Motions

Regional Health Services

Mr VAN HOLST PELLEKAAN (Stuart) (11:01): I move:

That this house establish a select committee to inquire into and report on—

1. The review by the Health Performance Council on the operations of the health advisory councils in accordance with the Health Care Act 2008.

2. The current provision and plans for future delivery of health services in regional South Australia, with particular reference to—

(a) the role and responsibilities of health advisory councils and the benefits, or otherwise, of the removal of local hospital boards;

(b) amalgamations of health advisory councils in regional South Australia;

(c) trends in local community fundraising for medical equipment and services;

(d) how funds currently and previously raised by local communities are held and spent, with particular regard to authorisation and decision-making;

(e) timing of provision of finalised operation budgets in country hospitals;

(f) ownership and transfer of property titles of country hospitals;

(g) the process and timing of the hiring of staff for new and existing positions;

(h) South Australian Ambulance Service arrangements, including the role of volunteers, fees and fundraising and the benefits, or otherwise, to local community events;

(i) scope of practice of general practitioners to country hospitals and the provision of accident and emergency care;

(j) procurement by Country Health SA and the benefits, or otherwise, to country communities;

(k) mandated fees to DPTI for management of maintenance and minor works;

(l) the benefits, or otherwise, of all rural and remote South Australia being classified as one primary health network within the federal health system;

(m) the implementation of EPAS in country hospitals;

(n) integrated mental health inpatient centres for regional South Australia; and

(o) any other relevant matters.

This motion is extremely similar to one that was moved by the Liberal opposition back in February 2011. On 23 February 2011, the Hon. Michelle Lensink, on my and my colleagues' behalf, moved in the other place a motion with very similar terms of reference.

The reason this was done was that, back in May 2008, the state Labor government put forward its country health plan, and every member in this place, even those who were not elected at the time, will remember the enormous community backlash against that plan, including from people in metropolitan Adelaide, I have to say. They were very supportive of country South Australia because they have friends and relatives in country areas. They want to go on holidays or short visits to country areas. They understand far better than this government does that its job is to represent all of South Australia, not just metropolitan areas, so even people in the city supported people in the country.

It is imprinted on my mind, as it is upon the minds of all other country members of parliament, how passionately, vehemently, strongly and, in many cases, angrily country people voiced their opposition to what the government wanted to do, which essentially was a watering down of all of country health, removal of local decision-making opportunities and authorities and, really, centralising all that power back to Adelaide.

Of course, there are decisions that only professional, trained medical practitioners, whether they be doctors, nurses, allied health professionals, whoever they are, can make but community people have an enormous role to play with regard to the best way for that medical support to be delivered into their communities, and for the government to be trying to water down that contribution is absolutely disgraceful.

To the government's credit, and to the minister's credit, back in early 2011 former minister Hill said, 'Look, that's okay, Dan. I'm happy to have that inquiry. Let's figure out the terms of reference together. If we can agree together those terms of reference, then yes, I'll certainly agree to it.' We did exactly that. Minister Hill and I sat down and agreed a very reasonable, very responsible terms of reference, which would suit my aims with regard to having a frank and thorough inquiry into the delivery of health services in country areas, and which was also, minister Hill said, one that he was very comfortable to have inquired into as well. So good on former minister Hill for doing that. Current minister Snelling has been very, very quiet on this issue, and I think unfortunately so.

The SPEAKER: 'The Minister for Health' will be sufficient. We do not need his surname.

Mr VAN HOLST PELLEKAAN: The current Minister for Health has been very quiet on this issue and that is, of course, concerning, but the government at one stage did say, 'Yes, we will participate in this inquiry.' Government members in the other place were allowed to join with all other members and it was unanimously supported that the Social Development Committee would undertake this inquiry. I thought that was great: bipartisan, genuine, looking to country health—terrific. The terms of reference were agreed and everybody was on side.

But, Mr Speaker, nothing has happened since then—absolutely nothing has happened since then. I very regularly engaged with the Social Development Committee. I was perpetually told that this would be the next inquiry—'not the current one, but the one after that, and we will get on to your country health inquiry'—but it never ever happened.

On Friday 3 August, I wrote to the Hon. John Gazzola, who was then the chair of that committee, and asked him exactly what the status was, because my verbal approaches were not making any headway. He wrote back on 10 October, eight months later. I will not read the whole letter out, but essentially it stated:

The terms of reference into the delivery of health services in regional South Australia remain on the committee's work program for 2013.

It was a bit slow, but the chair said that it would happen in 2013. In February 2013, I wrote to the then chair of the Social Development Committee, the Hon. Russell Wortley, and said, 'I have been advised it will happen in 2013. Committee chair, can you give me an update, please?' Again, I will not read the whole letter out, but, just as in the previous letter, the last sentence says it all:

The committee secretary will keep you apprised of the committee's continuing work program.

So, far less specific than the former chair, which of course set off even more alarm bells. That is why I have come back to this house asking for a select committee, because I am not comfortable with leaving it with the Social Development Committee. That is no reflection upon the members of the Social Development Committee, who I am sure are jointly trying to do the very, very best work that they can. But clearly since early 2011 no progress has been made on this matter by the committee, despite the chairs telling me that it would actually be progressed.

That is why I am uncomfortable with asking the Social Development Committee to embark upon this work and that is why I am specifically asking this house to establish a select committee to look into this issue. I have been advised by the minister's office that they have a strong preference for asking the Social Development Committee to continue to do this work. I appreciate the fact that the minister and his staff have been forthright with me and given me their position on their preference. However, as I have said quite openly to them, we have been down that track before, and it will not satisfy the people I represent or the people in broader regional South Australia to be told again, 'Well, we'll just hand it over to a committee that may or may not be able to do the work.'

I also said in my discussions, 'If I could be given some form of commitment on exactly when this will happen I could be persuaded to consider accepting that suggestion.' Unfortunately, no such commitment has been forthcoming, so I think the only appropriate path to take is to have this house establish a select committee because I have no confidence, and the people I represent in regional South Australia have no confidence, that the Social Development Committee will get to this piece of work.

There are nine hospitals in the electorate of Stuart and every single one of them is an incredibly important institution that provides very good health care with really capable people working exceptionally hard in those hospitals and in all of the other medical support services that are typically linked to hospitals. Of course, they do not just support the towns they are in; they support the districts that surround them and the towns that surround them.

My reason for pursuing this issue is that not only do I still have constituents who range from being concerned all the way through to being exceptionally angry about what the government has flagged that it wants to do with country health services—which is the case, of course, as people are there in my electorate—but I am also approached regularly by doctors, nurses, allied health professionals and members of health advisory committees (HACs), people who work in the system who say, 'There are problems with the system. We need this inquiry to go ahead.' It is not about trying to axe everything that goes on; it is about trying to improve everything that goes on. Professional people working in the system want this inquiry, and patients and potential patients want this inquiry.

There are nine hospitals in the electorate of Stuart. I do not know how many there are across all of country South Australia, but there is an enormous number of them and they are all saying with a united and responsible voice, 'We want this to go ahead.' If it is deferred to the Social Development Committee, those people—the patients, the potential patients and the health professionals—have no confidence that it will ever reach an active stage of work.

I do not have time to discuss all the terms of reference I am proposing here, but I will just touch on a few of them. Trends in local community fundraising for medical equipment: it is a fact that over the last several years country communities' appetites for fundraising have diminished significantly because they are worried about where the money is going to go. Provision of finalised operating budgets to HACs: it is a fact that the people who represent their communities on health advisory councils are not getting timely advice, so how on earth can they make recommendations on behalf of their committee when they do not get timely advice on how hospital finances are operating?

Property titles, which were held by the community, are now held by the government—for example, SA Ambulance Service. Deputy Speaker, give you a very real and very specific example. Booleroo Centre and District Ambulance Service was founded as a community-run ambulance service operating under the St John banner. It operated independently, and fundraising by the Booleroo Centre community provided the funds for the purchase of assets for the BCDAS, as normal ambulances could not cater for multiple patients or whole-day attendances.

In 1986, the community identified the need for a mobile field unit to provide a mobile room operating as a first-aid station for community events and natural disasters. The community raised enough money to purchase a Toyota truck and cab chassis, and it built a body to suit the requirement. The community did that work.

Inside the purpose-built body, additions included a high-low raising platform to lift patients into the area, cupboards, a permanent bed, a stretcher, a fridge, air conditioning and heating, and bench space was built or bought by the community to create a unique vehicle satisfying the community's needs. Many people worked tirelessly to make this happen, with many hours and dollars put in by the community to achieve this unique engineering feat. Since the vehicle was finished virtually every annual or one-off event held within the community serviced by the BCDAS was successfully attended by this unit.

During 2005-06 BCDAS was seconded to the South Australian Ambulance Service from St John but continued to be owned and operated by BCDAS. On 1 July 2009 the Boolaroo Centre and District Ambulance Service ceased to exist and was amalgamated with the SAAS. All assets came under SAAS ownership. This included land, vehicles, equipment and associated assets of the services. The field unit was sent to Adelaide to be rebadged in SAAS colours and returned to Boolaroo where it continues to operate successfully.

In February 2014 the vehicle was asked to attend the Peterborough Rodeo, but three days prior to the event the SAAS regional team leader declined the use of the mobile field unit and, for some reason, this perfectly functional and useful unit was required to be reassessed. No formal notification was given to the Booleroo Centre team and it was only when a team member inquired about the result of the inspection of the unit on 17 June that they were informed that the unit was to be decommissioned.

Without any further consultation with ambulance members or the community who built the vehicle, it was taken to Adelaide on 26 June and stripped, and it is now awaiting auction on 16 October. I could give you hundreds of examples, but that is a shining real-world example of what the government is trying to do to country health and it needs to be investigated.

Mrs VLAHOS (Taylor) (11:16): On behalf of the government I move to amend the motion as follows:

Delete the words 'this house establish a select committee to' and replace with 'the Social Development Committee'

As the member for Stuart has outlined some of his arguments, I will place the government's response to that on the record. I understand that he has had discussions with the minister's office today. Are you happy for me to proceed?

The DEPUTY SPEAKER: Yes.

Mrs VLAHOS: The government seeks to amend this motion:

That this house establish a select committee to inquire into and report on—

1. The review by the Health Performance Council on the operations of the health advisory councils in accordance with the Health Care Act 2008.

2. The current provision and plans for future delivery of health services in regional South Australia…

The amendment to establish an inquiry under the Social Development Committee instead of a select committee is most relevant. Whilst we in the lower house have no control of the upper house, we can ask the Social Development Committee to prioritise this as a matter of urgency for the member for Stuart, but it is up to the upper house, as master of its own destiny, to decide how it deals with its internal committees.

The proposed scope of the inquiry is very broad and, in fact, it has been canvassed previously by some speakers. A number of the items are important. Health reform is important to all of us in South Australia, and it is an ongoing process. Certainly the federal budget cuts have made transforming the health agenda, innovation and consolidation of health facilities to ensure all Australians are represented pivotal to the minister's role, and he is very mindful of this. That is why he seeks the guidance of the Social Development Committee in the upper house to consider these matters.

Under the Health Care Act 2008, the National Health Reform Agreement, local health care networks are accountable for the planning and provision of health services in their networks. The Country Health South Australia LHN undertakes planning for the provision of health services based on extensive local consultation through health advisory councils and business plans, clinician consultation through clinical government processes and discussions with SA Health through commissioning processes. A number of the items specifically related to health advisory councils in country South Australia are subject to a reform process currently being undertaken by the Premier of South Australia, where every South Australian government board and committee has been requested to demonstrate its essential process and cannot be met through other means.

All of these things are in a dynamic playing space at the moment and it is best that we provide the Social Development Committee with this ongoing statewide task rather than have a select committee, which will be a witch-hunt, to demonstrate one case, as the member for Stuart highlighted earlier, where we do not understand the clinical, operational or accreditation needs about why that vehicle was decommissioned. That evidence has not been brought before the house and we have only heard one side of the story. I think it lays in the gamut of the Social Development Committee to deal with this matter and I seek the government's support for the amendment.

Dr McFETRIDGE (Morphett) (11:19): I strongly support the motion by the member for Stuart to have a select committee set up to examine country health in South Australia. Can I just say if the government thinks their health system is so good, they should be afraid of nothing, they should set up a select committee, they should have it report as soon as possible and not shove this inquiry off to a very hardworking committee, the Social Development Committee, and list it with their other inquiries.

It is very important to all South Australians that the health system is working well, and we all remember the words of former minister John Hill when he said that the South Australian public expect him as the minister of the Crown to provide a good public health service and the buck stops with him. Minister Snelling cannot walk away from that responsibility either. He has to be responsible for all of South Australia.

If he has nothing to be afraid of, if he is proud of the system, if he is proud of the way it is working and if he is proud of the fact that we have ambulances ramping, we have hospitals full and we have chronic overcrowding in our system, well let's have a look at what is going on, because we all know in this place that one of the biggest country hospitals is the Royal Adelaide Hospital.

We have hundreds of people from the country in the Royal Adelaide Hospital. They are stuck in there in many cases because they cannot go back to their country hospitals because this government has been so city-centric in the past. If the government is proud of what they are doing, let's set up a select committee. The terms of reference are quite clear, quite explicit, nothing dodgy there, it is all there. Let's be proud of the system, minister, let's set up the committee and let's get on with it.

The members of this place should, if they want to equate themselves with the state of health in South Australia—an up to the minute state of health in South Australia—go onto the Department for Health's dashboard, elective surgery dashboards, ambulance dashboards and inpatient dashboards and have a look to see the state of our hospitals today.

I will go through some I downloaded this morning. Let's look at the ambulance service dashboard this morning, a bit over an hour ago. You will see every hospital, other than the Repat, is chock-a-block full; it is in the white-hot zone. The Women's and Children's women's section still has some spare capacity. They have flexed up the beds and they are full to the brim and overflowing.

The minister cannot say they are setting up more mental health beds, and they have had review after review because, an hour ago, at 10.18 today, at Flinders Medical Centre, the mental health unit was full and they were three beds short. An hour ago, at the Royal Adelaide Hospital the mental health wards were full and 10 people were waiting for a mental health bed. The EDs are in the red-hot zone or in the white zone. We know that a full hospital, according to the AMA—

Mrs VLAHOS: Point of order.

The DEPUTY SPEAKER: Member for Taylor.

Mrs VLAHOS: Relevance; I believe we are talking about country health not EDs.

Members interjecting:

The DEPUTY SPEAKER: Order!

Mr Marshall interjecting:

The DEPUTY SPEAKER: Order! I am on my feet, leader. Let's not have a day that we will all be ashamed of at the end of it. I will keep listening to the debate and ask the member for Morphett to remain on topic. Thank you.

Dr McFETRIDGE: Thank you, Deputy Speaker. Obviously the member for Taylor was not listening when I said that the biggest country hospital in South Australia is the Royal Adelaide Hospital.

An honourable member interjecting:

The DEPUTY SPEAKER: Order!

Dr McFETRIDGE: There are hundreds of people in the Royal Adelaide Hospital today. This is all about country health. This is about equity and country people in South Australia being treated exactly the same as their city cousins. They want it, they need it and they deserve it, but this government is not delivering it. Just look at the government's own website; look at your dashboards. Member for Taylor, go and look at the dashboard. You have some medical background, go and look; you will understand those. The facts cannot lie. If this is correct, if there are 10 patients waiting at the Royal Adelaide Hospital because there are not enough mental health beds, that is a crying shame. It gets worse because at the Royal Adelaide Hospital today at 10 o'clock today, there were six—

The DEPUTY SPEAKER: Member for Morphett, I do think this is slightly straying off what we want to talk about which is health performance—

Dr McFETRIDGE: Deputy Speaker, I do not know how many of the seven people who are stuck in the ED at Royal Adelaide Hospital because they are waiting for mental health beds—

The DEPUTY SPEAKER: Do you know how many of those people are from the country?

Dr McFETRIDGE: I do not know how many of those are from the country.

The DEPUTY SPEAKER: Well, you don't either.

Dr McFETRIDGE: I don't know.

The DEPUTY SPEAKER: So let's—

Dr McFETRIDGE: But I would guarantee because there are hundreds of people—

The DEPUTY SPEAKER: —try to keep on task, which is regional heath, as far as I can understand.

Dr McFETRIDGE: I cannot move away from the fact that country people require the best quality treatment they can get and, unfortunately for them, that requires a trip to Adelaide. It is part of country health, it is part of the services. The facts are that sometimes they cannot get that because our city hospitals are full.

Mrs Vlahos interjecting:

Dr McFETRIDGE: Well, okay; let's look at the inpatient dashboards. The inpatient dashboards show that there is no room for any country patient to come to our city hospitals because they are all full. The Royal Adelaide Hospital at the moment has 570 beds occupied, with 15 patients waiting for a bed. I hope they are not country patients who are waiting for those beds. This was at 9.30 this morning. I am sure that if I looked at the dashboards now it would be worse than that. Let's look at country hospitals. Let's see what is happening at Port Pirie. Let's see what the Minister for Regional Development's hospital is like in Port Pirie this morning. Let's see—

Mr Pederick: Where is he?

Dr McFETRIDGE: Let's see—

Mr Pengilly: He's not in here.

Dr McFETRIDGE: No, no, no—

The DEPUTY SPEAKER: Order! There is a ruling about drawing attention to people being in the chamber or not being in the chamber, and I would ask for members not to interject.

Dr McFETRIDGE: I was not in this place last week because I was having some personal health issues sorted out, as I understand the minister is today, so all fairness to the minister. Everybody—

Members interjecting:

The DEPUTY SPEAKER: Order!

Dr McFETRIDGE: —in this place—

The DEPUTY SPEAKER: Order!

Dr McFETRIDGE: —particularly country members, because of the distances—

The DEPUTY SPEAKER: Order! Sit down!

Mrs Vlahos: It's inappropriate.

The DEPUTY SPEAKER: Everyone's behaviour is inappropriate at the moment. Let's have some decorum in the chamber. I ask the member for Morphett to remain on topic and members to not interject or respond to interjections.

Dr McFETRIDGE: Thank you, Deputy Speaker. I was speaking about the health of a country member, so I think it is country health. Let's go to Port Pirie regional hospital and see what that was like at 9.30 this morning. They had no patients waiting for beds, which is very good and which is the general case across South Australia, other than Mount Gambier, where there is a patient waiting for a bed, and Port Lincoln Hospital, where there is a patient still waiting for a bed.

Port Pirie regional hospital is in the red zone because they have, even with the beds flexed up, 51 beds, and 49 are occupied. Let's hope there is not a serious accident, illness or some other problem, because patients will have to be transferred to other hospitals. Country health in South Australia needs the full attention—the full attention—of this government, and I do not believe it has had that. This inquiry will help deal with that. If we have a health system that we can be proud of, we should not be afraid to inquire into it straightaway.

Let's go back to the elective surgery dashboards from this morning and look at country hospitals. I will list the country hospitals as they are listed here: Angaston, Bordertown, Crystal Brook, Clare, Ceduna, Gawler, Jamestown, Kangaroo Island, Loxton, Mount Barker, Murray Bridge, Millicent, Wallaroo, Port Augusta, Peterborough, Port Lincoln, Port Pirie, Renmark, Riverland, South Coast, Strathalbyn, Yorketown and Whyalla. They are the country hospitals and they are all listed. Fortunately for them, they do have some spare capacity this morning and their elective surgery list is under control. Port Pirie is struggling, but the others are under control.

If you have country patients in Adelaide and you want to free up beds in Adelaide, surely putting those patients in the closest hospital to their home is a reasonable thing to do. You cannot do that if you do not maintain the country health system. If those facilities are not up to scratch, if they are not up to standard, if they are not being staffed at adequate levels, that will not happen. If you have nothing to worry about with our country health system, then let's have the inquiry. Let's not push it off to a standing committee, which has many other jobs and many other inquiries. Let's have this inquiry, and let's look at the real impact of the cuts to health in this state by this government and the way they have neglected country health.

If you have nothing to be afraid of, stand up and deliver. Do it for South Australia, do it for country South Australians. Do not hide behind some other diversion, deception or deceit. We need the facts, and the facts are on the dashboards. I encourage every member in this place to familiarise themselves with the dashboards, because they are there in living colour. They show you the state of the health department and health services in South Australia. They are struggling, and this house deserves the respect of South Australians by getting on with our jobs and looking at inquiring into country health. This motion should be supported unamended.

Mr PICTON (Kaurna) (11:29): I will firstly address my remarks to the original motion from the member for Stuart, and I will deal with some of the other issues raised by the member for Morphett in a little while. I think that the member for Stuart comes into this place to bring this motion with absolutely good intentions in representing his community. I think that is why he is generally regarded as a good MP by many people and seen as a future leader of the opposition in this house. However, I very much do support the amendment that was moved by the member for Taylor, in that this is something that should be dealt with by the Social Development Committee, which is set up to inquire into issues such as this.

Members interjecting:

The DEPUTY SPEAKER: Order! It is pretty obvious I will have to listen to every single word this morning. I was just trying to read the actual words of your motion again to make sure I am ruling correctly, and I cannot do that while you are all screaming at each other. I will now devote my entire attention to listening to this. Remembering that you have had a lot of leeway on your side, I will try to be as firm as possible. The member for Kaurna.

Mr PICTON: Thank you, Deputy Speaker. I tried not to respond to the interjections, but it seems that people opposite—

The DEPUTY SPEAKER: You must not.

Members interjecting:

The DEPUTY SPEAKER: Order! You are all as guilty—hands down. Off you go.

Mr PICTON: Thank you. I fundamentally support the amendment moved by the member for Taylor, because this is something that the Social Development Committee should be looking at. I think that an inquiry into country health is definitely a good thing for them to be considering in their program of work, and I would recommend that our colleagues in the other place consider it. I think it is worth, though, reflecting for a moment upon the process of reform to governance of country health over the past five or 10 years and how we got to where we are, which many people think is a fantastic improvement, while obviously there are some people who do not.

Previously, when we came to government, there were some 60 country health boards across South Australia that had complete running of all financial, human resources, and safety and quality systems in place. There were also eight regions that the previous Liberal government put in place on top of those country health boards, and then there was the country health and health department architecture on top of that.

We were completely overgoverned in terms of country healthcare arrangements, and it did lead to some disappointing situations in the management of country hospitals, where we saw some instances of financial mismanagement. We saw issues in terms of the safety and quality of health care being compromised in some country hospitals. We saw some frankly bizarre arrangements in terms of contracting and procurement in some of those country hospitals. We also saw some significant human resources issues in some of those country hospitals.

That is why the government moved the Health Care Act, which changed the governance of country health and created the health advisory councils, because we wanted to keep the voice of country people in those country hospitals, but to focus the energies on the things that those people generally wanted to be involved in, which were things like fundraising for their country hospitals, advocating for their particular communities and what services they wanted to have in their area, input into health service planning and input into the hiring of the managers of their hospitals.

They are the things that health advisory councils now do right across the state and I am very glad to see that they are going to be retained in the review of boards and committees that recently took place, because I think they have a strong role to play in terms of standing up for country people in the running of country hospitals.

If the Social Development Committee does look at this area, one thing that will be fundamentally apparent is the risk that is going to be in place from the federal cuts to health care.

Members interjecting:

Mr PICTON: We hear the usual wails of opposition to that from those opposite, but it is fundamentally clear that the system that was put in place by the previous federal government of implementing activity-based funding—

Members interjecting:

The DEPUTY SPEAKER: Order!

Mr PICTON: —for hospitals across the country was going to benefit country health care and benefit country hospitals.

Members interjecting:

The DEPUTY SPEAKER: Order! The member for Morphett had quite a lot of leeway. I am listening very carefully to what the member for Kaurna says. If he strays off as far as the member for Morphett did, I will bring him straight back.

Mr MARSHALL: Just for clarification here, your ruling says that the member for Morphett cannot speak about the Royal Adelaide Hospital, which is a primary piece of medical infrastructure servicing Country Health SA, but the member for Kaurna can stand up in the parliament and talk about federal government cuts to health as being relevant to country health. Is that your ruling?

The DEPUTY SPEAKER: No need to shout at me; I find that quite offensive. Sit down, and I will give you a ruling. I will give you a ruling alright. I cannot see that the point you are trying to raise has very much relevance in that the member for Morphett's tangential speaking on this vote is exactly the same as this tangential speaking.

Mr Marshall: But you made a ruling on it.

The DEPUTY SPEAKER: I asked him not to speak. He did continue to speak, and he stopped; that is fine. I said I am listening to the member for Kaurna and, if he strays off any further, you have options if you wish to exercise them. Member for Kaurna, remembering that I would ask you, as I have asked the member for Morphett, to stay relevant to the topic.

Mr PICTON: Thank you, Deputy Speaker. There is nothing more relevant to country hospitals than the scrapping of the federal healthcare agreement which is going to impact the funding for country hospitals in this state.

Mr PENGILLY: Point of order.

The DEPUTY SPEAKER: There is a point of order.

Mr PENGILLY: Relevance: it has got nothing to do with it.

The DEPUTY SPEAKER: Sit down.

Members interjecting:

The DEPUTY SPEAKER: Order!

Mr Pederick: Chuck them out, Deputy Speaker.

The DEPUTY SPEAKER: I will chuck you all out. We will continue to listen very closely to the member for Kaurna and ask him to remain on topic.

Mr PICTON: Thank you, Deputy Speaker. There is nothing more relevant to the running of country hospitals—

The DEPUTY SPEAKER: You have already said that.

Members interjecting:

The DEPUTY SPEAKER: Order! I don't need your help.

Mr Pederick: We are just trying to help him.

The DEPUTY SPEAKER: I will have to get out the book, that's it. We shall have to get the Speaker's list out and start naming people or calling them to order. I think it's really outrageous that your behaviour is so bad this morning. It is lucky there is no-one in the gallery, as usual. Alright, we will continue. Stay on topic.

Mr PICTON: Thank you, Deputy Speaker. As most members would know, most country hospitals are small. They deal with a small number of patients. We had an agreement for activity-based funding that had a carve out for country hospitals, for those hospitals that have a low number of patients, a low number of turnover, a low number of activity, to protect their funding, to make sure that their funding was going to increase and the federal government's share of that funding was going to increase over time—that no longer exists.

At the same time, the funding for city hospitals has been cut. What that means as a state is that, with only a certain pool of funding available to the state government, and the city hospitals' demand continuing to go up and up, as the member for Morphett referred to, there is more pressure on country hospitals' funding because there is not that carve out of protection that was there under activity-based funding.

There is nothing more relevant to country hospitals than that carve out, which has been completely trashed by the federal government. I hope that the Social Development Committee can investigate that issue and look at what the impact upon country hospitals is going to be because that is of particular concern to people right across the state and should be of concern to this house. The member for Morphett also referred to the Royal Adelaide Hospital.

The DEPUTY SPEAKER: No need to refer to the member's remarks about the Royal Adelaide Hospital.

Mr PICTON: Okay. What I will say though is that I completely agree that many people from the country need to come to city hospitals to get care, and that has always happened. If you think that that did not happen under the previous government, then you are mistaken. What has happened recently is that we are actually investing in significant upgrades to country hospitals in Whyalla, in Port Lincoln, in Berri and in Mount Gambier to improve the care in those hospitals.

Members interjecting:

The DEPUTY SPEAKER: Have you finished your remarks? I am asking you to get back to the topic and—

An honourable member: Address your remarks through the Chair.

The DEPUTY SPEAKER: All of you could do that. Let's be reasonable about this. Keep on topic.

Mr PICTON: Thank you. Those upgrades to country hospitals across those four sites is something that this committee should look at to see the benefits that have been raised by those investments, many of which came from the federal government but also the state government. That means that more and more patients can get their treatment in country areas and do not have to come to the city for treatment.

We should also note that there has been a history of closing beds in country hospitals. Some 500 beds were closed between 1993 and 2002 across mainly country hospitals. Not all of them were necessarily bad decisions; some of them were conversions to aged-care beds. In rebuttal to some of the comments made by members opposite, I say that it is ridiculous to say that people have to come to the city because of changes this government has made. We are increasing the bed numbers in key country locations to make sure that care can be provided.

I support the Social Development Committee looking at this issue, but I hope that it takes a broad look at all the funding and all the investments which need to be made, as well as what are the key safeguards for finances, safety and quality, human resources and contracting which need to be in place.

Mr PEDERICK (Hammond) (11:40): I rise to speak to the motion by the member for Stuart, which states:

That this house establish a select committee to inquire into and report on—

1. The review by the Health Performance Council on the operations of the health advisory councils in accordance with the Health Care Act 2008.

2. The current provision and plans for future delivery of health services in regional South Australia, with particular reference to—

(a) the role and responsibilities of health advisory councils and the benefits, or otherwise, of the removal of local hospital boards;

(b ) amalgamations of health advisory councils in regional South Australia;

(c) trends in local community fundraising for medical equipment and services;

(d) how funds currently and previously raised by local communities are held and spent, with particular regard to authorisation and decision-making;

(e) timing of provision of finalised operation budgets in country hospitals;

(f) ownership and transfer of property titles of country hospitals;

(g) the process and timing of the hiring of staff for new and existing positions;

(h) South Australian Ambulance Service arrangements, including the role of volunteers, fees and fundraising and the benefits, or otherwise, to local community events;

(i) scope of practice of general practitioners in country hospitals and the provision of accident and emergency care;

(j) procurement by Country Health SA and the benefits, or otherwise, to country communities;

(k) mandated fees to DPTI for management of maintenance and minor works;

(l) the benefits, or otherwise, of all rural and remote South Australia being classified as one primary health network within the federal health system;

(m) the implementation of EPAS in country hospitals;

(n) integrated mental health inpatient centres for regional South Australia; and

(o) any other relevant matters.

Certainly, I am a strong supporter of country hospitals. We have seen, over the years, many attempts by the Labor Party in this state to distance themselves from country health. We have seen the feigned outrage in this house today at this proposed inquiry by a select committee because the government is saying that they want the Social Development Committee to inquire into country health. Well, the Social Development Committee has had over three years to inquire into this.

I note that I am a newly elected member on the Social Development Committee, and I have made sure that that reference stays on the books so that we can get to it, but I am a realist. When we have discussed it at Social Development Committee meetings, the Presiding Member, the Hon. Gerry Kandelaars, has even made the point, 'This is a very political reference.' What has everyone to fear? We have the Presiding Member of the Social Development Committee not wanting to debate the issue. We have pushed up other new references since then; a new one was tabled in the house yesterday by the member for Reynell, which is quite a fine reference. But why are all these other references being pushed ahead of a reference that was put 3½ years ago?

We have seen all this feigned outrage from the Labor government about why the Social Development Committee will not look at country health, but I will give you the simple reason: because the comrades have all got together and decided that it is too dangerous to talk about. That is exactly what has happened. I do not know why they come in here feigning all this outrage when they would have had the meeting, all of the group. We know how it happens: they would all get together; and they have to vote according to one song sheet, especially the backbenchers.

I give credit to the backbenchers, such as the member for Ashford, who do speak out on some legislation. But when the comrades come to vote, they have to vote as one because that is how it works—and that is exactly how it works. They are embarrassed by our freedom of choice and our liberties and our true values as Liberal members on this side of the house.

Members interjecting:

The DEPUTY SPEAKER: Order! It is only Wednesday; this is Thursday behaviour. Let's do Wednesday behaviour and listen to each other in respectful silence, reminding members that it is unparliamentary to interject and worse so to respond.

Mr PEDERICK: What I say to members on the other side and members in the other house is that if they are so serious about country health and having this before the Social Development Committee, tell the member for Reynell, tell the member for Torrens and tell the Hon. Gerry Kandelaars; if that is where they want to go, that this has to happen. I do not think that is going to happen because they have had ample opportunity for over three years to do that, so I fully support the member for Stuart's reference to pushing this into a select committee.

Now I want to talk about the Royal Adelaide Hospital—and, before all the outrage sparks up from the other side, it is linked to country health. Why do you think it has a helicopter landing pad on the roof? So that it can receive patients from country South Australia—the ones who have been involved in accidents or the ones who need high-needs care in a hurry—who need to be flown into the Royal Adelaide Hospital. It is just simple. Why do we have all these helicopter landing pads at places like the Murray Bridge hospital in my electorate and many other hospitals throughout the country?

Mrs Vlahos: The Lyell McEwin.

Mr PEDERICK: That's right. They can land at many of the metropolitan hospitals in South Australia, so there is that direct link for country health. What makes me so angry in this place is that long before I was here, about 25 years ago or so, there was a move by the Labor government of the time to shut down hospitals in my electorate. I remember protesting on the front steps of this place about the threat of Tailem Bend being shut down, and that was reignited in the years that John Hill was the minister for health. I just do not think that people in the Labor Party understand how it works in the bush.

We also had the debate about the Keith hospital and its funding. People who really understand the state and how it works, especially people who travel to Melbourne, for example, for footy finals—like last weekend for the preliminary final, when Port Adelaide put up such a valiant effort and, sadly, did not quite get across the line—

Members interjecting:

Mr PEDERICK: I will just say that at least we have a coach and we were in the prelim final.

Mr Whetstone interjecting:

Mr PEDERICK: That's it. All I am saying is that many thousands of people travel the Dukes Highway, and the Dukes Highway splits off 40 hectares of my farm on one side, so I live right there and see how it happens. In fact, I saw the police pull someone up for speeding right in front of me as I was coming out of the gate on Sunday. When things happen—

Mr Whetstone: A Labor voter.

Mr PEDERICK: Yes—we need those medical services to get us to the local hospitals or to get the Westpac helicopter or other rescue helicopters in to pick people up. I am well aware of actions in my community where there have been incidents and the helicopter has had to land either on farms in the paddocks or they have shut the road to get the helicopter on the site to get people on board so that they can get to Adelaide for the required treatment. That is an absolutely vital service, to have that link to the city.

We do need the absolutely vital health services in the bush. We have issues with staffing and we have issues with attracting doctors, getting international doctors up to speed so that they can operate in our country. That is fair enough; they need to have the right registration requirements, as we do not want to have an issue like Queensland did in Bundaberg. We need so much more of it because so many communities are crying out for better health services in the bush.

The former minister for health quite frankly scared me one day when he made a point in this house that there are even hospitals or surgeries in his electorate that could not attract enough doctors to service a suburban area. If that cannot happen, what happens in the country? Parts of my electorate that were formerly in my electorate, like Karoonda and Lameroo, know what it is like to have doctors who have to fill in from either Mannum or Loxton to keep up those vital health services.

I note that the medical services in the Mallee do a great job. They have tele facilities and the nurses are there on a Saturday, and I can quote an example. One of my sons had a bit of concussion one day at footy and the nurses did a great job and they were able to talk to the doctor in Loxton to get advice on what to do. These are absolutely vital links for our community and you have to have these health services in the country so you do not get all that rush on effect so everyone ends up in the city with the obvious social dislodgement of all the people who need to support the people who need those health services.

In closing, in the little time I have left, it is interesting when we want to go on an official visit of even our local hospitals we get shepherded around and we have the minders all around us. In the last couple of months I have had to go to local hospitals for various health reasons for my family and we get to have a good look at what is going on. There needs to be more investment not just in infrastructure but also staffing levels and making sure that the right health professionals are attracted into regional areas. At the end of the day, the Labor Party must get serious and support this motion, because the Social Development Committee is just not going to get to it.

Mr HUGHES (Giles) (11:50): I actually commend the member for Stuart for this motion. There is much in it that I strongly support. I think it is valuable to have a look at a range of these issues but I believe that the Social Development Committee is the appropriate committee to look at these issues, and I believe it should do so in a timely fashion. I can understand the frustration that has been expressed by the member for Stuart. The committee, I believe, does need to treat this as a priority.

Many of these issues that have been canvassed have been canvassed with me as I move around the electorate, both in Whyalla and also in the smaller country communities. There are concerns about the health advisory councils. I met with some of the people from one of those councils in Hawker just recently and they were concerned about the future of the health advisory councils. I have a personal view that these councils are important and they do capture that local voluntary commitment. It is very important, and we do not want to lose that. We want to make sure that we have a framework in place that continues to cultivate that voluntary activity.

I have heard a number of things about country health today and it is almost as though it is all doom and gloom, but it is not all doom and gloom out there in country South Australia when it comes to the provision of health services. If anything, at a number of centres, the health services have improved, and they have improved out of sight.

I would admit that is in some of the larger centres but, if we were to go through and look at what has been spent in the recent few years, it is a huge amount. Admittedly, a lot of that money came from the federal government, but in partnership with the state and actively facilitated by the state and the state actively putting up how best the feds can spend their money in country South Australia.

I am not going to dwell on this but I would like to point out that a lot of those major expenditures on hospitals in regional South Australia were opposed by the then Liberal opposition at a federal level. For instance, the $69 million redevelopment of the Whyalla Hospital was opposed in Canberra by the federal opposition.

There has been major expenditure in Berri, Mount Gambier, Ceduna, Port Augusta and Port Lincoln. In Port Lincoln it was $30-odd million plus. I do not think the member for Flinders is going to be saying that is a terrible thing to do. That is a real improvement in health services in Port Lincoln in his electorate. I am particularly proud of what has happened in Whyalla, and if you look at what has happened that particular initiative was partly designed to reduce the need for people in Whyalla and surrounding areas to come to Adelaide for health services. However, there will always be reasons requiring people to come to Adelaide.

The member for Morphett quite rightly points out that the Royal Adelaide Hospital is the largest country hospital, and that is going to be very significantly improved with the new facility. It will be a good facility for country South Australians who have to come down—whether it is to the Royal Adelaide Hospital, The Queen Elizabeth Hospital or Flinders Medical Centre—and a lot of people do come down. Some members of my family have recently come down to the major hospitals in Adelaide.

The sorts of facilities and services that have now been put in place in Whyalla have been extensive. There are new mental health beds that did not exist in the past. Active negotiations are going on at the moment to secure a resident psychiatrist. That is something that has been as rare as hen's teeth in regional South Australia, despite the proportionally greater need when it comes to mental health services in regional South Australia. That will be a real plus.

The placing of an MRI machine at the Whyalla Hospital in January—the first MRI machine in regional South Australia—will service not just Whyalla but Port Augusta, Kimba, Cleve, Cowell and other people on Eyre Peninsula. That is a fantastic initiative. There are cancer treatment services now being provided in Whyalla. These were services that people would have to travel to Adelaide for in the past. People can now have chemotherapy in Whyalla, as can people from Eyre Peninsula and in the north of the state. There has also been a significant increase in dialysis beds in both Port Augusta and Whyalla to serve the great need that exists there.

One of the great things about some of these redevelopments—and obviously I am really up on what is going on in Whyalla—is that there is now the opportunity for people from around the region to come to Whyalla with their families, if need be, and residential services are now provided for the people who come to visit Whyalla Hospital. These are incredibly important changes. Then, of course, there was the commitment by Labor at the last election to significantly increase funding for PATS. That will be implemented next year. That is yet another improvement in services. There has been a consolidation of the provision of services by some of the major hospitals which has reduced the need for country people to travel to Adelaide.

We continue to look after the smaller country hospitals that not only play an incredibly important medical role but also play an incredible social role in smaller regional communities, not the least of which is the fact that they are often significant employers in those regional communities. Accordingly, we have to look after those smaller country hospitals.

Health is always going to be an incredibly challenging portfolio with over $5 billion spent on health in this state, and that is going to increase. The projected cutbacks by the federal government are not going to help the situation, and that is why other state Liberal governments have been up in arms about the cuts. I seek leave to continue my remarks.

Leave granted; debate adjourned.