Health Care (Administration) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 11 February 2015.)

Mr TRELOAR (Flinders) (16:21): I inform the house that, although I am speaking first for the opposition, I am not actually the lead speaker on this bill. In fact, I understand our shadow minister is paired with the Minister for Health to attend a funeral today. He will make a contribution when the time comes, but we have a number of speakers on this bill so he will have that opportunity, I am sure.

I rise to make a contribution on the Health Care (Administration) Amendment Bill. In fact, this is not the first time we have debated this bill. It was introduced previously but, of course, when parliament was prorogued at the end of last year, it dropped off the paper so it has been reintroduced. I also indicate to the house that we will be supporting the bill, although I also flag that there will be a number of questions asked in the committee stage.

The bill we are debating today is exactly the same as in 2013 and 2014 and, in fact, has the same name. Both of those bills lapsed, as I said. This bill deals with the following issues, and I might just take the time to talk about them. The first is the fees for services provided by the South Australian Ambulance Service not involving ambulance transport. In fact, section 59 of the act allows the minister to set fees by notice in the Gazette to be charged for ambulance services which are defined in a way which is limited to transportation in an ambulance.

Since July 2010, fees for ambulance services not involving transportation have been levied under the fees regulations 2009 under the Fees Regulation Act 1927. This bill allows fees to be set under the Health Care Act 2008, so there is a change, and that change is made by inserting into the act almost identical words to the current regulation. The key difference is that the bill provides that fees can be fixed for any other matter prescribed by regulation. There are going to be some queries about this and I understand the government in their briefing were not able to adequately explain what changes that might make.

The bill also deals with the employment of clinicians in the Department for Health and Ageing, and the aim of this amendment is to allow health professionals employed under the act to be employed under their relevant professional award and if that position requires them to engage their professional skills, qualifications and clinical knowledge. It is very broadly worded and, once again, needs clarification.

The bill provides for proclamations to dissolve three now non-operational incorporated associations and transfer their assets to the appropriate incorporated health advisory council, otherwise known as HACs, and for the transfer of assets of three non-operational incorporated associations. They are Lumeah Homes Inc., Miroma Place Hostel Inc. and Peterborough Aged and Disabled Accommodation Inc. The transfer of the assets to their local country hospital sites was attempted at least 10 years ago—that was before the Health Care Act 2008. The transfers were never legally effected, even though the hospitals involved supported the transfer.

I might just take a moment to talk about this because one of the incorporated associations, namely, the Miroma Place Hostel, is not only situated in my electorate but it is, in fact, in my home town. I know the hostel very well, and I have visited a number of times, both visiting residents there and also attending various functions held there. It is probably likely that I will end up there myself, in fact—hopefully, later rather than sooner. It is a lovely place and is well regarded by the local community.

This transfer should have been done some years ago, but it has not been done. It is going to the HAC now, and the appropriate HAC in our case is the Lower Eyre Health Advisory Committee. The others involved in this transfer will be the Lower North HAC and the Mid North HAC. Of course, our local HACs are made up mostly of community members who really work for the best interests of the delivery of health services in their communities . Our local HACs and our local members are very possessive and protective of the assets they have and hold, and they take their responsibilities very seriously. I have to say that almost unanimously across country areas the members of the HACs and the HACs themselves remain somewhat wary of government intention around health.

Of course, there are so many small country hospitals, not just in the electorate of Flinders but right across the country. The delivery of services, and the importance of those hospitals to country towns, is critical. In many cases, the communities and the towns themselves have built these hospitals in generations past. The towns themselves raised the money, raised the capital, did the work, found the doctors, found the nurses and put the placements in, so you can understand why they are so protective.

In fact, in many ways, a hospital is the hub of a small town. A hospital being closed or removed from a community does happen from time to time, and there was one in the paper this week, when the hospital at Mallala was closed. It was a board decision, and I understand that, because they could not continue to keep running at a loss. However, I fear for the future of the township of Mallala and what might happen as a result of the closure of that hospital.

The hospital really is a hub and it is essential. People live in a town knowing that those services are provided, that there are healthcare professionals available, that there is a doctor available and that there is a hospital available where they can present should they become sick or have an accident. They are critical elements in our community. As I said before, the HACs are very possessive and protective of those assets.

There are other minor amendments in the bill and I suspect that a lot of our questions will go to how the amendments to the bill relate to health delivery in country areas. This bill, in past years, has been supported by the various relevant associations, including the Australian Medical Association and the Australian Nurses and Midwifery Federation—so it has general support.

I have touched on the delivery of health services in country areas, and there was an excellent editorial in The Advertiser on Monday of this week, entitled 'Health care goes beyond the city limits'. I think it really strikes at the core of how a lot of members on this side at least, given that many of us are from regional areas, feel about the delivery of health services into the country and how we think the government might view it.

There has been much discussion about Transforming Health and what that might mean to health delivery, but there is very little in the Transforming Health dialogue that talks about country health. It seems to me that the focus has been almost exclusively on metropolitan hospitals. I am sure, and I do hope, that at some point in the future that Transforming Health, those very important improvements in health delivery, will extend to country areas.

I have a situation in my electorate where the communities of Kimba, Cleve and Elliston have come together to engage a single practice. This almost certainly comes on the back of the fact that the days of single-doctor country GPs are coming to an end. Once upon a time, doctors and graduates made their life's work in a small country town and were happy to do that. They were happy to be on call 24 hours a day, seven days a week. They were happy to raise their families and happy to be involved in the community. For a whole host of reasons, those days seem to be coming to an end.

Kimba, Cleve and Elliston, under guidance from Country Health SA, have come together in a model where doctors are based at Cleve and service Cleve, Kimba and Elliston. There was a bit of a hiccup along the way. My personal opinion is that the Country Health model did not have enough flexibility in it to accommodate what the doctors involved in the practice actually wanted for themselves, because that needs consideration as well. It is all very well to attract a doctor to a country area, but you need to be able to retain those doctors, and the Country Health model needs to have the flexibility and the ability to accommodate the doctors.

That situation seems to have resolved itself for the time being because a doctor has now become resident at Elliston, which I have to say is some distance from Cleve—probably about an hour and a half's drive. When some of these models are drawn up by people further up the hierarchy, they forget to take into account the distances involved in country areas. As I said, it is an hour and a half from Elliston to Cleve and a good half an hour or 40 minutes north to Kimba. Kimba still does not have a resident doctor. That is not to say they do not have the opportunity to look for, seek out, find and attract a doctor to their community, but I have to admit that it is going to be very difficult for that small town, a very proud community, situated on National Highway 1 to be able to do that in the current environment.

I also note that there have been schemes in place to try to attract young doctors into country areas. In fact, last night's federal budget made a significant funding contribution of $2.6 million to the General Practice Rural Incentives Program. This is a deliberate effort by the federal government to help attract rural doctors into South Australia. I know there are at least half a dozen final year med students at the Port Lincoln hospital. They are not all country kids by any means; a couple of them are, but others are from the city. They have been given the opportunity—and grasped it with both hands—to work in a country hospital.

The thing about working in a country hospital and a country practice is that you deal with everything that comes in the door, obviously. The specialists are not at the end of the corridor; they are some distance away, so the doctors and those students doing medicine have the opportunity to be confronted with every single situation. I give credit to the federal government for providing that funding and credit to the med students who are prepared to take that opportunity. Who knows? Some of them may choose to take up general practice in a country area, which I think would be a wonderful thing. It is not just about doctors; it is about a whole host of allied health professionals.

Just last week we had a motion in this place celebrating the work and effort of nurses in our community and all those other allied health professionals, such as physiotherapists—the list is endless. It is about attracting and retaining them—and it is a real challenge. Initiatives are needed within the health department. The education department does it very well; South Australia Police does it very well. They have incentives in place that are attractive enough for people to want to go and live and work in country areas. Financial incentives are always needed, but I think that, once people get there, they realise what a great lifestyle it is and how wonderful it is to live in a community, then that is attraction enough.

We support the bill. There are some changes, and they are significant in that the Miroma Place Hostel will, at least, be transferred to the local HAC. It means that ownership stays local, and the HAC members I have spoken to are pleased about that. They are pleased that it is going to be finally resolved. There are questions to be asked at the committee stage and clarification is needed on more than a few points. With that, I support the bill.

Ms COOK (Fisher) (16:36): I rise to speak in support of the government's bill before this place today. In so doing, I note that one of the most difficult tasks for the public sector that arises from time to time is ensuring there are good systems in place for identifying and managing important assets such as property, contracts and agreements, and ensuring appropriate continuity in the management of these things when major legislative change creates subsequent considerable administrative changes.

Our hospitals and associated health services have developed over time in response to different social circumstances and medical knowledge. There are many significant moments in the history of health service provision in our state where we have seen new approaches to the management and provision of health services. For example, the Report of the Committee of Enquiry into Health Services in South Australia, led by the Hon. Mr Justice Charles Bright and published in 1973, resulted in the establishment of the South Australian Health Commission. The establishment of this statutory authority saw the majority of hospital and health services come under a centralised management, enabling a more consistent and coordinated approach to the delivery of health services.

In more recent times, there has been the Generational Health Review, the commencement of the Health Care Act 2008, and now we are engaged in a major reform process—Transforming Health—which continues the important work of modernising the delivery of health services to ensure efficiency and the best possible health outcomes for the South Australian community. There are legacies of such change, and often we have to deal with them well after the fact.

In the 1990s to early 2000s, the operations of three associations incorporated under the Associations Incorporation Act 1985, namely, Lumeah Homes Incorporated, Miroma Place Hostel Incorporated and Peterborough Aged and Disabled Accommodation Incorporated, were taken over by bodies corporate which were incorporated under the now repealed South Australian health commission act 1976. In preparation for these takeovers, I understand that the associations and health bodies corporate believed legal arrangements for the vesting in the health bodies corporate of the associations' assets, liabilities, employment issues and so on would be carried out, and it was intended that this would occur following the enactment of the Health Care Act 2008—but this did not eventuate.

Many country hospitals had arrangements like these occurring, and due to an administrative oversight in the case of the three associations, the contemplated legal arrangements were never executed. The associations and health bodies corporate were not aware of this oversight and, therefore, proceeded as though these legal arrangements had been effected. The associations regarded themselves as dissolved and stopped holding meetings and ceased to incur debts. The health bodies corporate believed themselves to be owners of the land and assets and employers of the staff, and have acted in good faith accordingly.

In 2008, with the repeal of the South Australian Health Commission Act 1976 and the enactment of the Health Care Act 2008, a new body corporate was established, namely, Country Health SA Incorporated, and the operations of the previous bodies corporate were taken over by Country Health SA and its relevant health advisory councils, including the operations of Lumeah, Miroma and Peterborough. However, as I said, the vesting of the property of these associations and their dissolutions have never been effected at law, and so, in fact, the property is still legally held by the non-operational incorporated associations. If they had been transferred, the assets of these associations would now be held in the case of Lumeah Homes Incorporated by the Lower North Health Advisory Council; Miroma Place Hostel Incorporated by the Lower Eyre Health Advisory Council; and Peterborough Aged and Disabled Accommodation Incorporated by the Mid North Health Advisory Council.

I understand that this is the first opportunity to finally remedy this situation. The proposed amendments will allow for proclamations to dissolve the three non-operational incorporated associations and formally transfer their assets to the appropriate health advisory council. These health advisory councils have formally supported these transfers. Finally, I believe it will be a great relief to all of those most involved, given the passage of time, to see this bill passed so that the legal formalities can proceed for the transfer of these assets. I commend this bill.

Mr WHETSTONE (Chaffey) (16:41): I too rise to speak on the Health Care (Administration) Amendment Bill to highlight the importance of providing adequate health care across South Australia. As background, I note that the Minister for Health tabled this bill on 11 February 2015, and it is very similar to previous bills of the same name introduced into this house. This bill deals with issues, including fees for service provided by SA Ambulance Service, not involving ambulance transport but the employment of clinicians in the Department of Health and Ageing, and the transfer of functions, assets, rights and liabilities between incorporated hospitals.

I think there are many questions still to be answered as to how these changes will impact on health care in regional and rural South Australia. I speak particularly about regional and rural South Australia, because that is where I am from, that is my electorate. I think that metropolitan healthcare services are very well documented. The state is going through a hiatus at the moment, with the current Transforming Health initiatives impacting on almost every South Australian.

Country patients account for about 16 per cent of overnight admissions in metropolitan hospitals. People in the Riverland and the Mallee frequently access health services and specialists in Adelaide. They have to travel. It is not an easy process for a country or regional person to undertake health care or medical procedures. It is not just about hopping in the car and driving to Adelaide. They have to find accommodation, and they rely on family and friends, so it is also an emotional burden, particularly when they have ill-health or when they are in need of a medical procedure. It really impacts on them physically and mentally. Any changes need to ensure that country patients are not disadvantaged when accessing health care in both metropolitan and regional areas.

In the electorate of Chaffey, which includes the Riverland and the Mallee, there are eight hospitals, and each one of those hospitals plays a vital role. They are part of the fabric of the communities in the area. The continued need for appropriate infrastructure is particularly relevant, especially for an ageing base of over 40,000 people and where the median age in the Riverland region is about 44 years. It is an ageing population.

One thing that I did pick up on my recent trip overseas to Tokyo is that they have a very similar demographic, albeit much larger, but the same demographic of an ageing population with the need for more health facilities, particularly aged care. They are looking at about an extra 70,000 aged-care workers a year just in one city, so we have to pull that to bits and look at how South Australia will position itself with its aged-care needs and requirements into the future.

I would like to commend all the medical and healthcare professionals who provide healthcare service in the regions in South Australia, particularly in Chaffey. Whether they are doctors on placement doing their regional time, if you like; the nurses; or the support staff, right from the person cleaning the floors through to the top-of-the-range surgeons who visit the regions, I thank them. They perform an outstanding service to every person who is in need of medical care.

Again, there is also a strong band of ambulance personnel. Most disappointingly, I was recently advised that the local SA Ambulance Service had been told they would need to find efficiencies due to major funding reductions. The people within the industry I have spoken to have expressed much concern about the future delivery model of SA Ambulance Service, particularly in the region of Chaffey. I do not want to see the scaling back of any services that will endanger lives.

A number of constituents are concerned about having to pay for after-hours emergency service care in River Doc's, a privately run organisation in the Riverland. They do an outstanding job and they are a private provider, but when we hear of people complaining about co-payments and we hear about people complaining that they have to pay some up-front fee down here in metropolitan Adelaide, have a thought for the people of the Riverland and the people of the Mallee who have to travel to the regional hospital. They have to pay a $60 up-front fee and in many cases, as well as that up-front fee, then they have to travel to pick up a script and it becomes a very expensive operation.

For anyone who has to travel, for example, from Renmark to Berri or from Loxton to Berri, it is about a half an hour. Let's say in some instances those people do not have transport, then they have to catch a cab. A cab from Renmark to Berri is about $60 one way, so it starts to add up by the time you catch a cab. So you catch a cab to the hospital, you have treatment and then you have to get home and it really starts to eat into a pay packet, a cheque of some description or a service cheque—that really has an impact on those people's lives and it is not just the individual, it normally has an impact on the far-reaching family.

Again, I think that we need to be very mindful of the burden of travelling far in the regions, seeking health care after hours and what it means to those people. We just have to remember that it is mostly free down here in metropolitan Adelaide but it does highlight the inequity between country services and what happens in Adelaide.

We need to keep hospitals in each town resourced, due to the proximity of each town in the Riverland and the Mallee, instead of centralising services, particularly to the Riverland General Hospital. I commend the recent upgrade. Sadly it was a $41 million upgrade that was revised down to $36 million. I think every community member in the Riverland has made some form of contribution, whether it was part of a fundraiser or a campaign to raise money for extra services to put equipment into the hospital.

As I said earlier, it is part of the fabric with each of those communities and they take ownership of those hospitals. Whether it is raising money or putting money into the auxiliary funds that are so crucially important to those regional hospitals. With those auxiliary funds, whether it is a bequest, a fundraiser, a donation or whether people give in-kind work, we see upgrades, new equipment and the betterment of a hospital, particularly in country towns.

It is not about a major upgrade that we see at many of these government hospitals. It is about creating comfortable rooms, putting in more comfortable beds, televisions and small creature comforts that make the hospital something a bit nicer when you are away from home and having medical treatment. We have to look at other issues around what we expect.

Particularly in Adelaide, I think a lot of people take getting to hospital for granted. We do not have public transport in the Mallee or in the Riverland. We do not have those services that most people take for granted, and we experience the extra cost and burden of getting to a hospital. When you do get to a hospital, you receive a great, friendly welcome and good country hospitality. They are some of the concerns.

The Renmark Paringa District Health Advisory Council put forward a submission to the Transforming Health discussion paper, as did I. A concern that was raised in that submission was that country people seeking treatment in Adelaide must be able to do so with the greatest possible efficiency, and the cost should be comparable. The divide between what it costs to have medical treatment in Adelaide and what it costs to have it in the regions is significant.

The council recognised the benefits of specialisation in the area of health care and separating elective surgery from emergency, but this should not lead to a net increase in travel time. We talk about assistance for people who travel to hospital, and I think it has been fairly well documented in this place. We need to ensure the compensation for people who have to travel far away for health procedures is fair, that a fair amount of money is returned to them so that they can head home without being seriously disadvantaged.

The Renmark HAC has many concerns. I will not go through them all, but the disadvantage of having to travel is one of them. The health services also need to be available seven days a week. The majority of hospitals in the Riverland (Waikerie, Loxton and the regional hospital) are open after hours, but the rest of the hospitals seem to have been scaled back. We see staff reductions, and they are essentially being wound back to aged-care facilities.

I think we need to be mindful of what those hospitals represent, the demographic they look after, and the distance between them. Most of those hospitals have at least a half-hour drive between them. The minister and the government need to understand just how important they are, particularly in an emergency situation. Again, that is something that needs to be put forward.

I would like to mention the petition from concerned Mallee constituents about the uncertain future of the Repat, which I grieved on here in the parliament. There was a little bit of a hiccup with the way the petition was presented, but I commend the passion of those Mallee constituents who came forward. A lot of them are returned servicemen, and they have real concerns about the way this government and the Repat's local member have treated this situation. I think it is deplorable that a local member is supporting the closure of a hospital that was gifted to the government.

We talk about the centralisation of health services, and we believe that the general hospital needs to continue to be supplemented by day surgery at Renmark Paringa. The Renmark Paringa District Hospital has a long history, and that is because it has been supported by the community. It has had many upgrades that have been funded by the community. Again, they feel that the additional day surgery can done at Renmark, particularly the orthopaedic surgery, enabling the Riverland Regional Health Service to focus on other acute and emergency care services requiring hospitalisation. We need quality and safety standards for paediatric and other areas of care that are practical and achievable to ensure that our nursing staff and medical workforce can continue to support the provision of high-quality, safe day surgery—particularly at the Renmark Paringa hospital.

I would also like to commend the Loxton hospital and talk about its reputation as one of the favourite hospitals in regional South Australia. I have visited the Loxton hospital many times, and they have a very passionate advocate in their HAC. The presiding member of their HAC, Sally Goode, is an absolute terrier in making sure that the hospital is kept up to scratch, is provided with adequate funding, and is given a certain future. However, the birthing unit is something I really admire about the Loxton hospital. I admire all that the Loxton hospital provides, but it has a very special birthing unit. It is very inviting, with a suite to bring in the family so that they can come and stay with the expectant mother. It really does offer a unique experience, and I think that any expectant mother in the near vicinity of Loxton should consider it. So there is a plug for the Loxton birthing unit.

There is the importance of maintaining the local boards, and I guess we regularly talk about the HACs. They are volunteers, members of the community, and they volunteer the benefit of their time and their passion, and also volunteer their expertise in keeping those hospitals relevant. As I said, I have many HACs. With the eight hospitals in Chaffey I think there are seven HACs, potentially six including the Mallee, and each of those HACs is to be commended for the great work they do, the support they give and for their watching eye over that hospital, making sure it receives the appropriate support and funding that I believe every regional hospital deserves.

In conclusion, I support the bill but I also want to reiterate the need for the state government to change its attitude towards decentralisation. We have to understand that, yes, country hospitals are small hospitals and do not have the efficiencies that we perceive the larger hospitals here in Adelaide to have, but, let's face it, a significant amount of the state's budget is put into the major hospitals here in Adelaide. We need to take a holistic view of supporting health care right across South Australia, in particular the regional areas. Adequate health care is paramount across South Australia, and any changes to the way we approach them and the way we approach health should be done in the best interests of all South Australians.

Ms DIGANCE (Elder) (16:58): I rise to speak in support of this bill and, in doing so, will address the benefits of the changes to ambulance fees for what is known as 'Treat no Transport'. These are services provided by the SA Ambulance Service for the SA Ambulance Service and the community. The bill will do so by way of reducing red tape.

The South Australian government acknowledges the need to cut any unnecessary government regulation and legislation that is costly for the business sector, for the community and the government. All organisations need to review red tape, and I note that Deloitte Access Economics released a report in October last year which indicated that the private sector should be conducting a red-tape audit, since the calculated costs of complying with self-imposed business rules were double that associated with government regulations.

Just as red tape exists within the business sector, it also exists within government, and the amendments proposed in this bill will allow the minister to set fees for Treat no Transport services provided by the SA Ambulance Service under the more efficient and streamlined process provided for within the Health Care Act 2008.

The Treat no Transport fee is for those cases where the South Australian Ambulance Service attends to the patient and provides expert pre-hospital care but does not need to transport the patient to hospital. One innovative example of this is the Extended Care Paramedic Program. Extended care paramedics are the SA Ambulance Service's most senior clinicians. These paramedics are trained to treat patients in their home surrounds (this includes nursing homes and also residential care centres) and provide tailored health care. Treatment can mean that unnecessary hospital admissions are avoided.

The South Australian Ambulance Service has been implementing the Extended Care Paramedic Program as part of the Ambulance Service delivery model, outlined in the report titled 'Defining the road ahead 2008-2015'. The Extended Care Paramedic Program is part of the broader strategy to avoid unnecessary emergency department attendances and admissions and supported by the SA Health Out of Hospital Strategy.

The Extended Care Paramedic Program targets those persons who have traditionally called the South Australian Ambulance Service for treatment and transport to an emergency department but who are assessed as suitable for being managed outside of the hospital environment. The cases are carefully identified through secondary triaging methods by senior clinicians in the South Australian Ambulance Service's Emergency Operations Centre as potentially not needing transport, but they can be treated by an extended care paramedic within their home or residential aged-care facility. The South Australian Ambulance Service completed the piloting of this program in 2009 and began to roll out this initiative in a phased approach to full implementation.

The South Australian Ambulance Service needed to be able to charge a fee for the particular service where a patient was treated but not transported, as the SA Ambulance Service does for all its services. Under the now repealed Ambulance Services Act 1991, the SA Ambulance Service charged a fee where an ambulance responded to a 000 call expecting to treat and transport a patient but the callout did not result in transportation. The SA Ambulance Service had continued this practice under the Health Care Act 2008.

However, when examining the issue of the capacity to charge a fee for those occasions when treatment is provided but transport is not required, there was doubt about the SA Ambulance Service being able to charge a fee. The establishment of a Treat no Transport fee was essential to ensure that the SA Ambulance Service could charge a fee in line with previous practice, when it responded to the 000 call but transport did not eventuate and when an assessment is made that a person can be treated at home or in a residential care facility.

Most fees across the healthcare system are fixed through the Health Care Act 2008, and this act has streamlined the arrangements for changes to all fees and charges to be achieved through ministerial approval and by notice in the Government Gazette, including those for ambulance services. The definition of ambulance services within this act is as follows:

Ambulance service means the service of transporting by the use of an ambulance a person to a hospital or other place to receive medical treatment or from a hospital or other place at which the person has received medical treatment.

Because of this definition, the Fees Regulation (Incidental SAAS Services) Regulations 2009 were introduced in 2009 after the passage of the Heath Care Act 2008 to allow the SA Ambulance Service to charge for Treat no Transport services and roll out the Extended Care Paramedic Program. There was an intention to remedy this anomaly by amending the Health Care Act 2008 at the next available opportunity, which this bill now provides.

The highly successful and innovative Extended Care Paramedic Program has developed and grown since it was first piloted in 2008-09. In the 2013-14 annual report, the South Australian Ambulance Service reported that for this financial year 70 per cent of the extended care paramedic attendances resulted in emergency department avoidance, and 79 per cent of the extended care paramedic attendances at residential aged-care facilities had the same result. For patients who were admitted to hospital, the treatment path and subsequent discharge from hospital were often accelerated due to the prior extended care paramedic treatment.

Through the Emergency Operations Centre, extended care paramedics also undertake more than 900 client call backs per month and an average of 600 consultations per month. The South Australian Ambulance Service is also an increasingly pivotal part of the health system in times of extreme heat, particularly with the deployment of extended care paramedics who are able to provide assistance to low acuity patients in their homes rather than convey them to hospital, as would traditionally be the case.

This amendment to the Health Care Act 2008 for fee setting for the Treat no Transport ambulance services provides for a more efficient and consistent approach to determining fees across the health system. It also future proofs development and further innovation in line with international out-of-hospital services and provides for associated changes to the fee structure. These innovations and the changes to ambulance service delivery are all about providing the right care to the right patient in the right time. I commend the bill.

Mr PEDERICK (Hammond) (17:05): I rise to support the Health Care (Administration) Amendment Bill 2015. This bill was tabled by the minister on 11 February 2015 and is the same as the 2013 and 2014 bills which lapsed when parliament was prorogued in both years. Some of the issues that this bill deals with include fees for services provided by the South Australian Ambulance Service not involving ambulance transport. Section 59 of the act allows the minister to set fees by notice in the gazette to be charged for ambulance services which is defined in a way which is limited to transportation in an ambulance.

The history of this is that, since July 2010, fees for ambulance services not involving transportation have been levied under the Fees Regulation (Incidental SAAS Services) Regulations 2009 and the Fees Regulation Act 1927. This obviously involves the fees around Treat no Transport. The bill also allows fees to be set under the Health Care Act 2008 by inserting in the act almost identical words to the current regulations. The key difference is that the bill provision additional says that fees can be fixed for any other matter prescribed by the regulations.

Also, part of the bill provides for the employment of clinicians in the Department for Health and Ageing, and the aim of the amendment is to allow health professionals employed under the act to be employed under their relevant professional award if their position requires them to engage their professional skills, qualifications and clinical knowledge. There have been some concerns expressed that this provision is too broadly worded and could apply to someone with health experience but lacking professional skills.

Also, as has been indicated by some members in this place, the bill provides for proclamations to dissolve three now non-operational incorporated associations and transfer their assets to the appropriate incorporated health advisory council. The bill provides for the transfer of assets of three non-operational incorporated associations, namely, Lumeah Homes Inc., Miroma Place Hostel Inc. and Peterborough Aged and Disabled Accommodation Inc. The transfer of the assets to their local country hospital sites was attempted at least 10 years ago (this was before the Health Care Act was in existence), but the transfers were never legally effected, even though the hospitals involved supported the transfer. Under this bill, it will allow for these assets to be formally transferred to the appropriate local HACs—the Lower North HAC, the Lower Eyre HAC and the Mid North HAC.

The next couple of amendments are ones that can certainly affect rural constituents. One of them states:

…a body under the Act does not need to be providing services and facilities specifically to an incorporated hospital for the undertaking of that body (or part thereof) to be transferred to the incorporated hospital;

It continues:

…functions, assets, rights and liabilities can be transferred from one incorporated hospital to another, without the incorporated hospital to which those first belonged being dissolved;

That can certainly have an effect on local communities. As long as it is operated in a transparent way I cannot see any issues, but it is when these things are done without local consultation that the trouble starts. Also, in removing section 49(5) of the act it states:

…which allows the Minister to determine a constitution for the South Australian Ambulance Service as the functions and powers of the South Australian Ambulance Service are clearly set out in the Act.

The bill is also about clarifying when disclosure of information can be made legally and adding 'substitute decision-maker' to the list of persons who may request or provide consent for information about a person to be released.

The previous bills have been supported by the South Australian Salaried Medical Officers Association, the Australia Medical Association and the Australian Nurses and Midwifery Federation. Certainly the local health care that we get in our local communities is absolutely vital, especially for rural constituencies like the seat of Hammond. We have only two hospitals directly in my electorate, those being at Murray Bridge and at Tailem Bend, but there are also some hospitals close by which my constituents would attend. They are at Strathalbyn, Meningie, Mannum, Victor Harbor and Mount Barker. Obviously if there needs to be more treatment or it is an emergency situation which needs treatment at a hospital in Adelaide—it could be the Adelaide hospital or the Flinders Medical Centre—people can go straight through to those hospitals.

Over my time living at Coomandook, to have those medical services only 20 minutes up the road (such as at Tailem Bend) has been absolutely vital for the wellbeing of people in our community and certainly the bigger hospital at Murray Bridge in looking after the good people of Hammond, as well. It has not come easily. There have been times when there were threats by Labor governments to close some of these small hospitals around the state. I have mentioned this before in this place that, in fact, between 25 and 30 years ago there was a protest on the steps of this place, protesting about the possible closure of the Tailem Bend Hospital. Thankfully, the hospital was not closed because it does provide a vital service.

As has been mentioned by the member for Chaffey, a lot of these rural hospitals now incorporate a large area of aged-care wings, and that is certainly the case at Tailem Bend. Essentially, the majority of the hospital is for aged care and that obviously attracts federal funding, which spreads the funding stream and makes the whole operation viable. They are teamed up as the Coorong Medical Service with the Meningie hospital, which has a similar arrangement. They have Jallarah Homes for aged care, which is at the hospital, but at Tailem Bend the aged-care section it is housed in what were the old hospital wards and rooms.

I think this is something people really need to understand about country areas. We have seen, sadly, the Mallala hospital shut down recently, and we have seen ongoing issues at Keith. These community hospitals provide a vital service for acute or subacute care—and I can guarantee it. We had three generations of Pedericks in Tailem Bend one day. I had my youngest son sitting on my lap—he was only 18 months old; he is 14 now, so it was a little while ago—and we fell into a header box. I forgot that the top lip of the header box was hinged and, sure enough, in I went. I ended up with about 22 stitches in my right arm. Thankfully, he only had a small cut on his head, which I worked out came from him being held so tightly against my chest that he hit his head on the pen in my pocket. My father was also in for one of his far too regular stints in hospital.

Hospitals are vital to the community for acute and subacute care, but they also play a role in the aged-care scene in this state. They give vital service in making sure that loved ones are not too far from where they were working or living, and it provides options. As we all get older, these services are going to be demanded more and more as people's lifespans extend. As you get older, you like to think that your lifespan might extend a bit longer than what you thought originally.

Hospitals provide a vital service, and these services have come under threat over time. It has certainly been a challenge to attract some doctors and chief medical staff out to regional hospitals. It is not in my electorate anymore, but at Karoonda they had the challenge of getting a hospital. I believe it is being looked after by a doctor from Mannum at the moment, about three days a week. Even though it is not ideal, it is far better than not having a service at all.

The workings of a country doctor have changed so much. Dr Phil Gooden would have been delivering babies who would have been born around the same time I was born, which was a couple of days ago. When you had a country doctor like Dr Phil Gooden, they had to look after the road crashes all night, deal with their operations or appointments all the next day and maybe do it all again the next night, and that is just what happened. They had nurses and other appropriate staff helping them to conduct their work. Thankfully, things have got better.

I want to congratulate Bridge Clinic on its most recent expansion, which I believe is the most successful clinic that is actually owned by the doctors involved operating in Australia, not just South Australia. As a regional clinic, it does great work and attracts many visiting specialists, so it saves people that trip through to either the Royal Adelaide Hospital or Flinders hospital. I commend the doctors, clinicians and administration staff who make that place work.

There are many issues in health, and we have seen what has happened recently with what I believe is essentially the minister just looking at budget savings in regard to the health needs of our state. Look at what is happening at the forefront of health. We understand that, with bureaucratisation of health, central office staff numbers have increased by 167 per cent over the last 10 years. How does that add up when the health minister is going to cut front-line services at our main metropolitan hospitals, because he is basically trying to save money on specialists. So you only have a stroke specialist at one hospital, you probably have a cardio specialist at another hospital, and they are only there certain days.

If you get picked up by an ambulance, I firmly believe they need a scroll at the back of the ambulance so the paramedics and volunteers can check at whatever time of day which hospital they can transfer a patient to. It has got to the point where it is almost simpler in the country, because they have done this for years. For instance, if you go to Tailem Bend, they have been well used to saying, 'Do we send them through to Flinders or the Royal Adelaide?' I believe it will cause a lot of issues in the future.

The good people of Hammond have already been affected by the lack of triage at Goolwa Medical Centre. Previously, people could go to the Goolwa Medical Centre and most likely see their own doctor—or at least a doctor they know quite well—who would triage them if there was an incident. That service will no longer be available; and all that will happen in Victor Harbor, which can be another half-hour drive away. To me, that could be the difference between life and death, and that was indicated by the support of a community forum we held in Goolwa where 250 people turned up. There are aged-care facilities in Goolwa and there was a whole range of concerns about whether this will work. The same thing has happened in Yankalilla in the electorate of the member for Finniss. It is centralising services, whether it is in a regional area, or in the city. That is what we are seeing with these changes to health.

Minister Snelling indicated that his reason for getting rid of the Repat is that he wanted to centralise services. It is 15 minutes from the centre of Adelaide; how much more central do you want? For regional people, that means nothing. I am sure for most people in Adelaide it does not mean much at all either. It does not add up. The issue with the Daw Park Repatriation Hospital is all about real estate, and I think it is a disgrace on the part of the local member. One of the latest announcements about the future of the Repat came during the week that we were commemorating the centenary of ANZAC from a former SAS lieutenant colonel—you can work out how much honour is in that, and we have seen how that has gone in this place.

What I would like to do is commend all the people who work in the health services, and I would like to see more and more funding going into front-line services. If there are going to be cuts, they should be taken out of that overinflated bureaucracy. The unions will say, 'But that will affect front-line services.' Well, why does it have to expand by 167 per cent in 10 years? It is outrageous.

When you have the health minister come out to your electorate, there is strict protocol and you are shepherded around like a sheep, following on, making sure you do not see something you are not supposed to see. When you live in a community and your kids play footy in a community, if you need to go to hospital with them—and I have in the past, and probably will in the future—you see the hospitals, warts and all. And you do see some issues.

There are certainly some good things happening because of need—because of doctors not being attracted to some country areas like Pinnaroo, for example (which used to be in my electorate, but is not at the moment), and also attracting visiting doctors to Lameroo. The distance work that nurses and nurse practitioners can do with video equipment and that sort of thing is a great step, but it has only come about because the right provisions are not in place to attract professionals to those sites.

In the old days, nurses, teachers, doctors and livestock agents—people who were raised in the city—would be transferred to a country location. There used to be things like country bonds, and that type of thing, in certain professions—and most of them never came back. I know that nurses and teachers, for example, might head over to the Far West Coast, for example, or the Murray Mallee, or the South-East, and if they go to the footy club—or whatever—the rest is history; they end up marrying a local bloke and have a fantastic time. I say to people: reach outside your comfort zone and get into the bush because it is a great place to be. Even if some people only work at those sites for a little while, at least they have had a taste of what it is like to operate in country areas.

I would also like to congratulate the rescue helicopters that operate. The member for Fisher has worked directly with these helicopters; he has been on board. The work that they do is so commendable in saving lives and saving what otherwise could have been far worse news for families. Many a time, you hear about an accident that might not be on a major road—get the helicopter in, land it, pick up the patient or patients, and get them to the services that they need. It is fantastic work and highly commended, and it sometimes occurs in very challenging conditions when they take off and land.

On this side we commend the bill. I will be interested to see how it works in reality. I will also be interested to make sure that it does not have any adverse effects, certainly in my case, on regional communities and particularly the community of Hammond.

Dr McFETRIDGE (Morphett) (17:25): I am the lead speaker on this bill, and I might take us through to stumps, but we will see how we go. Third time lucky with this bill. Wednesday 30 October 2013 Health Care (Administration) Amendment Bill. I made a contribution then, and I could read it now, but I will not; there are other things I would like to add. This is the third time this bill has been presented to this place. It is unchanged and it is a disappointment. If these changes are so necessary, why has it not been put in place beforehand? It begs the question: are these changes really necessary?

I want to remind the house of something that former health minister John Hill said on 24 October 2007, when he made a speech about the Health Care Bill at the time. John Hill said:

There are clear and strong community expectations that the Minister for Health be accountable for the public health system, as I have said many times. The buck stops with me.

I have used that quote numerous times. On 24 October 2007, the minister said, 'The buck stops with me.' Ministerial accountability is something that is paramount to the Westminster system of parliament and government. I just remind the current health minister of what the former health minister said: 'The buck stops with me.' The minister has to be accountable for every change that is put in this place, such as through this legislation, which is fairly straightforward—and we will be supporting it. Having said that, though, I should say that there may be some amendments put up in the other place, but I cannot guarantee that. It will depend on further examination of the connotations and ramifications of this piece of legislation.

The legislation does a number of things. It is about the administration of health in South Australia. I will just quickly go through parts of the bill and talk about some of the issues that are associated with it. The first changes are to insert a new section 32A—Transfer of functions etc between incorporated hospitals. I always worry when you get a piece of legislation that says 'etc'. What is the etcetera? What else is happening? Between 'transfer of functions etc', I think we need to clarify what the 'etc' is. I do not think it should be in legislation. I think legislation should not be open to interpretation or extrapolation or other ways of getting around the intention of the parliament. Let's face it, it is not just the government's legislation: it is the parliament's legislation. The clause continues:

transfer all or some of the functions of an incorporated hospital to another incorporated hospital;

Is that not typical and topical of this government at the moment, with Transforming Health? Transforming Health is a massive challenge for this government. We know that we cannot keep treating the health system the way it is. We cannot allow it to just continue like a black hole that is sucking more and more money into the health budget out of the general state budget. If we do not change things that will continue to happen. Nobody is against change; it is about the way the change is managed, and it is about the way the change is consulted on, and the vision and the plan put forward.

We have already seen the problem with transferring some or all of the functions, and I will use the Repat as an example. When the A&E at the Repat was closed down, something like 7,000 admissions (I am not sure if that is per month, but that would be about right I would think) went somewhere else. Where did they go? They probably went to Flinders or possibly to the Royal Adelaide Hospital because if you need to go to an A&E you need to go to an A&E. Some of them might have gone to Noarlunga.

As to the dashboards the health department puts up, if anybody here does not know about the dashboards or does not understand them, I am more than happy to walk them through the dashboards. They are a very interesting piece of information and very informative if you know how to read them. I encourage every journalist in South Australia to acquaint themselves with the dashboards and see exactly what is happening in our hospitals in an almost real-time fashion. It is normally about half an hour late, but it is almost real-time.

You can see what is going on, how many people have been waiting for more than 24 hours for a bed in a particular hospital, how the hospital EDs are coping and whether they are in the 'white-hot zone' as I call it. There is green, amber, red and white for capacity in EDs. If they are in the white capacity, which they often are, that is more than 125 per cent of capacity. In other words, patients are in the cubicles, on the barouches, on the chairs, wherever they can be placed, but they are also waiting around the place—at 125 per cent capacity, and it is sad that many of our hospitals are often at that capacity.

Just have a look at the EDs if you want to see how bad it can get, particularly on a weekend. I must admit there is also some correlation between these and a full moon, particularly hot nights. Having overcrowded EDs is a serious issue, and to put that beyond any question I will quote from an investigation that was undertaken by the Australasian College of Emergency Medicine. I do not know what the latest figures are, but I guarantee you that they would be, if not the same, probably worse than these figures here. In this investigation into access block and emergency department overcrowding, there are seven or eight key points. Key point No. 2 says:

It has been estimated by different authors and methods, that there is a 20%-30% excess mortality rate every year that is attributable to access block and ED overcrowding in Australia.

This is the interesting figure, and it is a disgraceful figure for a country such as Australia, though:

This equates to approximately 1,500 deaths (at 2003 levels of access block) per year which is similar to the road toll.

South Australia's share—8 per cent of that, about 120 deaths per year—is purely attributable to access block and ED overcrowding. That is more than the road toll who are dying as a direct result of access block and ED overcrowding in Australia. We need to do something about that and you cannot do that by shutting EDs and by rearranging EDs to make them into walk-in clinics because, as the Australasian College of Emergency Medicine again points out, there is no correlation between the condition of the patient and the way they present. Many serious cases present which have not come via an ambulance; they have just been brought in by relatives or friends or through sporting clubs or that sort of thing.

With the changes that are going to be made in South Australia, some of them may be necessary, and others we really have to ask ourselves: what is going on? I will use the Repat as an example again because, even this afternoon at the late Bill Schmitt's funeral—Bill was a 97-year-old veteran who died recently, an icon of the veteran community in South Australia—one of the eulogies talked about how Bill, who after spending three years in Changi prisoner of war camp, was often admitted back to his beloved Repat.

The Repat, for the veterans, is their spiritual home; there is no doubt about that. You can look at the figures of how many veterans go there, what percentage of veterans use it, and what percentage of veterans make up the total patients. You can try to justify the changes that are going on by doing that, but the bottom line is that it is the spiritual home of the veterans.

The consultation process has been handled abysmally. This government just does not seem to understand veterans and volunteers, and they need to take some advice on this and slow things down. On 10 March 1995, the then federal minister for veterans affairs, Con Sciacca, along with Allan Hawke (president of the repatriation commission), Michael Armitage (then minister for health) and Ray Blight (chief executive of the South Australian health commission) signed a record of ongoing commitment to veterans at the Repat. That was followed up by the Veterans' Guarantee, which is a list of 15 different individual items, including everything from:

priority access to services

specialist care 24 hours a day

access to arrange admissions 24 hours a day

'Repat Card' for entitled patients to make access easier

reduced waiting times for the Repat Clinics

reduced waiting times for elective surgery

reserved parking for ex-service organisation representatives—

and others, right down to 'a complimentary cappuccino in the coffee shop near the Repat Clinics'. How are we ever going to replace that guarantee in other hospitals? I do not know what the latest bed number is at the Repat. I have heard 240, but on the government's website it states:

RGH is a 262 bed acute care public hospital specialising in the care of war veterans, their dependants—

including war widows; you want to talk to the war widows about what is going on—

and older people. RGH is proudly serving those who have served for us.

If you get rid of the Repat—we will use the example of 240 beds—you are getting rid of 240 public beds. Where are those patients going to go? What is going to happen to access block? We have just heard about the results of access block and ED overcrowding. Where are those veterans going to be squeezed out of because they cannot get into a clinic somewhere else? Where will the 3,500 arthroplasties that happen every year at the Repat go? Where are the 700 outpatient appointments that happen every month at the Repat going to go? Where are the 400 new referrals to the Repat every month going to go? They are going to go to other hospitals. What is going to happen? The pressure is going to increase on the access to those hospitals, their services, their access block, and ED overcrowding.

Again, we have seen the result, according to the Australasian College of Emergency Medicine. You had better know what you are doing. It is great to say, 'We are going to put more emphasis on primary health care.' We have heard that for so many years, but when you look at the dashboards you see that it is not getting better.

There is a new clause regarding the 'transfer of functions etc., between incorporated hospitals'. This government had better tell us what the 'etc' is. They had better tell us how they are going to manage the access block and ED overcrowding that is already there, which I think will be exacerbated by the changes proposed in Transforming Health. The bill also mentions the 'transfer the assets, rights and liabilities of an incorporated hospital to another incorporated hospital'. Once again, that needs to be explained so that we are able to trust the outcomes. The bill also mentions the amendment of section 59—Fees, whereby:

(1) The Minister may, by notice in the Gazette, fix fees in relation to—

(a) the provision of ambulance services; and

(b) the provision of incidental services by [the South Australian Ambulance Service]…

We know that the role of ambulances has changed dramatically from 'lift and shift', where they would grab the patient and get them to hospital as soon as they could. There is now an extremely high level of intensive care being delivered on our roads, in our aged-care facilities and in our homes by very highly qualified ambulance officers and paramedics, and, in some cases, the doctors who come along with the ambulances nowadays. We have an opportunity here to make sure that we are able to recover the cost of those services when necessary. It will be interesting to see how extensive the changes are, how broad and all-encompassing those changes are, what the fees that are going to be charged are actually set at. I know there are a number of private ambulance services being set up around the place and competing with SAAS to provide medical and ambulance services at, say, the races and other sporting events. Will these fees also cover what they can charge? I do not know, but it will be interesting to hear about that from the minister.

In the bill they talk about incidental services that will be provided by SAAS. I should say that you do not actually have to receive any treatment from the ambulance service, you are just being assessed; if they are making a diagnosis or assessment of your condition you can be charged for that, even if the person is not transported by ambulance. Certainly with aged care homes that is a good thing, because if the person does not need further treatment the staff of an aged-care centre can assist there.

Obviously we are trying to keep people out of hospitals. They are very dangerous places to be, because the bottom line is that they are full of sick people, and with some of the superbugs and other things we hear about it is not good if you end up in hospital. In most cases I would say that South Australia has a very good record in this area, of making sure that people do not get hospital-acquired infections or experience other adverse events. Section 89—Other staffing arrangements provides:

The employing authority may appoint such other officers or employees (in addition to employees and officers of the Department and persons employed under Part 5) who have skills or experience in connection with the provision of health services…

So you would think that if you need someone who has some accounting or managerial expertise you would go and get them, you would go and seek them out.

Going back to the former minister for health's speech in October 2007, the minister said that the total staff employed within the health sector was just under 27,000, of which 711 were in central office. I am not sure what the total number is of staff employed within the health sector now—it would be interesting to find out—but I understand that the number of bureaucrats has increased from 813 in 2005—not the 711 in 2007. This is 813 on this figure, so perhaps the minister was wrong at that time. It has increased from 813 FTEs in 2004-05 to 2,175 FTEs in 2013-14. That is a significant increase.

I remember asking about the number of doctors and nurses employed in central office and in September 2014 I think there were 61 nurses or midwives and 13 doctors employed in the head office. We need to make sure that we have the best people in the best place to deliver the best outcomes. I do not have any issues with this, we just need to make sure that we are not filling it up with doctors and nurses who could be doing more front-line work rather than just paper shuffling or, which you would hope if they were in there, contributing to improving the patient flow, the care of patients.

It always intrigues me how the changes going on in health at the moment seem to be couched in terms of being all about 'patient-centred care'. I would have thought that since Florence Nightingale was in the wards it was all about 'patient-centred care'. What are patients there for? They are there to be cared for, and I know that the doctors and nurses put the patients at the centre of their care. They want good outcomes for their patients; they want to be proud and able to go home to their family and friends and say, 'Look, this is what we did for Mrs Smith today. She was a heartbeat away from her eternal rest but we managed to save her and she's back with us.' So, it is all about patient-centred care.

Let's make sure that our doctors and nurses are able to do what they want to do in the best and most effective way for all of South Australia. I put on the record that we do have an exceptionally good health service in South Australia. It needs improvement, there are big issues around the place, but I have been to China and the Middle East and I have had occasion to accompany people to hospitals in both of those places, and I can tell you that my vet clinic was better equipped than some of those Middle East hospitals. I just think in South Australia we are very lucky to have what we have.

The bill continues on with some transitional provisions, and this is to allow, I assume, some job arrangements and financial arrangements to be put in place. There is in there, under part 2 of schedule 1, 'Cancellation of incorporation etc of certain associations', and there is Lumeah Homes, which we know is at Snowtown; Miroma Place, which is at Cummins; and, of course, Peterborough Aged and Disabled Accommodation. Changing the arrangements there to make sure that the facilities and services they offer are being kept at their most viable for all country South Australians is something we need to ensure is happening, and so some explanations about the future of country aged care and health services is something that this opposition will be wanting to hear about from the government and have it clearly explained that there are long-term solutions for what are going to be long-term problems.

As I have said, making sure we do have long-term solutions for these problems is something that is vital, because I do not want to be back in here doing this for a similar bill for the fourth or fifth time and talking about the really alarming statistics that are being collated about overcrowding and access block in our hospitals—the avoidable deaths that have occurred because of access block and ED overcrowding. It is pretty straightforward that the benefits of managing our health system far outweigh the costs. The cost of doing nothing you just cannot even consider.

I acknowledge that the government is there to do what they think is right. We as the opposition have the right to question it, whether it is the transfer and functions, etc., the financial arrangements or the numbers of bureaucrats, or whether it is a straightforward question about a particular patient who may not have received what they consider to be the best care. In most cases, if I have had people (in most cases relatives) query the health care of patients who have been constituents of mine, the explanations have been very frank and full and very transparent, and in most cases the concerns have been answered.

They may not have always been to the full satisfaction and understanding, I should say, of the constituents, but I am very fortunate, having had my training, to be able to interpret a lot of the medical jargon and understand the implications and repercussions of interventions and procedures, and the long-term outcomes of these procedures, and try to explain them to constituents who are perhaps not satisfied with what the government says.

I wish the government luck with what they are trying to do, because they are going to need it, because they are not explaining it well at the moment. They need to take a deep breath, come back and sit down and perhaps reconsult. Nobody will criticise a government for saying, 'We are going to have a rethink about this.' It is not a backflip, a U-turn or anything like that. It is common sense, and that is what we want: good common-sense outcomes.

With that last comment, I will say that this bill will go through this place unamended. The shadow spokesperson in the other place has said that he may need to reconsider some areas, and that is his prerogative. I will perhaps come back and speak about those amendments if that is the case.

Debate adjourned on motion of Mr Gardner.

At 17:50 the house adjourned until Thursday 14 May 2015 at 10:30.