HEALTH FUNDING

Mr HAMILTON-SMITH (Waite—Leader of the Opposition) (14:33): I accept the Premier's invitation to a rugby game. I think I know who would come out on top, sir. We have a couple of scrubbers over on our side.

Members interjecting:

The SPEAKER: Order!

Mr HAMILTON-SMITH: What action will the Premier take as Leader of the Government to change the health minister's culture of not managing his department's expenses within allocated targets? On page 8 of the Paxton report into the efficiency of our hospitals, it states that increased costs associated with peak demand such as winter illnesses are met by 'the allocation of top-up or bailout funding'. The report then states that this bail-out funding process has become a generally expected annual process and fostered a culture of not having to manage within targets; in other words, mismanagement at the top.

The Hon. P.F. CONLON: On a point of order, the question is disorderly. Given the difficulty of getting an orderly question, I do not think that we should rule it out, but it is impossible for us not to engage in debate if the question itself is nothing more than an inflammatory statement.

An honourable member interjecting:

The SPEAKER: Order! I have said previously to the chamber that in judging the orderliness of an answer I will take into account the nature of the question.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (14:35): I will resist the temptation to use the leave that you have implied in your statement then, Mr Speaker, in relation to this question. I thought it was a reasonable question except for the last comment, which associates the issues that are before the health system with me personally. What this report is really about is looking at the way that health has been managed over many years under governments of both sides. If we try—

Mr Williams interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: If the opposition wishes to be treated seriously in relation to this issue or indeed any other issue, it must look—

Mr Hamilton-Smith interjecting:

The SPEAKER: Order!

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: I would say to the pretend leader of the government, the would-be leader of the government, that if he seriously wants to hear an answer to the question, he should resist the temptation to intervene and interject every time I say something. I want to say something serious to the house about this issue.

Honourable members: Hear, hear!

The Hon. J.D. HILL: It is a serious issue for us as a state, not just on this side, because at some stage when you are in government you will have to deal with the same kind of issue. It is important for the future of our state and the sustainability of our health system that we actually get these things right. What we are doing in South Australia and what we have been doing for the six years that we have been in government is trying to make our health system sustainable.

The first act was to have the Generational Health Review. That review created a strategic platform for the reform processes that we are going through. It said, in part, that we needed to have a much greater emphasis on primary health care; it said that we should make our hospital systems more efficient and streamlined and get rid of overlap and duplication. Then last year, as part of our budget, we introduced a healthcare plan which did a lot of what John Menadue in his report had called for us to do.

In addition, the Health Care Act has been passed by this parliament which fixes up the government's issues which Menadue pointed to as well, so those are the big picture items that we needed to get in place. All of the time that we have been going through this process, of course, the opposition has opposed every single one of those initiatives. Every step of the way, members opposite have objected; every step of the way, they have attempted to play politics. I have to say that they have failed.

They have not connected with the community whatsoever, and the evidence of that, of course, is that at the last federal election a number of their candidates tried to pick up these issues to run their campaigns on and they failed spectacularly, because the people of this state are too smart. They understand that this is a government that is dealing seriously with the issues of health.

This report brings to our attention a key issue which all of us in this parliament and all governments indeed in Australia have to deal with when it comes to health, and this is certainly one of the issues we need to deal with seriously as a community. There are two contradictory forces that apply to the hospital system—the public health system. On the one hand we have an agreement with the commonwealth government that everybody who turns up to a hospital has to be given treatment.

That is an uncapped liability that we start with every financial year, because we can never predict how many people will turn up and what complications or what needs they will have. Every year to date that this party has been in office there have been more people coming to our hospitals seeking services than in the year before. We have to deal with every single one of them, even if it is a person with a sore eye who could go to see a GP. If they choose to go to a hospital, we have to deal with them and we have to pay for those services. That is one pressure.

The second pressure—which is what Treasury, cabinet, the parliament and the public expect—is that health operates within its annually granted budget. Those two things are absolutely in contradiction. How do you resolve that? We could set a cap on the number of people seen in the emergency department at a particular hospital and, once that cap is reached, we say no. We do not do that at all in relation to emergency departments, and that is the central—

Ms Chapman interjecting:

The Hon. J.D. HILL: For the benefit of people who may think that the Deputy Leader of the Opposition might actually know what she is talking about, I say that she is talking absolute rot. If she comes to that conclusion then she has not read this report.

Members interjecting:

The SPEAKER: Order!

Mr Williams interjecting:

The Hon. J.D. HILL: I would welcome a question from you on that point, Mitch, and I do hope you get around to getting a question up, I really do. The central point that this report makes is that that inherent contradiction has to be resolved. What we have done is ask these experts to look at how our hospitals operate, to drill down into the detail—to the ward level, the surgery level, the procedure level—to see how those hospitals compare with all the other hospitals in Australia, the national benchmark.

That is something that Kevin Rudd and his government are insisting all states do in order to apply for extra funds which they say they want to put in. We are doing this in advance of that request, but we know that is where we are going. We put up our hand for this and said, 'This is good government, this is good public policy, this is the right way for us to proceed.'

Ms Chapman interjecting:

The Hon. J.D. HILL: Will the Deputy Leader of the Opposition please listen for a while? You can ask any number of questions you like—

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: I would like to extend an invitation to opposition members: they can ask every question they like, but I have to be given a chance to answer those questions seriatim.

Members interjecting:

The SPEAKER: Order!

An honourable member interjecting:

The Hon. J.D. HILL: There is nothing glass about my jaw, my friend; nothing at all. Now, we have asked Paxton Partners to drill down and look at how individual hospitals compare one with the other and with national benchmarks, and it is not surprising that not every hospital is doing everything in the most efficient way. That is clearly a result of the different cultures, different arrangements, different circumstances and different processes that are in place in our system. If you went into private enterprise and asked an outside consultancy to look at every franchisee of a particular chain they would come up with similar kinds of results.

We have done that, and we will now be able to work through this report with the individual hospitals and their managers, doctors and nurses and allied health workers, to get the efficiency dividends so that we can reinvest that money back into the health system. Let me put this in perspective for the house—

Ms Chapman interjecting:

The SPEAKER: Order! I warn the Deputy Leader of the Opposition.

The Hon. J.D. HILL: Mr Speaker, I am sorry for going at it for some time but this is an important issue. Let me put this into perspective for the house. This report recommends, in toto, savings of about $50 million to $51 million dollars. That is a lot of money in anyone's business; however, it is a very small proportion of the amount of money that we spend on public health in South Australia every year. We spend $3.4 billion each year, so $50 million is, I think, less than 2 per cent (doing some rapid mental maths). If there are only 2 per cent efficiency gains to be made in our hospitals, what we are saying is that our hospitals are very efficient—but our goal is to make them 100 per cent efficient, not just 98 per cent.

If you think that is bad policy, please go out there and say so. I predict that the opposition will come in here, say that the hospitals are in a mess and are inefficient and that we should make them work better, but when they go outside into those communities they will attack every single one of these initiatives, defend the practice that is currently in place and say that any change to that will be detrimental to the local community. I make that prediction and I know it will happen.