Health Review

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (12:06): I move:

That this house expresses its concern at the systematic reduction in acute health services for the people of the western suburbs as a result of the government's Transforming Health program and in particular, the reduction in services including—

(a) the downgrading of the emergency department and intensive care unit services;

(b) the reduction in cardiac services;

(c) change in mental health services; and

(d) the removal of kidney and other renal care services.

I rise to speak on this motion with pride but with sadness. There is an old saying in politics: you have different friends on different days for different reasons. To now today speak on the demise of health services in the western suburbs of South Australia and to be standing arm in arm with my good friend, the former Labor member for part of the western districts, Kevin Hamilton OAM and his wife, Maureen Hamilton OAM, and attend meetings or protests with former Labor members of the parliament (Murray De Laine, Norm Peterson, Ralph Clarke and federal member Ron Sawford) is an interesting day. It makes for great conversation, but we are at one on a number of things.

I am proud to stand with former members of this side of the house who have represented us in the parliament, both as ministers and former ministers: Dean Brown, the member for Morphett (who has been a shadow minister), our current shadow minister Stephen Wade, and the like. Every one of us, irrespective of our political colours, together with the Hon. Kelly Vincent from another place and other members, have rallied to say that the government's Transforming Health is just one death knell in the coffin of health in the western suburbs.

In the 14 years I have been here, we have seen the demise of maternity and paediatric services, so much so that they relocated a sexual advice clinic out of my electorate down to Woodville in that time. They cancelled the capacity to be able to have any maternity or obstetrics services. So, what can you get in the western suburbs now? You can get an abortion, but you cannot have a baby. That is the reality. That was in the first few years of me being in this place.

Then they did what I thought was the most disgusting kick in the guts to The Queen Elizabeth Hospital: they ripped out the renal unit and the kidney transplant services and took them up to the Royal Adelaide Hospital on North Terrace where it currently is and built a $15 million new home for that service on North Terrace, even though they had already announced they were going to bulldoze that hospital and move that facility and service down to the other end of North Terrace.

Against absolute stupidity, they insisted in pursuing that objective in the full knowledge that that $15 million was going to be completely and utterly wasted. When asked why, they said, 'We need to ensure that the specialists in this area understand our new culture,' whatever the hell that was. So that is the situation: we have this obstinate insistence that they are going to crush this hospital, and the things that they were most proud of in providing services.

I will not go back to my grandmother's day working in the Mareeba babies' home at Port Adelaide, but the whole of this area has had a very proud history in the provision of services to the western suburbs. To take these out and to crush these services one by one has been an absolute insult to the people of the western suburbs, who incidentally and statistically are the oldest, sickest and poorest demographic in South Australia. Even compared to some of the very remote rural areas, they are the oldest, sickest and poorest demographic profile of all the areas in South Australia. They need to have acute services and they need to have a diversity of services.

Many patients present to emergency departments and the like with multiple conditions, pre-existing conditions and comorbidity. However expert you are in this field, obviously these people are arriving with a number of conditions which affect those who can treat them and the level of service that they require for acute services. It is a very dangerous situation that we have in reducing services when there is an increasing demand and need in the western districts.

More recently, the announcement of the reduction of cardiac services has brought out people such as Professor Horowitz, a longstanding surgeon and specialist in this area. He has spoken out on many occasions as The Queen Elizabeth Hospital has been systematically stripped and explained how dangerous this situation can be, and indeed is for the patients of this area. He says:

I'm sure the Government is well aware of what I have to say, however, the minister has refused to have any discussions with me at any time in the last five years, I guess because he probably doesn't like what I tell him.

The idea of actually having to either transfer all patients automatically to an overcrowded new Royal Adelaide or, alternatively, shuttle patients back and forth between the Queen Elizabeth and the new Royal Adelaide. Both of these will engender costs which are way, way greater than any possible benefits.

I do not know how many times specialists—people with experience and people who have given their life serving for the good health of others—have to come out and say, 'Transforming Health is a dangerous direction to go in, it will do nothing to assist the services that are currently provided and the costs that are going with it, it will further endanger lives and we cannot allow it to be introduced.' The Hon. Kelly Vincent made a statement on Transforming Health. She said:

It has become increasingly clear to me through my conversations with many professionals in the health sector, as well as many community organisations and individuals, that the data being used to support Transforming Health is grossly misleading, and that the consultation process has been rushed and narrow.

To create a health system that genuinely meets the needs of South Australians, the Government must have a mature and honest discussion with South Australians about all of the possible options, rather than putting Transforming Health forward as a fait accompli.

I find Kelly to be someone who is very measured in her contribution and her language, but I think she makes absolutely clear her concern and utter despair when it comes to the government insisting on progressing this. It is bad enough that the minister stands here day after day blaming the federal government for cuts, ignoring the fact that his own Treasurer, who sits next to him here in this parliament, is budgeting for a $2.7 billion surplus. He still claims that his Transforming Health is nothing to do with money, it is all to do with improving health and avoiding 400 avoidable deaths a year in our hospital system.

So far, the links do not match up. So far, the public have repeatedly, through their petitions and attendance at public meetings, said, 'No, this is not acceptable. You are downgrading our acute services; we are in desperate need of them. We cannot crush seven hospitals into three. Get real! Understand that we have a very high demand in this area, and it won't be remedied by you shutting down services in the western suburbs.' It will create a very harsh circumstance for the residents there.

I could talk about Cleveland Clinic and the mental health services that are much needed in that area. All of these are acute services which are absolutely critical. You cannot have major surgery without a high level of intensive care unit support, and this stripping away has been very concerning. What is alarming to me, particularly, are the local members. Do we hear from them? No, we do not hear from them.

In 2006, the now Premier sent a letter to his constituents saying that the Rann Labor government is getting results rebuilding The QEH and recruiting more doctors and nurses. He went on to carry on about open space at Cheltenham and all of these other laughable things he promised at the time, but on The QEH he said: 'We're rebuilding The QEH.' That lasted five minutes. Of course, before 2010 that evaporated.

The member for Colton sent a lovely letter to all of his constituents espousing the virtues in April last year of Transforming Health, telling us about the incredible amount of upgrade that was going to be done at The QEH.

In relation to the Emergency Department (ED) at the QEH, in the current proposal, the ED will still operate to serve the local community however people with complex and life threatening conditions will be redirected to the new Major Emergency Departments.

That is what he said. Then have a look at what the member for Lee said. He sent out to his constituents:

I want to be clear that the emergency department of the Queen Elizabeth Hospital will be kept open under Transforming Health.

It is slightly different saying 'It will be kept open.' It then says:

If you are suffering from a medical emergency you can and always will be able to go to the QEH for immediate care 24 hours a day, 7 days a week.

There is no mention in here about what the minister has now said and that is, 'You will then be relocated in a bus somewhere, goodness knows where.' Perhaps that is what we got those Darwin buses down here for. We might need those ambo buses, the Darwin converted buses, to bring them up to the Lyell McEwin or to the new Royal Adelaide Hospital, assuming you can get in, of course.

In any event, this is what they are telling their constituency. Their constituency does not believe them. They are turning up at the meetings saying, 'This is not acceptable. You promised certain things to us. You have failed us. You are now trying to give us this bulldust in these letters about what services are being preserved and which will be available,' when we have the head of the cardiac unit come out and say, 'There are changes and they are significant. We are not going to turn you away from a hospital. You can't self-diagnose. You should ring an ambulance and somewhere, at some time, somewhere in the state, you will get into a hospital. We can't tell you where, but leave that up to the ambulance driver.'

That is what we are left with. The people present with symptoms of a heart attack, stroke, comorbidity of diabetes, dietary issues, may smoke or been a long-term smoker or have a war injury. There are all sorts of comorbidity circumstances which alarmingly increase the acuity of the condition of patients when they present and increase the need for the services that they require to be able to stay alive and hopefully have a chance to recover.

I am utterly disgusted at the government's insistence that they continue to push and have their little army of apparatchiks, including the local members, go out and try to present this rainbow-coloured beautiful idea of a panacea of a healthy place to live in the western districts, when day by day they are stripping away these services that are necessary for the mature-aged population to stay there, for the young population to invest in and for an even younger population to build a life in and a career and have the opportunity of living adjacent to the ocean, living in a circumstance where they might be close to city amenities, but with no health service. This is absolutely disgusting. I ask the motion be given support.

The Hon. P. CAICA (Colton) (12:18): It is a bit rich thinking that the member for Bragg actually cares about the people of the western suburbs. On this occasion, I will state that the government opposes this motion. It is clear that, once again, those opposite are trying to score political points by putting unfounded fear into the good people of the western suburbs. We have members opposite implying that The Queen Elizabeth Hospital's emergency department is closing when it is not. We have members opposite telling the community, the good people of my area, that their health services are being downgraded when they are not. We have members opposite implying that The Queen Elizabeth Hospital is closing when it is not. These are just downright untruths and downright irresponsible.

The truth is that the people of the western suburbs will continue to have access to the high quality and safe public health services they need. Services will not be downgraded. The state government makes no apologies for the fact that some services will be provided differently under Transforming Health. Having been a member of cabinet for a significant time, I understand the importance of this particular process.

Members interjecting:

The DEPUTY SPEAKER: Order!

The Hon. P. CAICA: I understand it. All changes are based on sound clinical evidence and data, and are driven by clinical quality principles that will ensure safer, better health care for South Australians right across—and I will reinforce this point: right across—the health system. In most instances, the people of the western suburbs will receive their public hospital services at The Queen Elizabeth Hospital, or the state-of-the-art new Royal Adelaide Hospital. These hospitals will complement each other and ensure a full suite of public hospital services are available to those who live west of Adelaide.

I can give a couple of examples of having to take my two sons, as is the case with young men, to the emergency department at The Queen Elizabeth Hospital on quite a few occasions. Each of the problems and difficulties they had at that time will still be catered for at The Queen Elizabeth Hospital. It is important to counter the mistruths of those opposite by reiterating what the Minister for Health has consistently told us. The Queen Elizabeth Hospital emergency department will continue to be staffed by doctors and nurses, and will provide emergency care to the local community 24 hours a day, seven days a week.

Only patients with once-in-a-lifetime life-threatening emergencies (such as a car accident, stroke or heart attack, which account for a very small percentage of patients currently taken by ambulance to The Queen Elizabeth Hospital emergency department) will be taken directly to a major metropolitan hospital like the Royal Adelaide Hospital. In relation to what the member for Bragg said about what vehicle they might be going in, the simple fact is they will be taken by paramedics in an ambulance, and we know that is essentially an intensive care unit on wheels. They will take them to the correct place to get the proper level of service. For everyone else, emergency care will still be provided at The Queen Elizabeth Hospital.

Again, I use the example of my two boys and the numerous times I had to take them to The Queen Elizabeth Hospital. Contrary to the concerted fear campaign being launched by those opposite, the community will continue to access health services at The Queen Elizabeth Hospital, such as treatment for ongoing conditions like diabetes, heart disease and kidney disease. In fact, I am advised that the people of the western suburbs will have full access to kidney and other renal care services within patient services provided at the new Royal Adelaide Hospital, and continuation of all kidney and renal outpatient services currently provided at The Queen Elizabeth Hospital, including dialysis.

I am also advised that mental health services for people in the western suburbs are not being downgraded. In fact, in October last year this government announced an increase to the acute mental health care footprint across metropolitan Adelaide. For the people who live west of Adelaide, this includes eight additional short-stay care acute beds at The Queen Elizabeth Hospital, as well as five additional beds at the Royal Adelaide Hospital. The people of the western suburbs will also continue to have access to the full range of existing acute and community mental health services currently located in the west.

While most people will continue to receive their health services very close to home, it is true—as it should be, and as is appropriate—that some people who require once-in-a-lifetime, very complex multitrauma and specialist care will instead be taken to a major metropolitan hospital. For people who live in the western suburbs, in most instances this will be the new Royal Adelaide Hospital, which is around 10 minutes in normal traffic conditions from The Queen Elizabeth Hospital, and in a state-of-the-art ambulance staffed by outstanding paramedics.

Once again, despite the fearmongering from those opposite, the government makes no apologies for this, because it is based on sound clinical evidence and data. It will result in safer, better quality health services for the people in western Adelaide. Through the Transforming Health process, it became apparent there was a variation in health care outcomes for major traumas like heart attacks and strokes across our metropolitan public hospitals. Despite the fact that the minister has outlined this on numerous occasions, it would appear that people on the opposite benches do not listen.

When the government and our doctors, nurses, allied health professionals and paramedics looked at this data, it was found that outcomes varied depending on which hospital the patient was taken to, the complexity of care required, the time of the day, and the day of the week the patient was admitted to hospital. Quite frankly, the government could not just sit there and ignore this data.

Currently, specialist staff are only routinely on site at The Queen Elizabeth Hospital during business hours to treat major traumas like strokes and heart attacks. But, we know that heart attacks and strokes do not discriminate; they can occur at any time of the day or night. Under the current system, when a patient presents with a heart attack or stroke overnight, they often need to be transferred to another hospital, or a specialist team needs to be called in to treat them. This can mean critical time is wasted during the ambulance transfer or it could mean the patient does not receive comprehensive care for a stroke or heart attack until the full specialist team arrives at the hospital.

Under Transforming Health, the new Royal Adelaide Hospital will have more senior doctors and nurses routinely on site outside of business hours, as well as access to all the specialist diagnostic support needed for their specialties. For the people of the western suburbs, who will be taken directly to the new Royal Adelaide Hospital, this means there will be specialist teams there ready to treat them for longer periods of time outside of business hours, when patients with heart attacks and strokes actually present to hospital.

By providing the complex multitrauma care at the new Royal Adelaide Hospital, we will see faster treatment at The Queen Elizabeth Hospital for people with less serious health problems. This means better health care for the people of the western suburbs. The Queen Elizabeth Hospital will become a dedicated specialist centre for multiday elective surgery, as well as increasing its provision of elective day surgery procedures. Having a separate dedicated elective surgery centre will mean shorter waiting times for the people of the western suburbs. It will also mean fewer elective surgeries are bumped, as currently happens, because the clinical team is pulled away for emergency surgery.

The dedicated elective surgery centre will ensure clinical teams can specialise and see enough patients to maintain and improve their highly specialised skills, meaning safer, higher quality health services for the people of the western suburbs. The Queen Elizabeth Hospital will become the statewide centre for rehabilitation for spinal and brain injury, with allied health professionals available there seven days a week. The government is upgrading the hospital, building a new hydrotherapy pool as well as new allied health facilities.

In fact, since we have been in government—and this is an important point—we have invested $136 million to upgrade The Queen Elizabeth Hospital and we are investing a further $20 million to upgrade its facilities under Transforming Health. Yes, that is right, we are upgrading The Queen Elizabeth Hospital. Let me remind those opposite (as if they need any reminding), who keep saying we are downgrading our hospitals, that since 2002 this state Labor government has upgraded every major hospital across the state. Go and see the Modbury, go and see the Lyell McEwin, come down to The QEH. We have invested almost $2 billion to upgrade every metropolitan public hospital and every major country hospital. Through Transforming Health—

An honourable member interjecting:

The Hon. P. CAICA: Go and look at Whyalla—we are investing an additional $250 million in new capital investments across our metropolitan hospitals. I might add, the previous Liberal government had let our hospitals run to ruin before this government took control in 2002. It was this same party who privatised the Modbury Hospital. It was the same party who opposed the building of a state-of-the-art brand new Royal Adelaide Hospital. In 2002, the then minister Dean Brown could not articulate what the future of The Queen Elizabeth Hospital was. It was heading down the same road as the Modbury Hospital. The same party is now accusing the government of downgrading our hospitals.

Once again, this government makes no apologies for making changes to our health system. We know that reform is required and our changes are based on improving the quality of health care in this state. Unfortunately, it seems those opposite would prefer a health system that stays the same, a health system that does not change and evolve, a health system that does not modernise and innovate to meet the future healthcare needs of our community.

We have the Leader of the Opposition, who says on 891 radio that we need to run our hospitals more effectively, but instead of coming up with any vision for a contemporary healthcare system in this state, the opposition opposes every change we are trying to make. They have chosen to respond only with negativity. They would prefer to put unfounded fear into the people of the western suburbs. On the other hand, this government, by changing our health system to provide better quality services, by ensuring our patients do not sit in hospitals waiting for an on-call team to arrive, by increasing the provision of elective surgery at dedicated elective surgery centres, by upgrading our hospitals and investing significantly in modern healthcare facilities, is doing exactly what the Leader of the Opposition has said we need to do: making our hospitals run more effectively.

Dr McFETRIDGE (Morphett) (12:28): I do not know who writes the speeches for some of those opposite, but I think they should be speaking to the real doctors and nurses, not the spin doctors and not the nurses who nurse the ministers through disaster after disaster. They should be speaking to the real doctors and nurses out there. I can tell the house that they talk to me, they talk to the opposition, and the real situation out there in the South Australian health department is one of absolute fear. This government has put the fear of god into health workers that if they dare speak out and get caught they will be persecuted. The fear of health workers for the future of the health department and the delivery of health services in South Australia is real and getting bigger by the day.

Those parents and grandparents in this place have probably had kids with Transformer toys. These are little toys that turn from an innocuous little car, an aeroplane or a boat into this metal-munching, people-punching monster, and that is what we have got here with Transforming Health. We have got a system, a plan, in place that is turning the health system on its head. We are going to see fewer beds in this state, we are going to see fewer services being delivered in this state, we are going to see people waiting longer and longer in this state.

For many years I have been using the government's own information to show the disgraceful situation in the South Australian Health Department. Let us just quickly talk about the history of The Queen Elizabeth Hospital and then I will talk about the disgraceful situation we had this morning at The Queen Elizabeth Hospital and some of our other hospitals.

The Queen Elizabeth Hospital was opened as a 311-bed hospital back in 1954 by Her Majesty the late Queen Mother. The hospital in 2010, according to its financial report, employed 2,500 staff, there were 42,000 emergency department presentations and examinations, 16,000 surgical procedures were undertaken, 36,000 patients were admitted and an astounding number of 175,000 outpatients were seen.

The hospital has been downgraded by this government over the years. We heard the member for Bragg talk about the kidney transplant unit being transferred to the Royal Adelaide Hospital—a waste of $15 million there when the new hospital is being built. The Queen Elizabeth Hospital has been a very proud hospital. The member for Colton did not mention the fact that he was born there, but now his relatives will not be able to have their children there.

You can go to The Queen Elizabeth Hospital and have some procedures but, as the members are admitting, not all procedures will be undertaken at The Queen Elizabeth Hospital under this Transforming Health. Just today The Queen Elizabeth Hospital, according to the government's own dashboard, has 302 beds, not 311 beds which it says on the other health site. It is in the yellow zone, which is a traffic-light system that is being used to let people have a look at the dashboards to see how their hospitals are coping.

The Flinders Medical Centre is in the white-hot zone; that is well over capacity. This morning The Queen Elizabeth Hospital actually did have some spare space in there, and I understand that there are reasons for that which I will not go into at this particular time. There are some problems with air-conditioning systems down there. The need to look at what is going on in the wards at The Queen Elizabeth Hospital to see how it is coping is just in the government's own dashboards.

Let us have a look at Cramond Ward and mental health. The base capacity there is 21 beds. They have not flexed up any beds there because they have no spare beds. It is in over capacity, it is in the white-hot zone. The only green zone is the surgical stream there, and as I say I think that is because there have been problems with air-conditioning in some of the operating theatres down there.

The need to make sure that the hospital is being managed well is something that this government just does not realise. Minutes do matter. You do not plan a heart attack, you do not plan a stroke. Minutes do matter, and those minutes, coming through traffic getting into the new Royal Adelaide Hospital, can matter despite the best efforts of our highly-trained paramedics in our ambulances.

The current state at The Queen Elizabeth Hospital is that 480 people are ready to be seen for elective surgery. Unfortunately 73 of those have been deferred and 20 have been postponed, and that was just this morning according to yesterday's dashboards. So we do not know what the current position is at this stage but people are waiting. They are waiting over time, there are delays. As I said, the mental health stream is well and truly over capacity.

Let us look at the emergency department this morning at The Queen Elizabeth Hospital. It shows on the government's own dashboards, in the bottom right-hand corner of the dashboards, the 24-hour activity at The Queen Elizabeth Hospital, and can I say that approximately 95 per cent of the time the emergency department has been over capacity. For about 12 hours from midday yesterday until 1 o'clock this morning—I am just interpreting this as I am looking at it—the emergency department was in the white-hot zone.

In other words, that is over 125 per cent capacity. People are waiting, waiting, waiting. Even at the moment, as we speak, this morning, with the capacity of 31 cubicles, there were 28 people waiting there, which is relatively calm for The Queen Elizabeth Hospital. If you had gone to the dashboards down there, the pressures are immense for The Queen Elizabeth Hospital—immense.

Time after time we see the government's own dashboards showing that this is a hospital that is overworked. You talk to the doctors and they say it has been gutted down there. There are some medical professionals down there who have unfortunately turned their back on The Queen Elizabeth Hospital because they see better opportunities for themselves (selfish opportunities for themselves) in the new box of toys down the road here, the new Royal Adelaide Hospital.

It is a disgrace that they have allowed The Queen Elizabeth to be treated the way it is, and this is not me saying this, this is doctors and nurses telling me this, who have had many years of experience working at The Queen Elizabeth Hospital. If the people of the western suburbs are going to be abandoned by their local members down there, if this hospital is going to be allowed to become a part of a bigger plan where it is a hospital that is not able to deliver everything that a hospital should, well then that is a disgrace for those local members and for this government.

We need to make sure that we deliver the best health services in South Australia and Transforming Health is not doing that. In the western suburbs people are going to miss out; they are going to miss out very badly, and that is verified by the government's own dashboards and anybody can go on to the health website and look at those any time they like, and I encourage them to, because the figures there should not lie.

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (12:36): I thank members for their contributions. It is a sad day for The Queen Elizabeth Hospital but I do urge members to really dig deeply into their conscience here and support this motion. It seems rather tragic to me that we are recognising Queen Elizabeth with a new rail line in London as we speak—the Queen Elizabeth line—and now back here in South Australia, have a hospital that is stripped to the bone. That is a very sad situation, so I would ask members to support this motion.

Motion negatived.