Health Care (Administration) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 13 May 2015.)

Mr SPEIRS (Bright) (16:34): I rise to speak in general support of the Health Care (Administration) Amendment Bill. The Liberal Party supports the Health Care (Administration) Amendment Bill with some amendments, and further comments about this will no doubt be undertaken at the committee stage.

The arrival of this bill in the house gives me the opportunity to reflect a little more broadly on healthcare issues facing our state, and in particular the impact of that in my own electorate. Transforming Health has the capacity to place our healthcare system on a modern footing, which will enable it to sustainably adapt to the growth and changing demands that are part of our ever-changing healthcare landscape.

However, it is my view and the view of many healthcare workers, clinicians and many experts in the field that there are significant flaws in Transforming Health. Its lack of appropriate community engagement has left it lacking the support of the South Australian community, many in the health industry, and has shaken our community's confidence in public health services.

The issue with Transforming Health most frequently raised with me is the closure of the Repatriation General Hospital at Daw Park. This hospital is a 300-bed facility which employs 1,250 staff. The hospital is viewed with clear-eyed affection by thousands in our community who have first-hand experience of how it has cared for loved ones, supported veterans, got seniors back on their feet after serious illnesses or falls, provided palliative care for people in the twilight of their lives, and simply provided a quality healthcare service to those who needed it.

I recall that recently at one of my regular seniors forums held at Brighton, a local man stood up and told of how the Repat saved his life. He eloquently outlined how he left the Repat in a healthier state than he had been before the illness which resulted in him being there in the first place.

The closure of the Repat is defended as being a necessary step in the transformation of our health system. The government says that this is about modernisation and renewal, not cost cutting. I would have to disagree. The health minister has said in this place that the physical state of some parts of the Repat building are squalid. I draw the house's attention to the fact that any decline has happened under the watch of a four-term Labor government. It is worth noting that much of this facility is deemed to be state-of-the-art, with its rehabilitation facilities world-renowned and the skill of hospital practitioners often lauded nationally and internationally.

The incredible feeling in our community about the proposed closure of the Repat has been demonstrated by the more than 60,000 people who have signed petitions led by the Liberal Party and the many people who have contacted my office and the offices of my colleagues. Meanwhile, 44 RSL sub-branches from across the state have signed an open letter calling on the government to save the hospital.

I commend the efforts of the Hon. Stephen Wade for his endless commitment to the Repat. I have utmost respect for the many veterans who are maintaining the rage with an ongoing vigil on the steps of Parliament House. As the weather continues to be particularly unpleasant, their commitment to the cause is unwavering, and each day that I arrive here for work, they are still there. All power to them.

The recent establishment of the Save the Repat Steering Committee is a further valuable plank in the strategy to prevent the closure of the hospital. The committee brings together veterans, community members and medical professionals and includes:

Augustinus Krikke, a veterans' spokesperson;

Professor Ian Maddocks, former South Australian of the Year and an expert in palliative care and a resident of the electorate of Bright;

community advocate Lyn Such;

former head of Veterans SA, Bill Denny;

Professor Annette Summers; and

the leader of the Liberal Party.

I want to briefly mention the $3 million promotional campaign that has been undertaken by the government to promote Transforming Health. This is using taxpayers' money to spin the government's position and, in my view, is entirely unconscionable. How can a government seriously justify spending this money on propaganda and spin? This has included not only all manner of glossy flyers being churned into letterboxes across the southern suburbs, but also online campaigning, social media advertisements and even telephone canvassing.

The government is abusing the privileges of office by exploiting the Public Service and instructing public servants to undertake what is nothing short of a political campaign. This is not the first time public servants have been used as political fodder, and I am sure it will not be the last. We have seen the More Than Cars campaign and the pensioner concessions campaign used to spray the politics of fear into our communities. What will be next?

I think the state Labor government thinks that the opposition is simply harping on about saving the Repat because it gives us something to do, because it is something to take an anti-stance on and because it is a reason for us to get up in the morning. I fear that in a few short years the Repat site will be filled with trendy high-density apartments and urban infill. This would be an absolute tragedy for our health care in Adelaide's south. With that, I support the bill.

Ms HILDYARD (Reynell) (16:39): I rise to speak in support of the Health Care (Administration) Amendment Bill. This bill will make a number of technical amendments to the Health Care Act 2008 and I would like to particularly address one of these, namely the issue of the employment of medical officers, nurses and midwives within the South Australian Department for Health and Ageing.

The department employs medical officers who may be employed as public health medical practitioners, or medical administrators, and it also employs nurses and midwives who all undertake key clinical advisory functions related to their profession. These clinical advisory functions are essential to the department's support of public health and health service provision.

For example, nurses are employed in overseeing the management of vaccine services across our state. They provide professional advice to community immunisation nurses and general practitioners, as well as other health professionals in the community on the National Immunisation Program Schedule and the Australian Immunisation Handbook, which provides clinical advice on the safest and most effective use of vaccines and their practice. These dedicated nurses are the backbone of the state's immunisation program, making sure that vaccine is distributed where it is needed as well as ensuring consistent and appropriate vaccine practices across public and private health systems.

As another example, medical officers are employed in communicable disease control and these officers support and enable the public health protection requirements that are set out in the South Australian Public Health Act 2011, regarding notifiable and controlled notifiable conditions. They monitor and respond to any notifiable conditions that are reported ensuring and providing timely intervention to protect public health.

The proposed new section 89 in the Health Care (Administration) Amendment Bill 2014 that will be inserted into the Health Care Act 2008, addresses and remedies a longstanding technical issue that was an unintentional consequence of the passage of the act. The Health Care Act 2008 repealed the South Australian Health Commission Act 1976 under which the administration and management of health services within the state was undertaken by a statutory authority under which all staff are employed.

When the Health Care Act 2008 came into effect, staff working in the department came under the employment arrangements of the Public Sector Act 2009. In establishing the mechanisms for employment of staff, it had been thought that medical, nursing and midwifery officers could be employed to work in the department pursuant to their professional industrial awards under section 34 of the Health Care Act 2008.

This section is within part 5 of the act that deals with hospitals and their management arrangements. I understand that the department was subsequently advised that the purpose of engagement of staff under section 34 was to facilitate the functions of an incorporated hospital. The department is an administrative unit for the purposes of the Public Sector Act 2009, and so medical officers, nurses and midwives would need to be employed under the latter act.

I note the preferred approach that has been adopted for the purposes of this legislation is similar to the mechanism used by the Department for Education and Child Development to employ teachers within that department pursuant to their professional award under section 101B of the Education Act 1972. This mechanism was introduced to overcome the very problem that this bill seeks to resolve by enabling clinicians to be employed within central government agencies under their professional awards.

Using a similar approach through this amendment is important because it ensures that professional requirements including registration requirements such as recognition of qualifications, continuing professional development and other requirements for clinicians are appropriately recognised and ensured just as they are in our health services. It provides a better mechanism compared with the only other option which would involve employment through the Public Sector Act 2009 and its associated instruments such as the South Australian Public Sector Salaried Interim Award and the South Australian Public Sector Wages Parity Enterprise Agreement (Salaried) 2012, none of which recognise the qualifications, entitlements and continuing professional development requirements for clinicians.

I understand that the representatives of medical officers, nurses and midwives, namely, the South Australian Salaried Medical Officers Association of South Australia (SASMOA) and the South Australia Branch of the Australian Nursing and Midwifery Federation (ANMF) have been consulted about this proposed change, and they have indicated that this amendment would not present any problems, as long as the conditions of employment of such staff were not reduced.

I understand that this is a technical matter and I am reassured that there is no likelihood that any employee's condition would be affected by this amendment; indeed, it gives full recognition to their current awards. I commend the bill.

Mr BELL (Mount Gambier) (16:45): I rise in support of the Health Care (Administration) Amendment Bill 2015. The Mount Gambier hospital has just undergone a $27 million upgrade and it is greatly welcome. I had the privilege of a tour through the hospital in February this year. What I observed were state-of-the-art facilities and, certainly, the chemotherapy section of the hospital is a welcome improvement upon what patients have had to endure before.

One disappointing thing is the mental health beds. Our beds were ready to go pretty much at the start of March, but I have been informed this week that they will not be opening in April as was predetermined and promised. That has now been pushed back to the end of June due to staffing issues. The one thing that staggers me a little bit is that this development has been going on for two years and we get to the end of the development and say, 'Oops! We need some staff.' The recruitment process had not occurred in a timely fashion, and now our mental health facilities, a much-needed service, particularly in light of the ice forums going on in Mount Gambier at the moment, will not be open until 29 June.

There are 15 positions to be filled; many have been sought but have not been put on yet. Having a local mental health facility will save travel time to Adelaide and enable those requiring a higher level of care in Adelaide to return to Mount Gambier, where they can continue their rehabilitation and recovery. But it staggers me that when you build something two years out, you do not think that perhaps we need some staff to fill it and address that in a timely manner. It is probably a little bit like organising the transfer from the Royal Adelaide Hospital to the new Royal Adelaide Hospital and not factoring in some funding to transfer the equipment and staff over there. I think it might be about $176 million—somebody has to pick that up, and it will undoubtedly be the taxpayer again.

I also want to talk about the renal dialysis unit in Mount Gambier. On that tour, I was shown into a section of the hospital which comprised a single room. Within this room, which was just a conventional room, probably six metres by six metres—the size of a typical double-bay garage or carport—there were four beds in a configuration all facing one TV on the wall. The infection control is actually a yellow line painted on the floor to separate the four beds, with a makeshift office in the corner and staff at a desk in that office, as well.

This renal dialysis unit is used from morning through to night. It is fully booked and people are hooked up to dialysis for up to eight hours at a time while receiving this treatment. I implore the state government to put this improvement to the top of the list, and I have had a meeting with the minister, Mr Snelling, to make sure this gets the attention it needs.

I will quote Jim Lewis, who is an elderly patient of the renal dialysis unit, and these are his words:

…the room is crammed with four chairs, four machines, a makeshift kitchen and an office space for one person shared by all staff…Most of us are on dialysis three days a week, five hours a day and are too old for kidney transplants…We will spend the rest of our lives reliant on this unit. It would be great if we could look forward to some improvements to the unit in the near future.

It really does beggar belief when you go through a state-of-the-art hospital into a room with these types of cramped facilities. I encourage the health minister to make this a top priority.

I stand for decentralisation, a system where decisions are made as close to the people as possible, and I see hospitals as no different. Currently, we have moved away from health boards, which I thought had a very good place in our system, particularly for larger regional centres like Mount Gambier, where the board would determine certain things—and I will talk about that in a minute. A board is responsible for the governance activities of the hospital. There is always a clear distinction between the strategic role of the board and the operational role of the executive. The board controls the service for which it is established, whilst the chief executive and leadership team are responsible for implementing the board's directions for the day-to-day management of the service.

Functions of the board include: developing the strategic direction and priorities for the operation of the hospital; monitoring the compliance and performance; ensuring safety and quality systems are in place and focused on the patient's experience, quality outcomes, evidence-based practice, education and research; developing plans, strategies and budgets to ensure the accountable provision of health services; ensuring risk management systems are in place and overseeing the operation of systems for compliance and risk management reporting to all stakeholders; and establishing and maintaining effective systems to ensure that the health services meet the needs of the community.

That is the point that I want to make. The people best placed to make decisions about the needs of our community are those who are based in our community, not based in Adelaide, some 460 kilometres away. The residents from Mount Gambier and surrounding districts are faced with few options should they need emergency or critical medical care. They rely on the hospital to meet their urgent needs, since the travel time to Adelaide or Melbourne is in excess of five hours each way. Having access to a full range of services at Mount Gambier Hospital means a patient can be supported in the hospital by relatives and friends who would find the trip to Melbourne or Adelaide far more onerous.

For some illnesses, particularly stroke, cardiac failure and other chronic conditions, treatment within the first hour, also known as the golden hour, can be of life-saving importance. For these patients, it is not just a matter of having access to an accident and emergency unit or any doctor: it is a matter of having a doctor available who has the ability to treat you for the condition that you have. A fully functioning general hospital in Mount Gambier is vital and of vital importance to not only the residents of Mount Gambier but our catchment area, which is up to two hours in any direction. It is on this point that I call on the state government to do more.

Unfortunately, there is cynicism that much of Transforming Health is city-centric and is at the peril or detriment of country areas. Many country doctors I speak to feel ignored and undervalued, and this is playing out in real time due to the dispute between the Rural Doctors Association, trying to negotiate a three-year deal, and the government, under an industrial agreement. They have pretty much been told, 'If you do not sign by the end of May, you can "sign up or ship out".' I just cannot believe the arrogance of a minister or a government that would be saying that to country doctors.

Already we have trouble recruiting doctors into regional areas. As of Friday last week, there were 30 GP positions unfilled in rural and regional areas. As of last Friday, up to half the doctors have failed to sign the enterprise agreement. They argue to me that they have been on a wage freeze for three years—three years, yet this government's approach is 'sign up or ship out'. It is appalling for country residents; it is appalling for country doctors. It shows a lack of empathy, a lack of awareness of what is going on in country areas. Let me tell you, that if these doctors do ship out, then there are going to be more and more country people coming up to Adelaide and clogging up the Adelaide health system.

I have also been aware in some country areas of aged-care facilities that are closing due to this industrial disagreement with the government. I implore the government to take serious action in these negotiations with the doctors' association and negotiate a three-year deal that is fair and reasonable for country doctors.

Sitting extended beyond 17:00 on motion of Hon. G.G. Brock.

Mr KNOLL (Schubert) (16:57): I rise today to speak on the Health Care (Administration) Amendment Bill and talk about the perennial issue that exists in my electorate, just for something different. I say from the outset that I asked questions in this place of the Minister for Health on Transforming Health proposals as they affect country areas a couple of months ago. After a couple of supplementary questions, we got to an answer where he said, 'Transforming Health is primarily based on metropolitan hospitals,' which is his way of saying it is completely based on metropolitan hospitals. There was some consternation and in my electorate I have received responses from people saying that it is disappointing that the government is not looking at regional hospitals as part of this.

Having said that, as the Transforming Health proposals have become clearer to South Australia, and especially to my electorate, I think the local residents of Schubert are quite glad that Transforming Health does not deal with country hospitals and regional health care, but there is a growing angst, and one that I am unable to quell, within my community about potential further changes to our health system and our hospital system when Transforming Health does eventually come to the country. That is something that the minister has outlined, that Transforming Health, as it exists currently, is stage 1, and that down the track the country healthcare system and the country hospital system are next on the chopping block.

Can I say that, if this government does not have any compunction when it comes to making cuts to hospitals that affect marginal seats, they will have no compunction when it comes to making cuts to country health where they do not believe there are any votes there for them, and that worries me. It worries me greatly, and it worries my constituents greatly. I genuinely would have had dozens of people come to my office, call my office, email and send letters saying, 'We are worried about the future of the Tanunda Hospital.'

I have got a situation where my daughter goes to child care a couple of days a week—in fact, she is there right now—at a beautiful little centre called Barossa Valley Community Kids that exists behind the Tanunda Hospital. It is a brilliant little centre that only has 12 kids. There are a couple of members of staff there who have been there I think almost since the inception of the creche, and my daughter loves that centre.

The centre manager Kia does a great job. She is young, vibrant and enthusiastic. There are a couple of carers who have been there for a bit longer—Lynn and Diane—who Ruby talks about every night when we get home. Kia came to me a couple of months ago and she said, 'Stephan, what is going on with the Tanunda Hospital? Is it going to close?' I said, 'I can't give you a firm answer to that.'

She said, 'The issue is we currently have a peppercorn rent to exist in our little creche facility, which is a not-for-profit facility, behind the Tanunda Hospital, and we are worried because we need to do upgrades to the toilet block and things like that, but we don't want to spend that money if we are going to get kicked out of here.' I said, 'I cannot give you any assurance that you will be here for the longer term.'

They have got a lease for the next few years but, when you are paying nominal rent, the cost of breaking that lease is not that much. Normally, when you break a lease like that, from the landlord's side, you can compensate for rent not paid, but that is going to be difficult to enforce in this instance. They are genuinely worried about the future of their centre because, if they have to change and move to a completely different cost structure, then it is going to impact on the care that kids in the Barossa have. I understand how important it is to help mothers and fathers be able to carry on employment by having their kids in child care. So, they are one group who are worried.

I have also spoken to a prominent local, Bill. Bill is retired now, but he was a dentist in the Barossa, and he is a great bloke of the community. He came to me and said, 'Stephan, I am worried about the Tanunda Hospital.' I said, 'Bill, there is not much more I can say to you at this point except that, if there is any proposal to touch the Tanunda or Angaston hospitals, or indeed the Kapunda Hospital, without provision of a new health facility, there will be riots on the streets of the Barossa.'

I am not mucking around here. The previous member for Schubert spent 20 years trying to get a hospital, and that community is expecting a new facility. If they have come to a situation where instead of getting a new hospital they get one less hospital, I can guarantee 10,000 or 15,000 signatures coming to this place, and I can envisage rallies on the steps of Parliament House in response to that, so that is a warning to the government. The Barossa as a community gives so much to South Australia and genuinely asks so little of the government. Please, do not go down this path. We wait with bated breath, we wait with angst, but we will see what comes next.

As I think the member for Mount Gambier alluded to, there are a lot of capital works that have been undertaken by the health department over the last few years in relation to country hospitals that are coming towards completion. We have got the Berri hospital redevelopment, which was due to be finished at the end of last year at a cost of $36 million. There was the Mount Gambier and Districts Health Service, which the member for Mount Gambier talked about, at a cost of $26 million. There is the Port Lincoln Hospital and Health Service redevelopment at a cost of $39 million, the Whyalla Hospital redevelopment at a cost of $68 million, and the other one I have forgotten is the South Coast primary health care at Victor Harbor at a cost of $10 million.

All these projects are coming towards completion. I thought in my naive little mind that, if there is some sort of recurring capital budget as part of the Department for Health and Ageing, new projects could start to come on board, but that does not seem to be the case. There is a great vacuum cleaner, a great Dyson bagless, which is about 10 times the size of Parliament House, that hoovers up any spare dollar within the hospital capital budget, and that is called the new Royal Adelaide Hospital. I am genuinely of the belief that there is no money for anything else because we spend all of it on North Terrace. Whilst the new RAH will be brilliant for those who get to use it, it will not be brilliant for those who do not get to use it.

Dr McFetridge: Third most expensive building in the world.

Mr KNOLL: That is right, it is the third most expensive building—

Dr McFetridge: In the world.

Mr KNOLL: —in the world. So, that is another great win for South Australia. I genuinely do not think that there are funds there for a new hospital, but the fight continues. The reason for a hospital is fairly clear. We had a business case in 2006, we had a revised business case in 2010 and I believe there to be a new business case that will be completed (I hope) some time this year by Country Health SA on the need for a new Barossa health facility, and I think it will say what it has said previously, without having seen it or been involved with it. I think there is a consistent theme that Country Health has put forth to the department over a long period of time, which is that we need a new hospital.

The reason is this: the Barossa Council, which this hospital will sit in the heart of, is the tenth fasting growing council in South Australia. That by itself indicates that there is a need for an upgrade to the health facility. But more than that, it is the changing demographics around there that make the difference too. We have Gawler, which has grown by 1.3 per cent per annum, which is well above the 0.84 per cent growth per annum of the rest of the state; it is a high growing area. The increase in demand will be soaked up by the Gawler health facility. We are seeing developments at Gawler East with Springwood, there is the potential Roseworthy development, there is Concordia and there is Orleana Waters. If we head further down to the northern suburbs, there is the Playford Alive Renewal SA development and there is the Blakeview development.

The 30-year plan designates that the northern suburbs are going to take a huge amount of new residents and new growth and that demand will be sucked up by the Lyell McEwin Hospital. So, in the northern suburbs you will have the Lyell Mac working to capacity because of demographic growth there, you will have the Gawler health facility used up by the increased growth in Gawler and then anything further north of that into the Barossa and the growth that it has by itself will need to be catered for by itself. It cannot go to Gawler, it cannot go to the Lyell Mac. That demand will need to be met within the Barossa itself. That is why I think it is very important that the government gets on and commits to building a new Barossa hospital.

For years, the member for Schubert, in its title honorary, has been coming into this place, banging on the tables and saying, 'We need a new health facility for the Barossa,' but I do not think that is enough. I am currently doing some work to help the government, to provide options for how we build this facility, and there are a number of options. The business case traditionally has said, 'We need a new hospital. These are the demographic reasons why. These are the health reasons why. Here are some of the internal savings we can make as part of it,' and that is where it stops. I believe that in order to make a better business case overall for funding we need to take that a step further.

Some of the work I am doing at the moment is around different funding models. We are exploring a model at the moment where we may try to get the hospital cooperatively funded because I am sure the Barossa community is willing to invest in a hospital that it can then lease back to the state government. That is one model where the Barossa has some history. We have the Barossa Co-op, which has 17,000 members, which is basically every single person in the Barossa (I have $20 worth of shares myself). It is a brilliant co-op that delivers for the community. The Barossa understands it, it loves it, it is one of the most favoured institutions and I think the people of the Barossa will get a cooperatively funded new Barossa hospital.

There are also opportunities for public-private partnership where a private developer could come in and build the hospital and either sell or lease back the public hospital part of the development to the state government and there would be allied health services and private rental space that the private developer could then lease out to Benson Radiology, medical practices, allied health services, to be able to offset the capital cost. I have a council that has stated publicly numerous times, 'We will give the land for free to the state government. You guys decide where you want to build it and we will make it happen.' I have heard that commitment on so many different occasions, and that is a way that the government can save money.

There is also around $1.5 million sitting in a fund specifically to go towards a new Barossa hospital, and on top of that we have two ageing facilities in the Angaston and Tanunda that could be sold off to help offset the capital cost of a new hospital.

Mr Picton: I thought you didn't want to have only one hospital.

Mr KNOLL: We are happy to have one hospital, as long as it is new, instead of a facility that was built before the Second World War—in fact, I think, if I am not wrong, it was built before the First World War. The Angaston Hospital was built in 1910, and the Tanunda Hospital was built in 1955, and it looked all of its years in the couple of times I have had to go into the facility. The people of the Barossa deserve better. When the people of Adelaide are getting a brand-new, state-of-the-art, third-most-expensive-building-in-the-world facility, I think it is only right that the people of the Barossa who contribute—

The Hon. P. Caica: Serving the people of the Barossa.

Mr KNOLL: The Barossa is one of the most productive areas of South Australia. If we do not start investing in the places that actually deliver the jobs, and deliver the growth and the exports, those regions are going to suffer.

The last part, which I think is something I am really keen to explore, is medical tourism. I think there are opportunities for elective dental surgery, orthopaedic surgery and cosmetic surgery all to be done in the Barossa. As part of the recovery program, you can stay and enjoy what is I think the best region in South Australia. I am exploring different models that work overseas for a variety of different reasons, but I think that medical tourism as maybe a public-private partnership, or some sort of co-located private hospital with a public hospital, could be another model to help offset the capital cost and bring about a facility for the community that also helps to bring tourist dollars into South Australia.

I will be saying more on this topic over coming months and years as the work continues. Certainly, after the next business case is brought out, I will be putting together an addendum to that business case to actually look at the next step of how we get it funded. It is not just, 'We need a new hospital,' the next question has to be how we fund it. I would like to help constructively provide some answers in that area so that, after what has now been 22 years' worth of waiting, the people of the Barossa can actually get what they so richly deserve.

Mr GRIFFITHS (Goyder) (17:12): I commend all who have spoken on this bill but, member for Schubert, you have succeeded the previous member wonderfully well and you are a very creative mind that is outcome focused.

The Hon. J.J. Snelling: Future leader.

Mr GRIFFITHS: Many years down the track. After the member for Dunstan has been premier, there is probably a good chance of that.

Members interjecting:

The DEPUTY SPEAKER: Order! I remind members the bases are fully loaded in the book, and I am going to drag it out again because we do not want the last hour of the day to disintegrate, do we? I am going to ask members—

Members interjecting:

The DEPUTY SPEAKER: Order! I am going to ask members to observe the Speaker's favourite ruling at the moment, which is No. 142, and warn that I will have to let him know if anyone transgresses. The member for Goyder will be heard in silence. Member for Goyder.

Mr GRIFFITHS: Well said, Deputy Speaker. The member for Schubert actually presents a rather compelling argument. I have no doubt that the time he spends in here will be focused on an outcome for his community, as was the previous member for Schubert's. Ivan Venning was a great bloke, and I think we would all acknowledge that. A friendly man—

The Hon. G.G. Brock: He still is.

Mr GRIFFITHS: He still is, yes. The only time I have ever seen him upset, I thought, beyond control was when he was talking about the Barossa hospital. I must admit that he went absolutely ballistic about the fact that he wanted it to be done.

I am very pleased that the minister is here because on Tuesday, I believe, the minister was asked a question about the financial commitment to regional health, and I believe he quoted $779 million in 2014-15 and $766 million in 2013-14. They are impressive dollars, minister, and I understand that, but the sums equate to that of a $13 million increase from last financial year to this year or about 1.7 per cent. I believe when I—

The Hon. J.J. Snelling: Money well spent.

Mr GRIFFITHS: Money well spent, yes, but my question related to the level of commitment from the previous financial year because it is around one-fifth of the total increase in health spending per year that you, minister, are dealing with. Regional communities are not quite benefiting in the same way as overall health spends are, and that was the reason for my supplementary question.

On the same day, I believe I asked a question of the Minister for Ageing about the Mallala hospital and aged-care facility, and he responded along the lines of, 'It's Liberal Party policy to take it over when they are in financial trouble.' That was not the question. The question was based around what level of oversight exists from a state department to assist community facilities (and this is very strongly a community-run facility) in helping them to ensure they are getting good advice. It was not anything else or any other policy matter; it was about the level of oversight that exists.

I put on record and pay my respects to the efforts of the Balaklava, Wallaroo, Yorketown and Maitland hospitals, and I appreciate the level of support provided by the Minister for Health for them and the investment that has taken place in several of those hospitals in recent years as well. I commend the Health Advisory Committees, the staff and, indeed, the generations of people who have actually made what is there possible because they have played absolutely key roles.

The member for Morphett referred to what we term 'Country Health Mark 1', which was in 2007 or 2008, I think, when the communities in regional South Australia rose quite significantly to express their view that they would do absolutely anything to ensure that Health exists and their hospitals remain. In my own electorate there were what I will call rallies; there were 700 people at Yorketown, 500 people at Balaklava and 400 people at Maitland and the word, very strongly, was 'Do whatever it takes to ensure they remain.' So when we talk about Transforming Health, there is no apparent impact on regional communities at this stage but it has to becomes a focus that all of us will debate.

In talking about the Moonta hospital, though, which is a hospital and an aged care facility, it is important to put on the record that, sadly, 18 months ago it closed the hospital-bed component of its operation. I know that the Minister for Health's office was advised of that and the shadow minister for health was advised of that late in December 2013. That devastated the community. I attended a public meeting there where everyone was talking about how they could rally behind it, how they could get it back, but it is an example of the financial pressures that regional facilities face, and it is in community hospitals and aged care facilities.

Now it is a great sadness to have, within the same electorate, the Mallala hospital and aged care facility close on 1 April. I know that in a conversation I had with the member for Frome, the Minister for Regional Development, he talked to me about having scheduled a meeting with, I believe, the Mallala council to talk about efforts that can be made to assist that community. For Mallala, in particular, it is $2 million per year taken out of the local economy, and for a small town that, yes, does have growth opportunities between themselves and Two Wells, it is a devastating issue. So I implore members to do all they can to assist the Mallala community in overcoming that.

I am pleased that we have had a bit of licence provided to us to talk about health in our areas. As the son of a lady who was a nurse for 50 years it has been part of my growing up, part of my DNA, to be respectful of it, to understand, in some small way, some of the challenges that are faced by staff, the difficulties in recruiting staff, the opportunities for them when they do come there, and the need for turnover to occur sometimes for professionals. There has been such a significant change in the generation of where our doctors are coming from that you are not going to have the situation any more of, in the community I live in at Maitland, Dr Bill Chappell, who was the sole GP for about 50 years and a man who was revered above all others in the town. He has had some troubles in recent times, but I have to say that no matter what it is the community has rallied around him. The community has helped him because of the respect and the knowledge they owe him. It really does come down to that.

I just wanted a few minutes to talk about some health issues in the electorate. I commend the bill, and look forward to its passage.

The Hon. J.J. SNELLING (Playford—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Arts, Minister for Health Industries) (17:18): Thank you for all those contributions on the bill. I think it was a fairly wide-ranging debate; anything that touched on health care anywhere at any time managed to make its way into the debate, but I always think it is good to give all members an opportunity to vent.

The Health Care (Administration) Amendment Bill 2015 is a bill to make a number of technical amendments to the Health Care Act 2008. They include provisions which allow the following:

to allow fees for services provided by the SA Ambulance Service that do not involve transportation in the ambulance—that is, Treat no Transport services—to be set through the Health Care Act 2008 rather than the Fees Regulation Act 1927;

provide a mechanism for the employment of medical practitioners, nurses and midwives in the Department for Health and Ageing (so basically central office);

the dissolution of three now non-operational incorporated associations and a formal transfer of the assets to the appropriate health advisory council;

amendment to section 29(1)(b) of the Health Care Act 2008 so it is clear that a specified person or body does not need to be providing services and facilities to an incorporated hospital for the business or operations of that body to be transferred to that incorporated hospital;

the Governor, on application from the minister, to make proclamation to transfer the assets, liabilities and undertakings from one incorporated hospital to another, without the incorporated hospital to which these first belonged having to be dissolved;

to remove section 49(5) of the act that allows the minister to determine the constitution of the SA Ambulance Service—the functions and powers of SAAS are already set out in the act and a constitution has not been determined and is not required for the effective functioning of SAAS;

an amendment to ensure that SAAS staff and medical practitioners, nurses and midwives to be employed under the new section 89 are covered by the conflict of interest provisions;

an amendment to clarify terminology used in section 93(3) of the act so as to limit disclosures of information required—under this section, the disclosures that are required are 'required or authorised by or under law' to reflect more accurately when and how legal disclosures of information may be made;

an amendment to add the term 'substitute decision maker' to the list of persons who may request or provide consent for information about a person to be released, so that the wording aligns with the provisions of the Advance Care Directives Act 2013;

transitional provisions regarding the continuity of employment and conditions of employment of medical practitioners, nurses and midwives in the central office; and finally

transitional provisions regarding the cancellation and incorporation of certain associations.

I am pleased to hear members of the opposition in this place have indicated support for the bill. It is good to hear and I thank the opposition for their support.

We heard the member for Flinders indicate his interest in seeing resolution of long and outstanding transfer of assets of three non-operational incorporated associations to the relevant health advisory council (namely Lumeah Homes Inc., Miroma Place Hostel Inc. and Peterborough Aged Care and Disabled Accommodation Inc.) and proclamations for the dissolution of these associations. The transfer of these assets to the local health advisory council ensures that these assets stay with the communities that contributed their money and labour for the greater and common good of their community.

As has been pointed out by the member for Flinders, it is important that these assets stay with those communities, in recognition of the fact that the community developed and contributed their time and money to their establishment. These assets belong to the communities and the provisions of this bill reflect and respect this by ensuring these assets go to the relevant health advisory council. The three HACs involved are the Lower Eyre Health Advisory Council, the Lower North Health Advisory Council and the Mid North Health Advisory Council. All of them some time ago formally agreed to the transfer of these assets and they have known that this transfer would occur once the bill was passed. I hope we can finally realise their expectations sooner rather than later, since they have been waiting long enough for this to occur.

The member for Chaffey indicated his belief that there are many questions still to be answered about how amendments to the Health Care Act 2008 as proposed in the bill will impact on health care in regional and rural South Australia. In the case of the Treat no Transport ambulance fees, there will be no effect. The bill will simply change the legal mechanism for enabling these fees to be set to one that is aligned with the setting of all the other fees under the Health Care Act 2008.

The proposed amendment to section 32 will be beneficial to the health system, since it will allow a transfer of functions between incorporated hospital sites without one having to be dissolved. This is an important capability that is required for managing any modern health system to ensure that services are provided at the most appropriate incorporated hospital site in response to changing and emerging community health needs. It is a sensible amendment that will assist regional and rural health services respond to the needs of their communities.

The member for Morphett raised a concern about clause 5, stating it was not clear what the 'etc' referred to in this provision. The use of 'etc' in this way is a well-known drafting convention which is regularly used to indicate that a clause or section refers to several matters, as can be seen from the proposed new section 32A(b) which mentions, in addition to the transfer of functions, the transfer of assets, rights and liabilities of an incorporated hospital—this latter part of the clause is what the 'etc' refers to. There is no mystery here.

I also understand that the use of the term 'health services' in clause 8 is troublesome to some of the opposition. The clause will provide for a new section 89—Other staffing arrangements, providing a mechanism for the employment of medical practitioners, nurse and midwives in central office. This clause will only apply to the employment of medical practitioners, nurses and midwives in the Department for Health and Ageing since all other health practitioners who are employed in the central office are employed under the Public Sector Act 2009. The term 'health services' can, therefore, only have a specific meaning in this context related to those health services provided by medical practitioners, nurses and midwives.

The bill provides a mechanism for the employment of medical practitioners, nurses and midwives in the Department for Health and Ageing, namely central office, under their professional awards. The medical practitioners, nurses and midwives employed in central office play a vital and essential role. They provide a range of clinical and professional advice that supports the provision of high-quality healthcare services at the coalface in hospitals and other health facilities. It is always easy to think that medical practitioners, nurses and midwives who are employed in the central office are not engaged in the real business of providing health care. I can assure the house that this is not the case. They are just as important and play a critical part in the functioning of the health system as a whole.

Many of them are front-line workers in their own right, providing important public health protection. For example, nurses are employed in overseeing the management of vaccine services across the state. They make sure vaccines are delivered to where they are needed in a timely and efficient way. Medical officers are employed in communicable disease control as well as providing professional advice regarding medical services and practices to support effective health service delivery by the health system.

The member for Morphett in indicating his support for the bill also indicated that there may be issues and questions that will be raised about this bill in the other place. The government has provided responses to any concerns that have been raised during the briefings, and there has been plenty of opportunity for the opposition to come back. Indeed, I think this might be the second or third time that this bill has, in fact, gone through this chamber. It would be very nice to have the support of the opposition, particularly given the issues relating to the transfer of those assets from those about-to-be dissolved incorporated bodies to ensure that the funds that have been raised by those regional communities can remain in those regional communities. I would be very grateful for the support of the opposition for the speedy passage of this bill, not only through this chamber but also through the other place.

Bill read a second time.

Third Reading

The Hon. J.J. SNELLING (Playford—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Arts, Minister for Health Industries) (17:28): I move:

That this bill be now read a third time.

Bill read a third time and passed.