Bills

Health Care (Miscellaneous) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 28 October 2015.)

Dr McFETRIDGE (Morphett) (11:02): I indicate that I am the lead speaker in this chamber for this piece of legislation, and indicate that the opposition will be supporting it; but in the true tradition of our upper house, there may be some revisiting of the legislation, and there may be some necessary amendments that will be put to the government.

The Health Care (Miscellaneous) Amendment Bill 2015 seeks to regulate stand-alone private day care procedure centres (DPCs) through various licensing arrangements and setting standards of construction, facilities and their arrangement. At present South Australia and the Northern Territory do not regulate stand-alone DPCs.

The state government issues licences for private hospitals under part 10 of the South Australian Health Care Act 2008. Currently, private DPCs must be issued with a provider number by the commonwealth Department of Health to be accredited against the National Safety and Quality Health Service Standards (NSQHS) and be declared a hospital pursuant to section 121- 5(6) of the commonwealth Private Health Insurance Act. The stakeholders broadly support the bill and the state government regulation of DPCs.

We all know, I think, that there has been substantial growth in the sector of DPCs, day procedures, and going in to have day surgery and having a day procedure is becoming very common. In fact, in his second reading speech the minister listed some of those procedures and I will just read from his list to emphasise the fact that there is a broad spectrum of services being offered now in day surgeries.

They are plastic surgery; reconstructive and cosmetic surgery; ophthalmic surgery; endoscopy; ear nose and throat surgery; fertility treatment and family planning; dental and oral maxillary surgery; renal dialysis; cardiac treatments; oncology; chemotherapy and radiotherapy; urology; paediatrics; orthopaedic surgery; general surgery; and mental health treatments. There are currently 30 stand-alone private day procedures centres in South Australia that have been declared as 'day hospitals'.

The growth in admissions has been spectacular by anybody's standards. Between 2001 and 2012 the number of private day surgery beds increased by 68.5 per cent, and the number of people having treatments—the numbers of separations, as they call them—increased by 115.6 per cent. That is a national figure, and our share of that is 8 per cent; so, the numbers would be a proportion but the percentages, I would imagine, would be about the same.

Certainly all of us in this place probably will experience or will have a family member or somebody experience a day procedure. With modern anaesthetics, modern sedation, the quick turnaround is something that we can look at, we can focus on, in terms of improving the turnover through our hospital system.

The hospital system and Medicare was designed for mainly accidents and illnesses with a high emphasis or a real regard to people staying in hospital for a long time. That has changed dramatically, and that is where we need to look at where we are going with Transforming Health to make sure that we do not only acknowledge what is happening but also to ensure that there is capacity in the system to cope for all those people who do need to stay in for longer procedures or if there are complications.

The legislation itself is relatively straightforward. The government believes that, by licensing stand-alone and private DPCs that provide a range of measures, this will not only increase the ability for South Australians to access DPCs but also ensuring the specific licensing conditions which ensure the safety of patients and that the standards which we would expect are put in place.

It is a very broad area and a very expensive area. We have seen some changes just recently in some of our DPCs in Adelaide. I think that it will be an area that will continue to grow, and I think that we will be able to assist individual South Australians and the public health system in coping with the demand that is going to inevitably happen with so many lifestyle illnesses that we are seeing now.

There have been a number of concerns raised with the bill by stakeholders, and I will read from those concerns that have been provided to me by the Hon. Stephen Wade in the other place. There is a grandfathering position. The Australian Day Hospital Association (ADHA) and the Australian Private Hospital Association (APHA) have expressed concerns about the retrospective application of previous bills.

Ultimately their concerns were that if the proposed licence conditions are applied to existing DPCs then the financial viability of such facilities could be put in jeopardy without any demonstrable benefit. As previously mentioned, all South Australian DPCs are currently registered with the commonwealth health department and adhere to rigorous standards.

The government in large part alleviated these concerns with the amendment of section 89A(3). Under the proposed bill these licensing conditions will not apply retrospectively to existing DPCs. Such licensing conditions will only apply if existing DPCs alter or extend their premises or change the health services they currently provide.

However, the ADHA is still critical of the drafting of section 89A(3) as the standards of construction may still apply to existing DPCs and not solely to new DPCs. The ADHA suggests that section 89A(3) be amended, and I assume that that will be taken care of in the other place by the shadow minister for health. There is a concern of lack of accountability. The ADHA is also concerned that licensing standards and conditions are going to be established by gazette and will not be subject to parliamentary scrutiny.

The minister will have very wide powers under section 89A(1) and (2). Although the minister may adopt standard guidelines and codes he is not required to do so under the proposed bill. A suggested amendment by the ADHA was that the minister be required to liaise in good faith with the relevant industry bodies, such as the APHA and other bodies, before gazetting any standards.

There is another concern about the removal of the cap on the number of bed licences. This bill also seeks to remove the cap on bed licences which currently exist for the Adelaide metropolitan area. Currently, 5,169 beds are licensed. The ADHA has expressed concerns about the removal of the cap on bed licences.

Although it is their submission that they welcome more beds, and that this is the foundation of a competitive market, they are concerned about the financial viability of DPCs through lost assets. These bed licences are recorded as assets for many DPCs, and the ADHA is concerned that removing these licences/assets from the balance sheet may again put the financial viability of some DPCs in jeopardy. It should be noted that the ADHA has stopped short of calling for compensation.

There is another concern over the definition of 'a suitable person'. The ADHA is also concerned about the absence of a definition of 'a suitable person' whom the minister may appoint as an inspector under his proposed act. The ADHA suggests that an amendment be included which would require such persons to have relevant experience in the operation and management of private DPCs. This has been rejected by the government, I understand, on the ground that the existing inspectors were appointed on the basis of their skills, knowledge and experience. However, the ADHA asserts that these inspectors primarily have experience in inspections of inpatient hospitals and not day care procedure centres.

There is also one further concern about the involvement of the public health service division. The ANMF, the nurses federation, and the ADHA have raised concerns about the definition of 'a prescribed health service' in new section 89, as it does not include the term 'local anaesthetic'. The concern is that DPCs which offer procedures under local anaesthetic or without a general anaesthetic will remain unlicensed under the proposed scheme, which may affect the willingness of health insurance funds to contract with these facilities.

If this occurs, it will be to the financial disadvantage of existing DPCs which offer these services and the privately insured patients who attend such a DPC. Both organisations suggest a simple amendment to the definition of 'a prescribed health service' under 89(a) to include the term 'local anaesthetic'. SA Health apparently has agreed in principle that procedures of sufficient complexity, even where only local anaesthetic is used, should be included by prescribed regulations.

With that, I will finish my comments and reiterate that the Liberal Party does support the bill. Most stakeholders support the bill, but there are some concerns, and I understand that they will be sorted out either between houses or in the other place.