HEALTH CARE BILL

Second Reading

Adjourned debate on second reading.

(Continued from 23 October 2007. Page 1280.)

Mr GRIFFITHS (Goyder) (12:08): It is a pleasure to be able to contribute to the debate on this important bill, and I will take but a few minutes. I certainly recognise the importance of this measure, as it will impact upon the provision of health services. So, it is an absolutely key area, and I am confident that the majority of opposition members will choose to speak. Today I wish to focus my comments on it as it relates to the 70 communities within the Goyder electorate that I am lucky enough to serve as their member of parliament, and the hospitals that are within those communities. I will leave the statewide comments on this bill to our very capable shadow minister, who I think spoke for nearly four hours yesterday on the bill.

Ms Ciccarello interjecting:

Mr GRIFFITHS: The member for Bragg did a very good job. She was very professional and detailed many of the issues about which the Liberal opposition is concerned. I have lived in a regional community since the age of four, and luckily all of those towns that I have lived in have actually had a public hospital in them. In fact, I am a bit of a hospital brat, as my mother is a nurse. She is 64 and works at Flinders. What has happened in hospitals has been a major part of my life for as long as I can remember.

The electorate of Goyder has hospitals at Yorketown, Maitland, Wallaroo and Balaklava, with the former Minlaton Hospital now not only being an aged-care facility but also providing accident and emergency services. In addition we have the Moonta, Mallala, Ardrossan and Hamley Bridge private hospitals. I have never been involved in the management of hospitals via being a board member, but my previous local government roles have required me to have good relationships with the administrations of hospitals and, in many cases, their board members.

In every case I express nothing but gratitude for the work that was done by these people, not just the generation I have known since I entered the workforce in 1979 but also the thousands of people who have contributed to the development of the public and private hospitals in Goyder since the settlement of the region. All these hospitals would have started as very small private affairs. The communities, the real people who live there, saw a need for the doctors, nurses and health care. They worked very hard to provide these facilities and services and, over generations, upgrade them as funds become available.

Governments at all levels have supported these efforts in the last 150 years, and there is no doubt about that. Now, however, we find the scenario whereby the government is proposing to take away the efforts of locals by removing any vestige of authority that the hospitals or health service boards have had and turn them into health advisory councils. Via becoming an incorporated body, these health advisory councils will continue to have ownership of the assets gifted locally by previous generations. What else will they have to do? Community people can talk to these health advisory council (HAC) members about issues, and the HAC members will dutifully raise them at their meetings, but what will then happen? That is my concern.

The HAC members can make decisions, but if the powers that be above them do not want to do anything about it, what can happen? From the information provided to me, very little. Whereas previously the health and hospital service boards provided direction and policy advice, reviewed staff performance and made strategic planning decisions, now this ability to influence what happens locally appears to have gone. I recognise that successive governments since the mid 1970s have looked to make changes to the running of the health services, but this bill takes that level of change and central control to a new level.

This bill proposes that all responsibility for the provision of health services in South Australia will rest with the minister and the chief executive officer. With respect to employment issues, I find it amazing that the CEO will accept responsibility for and have total control over some 25,000 employees. The responsibility that now rests upon the person who holds this CEO role is enormous. I have never met the incumbent, Dr Tony Sherbon, but I wish him luck in his role. In reviewing the second reading explanation, the government claims that this bill:

is necessary to meet the challenges and demands of health services in South Australia (and I think I heard yesterday that unless changes occur by 2042 it will consume the total state budget of the state);

will result in the creation of a unified single Public Service system which will improve coordination and integration of services; and

is justified because the Department of Health has direct responsibility and accountability to fund health, so therefore it should manage it.

Whilst all those reasons are interesting, I want to take up the last point, which is of particular interest to me because of my commitment to communities. If we extend the position that the government now appears to be pushing that, as it funds it, the department should have control of it, one must ask: what will happen in all the other areas of service provision across the state into which the government puts funds that revolve around the management of services by volunteers?

Another real concern I have with this bill is what will happen to the volunteers who support the hospital so much—the people who run the local auxiliary to raise money; the people who talk to those who may not have many visitors; the people who volunteer to upgrade the grounds and improve the amenity of the hospital; and the people who put the nice decorations on the wall—the people who truly make a difference to our public hospital system? These people all volunteer their time willingly because to them it is their hospital. They live within that community. They have a commitment to it and they want it to be the best possible facility it can be, and they understand that for that to happen it needs volunteer support.

The trouble is that it will no longer be their hospital: it will be the government's hospital, as it will run it totally, and that is my fear. The current generation of volunteers will no doubt continue with some degree of frustration but out of a sense of duty. My fear, though, is how will they be replaced? People of my generation have a lot of pressures upon their lives. So many families have both partners in the relationship working—

The Hon. J.D. Hill interjecting:

Mr GRIFFITHS: No; I am still a baby boomer—1962. However, the X and Y generations are a little more selfish. While a lot of people have had influence from parents along the lines that they need to volunteer their services to the community, it is becoming harder to do this. If our older volunteers, who have done such a tremendous job for so many years, can no longer take on that responsibility and fewer people are now coming through in this respect, there is a fear of what may happen in the hospital system. It will be a sad situation, and one of the triggers for this reduced volunteer effort is the fact that the local hospital board is losing its power and losing its ability to have a say in the management of its hospital.

I recognise as much as anyone the need to create efficiencies, and anyone who looks at the budget for the state and reviews the Auditor-General's reports understands that there are enormous financial pressures. It is not clear to me, and I ask the minister whether the changes will save money. The second reading explanation did not refer to this. Will these changes improve the range and quality of the services provided? I am aware that petitions objecting to this bill and its intention have been lodged with the house. In my own electorate of Goyder, I note that comments on the bill were made by the Balaklava and Riverton District Health Service and the Yorke Peninsula Division of General Practice.

The Balaklava and Riverton District Health Service stated that it supports in principle the intended repatriation of patients to country SA for their medical needs wherever possible and conducting elective surgery closer to the home of country residents. Secondly, it does not support the abolition of local boards of directors in country health services. They believe the loss will be detrimental to the state's country health services in years to come. Thirdly, they believe that if it is necessary to have health advisory councils instead, which will also allow for links to the local community, they want to ensure they are incorporated so that local ownership of assets can be retained, and I understand that has been covered.

The Yorke Peninsula Division of General Practice concerns related, first, to the abolition of hospital boards and replacement with health advisory councils. They state that the decision on whether or not to incorporate must remain locally, not with the minister. They have also alluded to the lack of enthusiasm of local volunteer bodies that will be jeopardised if they do not have control over the assets and funds they have raised over many years. The strong point they have made is that there appears to be no reference to GPs. Their comment here is that it may be irrelevant for the metropolitan area where hospitals are staffed by doctors, but country hospitals rely on local GPs to provide clinical services.

The Hon. J.D. Hill interjecting:

Mr GRIFFITHS: The minister has just confirmed that there will be a representative on the council. Fourthly, it is expected that demand will increase in the area of tourism growth and ageing, as indeed it will, as Yorke Peninsula is a very popular spot. That will require greater services, so they cannot condone the downgrading of the non-delegated regional hospitals. They allude to the investments that will occur in the forward estimates period in focusing on Port Lincoln, Whyalla, Berri and Mount Gambier. They want to ensure that hospitals in the Yorke Peninsula area have access to the full range of services. I find it interesting that in 2004 the Rann Labor government said that it would not get rid of hospital and health service boards. Guess what! We are now in 2007 and it is happening in a big way.

I firmly believe that many of the hospital and health service boards have been worn down. They have no more energy to fight the intentions of the government. People want to ensure that local management is retained, but they know the fight is lost; the government has made up its mind and has not consulted with them but has told them what will happen. In closing I put on the record my sincere thanks for the people over generations who have volunteered their precious time to support their local hospitals. These efforts have built the health service centres, the envy of many nations. Sadly those volunteer efforts appear to be no longer required.

The Hon. L. STEVENS (Little Para) (12:19): In contributing today, I will focus on some of the comments made by the deputy leader in relation to the Generational Health Review and those reported in the paper and attributed to John Menadue in relation to hospital boards. Probably along with most other people in the house, I attempted to listen to the deputy leader. I thought the first hour or so was okay, but after that it went off into a fairly wide-ranging muddle.

She made some comments that I think need to be clarified in terms of what the facts are, particularly when referring to a document. So, I encourage people who talk about the Generational Health Review actually to read it. It is on the internet through the Department of Health website, and I suggest that people read it. I will focus on what John Menadue said in his report, and I quote from chapter 2 of the Generational Health Review entitled 'Population Health and Governance'. He said:

Existing legislative protection of individual health unit boards has stood as a clear barrier to health system reform. Structures designed for the needs of an earlier time have not been able to address increasing complexity and the difficulties experienced by both consumers and providers. These difficulties include poor communication across the health system, rivalry rather than cooperation between organisations, and inadequate alignment of services to population priorities.

He goes on to say:

[The Generational Health Review] has received strong representations that local hospital boards provide a powerful voice for the community. It is important not to confuse corporate governance and community participation. Current corporate governance roles of incorporated hospital boards involve ensuring safe clinical outcomes within the hospital, responsibilities in employment and industrial matters, legal requirements, probity, budget management and risk management.

Further, he states:

GHR is of the view that hospital boards can over-emphasise their role as a voice for the public and their level of community representativeness. GHR believes community participation is better achieved in a different way.

In that chapter there is further discussion along those lines, and I suggest people who are interested in the detail read that. Further down, there is a number of ways forward that Menadue proposes in discussion. He says:

[The Generational Health Review] has adopted the following approach to promote a greater focus on population health in the South Australian health system—

population health being having responsibility for a geographical area of citizens. These are the points: first, planning for defined geographical populations in metropolitan, rural and remote areas; second, a population approach to health funding (an overall population approach); third, population service planning; and, fourth, population based health governance arrangements. Again I will quote what the report says for the way forward:

The power to direct and control resources and health services lies principally at ministerial level. However, in creating a balance between central control and direction and responsiveness to local communities, there is a need for a principal governing body at the regional level. This body should have adequate authority and responsibility for promoting the health of a defined geographical population and managing the health services within that region in accordance with regional health care needs.

At the same time, there is a clear need to maintain and strengthen local community participation in health care agencies and health issues. It is also important to recognise the continuing interest of local communities in assets that they have funded, and to support and encourage ongoing fundraising and contributions in kind.

Finally, in the final recommendations the Generational Health Review, under 'A population health approach', states:

2.11 The state government ensure that regional health service board members will:

(i) have the expertise and experience essential to the business of regional health services

(ii) be paid an appropriate sitting fee

(iii) be provided with an intensive induction and ongoing education program

2.12 [Department of Human Services] develop the governance arrangements outlined in chapter 2, which include:

(i) regional health services in each of the geographic regions

(ii) dissolution of separate incorporation of all hospitals, health services and regional health services currently incorporated under the SAHC Act, including statewide services

(iii) broad roles and responsibilities for the Minister for Health, DHS, regional health services and health units as defined

(iv) appropriate bodies to administer community resources in line with regional health service priorities

(v) regionalisation of all other incorporated and unincorporated services within three years, giving due regard to the specific nature of organisation service provision in each case

(vi) funding for all other incorporated and unincorporated services to be incorporated in the population health funding model and allocation targets set for each region.

I put that on the record so people know the facts of what was said. The government at the time accepted the majority of the recommendations from John Menadue. In relation to what John Menadue is reported to have said yesterday, he is quoted in The Advertiser as saying:

'The key to reform in SA was getting rid of the hospital boards—they maintain little fiefdoms, silos, they look after their own patch and resist integration.'

The issue of the dissolution of unit boards did occur voluntarily in the metropolitan area by all boards (except the Repatriation General Hospital Board), and that process occurred as a result of a lot of consultation, involvement and agreement. People would know there was no fuss and bother. It just occurred in the metropolitan area, but it did not occur in the country area.

Some processes needed to be put in place (just as Menadue said) in order to achieve a balance of corporate governance and community participation, but, again, adopting the regional population approach. I want to clarify that point because I do not think the deputy leader understands it—amongst many other points she does not understand. Certainly, Menadue was referring to the voluntary dissolution of all the unit boards in the metropolitan area, which occurred two or three years ago. Finally, I point out that Menadue is quoted as saying:

The key to reform [in health] is primary health care. That's the substantial reform area that's necessary to take pressure off hospitals and to strengthen general practice.

It is critical to get a governance model in place to enable this to occur, and that is where we have to put our energies. The issue of the federal Minister for Health suggesting that a way forward would be to have separate arrangements with every hospital and the federal government in relation to their funding flies in the face of all that we know about how to manage health services today. Clearly, that is what John Menadue was speaking about when he spoke with reporters from The Advertiser. I conclude my remarks by suggesting that those people who talk about the Generational Health Review perhaps should read it; perhaps that would make our discussions clearer and more effective.

Mr WILLIAMS (MacKillop) (12:29): The last contribution was interesting, but I stand here and speak unashamedly on behalf of the hospitals in my electorate, and the comments that I make will refer to hospitals across regional South Australia rather than in the metropolitan area. I think one of the problems that we are facing with this change to the governance of our hospitals is that the government has failed to recognise the difference between hospitals and their role in delivering health services in country areas and in metropolitan Adelaide, because there is a huge difference.

Hospitals and boards in country communities play a role that has no equivalent in metropolitan Adelaide. I will give examples as I go through my contribution, pointing out the difference between what occurs in country communities and in metropolitan Adelaide. A lot of this difference is because of the nature of the politics in the two distinct locations. Politics in country towns dictate that certain things happen that are probably irrelevant in metropolitan Adelaide, because the major hospitals in metropolitan Adelaide, especially the major teaching hospitals, are not specific to a particular electorate. So, there is not the political imperative in the same sense as one finds in country towns.

I guess the political imperative with regard to health in metropolitan Adelaide is to supply a world-class health system that has major teaching hospitals and hospitals that provide a large range of services, which we never expect to have in country towns. We never expect to have open heart surgery, kidney transplants and those sorts of operations performed outside of metropolitan Adelaide. We do expect—and I believe we have a right to expect—obstetric services to be delivered as far and as wide as possible.

In a contribution to the house in, I think, the last sitting week, I commented on the drought in the Eyre Peninsula region and spoke about the Cleve hospital, which has not only lost its GP, but which also has no obstetric or postnatal services. So, young women who are forced to travel from that community to Port Lincoln or Whyalla, for example, to deliver their baby cannot even go back to their local hospital to spend the next few days in their home town. That imposes a great burden on country communities, because their loved ones—their family—who are obviously working in the local community (in that instance, at Cleve), have a long way to travel.

We continually hear about work/life balance, paternity leave, and all those sorts of things, and how important it is for a father to be involved in the birthing process, and so on, from day one and to support the mother. It is almost impossible for a young family, in a place such as Cleve, to enjoy that experience in their life together; they are torn apart by the tyranny of distance, because we fail to deliver the services that we should be delivering in places such as Cleve. I guess that is where one of the imperatives comes from, when I talk about the political imperative, to ensure that, throughout the history of the state, we develop health services in our country communities.

The other important thing is that GP services in country communities depend very heavily upon the local hospital. I suggest that, when the local hospital has been downgraded to the point where it does not provide minor surgical procedures, that community will have difficulty in attracting and retaining GPs. In hospitals that have minor surgical procedures (or even significant surgical procedures) carried out by visiting surgeons, it is relatively easy to attract and maintain GPs—and I cite my own electorate. The communities of Millicent and Naracoorte traditionally have not had great difficulty in attracting GPs. I think about 12 GPs operate out of the Millicent medical clinic.

A large number of them undertake significant work in the local hospital, either on their own in obstetrics, minor surgery and anaesthetics, or assisting visiting surgeons. The work that is done in the hospital underpins the local medical clinic, and therefore it underpins the whole delivery of medical services in that community. That is the model we should be endeavouring to ensure we have across regional South Australia.

Unfortunately, with a centralised system, it is always easy to win the argument that you deliver the services from a central point, particularly the significant services; that is, the services that have any amount of risk or cost associated with them. I acknowledge that you can always deliver those services more cost effectively and minimise the risk from a central point. However, that comes at a great cost, as I pointed out in relation to the family at Cleve who have to receive their obstetrics at a distant point, say, Whyalla or Port Lincoln. The cost is shifted from the taxpayer and the health system to the individual family or the person receiving the service.

That is what is happening here. We are transferring the cost away from the Department for Health to the individual families. That only impacts in country South Australia. It does not occur in metropolitan South Australia; it will not occur and it is not an issue in metropolitan South Australia, because these changes will make very little difference there. My argument is that, as a result, not only will we see a downgrading of the services currently delivered in a significant number of country hospitals—some of them might be centralised to the four regional centres that the minister has identified: Mount Gambier, Berri, Whyalla and Port Lincoln—

The Hon. J.D. Hill interjecting:

Mr WILLIAMS: And I believe an upgrade at Ceduna, too. I do not have a problem with that. I have had much experience with the conflicting interests of a regional hospital (in this case Mount Gambier) and the sub-regional hospitals in my electorate, say, Millicent and Naracoorte in particular. I have had much experience with the sort of things that happen. The hospital at Mount Gambier believes that it should be all things to all people and will do whatever it can, irrespective of the impact on the sub-regional hospitals and their ability to continue to deliver their service.

They say that that is not important: the important thing is to have a good base hospital in a place such as Mount Gambier. I would argue that, in this instance, that is not necessarily delivering the best service to the community of the South-East. The reality is that, if people living at, say, Naracoorte (which is about an hour's drive from Mount Gambier) need a significant procedure which cannot be delivered in their local hospital, by and large, they would choose to come to Adelaide rather than go to Mount Gambier.

Members would ask: why do they do that? The reality is that families are very important when people are receiving medical services, and people in Naracoorte would be more likely to have family in Adelaide than in Mount Gambier; therefore, the support that they need when they are receiving their medical service is more than likely to be available in Adelaide. I receive a continual stream of complaints and inquiries through my office about families living in my electorate who have to come to Adelaide for their services.

Some people have family members in Adelaide and have access to living arrangements and therefore their husband, wife, loved one, children or the person supporting the patient can stay in Adelaide for the time—and obviously some of these procedures involve weeks of treatment—and that support is incredibly important. By and large, people in my electorate would not necessarily receive that support in Mount Gambier. This is an argument I have been having for a long time. The hospital in Mount Gambier—notwithstanding that it is a very good hospital which delivers a good range of services—is not the ideal delivery point for my constituents. That is a fact.

Another thing I want to say about country hospitals, as I was alluding to earlier, is that the country communities themselves throughout the history of the development of our health system saw that they had to help themselves. The reality was that distance largely meant that, for them to try to defray the costs that I was referring to that are pushed back to the individual families, they needed the service to be delivered within their local community. So, country communities got together and raised the money to build their hospitals.

They raised the money to support bringing GPs to their hospitals. They put together boards to manage those hospitals and, by and large, I would argue that those boards have done a very good job. When you add in the point that they have made the connection between the delivery of our health services and the community, they have done an excellent job and a job which will fail to be done under these new governance arrangements.

I will give an example. At the hospital at Bordertown some 10 to 12 years ago, a local GP, who had a large range of skills, decided to leave the town. A lot of issues are behind this story, and I will not go into all of those. When he left the town, he left the hospital bereft of a lot of its ability to deliver the services that it had been delivering. Basically, it meant that the whole health system in Bordertown was at the point of collapse. The Liberal government of the day—and I think it was a little tardy in doing it—intervened and put a new board in place with considerable support and a charter to rebuild the health system from the ground up, which it did in a fantastic way.

I remember an article which I think was on the front page of The Advertiser some months ago about how our health system in South Australia does not receive enough support and does not get enough money coming out of the private health sector to support our public hospitals and our health system in general.

The Hon. J.D. Hill: We're trying to get more.

Mr WILLIAMS: From memory, minister—and you may correct me—I think you were aiming at about 4 or 5 per cent of the total.

The Hon. J.D. Hill: I can't remember. It might have been 10 per cent.

Mr WILLIAMS: Anyhow, it might have been 10 per cent; I accept that.

The Hon. J.D. Hill: We wanted more.

Mr WILLIAMS: Yes, you wanted to double it, and I think it was commendable. It is an argument that I have been making, minister, in my electorate in regard to the Mount Gambier hospital for a number of years.

One of the things that have been achieved at the Bordertown hospital through this process of the community really getting behind their hospital and knowing how close they came to losing everything is that 32 per cent of the total budget of that hospital is generated from private patients. I would say to you, minister, that you have been saying that we need to run our hospitals with professionals and that it is time to push the amateurs aside. I would argue that the amateurs who have been running the Bordertown hospital have done a commendable job, and I would argue that they have probably done a better job than quite a number of your professionals.

Minister, it is not unique to Bordertown. I give the example of Bordertown because it is a fascinating example and case study, and I can tell you that both the Naracoorte and Millicent hospitals have a record not dissimilar. The board has understood that, to maintain the sort of services that the community wants and should aspire to have, it has to get those dollars out of the private sector. They have done funny little things. If I go into the Millicent hospital—

The Hon. J.D. Hill interjecting:

Mr WILLIAMS: No; they do funny little things, minister, which I do not believe you can do in your major teaching hospitals. If I went into the Millicent hospital, said that I would come in as a private patient and asked about the advantages, they would say, 'We'll put you in a private room.' I would say, 'That's very nice.' The reality is that, if I went into the Millicent hospital as a public patient, I would probably be in a room on my own anyway. I would say, 'Why should I come in?' and they would say, 'We'll give you a newspaper in the morning and a glass of wine or a stubby of beer with your dinner at night. The furnishings in a small number of rooms in the hospital are of a superior quality. You'll enjoy that. You'll get the TV without having to pay an extra few dollars a day for it.' It is a very small cost to the hospital to offer those little incentives, but it brings in a huge amount of income. They are the sorts of things we can do—and can do quite readily—in country hospitals, and I would suggest that it happens right across country health.

The Hon. J.D. Hill interjecting:

Mr WILLIAMS: The minister says that we can do it in the city. I would love to see it happen in the city. As I have said, within a bee's whisker of a third of the income of the Bordertown Hospital comes from private patients, and it is those sorts of things that have caused that to happen. If we could achieve half of that in our metropolitan hospitals, we would go a long way towards solving our health cost problems. But, minister, the reason this can be achieved in country hospitals is that there is a huge connection between the hospital and the community, and that connection, I would argue, is built through having a board that is responsible to its community.

Another thing that happens in country health, in a lot of our country hospitals—and it was a deliberate ploy of the previous government—is to have aged care facilities built on the same campus as our hospitals. This is to bulk up the services to defray some of the common costs and to ensure, again, that we retain GPs in country towns. Also, in country communities the local government body is quite happy to put a special rate onto their communities to put into establishing the bricks and mortar of those aged care facilities, and that has happened in a number of areas in my electorate. It has happened in Naracoorte, Penola and Millicent, and it has probably happened in a couple of other areas that do not come to mind right now. I do not see that happening in metropolitan Adelaide; I do not see the connection between local councils and health in metropolitan Adelaide. However, it happens in country South Australia.

So, there is a whole range of differences between country health and the system we have in metropolitan Adelaide. I have seen no evidence to suggest that by centralising the governance of our hospitals we will improve the system or improve the delivery of service, especially in regional South Australia. I see a mountain of evidence to say the contrary is indeed the reality, that is, as we centralise the governance, as we take the power away from the local communities, we will form a disconnect between the communities and their hospitals.

Another small point I make is that, as the local member, I have enjoyed fantastic access to the hospitals in my electorate. I question whether a minister—I am not necessarily talking about this minister—will enjoy me having the same access in the future. Through that access, I have been able to get a lot things over the years for various hospitals—and the renal dialysis unit in the Millicent Hospital is one that comes to mind—through being able to have access via the board. Once it is managed centrally, I fear that local members may well lose that access and lose the ability to have the influence we have enjoyed on behalf of our communities in the past. I do not support the measures that are before us today. I think they will be the death knell for services in country South Australia and will make it incredibly difficult to attract and retain GPs in many country communities. I think it is a bad measure.

Time expired.

The Hon. R.B. SUCH (Fisher) (12:49): I trust this new initiative will work. What I want to see happen is a system that is dedicated to the wellbeing of the patients, and that might seem a very basic thing to say. There is a danger—and I think it has existed for a long time—that the health system is often run for the benefit of doctors. The health system, to some extent, has been run for the benefit of the people who work in it: for doctors and, in particular, specialists; to a lesser extent, nurses and other professionals; and the support staff. It is very important in our health system that the role of caring for the patient be absolutely number one in regard to priority. It might seem a fundamental and basic thing but if one is not careful with bureaucracies they become self-serving and self-justifying. I believe we see that in education and other areas as well. I hope, with this new structure, that we do not end up with an overly bureaucratic system where the patient is forgotten. The patient should be at the top of the list.

Overall, our health system in South Australia is quite good. There will never be a perfect system which will satisfy all the demands that people put upon it. Expectations rise and people want prompt treatment, but their expectations are often unrealistic. The medical profession has to engage in a lot of detective work. It is not infallible or foolproof in the way it conducts investigations. There is always going to be the human element but, overall, I think we should be proud that, in South Australia, we have a very good health system.

I have experienced both private and public and I have found that the public system, in terms of the standard of medical care, is excellent. It does not necessarily have all the frills, the fancy glass of wine and those sort of things, but the standard of care, in my experience, has been fantastic. From time to time we hear negative stories about our health system but, overall, it is a very good system.

What I would like to see—and I know this is not the prime purpose of this bill—is more emphasis on keeping people out of hospital; not those who should be there, but greater emphasis on preventative health measures and education. I think, for a lot of people in the country—and I will be talking about this tomorrow in parliament if time permits—and particularly for rural men (who have been the big losers in regard to preventative health programs), it is important that, whether you are male or female in the country, you get adequate information and education about health issues. What the system needs to do is to focus more and more on preventative health, early screening and health checks so that people can take measures to ensure that they are relatively healthy. Once again, that is not foolproof. In our society we have a huge looming medical and, ultimately, hospital problem in terms of care and cost because we are not collectively doing enough to maintain issues and to focus on preventative health.

The administration of the health system needs to be kept simple so that there is direct accountability, wherever possible, and the fewer layers of bureaucracy there are, the better. The people actually delivering front-line services should have ready access to the people at the top, and the people at the top should be required to spend time at the front line (if they are appropriately qualified) so that they do not lose touch when dealing with front-line issues.

The approach then should be the old and famous one of KIS (keep it simple). I am not too sure that this model is going to do that. Staff should be allowed to perform and given responsibility, not hampered and restricted. Too much management is often focused on control of staff rather than allowing them to perform. If staff do not perform then one has to deal with it, but they should be allowed to get on with the job.

In our hospital system at the moment we probably have excessive accountability. Obviously, we need some accountability. I notice that, in hospitals, a lot of the professional staff spend more time attending to paperwork than they do to patients. Obviously, we need some paperwork, but it is not as important as the patient. If one visits any hospital, public or private, one will see a lot of the professional staff spending time filling out bits of paper rather than spending time with the patient. To me, that indicates that maybe the system is a bit out of whack in terms of accountability. There are so many people out there who want to sue for any trivial reason that the bureaucracy goes out of its way to protect staff to the point where accountability becomes an albatross around the neck of the staff.

In regard to training our staff, clearly we need more medical professionals. We now have a lot of women who work part time as doctors. If you go into a doctor's surgery at five o'clock, you will see old blokes like me, because the women have gone home to look after the kids. I do not have a problem with that but, if we are going to have that, we need to train more men and women as doctors. If we are going to have a system where female doctors want to spend time with their family—which is good—let us train more people so that we do not have a situation where we are left with grey-haired doctors after 4 or 5 o'clock.

We need to have high standards in regard to people coming in from overseas. I understand that the Nurses Board is now insisting on assessing all overseas trained nurses, because the training of a few who have come into the system is under question. I have heard that sometimes local nurses can barely understand some of these people who have come in from overseas. It is not good enough if professional staff members cannot communicate clearly and precisely with each other in a hospital situation.

There is also a cultural issue. For example, the Australian sense of humour can be found a bit disconcerting. One of my constituents, who had a leg removed, said to the medical staff that it was fantastic that he had his leg removed. He meant that he was pleased that his leg had come off because it saved his life, but the foreign-trained professional thought he was a nutcase and put him down for psychiatric referral. He did not understand that he was looking at it with a dry sense of humour: 'Thank God I've got my leg off, because it saved my life.' They thought he was a bit of a lunatic.

So, we need to make sure that we have adequately trained staff and that they can speak English. I know someone who has been involved in a training program for overseas trained nurses. That person is under pressure to approve them as being competent in English, otherwise the company training them in English will not get its money. In conclusion, I support this measure and trust that it will deliver even better services for those in South Australia who need care in our hospital system.

Debate adjourned on motion of Mr Venning.

[Sitting suspended from 13:00 to 14:00]