CHRONIC PAIN HEALTH CARE

Debate resumed.

(Continued from page 3060.)

Ms SIMMONS (Morialta) (11:59): Epidemiological studies suggest that in Australia approximately 20 per cent of adults describe that they suffer from chronic disabling pain. This is generally associated with muscular, skeletal or neurological disease. Approximately half of these adults describe severe unrelieved pain for which they regularly receive help from medical or allied health providers.

It is extremely unfortunate that approximately 60 per cent of Australians receiving disability welfare or workers compensation payments cite chronically painful conditions as the main reason for their inability to participate in the workforce.

We know that chronically painful conditions represent the largest single group of conditions presenting to primary health care services. Of these, chronic back pain is the most common adult diagnostic presentation in general practice. It is reassuring that, fittingly, most chronic pain is able to be managed effectively in general practice. However, there remains a significant minority of patients with complex chronic pain whose conditions are difficult to manage without specialist help. Some of these patients require complex medication regimes that are outside the everyday experience of most general practitioners. Some require interventional treatments requiring specific technical skills. Many require the skills of a multidisciplinary team, with input from providers in medicine, nursing, physiotherapy, psychology and even psychiatry.

This group of patients requires specialist services that are generally only provided by multidisciplinary pain management services, and this is really where these patients need to be referred to from their general practitioner. There are three public hospitals that provide this service in South Australia: the Flinders Medical Centre, the Repatriation General Hospital and the Royal Adelaide Hospital.

Of course, SA Health continues to review and initiate strategies around chronic disease and self management support. That has never been in dispute, and they will continue to review and initiate these new strategies as they emerge. This may include holding forums and education sessions for organisations and individuals and the development of team based care plans, because often it is not medication that is the answer to all chronic pain conditions.

Self management support includes helping individuals form better partnerships with clinicians to provide better management of their chronic pain condition. For example, a regional back pain clinic has been set up by the Central Northern Adelaide Health Service to provide a physiotherapy led assessment clinic to improve back pain management. To date, the program has achieved quite considerable successes in this area. There have been out of this clinic extremely low conversion to surgery rates: only 2 per cent of clients are now requiring surgery.

There has been a reduction in waiting times for assessment or consultation from nine months to five months. Those patients who are classed as 'did not attends', which is apparently a category, were reduced from 20 per cent to 5 per cent, and 57 per cent of patients were discharged back to general practitioners with pain management plans compared with the previous figure of 26 per cent.

In addition, as part of the implementation of GP Plus Health Care services, which are being spread out across South Australia, a project is currently under way in the northern metropolitan Adelaide area to develop a model of care using general practitioners with a special interest in chronic pain. Not all GPs have that specialist knowledge, so it is really important that we have a cluster of GPs who have become experts in that area. I commend the amendment to the house.

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (12:04): I may need your guidance as to how we deal with this, Madam Deputy Speaker, because I propose to speak against the amendment, and the rules indicate that the principal debate has to be dealt with here as there is no second opportunity. However, I foreshadow a further amendment to the motion, and I indicate, so that it is absolutely clear for the purpose of any negotiation in any subsequent adjournment of this debate, what we are seeking. We are seeking to have inserted in the amended amendment the words 'and further that the state government do review the practices of Drug and Alcohol Services South Australia, and in particular'—

The DEPUTY SPEAKER: Deputy leader, you have the opportunity to move that amendment now. Do you have it in writing?

Ms CHAPMAN: I do.

The DEPUTY SPEAKER: Would you like to move that now, and then you can speak to your amendment?

Ms CHAPMAN: I am happy to do that. My understanding is that, after some discussion with the mover, this would be taken away to perhaps try to construct something people could agree to.

The DEPUTY SPEAKER: The most formal way of doing that is to have an amendment before the chair, and then it is the property of the house and it is then up to all members to develop a compromise if they wish to do so.

Ms CHAPMAN: I move:

After the words 'South Australians' add the words, 'and calls on the state government to review the practices of Drug and Alcohol Services South Australia, and in particular DASSA's involvement with chronic pain patients and patients legally prescribed drugs of dependence, with a view to further improving medical services available to such patients.'

The DEPUTY SPEAKER: I will accept the amendment as being in order, although it does extend the subject of the original motion somewhat.

Ms CHAPMAN: Thank you, Madam Deputy Speaker. In speaking to the amended amended motion—

The DEPUTY SPEAKER: To clarify, it is the Chapman amendment you are speaking to. There is no amended motion.

Ms CHAPMAN: Did you indicate that you accepted the amendment?

The DEPUTY SPEAKER: There is a motion. There is one proposed amendment, and there is a second proposed amendment. Perhaps you would refer to them as your proposed amendment and the Morialta proposed amendment.

Ms CHAPMAN: Thank you, Madam Deputy Speaker. So that we are clear, my amended motion, which I read out, is to be in addition to the amendment proposed by the member for Morialta, not an alternative to it. So, the words are 'in addition to' her motion.

For the past two years, as the opposition spokesperson for mental health and substance abuse, I have been plagued by this issue, namely, patients who are in chronic pain and who are unable to access adequate or appropriate medication to manage their condition. This has been a very serious issue, and there have been deputations to the former minister in another place (Hon. Gail Gago) and to the current minister in this place.

This issue has been the subject of numerous very substantial television and print media articles about the plight, pain and misery of these people. It is a very serious situation. Repeatedly, the government and the minister, and spokespersons on their behalf, and Mr Keith Evans, as the Executive Director of DASSA, have said 'Look, we're managing this. Everything is okay. There has been no change of policy.' Hello; we are in the real world here. We have real people in real pain lining up to say that this is not satisfactory.

What has happened is that the drug dependency unit at the Royal Adelaide Hospital, under the Department of Health, has had this responsibility with qualified exempted doctors. I say 'exempted' doctors because there is a special provision to be a doctor to prescribe opiate-based medications, which are very dangerous drugs in the wrong hands, and we have a very strict legal regime which applies to qualified and experienced medical practitioners who administer them. The drug dependency unit used to do that, but it has now moved to DASSA's responsibility. In the past, it operated from Warinilla Clinic at Norwood and in Joslin, North Adelaide and various places around the South Australian metropolitan area, all of which are to be sold off and moved to the Glenside hospital site in the reform.

Irrespective of where they are, they now have the job to do that. Dr Ian Buttfield, a senior medical practitioner who has now retired, was in the professional camp, if I can describe it is that, of those who say that these patients cannot be treated like all other drug addicts. They are drug dependent, and we have to understand and respect that and appreciate that these are not people who have gone in for medical treatment or surgery and become addicted to medications and need to be slowly weaned off them. They are not heroin addicts who need to go through a trial of morphine replacement to wean them off drug dependency.

These people have chronic pain, and they will probably have it for life. There are only a certain number of things that will work. Certainly, there are patients who have come to me, those with opiate-based medications, who have been able to sustain a reasonable lifestyle with a minimum of pain and have even been able to go to work; one is a police officer. He told me that he can actually carry out his duties as a police officer under this medication. Of course, he is at risk of having that prescribed medication removed.

However, under the new policy, which is clearly operating, they have to be taken off this medication and go onto alternative medication, therapies or programs mentioned by the member for Morialta. Those may be terrific for some patients. That is great, and I am happy to support them, but they are not adequate for everyone. I am not just talking about one or two people, there are tens of them. They have taken legal advice, and there is pending action for a group claim against the government.

We are not talking about Mickey Mouse issues: we are talking about people, one of whom I saw writhing in pain in a hospital in South Australia. Her medication had been removed, and she was crippled up with pain in a bed in a public hospital because she could not stay at home. A friend came in to sit with her to help manage the pain. A psychiatrist contacted me to say that the only way this person could get the medication they have had in the past, which was properly managed and monitored, was for them to declare that they were a suicide risk.

It is unacceptable that we have to take people to the brink of slashing their wrists, because they cannot live with this pain, and say that we are going to give them some other program. It does not work, and we have to understand that. At the very least, let us have a review and support the clear intent of the original motion, namely, undertake a review and find out what on earth is going wrong, identify what we can do for these people and not leave them out in the cold completely isolated from adequate care in circumstances that are cruel, inhumane and unacceptable.

The DEPUTY SPEAKER: Deputy leader, before I invite anyone else to speak, I need to ask you to give us a formal written version of your amendment. In the debate, you indicated that this was to be added to the proposed amendment of the member for Morialta. It needs to say that in your written amendment, and you might like to reconsider its introductory wording.

Ms CHAPMAN: I have the motion and the amendment, which, as I understand it, is a replacement amendment from the member for Morialta. It reads, 'This house calls on the state government to continue', etc. The wording you have in front of you is 'and the state government to review'.

The DEPUTY SPEAKER: The wording I have in front of me does not indicate whether this is a substitute motion or an addition to the amendment proposed by the member for Morialta. It says 'that this house calls on the state government'. Perhaps you might like to have a word with the Clerk.

Ms CHAPMAN: I am happy to. So that Hansard is clear, I am happy to read what I read out before, which you have there in writing, that is, to be added onto the words after the motion by the—

The DEPUTY SPEAKER: Deputy leader, I understand that; I just need it in writing.

Ms CHAPMAN: I will hand it over.

The DEPUTY SPEAKER: I think you need to add some words to the written motion that you currently have.

Mr BROCK (Frome) (12:15): It has certainly been a learning experience today. First, let me make it quite clear that I am not in favour of drug addicts or anything like that, but I am certainly concerned, not only as a member of parliament but as a human being, about the constant chronic pain that people in our community are suffering.

People in my electorate have approached me regarding the system under the new DASSA requirements for continuation of medication. In one case a person has had 58 operations, and this person is only 39 years of age. You can imagine if you have an operation on one part of your body the amount of scar tissue that would be evident from that. Can you imagine the amount of scar tissue affecting this person who has had 58 operations in the same area?

She has that much scar tissue clinging to her bladder, or what is left of it, and she is in constant pain. This person is on medication, and what has happened now is that she has had written advice stating that as at 30 June her medication will be ceased. She is now at her wit's end. She is in fear that she is going to be in constant pain forever and a day.

I do not know if members of the house have been in constant pain, you may have. I want to relate back to six weeks ago when I was in constant pain with a suspected bowel issue. I was in constant pain for two days. I was lucky; I was admitted to hospital for a couple of days, I had intravenous medication and I got over it, but those two days were absolutely agonising. I was in so much pain, but it was only for two days.

I would hope that members of this house can imagine somebody being in constant pain for 24 hours a day, 365 days a year, and then all of a sudden you get this new advice stating that even though a medically approved doctor, or specialist, has prescribed certain medication, that medication will cease. That certainly does not sit very well with me.

As the Deputy Leader of the Opposition has indicated, there are some people out there, and there is one in Adelaide whom I have had contact with, and this particular person is basically indicating that he is at the suicidal stage. He does not know where he is going to go at this particular point. I am certainly not in favour of people continuing on drugs, but I believe that if a person has the need to have a suitable drug to keep constant pain under control then we need to ensure that there is the facility to keep that pain away.

I am also led to believe that you can go from South Australia into Victoria, and I have the occasion where a Victorian has come to South Australia and has asked for the same medication that he was having in Victoria. The new regulatory system states that he cannot have that drug any more. So, we need to get some clarity on this issue. This is one country; surely we can have the same rules for each of the states.

I understand that some time ago South Australia was the number one leading state in Australia for chronic pain relief. My information, and I stand to be corrected on this, is that at the moment we are about third in Australia.

The other thing is that there are no facilities in regional South Australia for any of these people to receive medication or assistance. At the moment, they have to come and make contact with somebody in Adelaide, and if they are attending somebody in regional South Australia who had the authority to do that, some of the doctors out there are a bit hesitant to even recommend it for fear of retaliation.

This is the information that I have been given. One thing that I would like to do is to ensure that when we go forward with this system we continue to review it. If we review something, that does not mean to say that our system is not working; we review it to ensure that we do not become complacent.

The whole idea of improving services is by reviewing them on a regular basis, and I think that is all that the Deputy Leader of the Opposition is asking here. That is what the member for Fisher and I are asking, to continue the services that are going at the moment but to review those services to ensure that, potentially, we have the best operation and facility in Australia. I commend the motion to the house.

Debate adjourned on motion of Mrs Geraghty.