made. I think that is pretty well the case now with the constitution. They are the existing provisions.

Ms CHAPMAN: Each of them includes a clause which, in fulfilling its roles of advocacy and of obtaining information in both its local geographical area and its area of expertise, seems to be (in all three) the constitution template. There is also a second constitution—

Members interjecting:

Ms CHAPMAN: Mr Acting Chair, it appears that the minister is unable to hear because of the noise in the chamber.

The ACTING CHAIR (Mr Koutsantonis): Order! I agree; the members for Unley, Goyder and Schubert will show due respect to the member for Bragg. Members to my right will also keep their voices down.

Mr Venning interjecting:

The ACTING CHAIR: I apologise to the member for Schubert. The member for Bragg.

Ms CHAPMAN: There are two things that these advisory councils appear to be doing in these templates. One is telling them that they must act in accordance with the bill (which, I assume, will be the act in due course) and give effect to the policies from time to time determined by the minister. Secondly, they have to operate consistently with the strategic objectives of the government of South Australia, either generally or specifically, and not act in any way to adversely affect the rights or interests of the government of South Australia under the terms of any agreement.

Minister, what on earth is the point, if you tell them they have an important role in providing you with advice and identifying what is important to their community, if they are hamstrung by the rules which say that you have the right to tell them what policies might be effected that are inconsistent with your direction or a government policy or strategic objective? In other words, they can only give the advice to you if it is consistent with what you say is determined policy or published government policy.

The Hon. J.D. HILL: I think the member is exaggerating what this means. It is not the government as in the Labor Party but, rather, the government as in the crown. Individual health units cannot take actions which are contrary to actions taken by the government. For example, if the government of South Australia entered into an agreement with the commonwealth to ensure Aboriginal children were provided with a particular service, the local hospital board cannot decide it will not provide that service.

Ms Chapman interjecting:

The Hon. J.D. HILL: They cannot do things which are contrary to general commitments the government has made. They cannot sign contracts outside the rules under which the government operates. They cannot enter into financial arrangements with some other body if it is contrary to the general provisions of the government of South Australia. For example, if they own property, they could not sell that property to a group that was to do something which is contrary to the interests of the people of the state (as represented by the government). I cannot give a particular example. It is a safety clause to ensure that they do not do things which are contrary to the interests of the state.

Clause passed.

Clauses 18 and 19 passed.

Clause 20.

Ms CHAPMAN: This provision allows for the transfer of assets with the minister's permission, as I understand it—or is it your transfer, irrespective of a HAC's permission? I am not sure about this new section.

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

Ms CHAPMAN: Is that a clause to provide for HACs being able to transfer their assets and be restricted by what you direct them to do or is it the other way round?

The Hon. J.D. HILL: The new section provides that the minister may do certain things, either on their request or after the minister has gone through a number of processes. Section 20 provides:

(3) The minister—

(a) may not act under subsection (1) to transfer assets or rights of a HAC unless the minister is acting at the request of the HAC, or the minister has taken reasonable steps to consult with the HAC.

That consultation process is specified elsewhere. It continues:

(b) must not act under subsection (2) unless the minister is acting at the request of the other entity.

This is to allow decisions. For example, if a HAC owns land and it decides to transfer the use of the land to another community group, say a childcare centre, nursing home, or whatever, it has to seek permission from the minister. I think that is consistent with the current rules under the Health Commission Act; I am not entirely sure. There was one occasion recently. Under the Health Commission Act they can transfer assets, as long as they are consistent with the provision of health services.

If they are doing it outside of health services, they need to get my permission. An example recently was where one of the boards tried to provide land to something, I think it was a kindergarten or childcare centre, which was not considered to be part of health provision but, obviously, it was a sensible thing to have in that setting. It is to allow those kinds of decisions to be made. I guess there is an ability there if a sensible request was made by perhaps a group of GPs to build a service centre on a hospital site and the hospital said it did not want it. I guess there is the capacity there for the minister to say, 'I have gone through this process of consultation. It seems to me a useful thing to happen, and I will authorise it anyway.' So there is that power there for the minister to do it.

Clause passed.

Clauses 21 to 24 passed.

Clause 25.

Ms CHAPMAN: This clause basically enables the HAC to get information as necessary to find out about its local district—what services are presumably there already and how it is performing, and so forth—from the department in its role of advising the minister. However, it has a provision in it that anything that is currently protected under regulations cannot be handed out. More importantly, there is a provision here that the chief executive can also veto information they are getting. I would ask for some explanation as to why that would occur given that it is already restricted under subclause (1), which provides:

...to be necessary or expedient to assist in the performance of its functions.

In other words, it cannot ring up the department and say, 'I want the entire financial history of the board or of a neighbouring area that is unnecessary for the purpose of giving you this advice on what the contemporary needs are in each district.' What is the purpose of having this chief executive veto—

The Hon. J.D. Hill interjecting:

Ms CHAPMAN: Well, I am sorry, but it says that it does not extend to information excluded by either the regulations or the chief executive. He has the power to say no, and alternatively he can impose conditions.

The Hon. J.D. HILL: The purpose of this is to protect information which is confidential. In relation to the imposing of conditions, the HAC might seek information about a particular contract that is being proposed to deliver machinery, services or whatever to the body. It would be reasonable for them to get that information, but a condition would be that you cannot make this publicly known: you must consider it in camera.

In relation to information that the chief executive may exclude, one example might be personal information about a matter that is perhaps before a court, or a matter that is personal to an individual patient's circumstances. There could be a range of things which cannot be foreseen by regulation. I imagine that most of those matters would be excluded by the regulation.

Ms CHAPMAN: The reason I ask this particularly is that there is a whole provision in this legislation to deal with confidentiality of personal patient information, and that is for good reason. Certainly, there are exemptions (which we will come to later) for quality improvement and research purposes, also for good reason. But it seems that HACs, which are an advisory body specifically to the minister, will be restricted by what the chief executive may decide they cannot have.

There can be commercial confidentiality reasons sensitive enough for the chief executive to say, 'Of course you can have this information. We will be getting it to you because we are directed to provide it to you, but a condition of it is that it not be published or copied'—or be returned at the conclusion of the meeting, or whatever, because it is fairly sensitive. All I am putting to the minister is that there is a whole lot of other protection for all the normal requirements to protect for privacy, but this is something that HACs must have imposed on them, which I have not seen similarly for the Health Performance Council.

The Hon. J.D. HILL: I will get some advice about the Health Performance Council, but in relation to this the HAC, of course, is always entitled to approach the minister, and any HAC has direct access to the minister. If they believed that the CE, as my delegate in all these matters, was acting inappropriately, they could come to me and then I have power to direct the chief executive, except in areas relating to things that he has exclusive province over, notably, the employment of staff.

So I think there is plenty of capacity to deal with this if the chief executive was misusing his power, which is really the point I suppose the member is getting at. In addition to that, of course, the health unit based HACs will have a member of parliament on them so, if the member of parliament felt the HAC was being denied information by the chief executive, I am sure they would rapidly raise the matter in here or in some other way with the minister of the day. So, I think there is reasonable protection.

In relation to the HPC, the language is different. In relation to the HAC it is entitled to request information. In relation to the HPC it may request information, so it is a softer use of language. And the chief executive may impose conditions that the HPC must observe in relation to the receipt, use or disclosure of information provided under subsection (6). So I think the provisions are right but, given they are slightly different language, I am happy to have another look at it, but I think the balance is about right.

Ms CHAPMAN: I cannot recall now which district put in the submission, but one of them raised the question of representation by a nominee of local government and, in particular, that they appeared to be servicing two local government areas. Of course, unless the boundary went straight through the middle of the hospital, obviously it can be physically located in one but on the boundary and therefore servicing another. So, is there some mechanism, if they are to get only one from local government, by which the local community can make that determination as to which council they have the representative from?

The Hon. J.D. HILL: The way that operates is that in most cases where there is a single health unit it will be within a particular local government area but, where there are multiple campuses, as there are in some parts of the country, obviously they could be in two local government areas. The way we have set this up is on page 11 of the draft constitution, which is still subject to further consultation, but this was the preferred way: there must be one member appointed by the advisory council in the following manner as a nominee of local government and, in the case of the employment of such a member to the advisory council—and it goes through the processes.

Essentially, what it boils down to is that if there are multiple councils the mechanism is such that we would get the councils to work with each other to try to identify who will represent the councils. If they cannot work that out amongst themselves and there are multiple nominations from a variety of councils, the health advisory council itself will choose a nominee. So, I would hope they would choose in such a way that they would circulate the responsibility across the various local councils over time.

If there is an issue about the member of parliament, we have a similar mechanism. There could be two members of parliament who are associated with various bodies of a HAC. If they cannot sort it out between themselves, as I understand it, the advisory council can appoint members of parliament and then they will just work out a way of sharing the responsibility over a three year term. Each nominee will serve an equal and consecutive term such that the aggregate term of all members combined is equivalent to three years. It is a way of sharing the role.

Clause passed.

Clauses 26 to 28 passed.

Clause 29.

Ms CHAPMAN: This is the commencement of part 5 of the proposed legislation to incorporate hospitals. As I understand it, this part comes into this legislation because, as has been identified, the Hospitals Act 1934-1971 is also to be repealed. That act has had this function to date. The current Hospitals Act does identify the provisions for the management of public hospitals, the determination of the powers of the minister to nominate the district hospitals and various powers.

Currently, part 3 of the Hospitals Act enables the Royal Adelaide Hospital to enjoy the unique status of having a division dedicated to it. This hospital has provided services to the colony and then the state for well over 100 years, and it enjoys certain privileges and responsibilities. The passing of this bill will repeal the act and therefore will remove the status that this hospital currently enjoys completely—it will just line up with the rest of them. The opposition has expressed great concern about part 5—the incorporation of hospitals—which identifies what the new obligations and powers will be, as well as the employment of staff. They will be centralised in this part under the exclusive management of the chief executive.

A very important section in the current Hospitals Act says that the Royal Adelaide Hospital shall be a school of medical and dental instruction in connection with the University of Adelaide, and any person who has been admitted as a student of the said university and is studying in the medical course or the dental course thereof shall be entitled to attend at the Royal Adelaide Hospital for instruction in connection with any such course, subject to any statutes and regulations made by the council of the said university and any regulations made by the board. That hospital has the unique statutory authority and responsibility as probably the major training hospital in this state. It has a very close and personal relationship with and a statutory obligation to accommodate students of the University of Adelaide.

This is all about to go—and how convenient, because the government wants to discontinue the Royal Adelaide Hospital and build a new one at the other end of North Terrace. It does not want the name 'Royal Adelaide Hospital' any more, that name not having been previously available until 1939 when, by proclamation of the then governor, there was a recording of the consent given by the reigning monarch, who had granted permission for the state of South Australia to give the royal title to this hospital. There is a statutory obligation, which existed even back then (this act predates to 1934), that it shall be a hospital for a medical and a dental school in cooperation.

We are going to see the death knell of this hospital, as announced by the government, and I think that is a shame, because not only does that link have statutory endorsement but also the two institutions are right next door to each other. There is also a very close relationship with the Institute of Medical and Veterinary Science and the Hanson Institute, which is quite a new building near the rear of the North Terrace site of the Royal Adelaide Hospital, accommodating a new, well patronised emergency department.

That is all to go, and it is something that the opposition does not support. The severance geographically between the state's major tertiary hospital and training facility for the medical and dental professions is a move which we do not support and which we think will be detrimental to the future training of students. I indicate that this clause will be opposed. Clause 29 provides:

'The Governor may, by proclamation—

(a) alter the name of an incorporated hospital;

(b) dissolve—

It does not even say 'or'. I am not sure of the grammar there, but also there is the power to dissolve an incorporated hospital. It would be a sad day when this occurred and, accordingly, I indicate that we will be opposing this clause.

The ACTING CHAIR: Before I call the minister, I inform the committee that George VI was the reigning monarch at the time.

The Hon. J.D. HILL: Thank you very much for that piece of contemporary history. When this act was enacted, I am advised that the Royal Adelaide Hospital was the only public hospital in Adelaide. So, quite clearly, the provisions that existed related to it. However, of course, since 1934 (some 73 years ago), things have changed. We now have more hospitals, we have more medical schools and different arrangements are in place. So, it is absolutely appropriate that we make contemporary what is already happening in a de facto sense. The opposition expresses great outrage at this. However, I have to say that no-one else has expressed any opinion about it whatsoever, and all the relevant parties have been given an opportunity to do so. In fact, I am in regular communication with the Dean and the Vice Chancellor of the Medical School at the University of Adelaide about their ambitions to be part of the new Marjorie Jackson-Nelson hospital, and they are very excited about the opportunities that hospital will provide. Indeed, they have entered into negotiations and discussions with the University of South Australia and the Flinders Medical Centre to have some combined teaching facility in the new hospital. Time has moved on. I recognise the rhetorical and other points the deputy leader has made, but the reality is that the provisions we are making reflect contemporary behaviour and standards.

The committee divided on the clause:

AYES (24)

NOES (10)

PAIRS (10)

Majority of 14 for the ayes.

Clause thus passed.

Clauses 30 to 48 passed.

Clause 49.

Ms CHAPMAN: This part incorporates ambulance services and the process whereby they are to be licensed, and the restrictions which are to be imposed on the services that provide emergency transport and non-emergency transport for health patients in South Australia. Essentially, the repealing of the Ambulance Services Act 1992 will be supplanted by this new part. I make the point, on this part, that what is new about part 6 and the procedure that has, until now, applied is—

The ACTING CHAIR: Order! If members do not wish to be in the chamber, please go to your offices and listen attentively to the debate, because we cannot hear what the member for Bragg is saying.

Ms CHAPMAN: It is largely similar, but the distinctive new addition is that the South Australian Ambulance Service is to be the sole provider (which is now to be legislatively entrenched) for the provision of emergency service. The current licensing structure has been transferred to enable the provision of non-emergency ambulance services by a body, an agency or organisation provided it complies with the licensing requirements of the act and as directed by the minister when he gives such approval.

Importantly, the minister claimed in his second reading contribution that SA Ambulance Service would remain as the single provider for emergency ambulance services and, in so doing, it would not be inconsistent with the national competition policy principles on the basis that, even though it was the sole provider, it complied with or at least came within the 'of benefit to the community' provision.

The South Australian Ambulance Employees Association has had a bit to say about this new initiative, to the extent of bringing the ambulance act and the tier of responsibility being transferred from the chief executive of the SA Ambulance Service directly under the minister, and indicating that, under the new regime, the chief executive of the ambulance service will be responsible to the chief executive of health, who is ultimately responsible to the minister. They are not too happy about that in the sense of what they have conveyed. As to the submission from the SA Ambulance Service, it was not too happy about that. It would have preferred that the SA Ambulance Service—and it claims to have been functioning very well under the current structure—be able to have its CEO directly accountable to the minister and not under another party designated by the minister. It is a significant shift for the service.

I suppose it is fair to say that, in exchange for putting up with that power now being transferred through another chief executive and not having direct access to the minister, it picks up the monopoly contract for the service which is now to be legislated. Once this legislation goes through it will make it clear that there is no other capacity for the minister just to appoint another service to provide this in most circumstances. There are a couple of exceptions to that, and I think they should be recorded.

It picks up the exclusive contract and it will have legislative endorsement, so I suppose for a bit of pain of the restructure it is not surprising that, overall, it is compliant with the terms of the new bill. It has sought, as I understand it, under this part some protection of its employees against any adverse response to their entering a property in a circumstance where they believe that someone is in need of health services—that is, uninvited or when the occupants do not want them to come through the door—and they are to be given some protection from any claim.

I think it is just civil liability arising out of that but, in essence, they are given that protection. The opposition does not have any objection to that. It seems that, if you are going to give the officers this power of entry, which is qualified by the reasonable belief restriction, then it seems to me that there needs to be some corresponding protection. It appears that the licensing regime now has a much heavier range of penalties for anyone who undertakes an emergency ambulance service without licence or, indeed, even holds themselves out to be a service provider of emergency services without having that licence.

It is quite a strict new regime, but overall the opposition does not express any dissent from incorporating it under health. It is noted that ambulance services have had a bit of a chequered history in the past 10 or 15 years. They were in health in the sense that, although they had separate legislation, they were accountable to the Minister for Health in the 1980s. At some stage (I think about mid-1995) they requested that they be transferred to emergency services.

On some investigation of that, the former Liberal government acceded to that and agreed to it, but it had something to do with wanting to get a slice of the emergency services levy in its budgets which it thought would be beneficial financially for the service. Largely, that was achieved. It enjoyed some financial benefits from that transfer. However, it is this government’s determination that it should be more appropriately seated with services in health. In effect, it has been its responsibility, and now it will have legislative endorsement in the repealing of the current act and being incorporated here.

Clause passed.

Clauses 50 to 63 passed.

Clause 64.

Ms CHAPMAN: I want to place on the record that my understanding is that this is largely a replication of the regime that currently applies in respect of the activities necessary for quality improvement and research. On the basis that that is the case—as we have been advised in briefings—the opposition does not have any specific objection to this process.

Clause passed.

Clauses 65 to 67 passed.

Clause 68.

Ms CHAPMAN: This is the commencement of part 8 of the bill, which deals with the analysis of adverse events. There is an important principle of protecting the privacy of people's medical information balanced against the also important provision of having processes that will protect the integrity of events to the extent of enabling that information to be used to make sure that, if there is an adverse event—that is, some sort of mishap or death arising out of someone's act or omission—it could be remedied if information is made available to ensure it does not happen again.

A simple example is having a protocol in a hospital which is designed to protect against a person having a medical procedure or intervention accidentally as a result of that person having the same name as another patient. If, for example, someone has the same surname as someone else and they get the wrong records that do not disclose that that person has a history of an allergy to penicillin or some other pre-existing condition like asthma, the procedure progresses and, consequently, it is discovered that they were the wrong records, the question then is: how do we use that information to make sure that a protocol is developed so that it does not happen again? For example, a patient can be asked their name and address several times, and whether they have any relevant history, so that there can be some capacity to ensure that such an adverse event does not occur again.

It is the balancing of these things that is important, as well as trying to ensure that a member of staff, whether medical, nursing or otherwise, is encouraged to come forward, provide information if they have made a mistake or acted in a way that was negligent, and confess. A third alternative involves someone who is present, or who is also involved in services to the patient (a nurse, for example) and who observed a failure—that is, an act or omission by a medical person; for example, a witness to a situation of the wrong drug being administered and so on. Such a person will be immune from any repercussion of disclosing information if that person acted in good faith.

Clause 68 provides that 'no act or omission of a person in good faith for the purposes of an approved activity' of the root cause analysis team 'or for the purposes of an activity that the person reasonably believes' to be an activity of the root cause analysis team 'gives rise to any liability against the person, or against any governing body or other entity involved in authorising' an RCA team to act under this part.

So, there are competing interests here. Again, I am advised that, largely, this part is a replica of what existed in the previous legislation and follows on from the provisions in part 7, which we have approved. I would like to say one thing, however, about adverse events, and Mr John Menadue has been quite prolific in his writing about this issue—that is, the importance of hospitals addressing adverse events and understanding how expensive they are financially (to the government and/or taxpayer), let alone personally (to the patient, their family or friends) if they survive the adverse event. He says that $4.17 billion is the estimated cost of harm in hospitals through adverse events, which represents 23 per cent of recurrent costs in all hospitals—one-fifth of the costs of all hospitals in Australia.

He has written about the Bundaberg hospital episode as being a very public example of where the system goes wrong and the enormous cost involved. He considers that at least half the adverse events are preventable, and he claims that there would be a very substantial saving of $1 billion if it were addressed. With all the proposed new structures—namely, a health performance council to advise the minister, the central control of the management of the hospitals to avoid the risk to patients by sloppy management of current boards and so on—the reality is that, unless you undertake the required root cause analysis reporting, you still have a problem.

I think what is important here is that there is little point in having all this process, which already requires hospitals to provide information; that is, to disclose this to the department, report on it, and there are obligations to actually investigate these events and to provide reports on them. You can have all this process, just like we are setting up a whole new process, but unless you actually do it and report on it then there seems to be a situation where you cannot possibly learn the lesson from the analysis of these situations.

On 26 June this year, I asked the minister to explain how many of the 42 sentinel events which occurred in South Australia from 2004 to 2006 had still not been analysed to identify why they occurred and to prevent them from occurring again. The freedom of information documents related to the sentinel events show that there were five in 2003-04, 20 in 2004-05 and 22 in 2005-06. The responding document stated:

The Health Department requires hospitals to document and analyse all sentinel events as soon as practicable in order to identify what occurred, how it occurred and how to prevent it occurring again.

The root cause analysis report that was then published for 2004-05, some two years ago, has only now, in the past few months, been put on the website. We know that there has been some inquiry and, from what we know, that is under the new proposed electronic reporting for events that occurred two and a half years ago, but it contains no detail of them.

Here we have a situation where we have all these rules and the minister says that we are going to have this new centralised, unified system, with the restructure, and we are going to be able to follow through with these obligations, but the reality of it is that this data is not being dealt with, I suggest, in a timely manner, and it is it is not being reported so that we can make sure that there are no further mistakes.

I will give you an example of a published story this year, in July, when a 41-year old woman, who was taking legal action against the Lyell McEwen Hospital, claimed that surgeons had left a piece of plastic tape inside her. The Lyell McEwen Hospital is not being looked after by some local hospital board that is responsible. This is a specific act by a surgeon. No hospital board can be responsible for the act; this is a direct action of the surgeon.

This woman claimed that it had ruined her long-term health, etc. She had a bowel operation in the hospital in 1995. She said that she had suffered dramatic weight loss and severe pain. Doctors told her that they could not find the cause and, four years later, when she had a hysterectomy, the surgeons found the piece of surgical tape. So, this is exactly the type of case that we need to know about and which, accordingly, John Menadue AO says is costing us $4 billion to $5 billion a year; that is, 10 per cent of the total health budget wasted because the government has not investigated the matter.

I think what is important is that, in making all these rules to make sure that the information is available and that it balances against the protection of privacy of information of the patient, the information is made available and actually analysed. So, it is very important that we get on with doing it.

The Hon. J.D. HILL: I cannot allow those comments to go without addressing them. The health system takes very seriously incidents that occur. A whole lot of protocols are put in place which this legislation describes, and there are other things as well to make sure that the system is self-learning and that mistakes that are made become the basis of new systems. All the comments made by the member were not addressed to the legislation but could well be addressed to me by way of questions on notice or by letter. I am happy to find any details she wants if she has concerns. I think the principles in here are absolutely unimpeachable.

Clause passed.

Clauses 69 to 78 passed.

Clause 79.

Ms CHAPMAN: This part addresses the question of the licensing system for the private hospitals. We have covered this in debate, and my understanding is that the minister indicates that this is an area that has been transplanted from the current legislation as it is in need of some review, and he will be doing that in due course. There is no sinister motive or undisclosed objective of the government to do anything adverse to private hospitals. I simply ask the minister that the licence of each of the private hospitals currently licensed in South Australia will continue and that no other conditions of licence will be imposed in the foreseeable future, that is, which is being proposed.

The Hon. J.D. HILL: That is a question that is not really related to the legislation. I have said before that the private hospital sections of this are exactly as is currently the case. The member could ask me that question on any day of the week from now until this legislation is passed. It would apply to the current legislation. Clearly, if individual hospitals breach the rules their licence will be threatened or, if they want to change what they do, their licences may change, but I have no other mechanism in mind which would affect the way private hospitals operate.

Clause passed.

Clauses 80 to 100 passed.

Schedule 1 passed.

Schedule 2.

The Hon. J.D. HILL: I move:

Clause 3, page 64, line 31—

Delete 'Part 4' and substitute:

Part 2

This is really a technical amendment. In the drafting the wrong part was referred to; it should refer to part 2 rather than part 4.

Schedule as amended passed.

Schedule 3.

Ms CHAPMAN: This relates to the special provisions that are provided to the Repatriation General Hospital Incorporated, which, of course, after the passing of this legislation will be the only hospital in South Australia to have its own board. There is provision in this part for the minister to have the power to remove a member of the board from office on any ground prescribed by the regulations. As we do not have any regulations, will the minister give us some indication as to the circumstances that would apply?

The Hon. J.D. HILL: I advise the deputy leader that existing regulations would be translated into this legislation, to cover somebody who is no longer capable of performing a role as a board member.

Ms CHAPMAN: There is also provision in clause 4 of the schedule for the dissolution of the board: 'the minister may at the request of the board dissolve the board'. There is nothing in here to require the minister or the board to consult with the veterans before such action is taken. It is fairly clear that the Premier has made statements in this house with words to the effect, 'They would have their board unless the diggers said otherwise' or something like that. It is our understanding that a very clear commitment has been made by this government at the highest level, the Premier, and it would not just be a board that said that the minister could get rid of it.

Presently it has two representatives from the RSL on it, but they are all members appointed by the minister. He could have anyone on them who could simply say to him that they agreed to the board being dissolved. The clear intent from the Premier was that there would be no dissolution of this board, that the Repatriation Hospital would have its own board, without the veteran community being in agreement. It seems that the only way of ensuring that that is covered is that there be some provision in the legislation that there be some referendum of the membership or stakeholder bodies before such action could take place. Is that the minister's understanding of how this is to operate, that is, that he would not act to dissolve the board unless there had been some process explored to canvass and obtain consent from the veteran community? If so, would he consider an amendment in another place to tidy it up?

The Hon. J.D. HILL: The political promise has been made by the Premier and by me that, unless the diggers (to use the generic term) are happy, we will not dissolve the board. It is hard to articulate that in a legal sense. The process I have gone through is to have discussions with the Veterans Health Consultative Committee, which has representatives on a range of bodies such as the RSL, Legacy, Vietnam vets, war widows and others. That is the body I would use to consult with the various membership groups. If they were of a mind to change it, that would be a reasonable reflection of what the veterans thought. I am happy to consider a way of articulating that between here and the other place. I am happy to talk to those groups about that. They have expressed nothing but satisfaction with the language here at the moment, so I am not sure that it is an issue.

Schedule passed.

Schedule 4 passed.

Title.

The Hon. J.D. HILL: Before I conclude, I gave some advice before about local government that if there were multiple local government authorities who wanted to put someone in a country health advisory council then the health advisory council itself would make the decision. I have been advised that that is largely correct, but technically that decision would then be referred to me and I would enact that.

Mr Venning interjecting:

The Hon. J.D. HILL: Ivan, it is a late night. I have to formally do that, but it would be the health advisory council that would make the recommendation.

I would like to thank all members for their contribution to the debate on the bill. I would also like to thank representatives of the health agency for their assistance, particularly Dr David Filby, Nicki Dantalis, Rob Smetak, Rebecca Horgan, Kelly Sims, Alicia Tsogas, Ann Johnson and, of course, Richard Dennis, the parliamentary counsel.

Title passed.

Bill reported with amendment.

Third Reading

Bill read a third time and passed.