Repatriation General Hospital

Mr MARSHALL (Dunstan—Leader of the Opposition) (11:57): I move:

That this house—

(a) reaffirms its commitment to the best possible standard of health care for veterans and war widows;

(b) acknowledges the care provided by the Repatriation General Hospital during the 73 years of its operation;

(c) recommits to the Repatriation General Hospital as a centre of excellence, maintaining its role as an acute care teaching institution with links to Flinders University; and

(d) opposes any moves to close the Repatriation General Hospital.

The Liberal Party reaffirms its commitment to the best possible standard of health care for veterans and war widows. The Liberal Party acknowledges the care provided by the Repatriation General Hospital during the 73 years of its operation. The Liberal Party recommits to the Repatriation General Hospital as a centre of excellence, maintaining its role as acute care teaching institution with links to Flinders University, and the Liberal Party opposes any moves to close the Repat Hospital.

This government has made an art form of promising one thing before an election and then backflipping or moving out of that position immediately after, but none of those broken promises could be considered more egregious than the broken promise to our veterans community in South Australia. This government cannot be trusted. This minister cannot be trusted. Why should we believe anything this minister has to say? Why should we believe anything this government has to say?

In September 2010, the Labor government in South Australia ruled out shutting the Repat Hospital, with the then premier, Mike Rann, stating:

The Repat Hospital is here to stay. The Repat Hospital will never, ever be closed by a Labor government.

But what has happened? They have made the announcement that this government is going to close it, but it does not stop there. It was not just one fleeting promise to the veterans community five years ago—it went on and on.

Let's hear what minister Hill had to say, when he was the minister for health in South Australia, when he was confronted with the comments that this hospital might be closed. He called those comments ridiculous. He said, 'I reject it forever. It's not something that is going to be done by the government.' But what has happened? We now have an announcement that the Repat is going to close. Shame on Labor!

More than that, we hear from the minister himself, the current minister, the member for Playford, minister Snelling, in July 2013. I want to read into Hansard what he had to say to the veterans community in South Australia before the state election:

[South Australia] Health is dedicated to maintaining the same high level of care that veterans and the local community have come to expect from the Repat, both now and into the future.

That is what he said before the election. He went on to say:

The Repat will continue to specialise in the care of older people and veterans, providing high-quality care from the acute stages through to palliative care.

That is what the minister had to say before the election. But even after the election this government maintained its position to support the Repat continuing to operate in South Australia. Let's hear what acting minister Close, the member for Port Adelaide, had to say. This comment was made in August of last year, not five years ago, not 10 years ago, just in August of last year—interestingly, before the two by-elections. She said:

I can assure you that SA Health and the Repat are dedicated to maintaining the same high level of care that…the local community have come to expect from this hospital. The Repat Veterans Service Guarantee will be upheld and the Repat will continue to specialise in the care of older people and veterans, providing high quality care from the acute stages through to palliative care.

She repeated the words of the minister. The government repeated the promise to the people of South Australia—made before the election in 2014 and repeated in August 2014—and they ruled it out. They said that it cannot be done but, of course, now they have gone back on that. This is a government and a minister who cannot be trusted.

When the final Transforming Health report was released, veterans read the document with horror. The Repat was to close. Why? I will tell you why, and it is important for us to understand why important critical services to the veterans community are being cut in South Australia, and that is because this government, after 12½ years of Labor mismanagement, is broke. The deficit last year was $1.2 billion, the largest deficit in this state's entire history, and that is why we are in such a perilous state in South Australia.

Health has to play its role and this minister has to play his role. Let's have a look at the budget blowout in this department over the last five years. We could go back longer, but let's not run out of time. Let's have a look at the last five years. Last year, in a single year, in one single calendar year this government blew its health budget by a staggering $176 million; the year before, a $216 million blowout in a single year; the year before that, a staggering $397 million blowout in one year; the year before, $126 million blowout; and the year before that, a $329 million blowout.

What does that add up to? Let me tell you what it adds up to: over the last five years, this government, this minister, have been responsible for unbudgeted expenditure in our health system in excess of $1.2 billion, and that is the reason the government is now talking about cutting services. They are cutting services because they cannot manage their own budget. They cannot be trusted to manage the budget in South Australia.

Let's just take a look at this important issue of the Repat Hospital. In the Sustainable Budget Commission report, which was handed down to this government in 2010, the Sustainable Budget Commission said that the total savings that would be derived by the government from closing the Repat Hospital, which has been under consideration—ruled out by the government, but under consideration for a long period of time—would be $14 million. Let me tell you, if the budget blowout had been contained last year and eliminated from last year's budget, you could continue to run the Repat Hospital in South Australia for 14 years, instead of the budget blowout that has occurred under this minister and under this government.

It is not just recurrent expenditure, annual expenditure, it is of course the gross mismanagement of the capital budget in this portfolio over an extended period of time. Take, for example, the new Royal Adelaide Hospital project. When this was first promised, when it first went to cabinet, this was a $1.7 billion project. Since then we have had a $621 million blowout and we are still not there. Let me tell you, if anybody honestly thinks that the blowout in the new Royal Adelaide Hospital project is going to be limited to $621 million, think again. There is plenty more to come, because this government has proved over an extended period of time that they cannot manage the budget. They cannot manage our economy and they certainly cannot manage health in this state.

In December, the minister snuck out just before Christmas—some of the media were still here, but many of them were on holidays—a press release saying, 'We've had another slippage on the project for the new Royal Adelaide Hospital.' What is this slippage? Is it a $5 million slippage, is it a $10 million slippage, or is it a biggie, is it a $20 million slippage? No! It was a $176 million slippage in this project, snuck out just days before Christmas while people were going about doing their Christmas shopping.

And what was this blowout? I will tell you what this blowout was. This government never ever considered doing one important thing and that was putting a budget line in for transferring from the existing Royal Adelaide Hospital to the new Royal Adelaide Hospital. The opposition has been raising this issue for an extended period but no, the government knew better. They thought they could just switch one off one day, lock up the doors, go down, open up the doors of the new hospital and start operating. We have been saying that that is not how it has worked in any other major hospital transfer, but they knew better. Guess what? They got it wrong and they got it wrong by $176 million, because they cannot manage money, they cannot manage the economy and they certainly cannot manage health in South Australia.

What is this government's response to their overspending, their overspending on the new Royal Adelaide Hospital, their overspending on the Oracle project, their overspending on the EPAS project, their annual expenditure blowout to $1.2 million over the last five years? Are they going to look at reining in their over budget expenditure? No, they are just going to cut services. They are going to cut services to the veterans' community in South Australia, the men and women who have served our nation, the men and women who do not deserve this disrespect from this government.

Approximately 6,000 veterans are admitted to that hospital every year, men and women who have served our country, plus their families, plus the war widows in South Australia. This decision by Labor will affect many more South Australians than just our veterans' community. People may not know this and I would like to put it on the Hansard, because I think it is important to know that there were nearly 19,000 people admitted to the Repat Hospital in the last financial year. It is a very substantial hospital.

There were 136,000 outpatient consultations in a single year. There were 4,438 elective surgery operations completed at the Repat in the 2012-13 financial year. That is almost as much elective surgery as is done at the Lyell McEwin Hospital in South Australia, and it is more than either the Modbury Hospital or the Noarlunga Hospital, but this government says we are going to close it. We are going to close it and somehow absorb that enormous number of elective surgery operations into the other hospitals in South Australia, the other hospitals that are already under enormous pressure from the mismanagement of 12½ years of Labor management in the health system in South Australia.

Take a look at orthopaedic surgery in South Australia. Almost a quarter of all orthopaedic surgery in this state is done at the Repat. Where is it going to be done now? We have no idea. Twenty-nine per cent, almost 30 per cent, of the state's urology surgery is done at the Repat. Where is it going to be now? This is the problem. This is the problem for South Australia. We have a government that wants to cut these vital services and they are not giving us a picture of what is going to be happening going forward. I will tell you what is going to be happening going forward: it is going to be chaos and one person is going to be to blame and that is the current Minister for Health.

Most disturbing is the way in which this government has arrived at this position. At the same time that the government has been assuring the veterans community in South Australia that their facilities are going to be preserved, the government has been letting these facilities become run-down. Take a look at Ward 17: it is in a disgraceful situation. The government has known about this for an extended period of time, but they have allowed these facilities to become run-down over time.

They have also started to whittle away at the services. Do not forget: this is the government which closed the ICU. This is the government which closed the acute referral unit, again pushing more and more people to the emergency department—where? At Flinders, the hospital that cannot deal with the current capacity. This government has been driving more patients to that facility in South Australia.

The minister has gone to great lengths recently to say, 'We have been consulting on this for an extended period of time'—what a load of rubbish. I asked members of the Veterans Advisory Council and the Veterans' Health Advisory Council when they first learnt about this change of policy, this decision, this backflip on their commitment. They said they found out about it when it was on the television. That is absolutely disgraceful. It is completely and utterly disrespectful, but this is something that we have come to expect from this government.

In the remaining minutes, I would like to highlight some other issues regarding this decision by the government to close the Repat Hospital. First of all, I must say it is very disturbing to hear these repeated claims that staff who are working at the Repat Hospital have been gagged. This is, again, something that the minister comes out and denies, but nursing staff and other staff down at the Repat come and tell us it is absolutely factual. They are telling us and they are telling the media, so who is telling the truth?

The consultation on this has been an absolute farce, the government has already made its decision, and we have no idea of the detail of this decision. Where is Ward 17 going to be? Is it going to remain at the Repat, like the veterans minister wants, or is it going to be more centrally located, like the health minister wants? We have no information. What we do know is that the government is going to stick the wrecking ball through the existing facilities, many of them upgraded on that site in recent years.

We have only just completed the 20 new subacute care beds down at that site on that campus at an enormous cost of $32 million. What is going to happen with that? Are we going to be sticking the wrecking ball through that, just like they are at the existing Royal Adelaide Hospital site? What about Ward 18? That aged acute mental health ward was completely refurbished in 2006-07, not that long ago, at enormous cost to this state. Are we going to be sticking the wrecking ball through that? What about the $6 million we spent in 2013 on the 4th Generation Rehabilitation centre at the Repat? What is going to happen to that? Are we going to be sticking the wrecking ball through that, or has the government actually done a deal with somebody?

Have they done a deal with no transparency? Is this going to be another Gillman? Is this going to be another example of where the ICAC Commissioner is going to have to come in and conduct an investigation into maladministration by this government? We have no idea what this government's plan is for that campus. All we know is that they are broke; all we know is that they want to sell off land to prop up their bottom line, which is looking so sick after 12½ years of Labor government.

Deputy Speaker, can I just say to you that in 1995 the government of South Australia signed a deal with the commonwealth, and that contract that they signed says that the Repat 'continues as a centre of excellence, maintaining its role as an acute care, teaching institution with links to the Flinders University', that the word 'Repat' would be kept in its name, and that 'treatment services continue to be available to entitled veterans and war widows, irrespective of their place of residence', and it goes on. It is a contract.

Let me tell you that this government has torn up this agreement. They have torn up this sacred agreement with the veterans here in South Australia and they are sitting here laughing. They are sitting here laughing at the veterans, because they have done what they always do, and that is to turn their back on the promises that they have made.

Members interjecting:

The DEPUTY SPEAKER: We can't continue until there is order in the chamber.

Mr MARSHALL: This government should hang its head in shame. They have torn up the contract they had with the commonwealth, they have turned their back on the veterans community in South Australia, they have turned their back on the more broad community that exists in that region in South Australia, they have mismanaged health for an extended period of time, and this minister and this government should hang their heads in shame.

The Hon. J.J. SNELLING (Playford—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Arts, Minister for Health Industries) (12:14): I move to amend the motion as follows:

Delete paragraphs (c) and (d).

Mr Gardner: There isn't an amendment standing in your name, Jack.

The Hon. J.J. SNELLING: The amendment has been circulated, and that is to delete sections (c) and (d) of the motion as proposed.

Members interjecting:

The DEPUTY SPEAKER: Order! It would seem that it is actually at the table but hasn't been distributed. So, we apologise for that.

An honourable member interjecting:

The DEPUTY SPEAKER: I can't do anything about that; it's here.

Mr Gardner interjecting:

The DEPUTY SPEAKER: Well, I didn't see it, I'm sorry. I apologise for that. Do you want to wait until it comes back into the chamber or are you happy for the minister to read it?

Mr GARDNER: It's up to you; you're in the chair.

The DEPUTY SPEAKER: Well, it's up to you; I have given you the courtesy.

Mr Marshall: We can't debate an amendment if we haven't even seen it and considered it.

The DEPUTY SPEAKER: Do you want it adjourned?

The Hon. J.J. SNELLING: If the opposition want an opportunity to consider it.

Mr GARDNER: Madam, there are other speakers who are willing to debate the motion. It has been on the Notice Paper for two weeks. The minister has not chosen to circulate his amendment.

The DEPUTY SPEAKER: That's not true; the minister had lodged it at the table, and the table has apologised.

Members interjecting:

The Hon. J.J. SNELLING: The amendment is quite simple, even for the opposition.

Members interjecting:

The DEPUTY SPEAKER: Order!

The Hon. J.J. SNELLING: The amendment is to delete paragraphs (c) and (d) and I have so moved. Madam Deputy Speaker, the opposition have been treating health policy in this state like the petty ambulance chasers they are. Every time that something happens in our hospital system, every time some patient does not get treated quite as well as they want, every time someone has to wait some time in an emergency department, they are all over it like banshees, Madam Deputy Speaker. Like the banshees that they are, they are all over it any time anything happens.

Mr KNOLL: Point of order, Deputy Speaker.

The DEPUTY SPEAKER: Point of order—and you have a number for us?

An honourable member: We're not animals—unparliamentary language.

Mr KNOLL: The minister has used unparliamentary language in his—

The DEPUTY SPEAKER: 126—you are objecting to a word?

Mr KNOLL: Yes, ma'am.

The DEPUTY SPEAKER: 126—are we happy to withdraw 'banshee'?

The Hon. J.J. SNELLING: Well, Madam Deputy Speaker, if you direct me so, I will do so, but otherwise I am rather attached to it.

The DEPUTY SPEAKER: Shall we divide under 'banshee', or are you happy to remove 'banshee'?

Members interjecting:

The DEPUTY SPEAKER: Remove banshee.

The Hon. J.J. SNELLING: Alright, Madam Deputy Speaker, I am happy to withdraw the word 'banshee'. But, Madam Deputy Speaker, it does reflect the way the opposition pursue health policy in this state, and it is why they remain, after 13 years, in opposition. I need only reflect upon the letter, the email, that Dr Phil Tideman sent to the Leader of the Opposition in response to the Leader of the Opposition's email, where he talked about the opposition's pathetically inadequate response to the Transforming Health proposals—and I could not put it any better myself, because the opposition's approach to health policy in this state is simply to see it as an opportunity to mine for whatever political points they think they can get and to try to take advantage out of—

An honourable member interjecting:

The Hon. J.J. SNELLING: You didn't address the motion, so don't lecture me, mate.

Members interjecting:

The Hon. J.J. SNELLING: Madam Deputy Speaker, the opposition just go around—

Members interjecting:

The DEPUTY SPEAKER: Order! I remind all members that the business of the house has to be conducted with decorum. Unfortunately, if this debate is going to get this way, I will have to start calling people to order. One speaker on their feet at a time. I ask the minister to continue.

The Hon. J.J. SNELLING: Madam Deputy Speaker, the opposition's—

Members interjecting:

The DEPUTY SPEAKER: Order!

The Hon. J.J. SNELLING: Madam Deputy Speaker, the opposition's approach to health policy is to try to take advantage of any human tragedy that they can find in our health system to try to score a few cheap political points, and what better example than last year, Madam Deputy Speaker—

Mr GARDNER: Point of order, Deputy Speaker.

The DEPUTY SPEAKER: We have a point of order.

Mr GARDNER: Imputing improper motive is clearly evident in that statement.

The DEPUTY SPEAKER: Perhaps I could ask the minister to continue and to observe standing orders.

The Hon. J.J. SNELLING: Madam Deputy Speaker, they can try to disrupt me with frivolous points of order all they want, because they do not like the truth. Last year, we had no better example of the way the Liberal Party in this state approach health policy—

The DEPUTY SPEAKER: Order!

The Hon. J.J. SNELLING: —than when the Leader of the Opposition came into this chamber—

Members interjecting:

Mr PEDERICK: Point of order, Madam Deputy Speaker.

The Hon. J.J. SNELLING: There they go, they don't like to hear it.

The DEPUTY SPEAKER: Member for Hammond, you have a point of order?

Mr PEDERICK: Point of order, Madam Deputy Speaker: relevance, 128—the minister is not responsible for what the Liberal Party says or does.

The DEPUTY SPEAKER: I will listen to the minister's contribution. Minister.

The Hon. J.J. SNELLING: When the Leader of the Opposition came into this chamber with the outrageous allegation that an elderly lady had died at the Noarlunga Hospital waiting to be transferred to the Flinders Medical Centre, no greater mistruth has ever been peddled in this house.

The DEPUTY SPEAKER: We have a point of order.

Ms CHAPMAN: Not only is this not relevant to the debate on the motion before the house but, Deputy Speaker, you have already ruled on this matter and the minister is clearly defying your earlier ruling. He just keeps repeating back to this particular incident, which has nothing to do with the Repat Hospital but is something to do with the Noarlunga Hospital. How many times does he have to be told?

The DEPUTY SPEAKER: I think the debate has been wide ranging this morning on your side as well, so we will ask—

Members interjecting:

The DEPUTY SPEAKER: Order!

The Hon. J.J. SNELLING: Thank you, Deputy Speaker.

Members interjecting:

The DEPUTY SPEAKER: Order!

The Hon. J.J. SNELLING: I know they do not like to hear it, but it is the truth.

Members interjecting:

The DEPUTY SPEAKER: Order!

The Hon. J.J. SNELLING: It is quite proper that they should be ashamed of themselves and they should hate it every time this particular sordid incident is referred to in this place. I am not surprised that they are getting up on their hind legs all the time to try to silence me, but here we have a good example. It is a good example of the Liberal Party's approach to health policy in this state: that they would use the death of an elderly lady, try to link it to delays in our emergency departments, and they were factually incorrect. They had not bothered to check their facts.

What happened as a result of this? The Coroner was forced to reopen the case into this lady's death. For some time the family were informed that the funeral they had arranged for this lady was not going to be able to proceed because the Coroner would have to reopen the case. What a disgrace. What a disgrace the Leader of the Opposition is to this place. He should be hanging his head in shame for his behaviour last year in this particular incident. If anyone is to be hanging their head in shame, it should be the Leader of the Opposition.

Members interjecting:

The DEPUTY SPEAKER: I am sure the minister is going to move on to the Repat.

The Hon. J.J. SNELLING: I am more than happy to, Deputy Speaker, but the Leader of the Opposition was quite happy to give a very wide-ranging speech as part of moving this motion and I think I should have—

Members interjecting:

The DEPUTY SPEAKER: I will have to leave the chamber if we keep conducting the business of the house in this fashion. As far as I know we listened to you mostly in silence. Every speaker is entitled to be heard in silence. I would ask the minister to come to the Repat, which is what you have asked. We are now going into that in silence.

The Hon. J.J. SNELLING: With regard to the Repatriation Hospital, we all have an enormous attachment to the Repatriation Hospital, but there are some undeniable facts.

Mr Pederick: Especially people who have served our country.

The DEPUTY SPEAKER: The member for Hammond is called to order.

The Hon. J.J. SNELLING: There are some undeniable facts. Firstly, I should state that the Repatriation Hospital has wonderful clinical services and I pay tribute to the hardworking doctors, nurses and allied health professionals who deliver wonderful services not only to veterans—because veterans make up at any one time about 10 per cent of the patients being treated in the Repatriation Hospital—but to a significant proportion of people who go there seeking the services of the Repatriation Hospital. They do a wonderful job, and anything that the government decides with regard to the future of the Repat is not in the slightest way a reflection on the hardworking clinicians who deliver wonderful services in there.

However, the majority of the physical infrastructure does date back to the 1940s and is quickly approaching the stage where, even if it was able to be given a major revamp, it still would not be fit for purpose. It would still not be able to be used as a modern hospital, because much has changed in health care since the 1940s. Regardless of what happens with this consultation, a government will one day have to make a decision about the future of the Repat and about what it is going to do.

One of the problems we have in South Australia with the way we deliver health services is that we are too thinly spread. We try to do too many things at too many different sites and sometimes, as a result of that, not through any fault of the clinicians delivering the services, the care of South Australians can be compromised. It is not because the clinicians are doing a poor job but simply because of the way our system is configured.

If we are to get the best and consistent health outcomes, we need to consolidate some of our sites. The Repatriation Hospital, given the age of the infrastructure, is obviously up for consideration as a venue where we would be looking to remove our inpatient facilities. Having said that, I should point out that with regard to services to veterans, in my consultations and discussions with the veteran community the most significant service on that site of most importance and relevance to modern veterans—the veterans coming back from Afghanistan, Iraq and Vietnam—is Ward 17.

Ward 17 is currently a centre of excellence for the treatment of people with post-traumatic stress, but it is in an aged building. It has been referred to by others (not by me) as squalid, from memory. It is not fit for the modern treatment of patients with post-traumatic stress. Veterans groups have been asking for a very long time for a new facility to be built. What I made quite clear is that, to ensure that we continue to deliver high-level services to veterans into the future, as part of this decision the government is committed to rebuilding a new Ward 17.

We have asked Dr Susan Neuhaus (I think she is Professor Susan Neuhaus) to co-chair a clinical group to start looking at what the models of care might be for the new Ward 17; from that, we will be making decisions about where that might be located. I have been quite open that a possible location could remain at Daw Park. That is certainly a possibility, but it will depend very much on the work that this clinical group does about what the new model of care should be for the treatment of patients with post-traumatic stress.

This government is absolutely committed to the care of veterans and looking after those who have served their country, but we do have to understand that the needs of modern veterans have changed. Hopefully, we will never again engage in a conflict where hundreds of young men come back from the front after being involved in a mass casualty war like World War II. That is why the Repatriation Hospital was built: to look after large numbers of young men and women coming back from war with injuries that needed a long time to recover from.

Modern conflict is much different, and the Minister for Veterans' Affairs, I am sure, can talk about this far more eloquently than I can. The fact is that Australia's commitments to overseas have been much smaller, with professional armed forces. Generally, when an injury happens, they are very well looked after by military forces, and the number of injuries, thankfully, are relatively small. One area where our system is lacking is looking after veterans who, sometimes decades afterwards, are presenting with post-traumatic stress following their involvement in overseas conflict.

The proposals we have put are about making sure that veterans get the best possible care and that they are treated in modern facilities, rather than being left in what is basically a museum piece.

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (12:28): I rise to support this motion and object to the deletion of paragraphs (c) and (d), as proposed by the Minister for Health. At home, I have a wooden engraving with an etching of the Repatriation General Hospital on it and a commendation in appreciation of the very long service of my father on the board of the Repatriation General Hospital. It represents recognition of those who serve in a voluntary way, not just on the board but in so many other ways, in the 70-plus year history of this hospital.

I think what most people do not appreciate about this hospital is the fact that it was actually built not just for the repatriation of veterans and for war widows: it was built right from the start to serve the civilian population—and it has—40 per cent plus of the civilian population ever since its inception.

Secondly, it is now the only freestanding veterans hospital in Australia and the only one left with a ward 17 which is specifically dedicated to the care of those who are suffering mental health issues, particularly post-traumatic stress from conflicts in which our men and women have served. So, its history and its special place in South Australia I think are very important.

I think it is a disgrace that this government has moved from a position under premier Rann to commit to ensuring that this hospital would remain, that the board would remain, that it would remain as a dedicated hospital and that it would 'not change', to use the premier's words at the time, 'until the diggers want it to'.

It is a disgrace that the Minister for Health, who has been a minister for veterans, and who has made myriad moving speeches in this state about the importance of the contribution of men and women of South Australia to this state in his capacity as a former veterans minister, should stand here in this house and now tell us that it is surplus to requirements, that they need to streamline health services across the state but not admit that there has been a financial muck-up on their part when they are clearly in a position where they need the money.

They tell us that they have appointed a clinical ambassador—Dorothy Keefe—to come out and tell South Australia that they need to deliver quality, that that is an imperative of their reform in relation to health and that, as part of that structure, it means the downgrading/disposal of the Repatriation General Hospital as a hospital for acute care.

Let me say this: if the government have a problem with the health services they deliver in this state, they ought to take a look at the minutes of the board which reported to the previous government and this government. Consistently, year after year, it is the only single public hospital in the last 20 years in this state that has delivered a balanced budget. It is the only one, if you had ever to find a public hospital in this state that has done what was asked of it—delivered a quality service, reformed when appropriate, provided more services, initiated and built capital works—and every year balanced the books.

Ask the other ministers who have been health ministers in this state and see how bad the administration has been of other public hospitals compared with the Repat and ask yourself a serious question: if ever there was an emblem of excellent quality, acute and other allied health service care to South Australia, in a balancing of the books environment, is it not the Repatriation General Hospital?

It should be held up as an example in this state of a hospital that has done what it said it would do, done it well and done it within its budget. Yet the government has slowly but surely completely ignored its promises, ignored the efficient management of this hospital, ignored the great and valuable contribution the Repat has given to health and training in this state and said, 'It's just surplus to requirements. We need to streamline; it's got to go.'

The leader has clearly pointed out how difficult it is going to be to deal with the tens of thousands of procedures which this hospital currently carries out, which are apparently going to be absorbed into a system which is not functioning well and which, as Dorothy Keefe tells us, apparently gives us 500 deaths a year that should not happen. They are going to remove the iconic piece of the health structure out of the system and ask that it be absorbed into a system that is apparently haemorrhaging. What an idiotic process that is. I think the government should hang its head in shame for ignoring completely the efficiency of this hospital.

As for Ward 17, can I say this: probably many other members have been through Ward 17, as I have on a number of occasions. It has served returned veterans, particularly men from the Vietnam conflict, and continues to provide that service today. Veterans of the Vietnam conflict are the greatest single cohort, other than Korean veterans, who have been provided services over a sustained period in this state. The government says, 'We're going to appoint a committee to think about where we might transfer them, perhaps to a central location.'

How dare he come into this house and talk about a Transforming Health model without even having sorted that out, without even having discussed with the people who deal with the mental health and recovery of our veterans (a) if they want to stay there, or (b) where else they might want to go and what other services they might have. Yes, the infrastructure is tired and completely below standard for the men and women we have asked to serve us and risk their lives for us. Absolutely right.

They built a ward 18 which, I think, was started under the time of Mr Brown as the minister for health. It is completed, it is beautiful, it is great for aged civilians who require mental health services. It is right next door and it is beautiful. Yet, in all these years, this government has done nothing to even improve the amenity for those who are in Ward 17 which provides services to veterans. It is disgusting.

If the government think they are going to come up with a committee and throw in $15 million for services—which would be lucky to pay for a couple of coffee rooms to be added onto a hospital—that will obviously be inadequate for our mental health patients and those returning from conflict with mental health problems. Professor Neuhaus, who has been appointed, has told me (and I am sure others) of the very significant legacy we have from subsequent conflicts and in which our men and women of South Australia are still serving—and dying—and they need a service.

If this government think they can throw them into some sort of cardboard cut-out that is added onto another hospital or shove those who are in very serious need of high-level acute care into Glenside, well think again. Think how they have stuffed up the Glenside Hospital already. If they think they can lock up our veterans into the secure care there, they will have a riot and there will be blood on the streets over this. Mark my words! They will not put up with this. It is a disgrace, and the member for Waite should hang his head in shame as well. He sits there with the government. The other day he lined up and gave me this drivel in a ministerial statement about what is going to happen with an iconic site in his own seat. It is a disgrace, and he should hang his head in shame.

The SPEAKER: The Tiber flowing, foaming with blood. Minister.

The Hon. M.L.J. HAMILTON-SMITH (Waite—Minister for Investment and Trade, Minister for Defence Industries, Minister for Veterans' Affairs) (12:37): I am delighted to rise to speak to this motion and to commend parts (a) and (b) of the motion which are very easy to support because they talk of the wonderful achievements of a fantastic hospital with a marvellous group of clinicians and professionals who, for over 73 years, have served us proudly. Those parts of the motion reaffirm a commitment, which I think everyone in this house would have on all sides, to veterans' health and health in general. I will be supporting the Minister for Health's amendment to remove parts (c) and (d) which are inappropriate and which do not really help the debate. In all of this, I am not so much interested in the politics as I am in what is in the best interests of veterans and the health needs of the community.

I sense in this motion, and in the debate that has followed the government's announcement about health reform, that the opposition understandably—and that is their job, I do not blame them for that—sensed a political opportunity. That is what is dominating their thinking rather than what is genuinely in the best interests of the community's health needs. I understand—and I think the public understand—that political argy-bargy, but I think on this subject it is important we focus on what is best for health, what is best for the elderly and what is best for veterans.

It is there that I want to focus my remarks from two perspectives: one as the Minister for Veterans' Affairs and one as the local MP who grew up only a few blocks away from the hospital. I start first as the Minister for Veterans' Affairs because I want to dispel claims that have been made that there was no consultation. It was consulted most thoroughly, actually, by the Minister for Health in August 2014 with clinicians.

In order to establish the quality of care standards, advisory groups were formed under Professor Dorothy Keefe, clinical ambassador for Transforming Health and, of course, in October 2014, Transforming Health proposals were made in our discussion paper that was released publicly. In November 2014, the health minister held a Transforming Health summit and 600 people attended. On 3 February, the health minister released the Delivering and Transforming Health Proposals Paper outlining a plan and delivering services that meets the principles and standards agreed on the previous phase of consultation.

Public and interested parties have had 23 days to respond to this current phase of consultation which has been going on for some time, and it has dealt with emergency care, specialised complex services, services for older people, comprehensive rehab services, mental health, better services for veterans and a host of other issues. Of course, the consultation will be going on and there will be subsequent phases of consultation as each part of this plan is taken to the community, considered, discussed and diagnosed in detail, and then slowly progressed.

Times have changed, both for our health system and for veterans. At the time the Repat was established after World War II there were large numbers of veterans, many of them having suffered physical and mental trauma. There was a need to accommodate the needs of thousands of veterans and their families. It was a different time with a different need and the very nature of hospitals was different at that time. Of course, in those days we did not have MRI machines or expensive and complex procedures and devices. Hospitals were much cheaper to run in the 1940s and 1950s than they are today, and as the Minister for Health has mentioned, the system has just run too thin.

But so too the needs of our veterans have changed and this has been consulted thoroughly with veteran leaders throughout its progress. I know that for a fact because I have taken groups of veterans to meet with the minister prior to it being announced. Veteran leaders throughout the community have been consulted in detail. Of course, not every veteran was consulted, nor was every doctor or every nurse, and there will be different points of view on this, but veterans have been consulted and veteran leaders generally acknowledge that veterans need first-class health care close to where they live or work.

Veterans live in the north of Adelaide, veterans live in the south, they live in the west, they live in the centre of Adelaide, they have heart attacks, they have strokes, they have car accidents, they fall off ladders like everybody else, and they have physical traumas, and when they have them they need to go to an emergency department that can meet their needs and because the health system is spread so thin we do not have such facilities. They need improvement and that is why when you look at the positives of Transforming Health you see a $252 million investment in improving those facilities and you see that we are going to get $154 million spent at Flinders Medical Centre, not only on improving the ED there and stopping the ramping but on rehab facilities, $32 million at Modbury Hospital, $20 million at The QEH and $15 million at the Noarlunga Hospital.

That means there will be better EDs, rehab facilities, hydrotherapy, gyms and so on, for veterans and for the elderly at hospitals close to where they live and work. Remember that many of these veterans have the gold card—not all, but many—and they choose to use hospitals other than the Repat. As the minister has explained, fewer than 10 per cent or so of the patients at the Repat are veterans. It is really a general hospital and that would probably be consistent with other hospitals where probably 10 per cent or slightly fewer are veterans. It is another hospital in our network. In nine hospitals the resources are spread too thin. By concentrating it into six hospitals, we will get better services where and when we need it, including for veterans.

This is a brave reform. I was the shadow minister for health for a couple of years and I can tell you it is easy to be the shadow minister for health. There is an opportunity every day, but I remember as I was doing it thinking, 'You know what? This would be the toughest portfolio to have in government.' I do not know if I would be volunteering. I think it would be daunting. I have seen it drain ministers before my very eyes over the years I have been here, and can I commend the Minister for Health for having the moral courage to at least come forward with a reform plan. The last time was Dean Brown who came forward with some brave reform options, including the sale of Modbury Hospital to the private sector, and we now have a minister who has had the courage to bite the bullet, front up to the tough decisions and come up with a reform plan, and the Repat decision needs to be viewed in that context.

On previous occasions—and the opposition is right to observe them—talk of cuts to the Repat in the context of Sustainable Budget Commission reports and so on have been made in the context of cuts. This reform is being made in the context of an entire health reform plan that seeks to improve the health system and make it more affordable and of a higher quality for all. It is the first time I have seen anything proposed in the context of measures that seek to improve the system, and for that reason I think it needs to be viewed differently.

Can I also say that the government of 2010 is a completely different government to the government of 2014. It has got a different cabinet, comprised of different people, with a different Premier, and with a different refreshed and new approach. It is a different government, and its proposing this in the context of an array of new and bold measures.

I think the new facilities in the remaining six hospitals will provide better care for veterans, and that is what veterans think too. I have spoken to them on the veterans health advisory committee, I have spoken to the veterans advisory committee, I have spoken to veteran leaders everywhere. I agree with the minister that Ward 17 is a key issue. I have complete confidence that Professor Susan Neuhaus, with whom I previously served in the Defence Force, will do a wonderful job, with Professor Dorothy Keefe, David Everitt, Brigadier Laurie Lewis, Professor Tarun Bastiampillai, and Taryn Cowain, in determining the best and brightest future for Ward 17.

I have no doubt that what we will finish up with is a better Ward 17 than we have at the moment, and I have had young veterans tell me the facilities are too old and they need renewal. I hope it will be at Daw Park, I sincerely do, but we will leave that to the clinicians and the experts under Professor Susan Neuhaus.

I am also delighted that the chapel, the gardens, prosthetics, the private health facility and, I hope, the hospice, will be remaining there; that is all still open. I have no doubt that the private health sector will have an interest in some of the facilities there, and I hope that we see retirement homes for veterans established either by RSL Care or some other entity at the site.

I think the site will have an ongoing role both as health facility and a facility for veterans. So, I simply say: health reform is never easy, but it is necessary. The opposition make the right point that we have to live within our means. Health reform, education reform, government reform generally is part of that. To me, the number one issue in all of this is what is best for veterans and what is best for the health of our community.

I think, by focusing the resources that we have available to us in six hospitals instead of nine, both veterans and the elderly will receive better health care with the resources we have available to us. I think, too, that we will provide a health system that clinicians find more usable in better and more modern facilities and which patients will find better. I just say to the opposition: it is fine to raise these issues but you must have a plan as an alternative, and I would like to hear what the opposition's plan for health reform is, including the Repat, because I think that would then give us a debate of substance.

Mr SPEIRS (Bright) (12:47): 'The Repat Hospital will never close under Labor.' Those words were uttered by that great stalwart of sincerity, our former premier, Mr Rann, just a few years ago just after the Sustainable Budget Commission canvassed the concept of shutting this hospital. We know now that this could very well happen under Labor, and what a tragedy that will be for both our veterans' community, seniors in South Australia who rely on their specialist care provided by the Repat Hospital, and also many other families and people connected with that hospital.

A good opposition should speak up for those who are most disempowered and most voiceless in our community, and there is no doubt in my mind that this announcement of the closure of the Repat is something that directly affects those who are least empowered in our community and least able to speak up for what they believe.

So, as an opposition in this parliament it is vitally important that, while we should show leadership and should endorse good ideas that the government puts forward, we equally should be confident and comfortable condemning bad ideas and bringing them into the public domain and actually saying, 'Actually, we don't agree with this. This is bad for our health care and bad for the future of our state, bad for pensioners, bad for seniors and especially bad for our veterans' community here in South Australia.'

The Repat Hospital, we have just heard, the closure of this facility, has undergone extensive consultation. Four weeks for Transforming Health does not feel like 'extensive' to me, and I think we are drifting into that announce and defend zone that the Premier was so keen for us to avoid when he came into office back in 2011. I do not think announcing, consulting for four weeks, then defending really gets anywhere close to the debate-and-decide model he was so keen to propound.

Consultation should be far more than four weeks with such a significant decision being made and clearly it is a decision which entails a huge emotional attachment to this facility within the South Australian public. This is something that has brought about a realisation in my mind since this announcement was made that the future of the Repat Hospital could be in some doubt. The realisation in my mind was that there is a huge emotional attachment to this facility. There is considerable affection for it and a knowledge in our community of the great work that the Repatriation Hospital has contributed over its 70-plus years of operation at the Daw Park site.

To date we have really had no explanation from the government as to the 'why'. There have been statements that this is part of a modern future health service for our state and there has been some mention that this will go towards budget savings along the way but there has been no clear articulation about why the Repatriation Hospital has to close.

The statement was made by the Minister for Health earlier this morning that Ward 17 in that hospital was in a squalid state and he then referred to it as an historical relic. Well, 13 years in government is quite a long time and for any health facility, by the health minister's own admission, to fall into a squalid state under a 13-year government's watch, I think, is absolutely disgraceful. Firstly, to describe a health facility as squalid but then to admit that under your watch you have allowed it—and any health facility at all times should be in a situation which is clean, modern and accessible. Nothing should ever be allowed to get to a squalid state, and he stood here earlier this morning and described it as squalid in his own words. I think after 13 years they have quite a lot to answer for if our health facilities are in such a state that they can be described as squalid.

I want to refer briefly to the situation of gagging of staff. Of course, we know and I have made statements in the past about the way this government seeks to control its Public Service through the use of fear and intimidation. It is no secret that that is something that I have considerable interest in and not just in the health department and the health service but the wider Public Service. I have spoken on that already this week, but the idea of gagging staff, making them fearful for their jobs should they speak up about this matter and inject their own ideas—

Mr Knoll interjecting:

Mr SPEIRS: The member for Schubert reminds me of filming people in public meetings standing up. It is all about fear, it is all about control, and it really shows a government which is not treating its staff with respect. Staff should be part of this consultation, too. If staff feel that this is the wrong approach, they should not be—

Members interjecting:

Mr SPEIRS: Well, they have been. You say—

The DEPUTY SPEAKER: Order!

Mr Pederick interjecting:

The DEPUTY SPEAKER: I don't need help, member for Hammond, but thank you.

Mr SPEIRS: The handpicked bureaucrats and handpicked health officials who have been brought in to ensure the government's line has been sold on this, they are the ones who have been involved.

Members interjecting:

The DEPUTY SPEAKER: Order!

Mr SPEIRS: I have spoken to quite a lot of health professionals who have significant concerns about the closure of the Repat Hospital. I have spoken to friends who have done their PhD training there in rehabilitative care and they are stunned that the government would go down this track.

I think the government is suggesting that you can just move this facility elsewhere and we will get a new build, a new unit, on another hospital's site, namely Flinders in most cases when it comes to breaking down the Repat. I think that shows a certain naivety in terms of the historic build-up of knowledge and experience that those bricks and mortar actually hold. There is a community that has been built up in that facility around rehabilitative care. People know the staff members who work there and who they can go and speak to about a specific issue. Staff members can build each other's knowledge and understanding. They can work together to have that experience and to use that experience.

If you move that site, if you break that up and if you break that down, that poses a significant loss of corporate knowledge. It also affects the capacity of our rehabilitative services to respond to the needs of our patients, of our veterans in particular, and also of our seniors. We have to remember that this hospital, while we do talk a lot about the services that it provides to the veterans community, also provides a vital service to geriatric health as well, which, given our ageing population, is also an area of expertise that we need to be continually building, not putting at risk.

Since the announcement that the future of the Repat Hospital is at risk, my electorate office has been inundated by concerned constituents. I just want to put onto the public record a couple of statements that I have had from members of the community. In particular, the first one discusses Daw House, the hospice facility on that site. We saw Lyn Such yesterday state that this was perhaps the only facility like it in the country, and I thought that was an interesting insight that she was able to provide, obviously, from personal experience.

A constituent of mine, Megan from Hallett Cove, wrote to me about when her father was there suffering from terminal cancer. She said:

Daw House was amazing, right from the beginning, they looked after him, not just physically, but emotionally, my mother, brother and I were there for 10-12 hours everyday, they counselled us, they gave us art projects to do with him, they were a shoulder to cry on for all of us. It was as homely an environment as I could ever imagine.

She goes on to say:

Daw House is not an environment that can be replicated in a hospital…it just can't be, no matter how wonderful a job our local hospitals or palliative care…is. Palliative Care isn't just making someone comfortable and painfree in their final days, it's so much more than that, its more than just medication and diagnostic testing.

Daw House holds a precious place for our family now…

That is just one insight into the affection that this facility has in our local community. I believe that, if we put all this at risk and see the Daw Park facility close as part of this short-sighted government's health reform, I think that would be a tragedy for our state.

Time expired.

Dr McFETRIDGE (Morphett) (12:57): Mike Rann on 20 September 2010, on closing the Repat, said, 'It took one second to reject this dopey idea.' I guess Mike Rann has gone but the dopey idea continues. Closing the Repat is a really dopey idea. We heard the Minister for Veterans' Affairs say a few moments ago that veterans deserved an ED they can go to. Well, let me tell you what the capacity of EDs was at 12:21 today—around half an hour ago: the Flinders Medical Centre was at 98 per cent capacity, the Noarlunga Hospital ED was at 126 per cent capacity, The QEH was at 132 per cent capacity, and the Lyell McEwin was at 143 per cent capacity.

The government want to shut down EDs and they want to close hospitals. This is a health system that is already bursting at the seams. They have no real plan. There was no consultation on this, and I know that because I have spoken to senior clinicians who did not know about this; they had no idea. The war widows had no idea that this was going to happen at the Repat. It is a dopey idea that needs to be rejected.

The Minister for Veterans' Affairs asked about our plan. Our plan is to maintain the Repat, respect the veterans, and to respect the heritage that is there. The Repat is the spiritual home of veterans in South Australia, and it is far more than that. It is a general hospital. It does 3,500 arthroplasties every year. The orthopaedics department has 400 new referrals every month. There are 700 outpatient visits every month. Where are they going to go, Minister for Health? Tell us that. Tell us where they are going to go.

We know what happened when they closed the A&E at the Repat: those 7,000-plus patients went to the Flinders Medical Centre. Today it is probably a quiet time for them, at 98 per cent capacity. Let us remind this house what the AMA say about hospital capacity: a hospital that is operating at more than 80 per cent is full. I seek leave to continue my remarks.

Leave granted; debate adjourned.

Sitting suspended from 13:00 to 14:00.