No-confidence Motion

Minister for Health

Mr MARSHALL (Dunstan—Leader of the Opposition) (14:03): I move:

That this house has no confidence in the Minister for Health in light of his handling of the South Australian public health system.

The health system in South Australia is in crisis and the minister responsible for this crisis is in this house—the Minister for Health. He was appointed by the Premier in January 2013. He was sacked from his portfolio as treasurer for this state, demoted to the important health portfolio, and ever since that time he has proven himself to be completely and utterly inadequate to look after this most important of portfolios.

This is a portfolio which deals with almost a third of the state budget but, more importantly than the monetary terms, it deals with the lives of South Australians. This minister is responsible, or supposedly responsible, for the care and treatment of our most seriously ill people in South Australia and his performance over the last three years is nothing short of deplorable.

There has been a rolling wave of scandals which have enveloped the South Australian health department since he came to look after this department. Let's take a look at some of these this afternoon: South Australian Pathology Services; I mean, a year ago, at the beginning of last year, we learnt that this agency had put hidden cameras in their department to spy on their employees. Then there was the chemotherapy dosing bungle, so the dosage which was given was completely and utterly wrong, but does this minister support the pleas of the victims? Does he support the pleas of the opposition to conduct an independent parliamentary or judiciary inquiry into this? No, absolutely not, he refuses.

The Lyell McEwin records bungle; this is another scandal where doctors' notes, put onto the private patient records, were tampered with by management within the department—another scandal that he has presided over—21 separate privacy breaches of patient records in South Australia. Another scandal: SA Pathology in recent weeks has been further in the media because of their bungling of the prostate cancer notifications where this department again failed to inform the victims and inform the people of South Australia.

This rolling wave of scandal and incompetence is undermining the people's confidence in our public health system in South Australia, and there is only one person responsible, and that person sits opposite. Not only do we have a scandal-ridden department in South Australia but we have a department which is not fulfilling its obligations.

Let me tell you, Mr Speaker, we have the highest expenditure per capita in the nation in terms of health expenditure, yet do we have the best outcomes? Absolutely not. So we have the highest amount of money going in, and in fact we have the equal worst performance in the nation. It almost beggars belief. It takes a certain type of incompetence to be able to deliver the worst outcome with the greatest level of input, but that is exactly what we have in South Australia after three years of mismanagement by this minister.

This afternoon I would like to focus on two specific areas of incompetence in service delivery: number one, mental health; and number two, I would like to look at elective surgery waiting times. Last year, this minister told the people of South Australia that his number one priority was fixing mental health in this state, and he did not want to have one single mental health patient in an emergency department for more than 24 hours. Let me tell you that there have been plenty of people sitting in emergency departments right to this day.

So what was his response? He handballed it. He decided, 'I do not want to do it, I am going to go nowhere near delivering on my number one priority, so my number one priority is going to be handballed to somebody else.' He no longer looks after that. He prioritised tickets to the opera, he prioritised tickets to arts events, because he kept the arts portfolio, but he handballed mental health and substance abuse to someone else. So we now have this ridiculous situation in South Australia where the department head is responsible to two separate ministers. I mean, is this anything like best practice? No, but this is what is presided over by this minister.

The Hon. A. Koutsantonis interjecting:

The SPEAKER: The Treasurer is called to order.

Mr MARSHALL: Elective surgery is the key indicator of the health of a system, and in this instance it is really found wanting. In South Australia, we were the only state last year which performed fewer elective surgery procedures than we did the previous year. It is the worst performance in elective surgery in the nation Elective surgery waiting times are massively blowing out, and what is the ministers response? He decides to close the elective surgery beds at the Repat Hospital. His response to the blowout in terms of elective surgery in this state is to close beds at that wonderful hospital which is doing a huge proportion of elective surgery here in South Australia.

The waste in this department is absolutely deplorable. We have had a massive blowout, of course, in the new Royal Adelaide Hospital, a $640 million blowout. We have had a massive blowout in the EPAS system, which has been presided over by this minister for the last three years, and we have had in excess of $400 million worth of unbudgeted expenditure in just a three-year period. In three years he has managed to blow his own budget by $400 million.

So we know that this is a system which is not working well, and so what is the minister's response to this system which is clearly in crisis? Well, let me tell you sir, this minister is the architect of a disastrous plan, which threatens patient safety, and it is called Transforming Health. What an absolute mess Transforming Health is. I will tell you what it is, sir, it is the closure of three hospitals in South Australia—

Ms Sanderson interjecting:

The SPEAKER: The member for Adelaide is called to order.

Mr MARSHALL: —the Repat, St Margaret's and, of course, the Hampstead Rehabilitation Centre. Three hospitals are closing and emergency department services are being cut across the state. The emergency surgery at Modbury is being closed, and, of course, we have the veiled threat by this minister that he is going to close a further 800 hospital beds in South Australia. He is on the record saying that he thinks that we need to get to the national average in terms of the number of hospital beds per person in this state. That means 840 beds in South Australia will be gone. This would be absolutely catastrophic; but that is the minister's plan. It is already in crisis, and his plan is to make it absolutely worse.

There are a couple of areas that I would like to highlight, where the people of South Australia have absolute critical concern. One is, of course, Hampstead Rehabilitation Centre, and this has been high profile in recent weeks. The government's plan, this minister's plan, is to cram all of the services currently at Hampstead into The Queen Elizabeth Hospital. He has been out on numerous occasions saying that this is the plan of the clinicians. So, lo and behold! Weren't we all shocked and surprised when 11 heads of unit made it clear that they were not even informed about the changes until three months after the department that this minister presides over informed the Public Works Committee. So they had already put the plans in place, and then they told the heads of department; and, guess what? It was not a very good plan.

If you have a look at the absolute avalanche of people who say that this is a poor decision, this minister really has to go. SASMOA agrees that this is a poor plan. Stephen Wade, our shadow health minister in the Legislative Council, agrees that this is a terrible plan.

Members interjecting:

Mr MARSHALL: And hear them scoff! But wait for the next name. The next name is none other than Mark Butler—Mark Butler the federal member for Port Adelaide, the President of the Australian Labor Party. He thinks it is a very bad plan. He is your federal president. He is the Premier's best mate (he was his best man) and he put it in writing, and the reason why he has put it in writing is because it is an absolutely dud plan.

Members interjecting:

The SPEAKER: The member for Mitchell is called to order as is the member for Elder.

Mr MARSHALL: That, of course, is not the only component of Transforming Health which is a dud, but it is one which must be humiliating for this minister. Let's hear what the minister—

The Hon. L.W.K. Bignell interjecting:

The SPEAKER: The Minister for Agriculture is called to order.

Mr MARSHALL: Sir, if you need any further evidence, we have got SASMOA, we have got the doctors, we have got Stephen Wade, we have got Mark Butler. Let's see who else thinks that this is a dud plan. Oh, it's the minister himself! On radio earlier this week, and I quote, sir:

We're trying to fit quite a lot of additional services onto The Queen Elizabeth Hospital site…we'd gone to those clinicians with a plan which hadn't been really well thought through. There were a lot of problems with it. We basically said to those clinicians, 'Look, we can see what you're saying, we're going to go back to the drawing board.'

These are the minister's own comments on his own hopeless Transforming Health plan. Let's hear what SASMOA said only last month about Transforming Health. This is Dr David Pope, President of the South Australian Salaried Medical Officers, and I quote:

What we're seeing is changes which are ill thought out and very destructive and it's destruction which will be very hard to fix. If these changes go ahead, as it looks like they want to, we're looking at 20 to 30 years to rebuild our health system to anything half functional again.

This is what the clinicians are saying. Out at the Modbury emergency department, horrendous problems are identified by the clinicians in that area. Nineteen out of 23 Lyell McEwin emergency physicians say that the government's plan will see their hospital being overloaded. Thirty Modbury doctors wrote an open letter to the minister. Three Modbury Hospital emergency department physicians have now resigned, including the head of the emergency department. He has gone. He does not think it is a very good plan.

Let me tell you what was said right back almost at day one when this was laid on the table by this inept minister. Let me tell you what Patricia Montanaro had to say, because I think she belled the cat when she said: 'This is a real estate deal around closing off the Repat and closing off Hampstead hospital.' That is what the people have to say.

What has this minister's response been to this avalanche of evidence that Transforming Health is going to be bad for the people of South Australia? He persists by telling us all that 95 per cent of clinicians in South Australia support it. It is hard to believe that he could continue to run this line. Let's just have a look at some of the evidence in the past two weeks. Yesterday alone, the AMA put out their survey:

Sixty-one per cent of doctors do not believe Transforming Health will provide better care for patients. In fact, less than 10 per cent of those surveyed agreed or strongly agreed that Transforming Health will produce better outcomes for patients.

Less than 10 per cent. These are doctors. These are the most trusted people in our society and they think it is a dud plan. Seventy-one per cent do not believe that they will deliver best care first time for South Australians. A staggering 79 per cent of people felt that the consultation had been poor. What was the minister's response? He said, 'Well, this is dodgy polling. This polling can't be trusted.' Has he put forward any polling to substantiate his claim that 95 per cent of clinicians think that this is a good plan? No, he hasn't.

Members interjecting:

The SPEAKER: The member for Kavel is called to order and the Treasurer is warned.

Mr MARSHALL: He hasn't put it forward, because it doesn't exist, because he is just making it up. There is no such support for Transforming Health in South Australia. Everybody knows that it is a dud. Only the week before, we had another survey which came out, this time from the Royal College of Surgeons. They had a staggering '84 per cent of surgeons do not support the implementation of Transforming Health, and more than two-thirds regard the plan as a risk to patient safety', yet this is a minister who persists with it.

This is a minister who persists with closing the Repat after the Labor Party went out very strongly—the former premier of South Australia went out and said, 'It will never, ever close. The Repat will never ever close.' The former minister for health said, 'It would be ridiculous to suggest that it would actually close.' Minister Snelling himself in 2013 said:

SA Health is dedicated to maintaining the same high level of care that veterans and the local community have come to expect from the Repatriation General Hospital both now and into the future.

That was in July 2013, but let me tell you what happened.

Ms Chapman: Just before the election.

Mr MARSHALL: Straight after the by-elections in Fisher and Davenport, this minister decided that this site was going to be flogged off and, let me tell you, once it is gone, it is gone. It is absolutely reprehensible that this minister, a former minister for veterans' affairs, would do it in this centenary of ANZAC year.

The minister has shown that he cannot manage public health in South Australia. His Transforming Health plan is a train wreck, which will cause irreparable damage to the health system and to the confidence of South Australians in our public health system. If the minister won't be open and transparent with the people of South Australia, he has no right to the continuing confidence of this house. The public and clinicians have lost confidence in this minister, and now it is time for him to go. I urge the house to support the motion.

The Hon. J.W. WEATHERILL (Cheltenham—Premier) (14:19): The Minister for Health enjoys my full confidence and should enjoy the full confidence of every single member of this house. He has courageously committed himself to dealing with one of the most important areas of public policy in our state that is confronting our state at the moment.

Mr Pisoni interjecting:

The SPEAKER: The member for Unley is called to order.

The Hon. J.W. WEATHERILL: He has designed an intelligent way of dealing with that system, and he has exercised great integrity in the way in which he has conducted that process.

Members interjecting:

The SPEAKER: The leader, the deputy leader and the member for Hartley are called to order.

The Hon. J.W. WEATHERILL: The reason why it takes courage to grapple with this great question of reform of our healthcare system is that you need to speak honestly to the people of South Australia about the challenges that face us. Every single intelligent commentator who has looked at our healthcare systems around the nation understands that they are growing at a rate which is overwhelming every state and territory government's finances.

Dr McFetridge: Fourteen years you have been here—fourteen years.

The SPEAKER: The member for Morphett is called to order.

The Hon. J.W. WEATHERILL: Every single state and territory government, Labor or Liberal, has reached the same conclusion, and that is because of the obvious reasons associated with our ageing population and the technological changes that are meaning we can do many wonderful things to sustain people in their health and wellbeing.

Mr Tarzia interjecting:

The SPEAKER: The member for Hartley is warned.

The Hon. J.W. WEATHERILL: Over the last 14 years, as we have rebuilt every single public hospital in this state, as we have allocated—

Mr Whetstone interjecting:

The SPEAKER: The member for Chaffey is called to order.

The Hon. J.W. WEATHERILL: —as we have allocated more resources into this system than any other state and territory per capita, as we have now gone through and rebuilt much of the destruction that occurred from the previous government, we have now turned our attention to the biggest challenge facing our state, which has been made more acute—

Mr Tarzia interjecting:

The SPEAKER: The member for Hartley is warned a second and final time.

The Hon. J.W. WEATHERILL: Mr Speaker, we listened to the Leader of the Opposition in complete silence.

Mr Gardner: Your own Treasurer was warned.

The SPEAKER: The member for Morialta is called to order.

The Hon. J.W. WEATHERILL: We have decided to tackle the single biggest challenge that exists within the healthcare system, the single biggest challenge to the public finances of the state, and that is the reconfiguration of the public hospital system. What that needs to be contrasted with is the approach that has been taken by those opposite. Instead of actually accepting, as every intelligent commentator accepts, that this is the real challenge, they want to pretend that by reducing bureaucracy, by somehow trimming and cutting, by pointing the finger at some nameless bureaucrats, somehow that is going to solve the challenges we face in our healthcare system.

The problem is that it lacks honesty and it lacks the courage that this Minister for Health has had to identify the real problem. On the basis of evidence and facts, he has identified that we have a system that not only is one that is expensive and difficult to run and is overwhelming our finances, but is one which is not delivering the best health care to our citizens.

He has bravely and courageously put that material on the public record, including material about the fact that there are deaths that could be avoided in our system as a consequence of the way in which it is presently configured. Now, that requires courage—the sort of courage which is sadly missing on the other side of the chamber. The way he has also approached this system is to design a system of reform which is also intelligent—

Members interjecting:

The Hon. J.W. WEATHERILL: —one which is—

The SPEAKER: Premier, just a minute. The Leader of the Opposition was not subjected to a barrage such as the Premier is being subjected to in this debate. I call to order the members for Davenport and Mount Gambier. I warn the members for Morphett, Mount Gambier and Morialta and the leader, and I warn for the second and final time the leader and the members for Chaffey and Morphett. Premier.

The Hon. J.W. WEATHERILL: The Transforming Health process began in June 2014 with clinical engagement committees. It then led to the Transforming Health discussion paper and consultation process between October and November 2014, with a substantial discussion paper which engaged 5,000 community members. It then led to the Transforming Health summit on 28 November 2014. It then led to the Delivering Transforming Health proposals paper in the early part of 2015 and culminated in Delivering Transforming Health—Our Next Steps, which was delivered on 17 March 2015.

That process, that decision to construct a process of engagement with the South Australian community, treated the community with respect. It sought to put before them facts and materials so that they could engage in a process and an intelligent discussion where they set aside their first thoughts and kneejerk reactions and were given a greater understanding so that they could reach a wise judgement together with us.

Because the truth is, it would not matter who was sitting on this side of the house; they would be grappling with precisely the same questions as the one we are grappling with today. Instead of just papering it over and waiting for the next guys to come in, this minister had the courage and intelligence to design a process that treated the people of South Australia as though they were intelligent, took them into his confidence—

Members interjecting:

The SPEAKER: The members for Mount Gambier and Morialta are warned for the second and final time.

The Hon. J.W. WEATHERILL: —and exposed himself and this government to the political risks associated with talking about difficult things that involve change. Contrast that, Mr Speaker, with what we saw emerge from the Leader of the Opposition just a few days ago with the so-called 2036 proposition.

The Hon. P. Caica interjecting:

The SPEAKER: The member for Colton is called to order.

The Hon. J.W. WEATHERILL: I will give you some of the highlights which were taken from this paper as they are relevant to Health. These are some of the quotes.

Members interjecting:

The Hon. J.W. WEATHERILL: Listen, this is your work, you would be proud of it:

It in our own best interests to stay out of hospital.

Penetrating.

Hospital care is very expensive.

Genius! And my favourite:

The infrastructure we will need in the coming decades is significantly different to what we required 100 years ago.

How can you compete with that? What we are really dealing with at the moment is that, as we go out with these very contentious proposals like amalgamating services and closing much-loved services, the people who have come to rely upon these services and clinicians who have come to enjoy their local surroundings and are very proud of the services they provide, when we ask them to disrupt those services in the interests of producing better outcomes for patients, that causes grief and concern. That is the sort of thing that those opposite are tapping into, and tapping into in the most shameless way.

I remind this house of the way in which the Hon. Stephen Wade took the death of a person at the Noarlunga Hospital and suggested that they had died as a result of not receiving proper care at that hospital and that they had been delayed in having them transferred to the Flinders Medical Centre. He reasoned that that was why Transforming Health should not be supported. This is the letter that came from the son of that deceased person:

Minister,

You may recall the incident [that] occurred [on August 22 2014] when my mother died suddenly at the Noarlunga Hospital.

At that time Mr Wade, the Opposition Health [spokesperson] obtained or received confidential information from her personal medical records which he used to create a false allegation that she had died as a result of not receiving proper care at the hospital.

I note with interest that Mr Wade is now seeking to criminalize the conduct that he sought to benefit from in 2014.

So, here we have a Leader of the Opposition who is prepared to permit those standards that apply to his shadow minister. If there is any lack of confidence that should be expressed in any health spokesperson in this state, it should be in the Leader of the Opposition's health spokesperson. It reflects on the integrity of the Leader of the Opposition that he permits the man to stay in that position.

That is what has characterised—and I want an extra couple of minutes—the way in which they have prosecuted their case against Transforming Health. They have prosecuted their case against Transforming Health by scaring people and by treating people as having a lack of intelligence and a lack of a capacity to engage in this debate.

Mr Speaker, I do crave your indulgence, because I was sorely interrupted for at least two minutes. This is not a debate about confidence in the health minister. This fundamentally is a debate about whether those opposite have confidence in the Leader of the Opposition. There is absolutely no—

Members interjecting:

The SPEAKER: The member for Unley is warned.

The Hon. J.W. WEATHERILL: Mr Speaker, as those opposite contemplate the possibility of 20 years in opposition, and they realise they are putting all of their faith in one man sitting over there, they would be wondering to themselves—

Members interjecting:

The Hon. J.W. WEATHERILL: They would be wondering to themselves, 'Is it going to be a rerun? Are we going to get—'

Mr van Holst Pellekaan: Did you run out of good things to say about Jack?

The Hon. J.W. WEATHERILL: Interviewing for the top job. They will be wondering to themselves whether the Leader of the Opposition is going to swallow his tongue on day one of the campaign and forget who he is voting for on day 28. They will be wondering about that, Mr Speaker, and as those Liberal staffers are crowding around in some small bar around Adelaide, tweeting #SackJack they must be full of fear when they see Labor staffers tweeting back #KeepSteven. They must be full of fear. I ask all members of this house to reject this ridiculous motion.

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (14:31): I rise to speak on this motion. The most disturbing contribution from the Premier to date is to assert to this house that his minister, in whom he claims he has confidence, has been courageous and brave, has acted with integrity over the last three years, and has overseen his department with confidence.

Let me say this: for a minister who even developed and announced the Transforming Health proposal after the last state election, without telling the people of South Australia what he intended to do, is defective as it is, and it totally underrides what the Premier has just said. That is the act of a coward, not a brave person. That is an act of a coward.

If he wants to have any mantle of integrity, honesty, competence or diligence, he needs to tell the people of South Australia what he is going to spend their money on, how he is going to spend it, when he is going to deliver it and what he is going to deliver, and actually be honest with them before the election, not six months later. That is the act of a coward.

But that is not the only reason I support this motion. This government, in 2011, signed a contract with the consortium SAHP to do three things: one was to build and design a hospital, the second was to maintain that new hospital for a period of 35 years, and the third was to provide non-clinical support services with it.

The SPEAKER: Can I interrupt the deputy leader. On many occasions, 'coward' has been ruled unparliamentary language. It is not for the minister to object; it is for me to object. She will withdraw it and apologise for it.

Ms CHAPMAN: I withdraw and apologise, sir, if any statement I have made was to indicate that I was calling a specific person a coward. I was referring to what the qualifications were for being a coward in light of what the Premier had said. But, in any event, I withdraw and apologise.

That is the contract that was signed, and that is what was entered into. What has happened is that it has now been marred—irrespective of the merits of building this hospital in the first place—with complete reckless mismanagement and incompetent supervision by the Minister for Health.

Let me just identify four things which are key to this: the time frame, the project cost, the services and build that we get, and finally, what has happened onsite. We have a project which was originally promised, from the time of that contract, on 19 January 2016. We then had a situation where in mid-2014, with the denial by the minister that there was any delay—ultimately, by September 2015 we have an admission that we are going into April 2016.

More recently, we have had reports from independent supervisors of this project who are now describing the whole project as being in a 'distressed state' having delayed the project to 25 May this year, and now we face the situation where it is yet to be confirmed, but by the minister in his own statements in the public arena has been talking about early 2017.

If we get this hospital in 2017, 10 years after it was announced—10 years after it was announced—when other states have been building one, two, sometimes three new hospitals in their states all around the country we are going to get one hospital, if we are lucky, and close three. That is the result.

As to the project leadership, who has been sitting side by side with the minister during this period of the last three years and particularly in just the last 12 months? We have seen CEOs come and go, etc. Some people will remember Mr David Panter. He was brought her from the UK. He was supposed to be the alleged expert to build the St Bartholomew's Hospital in London. He was going to be the man who was going to be the absolute expert that we were going to need—great new model of care, etc., etc. He has disappeared. He has gone. He is out of the picture. He disappeared early last year.

We then had Andrew Nielsen the program director. He lasted eight months; he left in March 2015. We had Judith Carr, the project manager, she left in April this year. Another one bites the dust! We have got a nurse, I think, from Canada, who is now a nurse administrator, who is going to be taking this poison chalice to try to manage this project.

We have got a whole stream of people who are just like frogs leaping off a log. They are fleeing the scene of the crime. They do not want to be sitting with the minister, Premier, and you ought to be taking note that it is not just us criticising the situation that prevails: their own people who are working in the high levels of the department are abandoning ship.

With respect to the project cost, people will remember the very embarrassing publication last year when this was identified in a national survey by an international company to be the third most costly building in the world. On dollars per capita per square of the build it is the third most expensive building in the world. It may not be anymore. I do not know. It might be more now; it might be higher up the list. But that ought to have been a shining example to the government that clearly there was some serious mismanagement in this project.

In June 2007 the then Labor government promised a new NRAH to build at $1.7 million. I wrote to the Premier after the 2010 election in late 2011 after he became Premier, as were others, calling for an abandonment of this complete folly. He wrote back to me a very interesting letter, and in it he said:

The new RAH and the associated maintenance and services provided under this contract is affordable for our state. The design and construction costs will be $1.85 billion plus $244.7 million and associated state costs etc…This will bring a total cost to $2.09 billion.

He dropped off $4.7 million, but who cares—$4.7 million, who cares, it's pocket money. He goes on to promote the project indicating that the only thing that is different, of course, from the $1.7 million in 2007 is because they had not actually added in the project risk costs. Oh, well, and why do you do that? That would not be terribly responsible. Then he goes on to say:

We will not pay a cent to the private partner until the new RAH opens in 2016 and from then the annual payments will be an average of $397 million per year…

That is what we got to by the beginning of 2012. Jump forward to now. We are in a situation where this project is costing some $640 million more than what was originally announced. I mean, how can you get all that just so wrong? Can't these people add up? They have got a Treasurer. The Premier and the Minister for Health have both been former treasurers of this state and they cannot even get it right. I mean, this is just impossible.

It is like the Premier woke up and thought, 'I'm going to be like Joseph Kennedy when he was asked what he would do to make JFK the President of the United States.' Joseph Kennedy said, 'I will do whatever it takes and not a penny less.' They are going to build this hospital and they do not give a toss what it is going to cost. It does not matter what it is going to cost. It is not their money: it is the people of South Australia's money. They are going to pay. They are going build their little Taj Mahal and that's it. As for services, for all that money we are going to get 50 more beds in the new Royal Adelaide Hospital than we had in the old Royal Adelaide Hospital.

Back in 2007 when they announced this, there were 1,000 beds under the Royal Adelaide Hospital website, 150 of which were at the rehabilitation centre at Hampstead with 850 on North Terrace. We are going from an 850-bed hospital actually down to a 700-bed hospital. We are going to pay billions of dollars for that purpose. Unlike the minister's claim in 2014 that all existing services would be retained, we now know that gynaecological and pain services will be lost at the new RAH. Twelve of the ICU beds are not even going to open on time, whenever that might be.

As to the build itself, we have this absolutely bizarre situation of the steel issue. Whyalla township is on its knees. It is not a side issue: it is a very important financial issue for the state, but the government, when asked questions about the composition of foreign steel on this particular government project, says, 'We don't know; we can't tell you. We haven't kept a record of it; we didn't need to keep a record of it.'

What if there is some structural defect in this steel? How are we going to know who to sue? How are we going to know who is going to be required to make the payments? We need to have some level of audit. Wouldn't that be basic to have audited that?

One alarming thing that has at least been allowed out from under the secret cloud of this development is to tell us that we do not have walls or floors strong enough, a structure strong enough, to be able to hold the patient records and the filing cabinets that hold them. I mean, what is going on down there in the Department for Health and under the minister's watch?

Finally, can I say this: a most disturbing aspect is that the government has been in conflict with the consortium. They are now taking them to court. It arises out of the deaths of two workers on that site who either were operating or were on scissor lifts. That is disturbing enough . What is of great concern is that the government is now in legal proceedings again with the consortium. These are the people they are supposed to be in partnership with for the next 35 years. It is a disgrace.

Ms COOK (Fisher) (14:42): I rise today as a politician but actually also as a clinician. I have been a nurse for 30 years and there are a couple of things I need to say and get off my chest. One is that I have never seen such appalling behaviour in the community as I have seen sitting here watching some of you people. It is a bit rich for the member for Bright to come out and criticise hardworking public servants and then to watch the behaviour here; it is absolutely disgusting. I think everybody needs to learn from what is the most trusted profession in this country and that is nurses.

Members interjecting:

Ms COOK: That is nurses. For 20 years, nurses have been the most trusted profession in this country; in fact, last year it increased. Health care is one of the most diverse and challenging but also one of the most progressive sectors that the government has to oversee. It's challenging, it's difficult—

Members interjecting:

Ms COOK: —and it's constantly changing.

Members interjecting:

The SPEAKER: The deputy leader received very little in the way of interjections from the other side. I would like the opposition to extend the same courtesy to the member for Fisher. Member for Fisher.

Ms COOK: Thank you, sir. Health care is constantly changing. I have worked in a mixed role in clinical and hospital management since the early 1990s and I know too well that there have been changes going on every single day in terms of how we deliver and manage health care. For the last 10 years, there has been an absolutely exponential increase in the demands and the challenges facing our healthcare workers because of other social problems—

Mr Bell interjecting:

Ms COOK: —and because of other pressures placed on them not just by the state government—

Mr Bell interjecting:

Ms COOK: —and the opposition but by the federal government.

Members interjecting:

The SPEAKER: If the member for Mount Gambier makes another utterance in this debate outside standing orders, he will leave us. Member for Fisher.

Ms COOK: What nurses and other clinicians do—and that is right, it is not just doctors who make up clinicians in our healthcare system: it is nurses, it is allied health professionals, it is paramedics—is work together collaboratively as a multidisciplinary team on a daily basis to face the challenges placed upon them by the demands of the healthcare system. Every criticism fired from this place towards the healthcare system hits nurses, allied health professionals—

Members interjecting:

The SPEAKER: The member for Hammond is called to order and warned; the member for Davenport is warned for the first time; and the member for Hartley is warned for the second and final time. Member for Fisher.

Ms COOK: Every criticism fired from within these walls hits health professionals, including nurses, hard-working physiotherapists—

Members interjecting:

Ms COOK: I do not expect people opposite to understand, because they have not worked in the system, and they have not seen the heartbreak that health professionals face on a daily basis. It hits them between—

Members interjecting:

The SPEAKER: The deputy leader is warned and the member for Finniss is called to order.

Ms COOK: It hits them between the eyes, and it offends them deeply and personally, because everything they do, they take personally with absolute commitment and courage on a daily basis.

Mr Pengilly interjecting:

The SPEAKER: The member for Finniss is warned.

Ms COOK: In the early nineties, I participated in what was one of the biggest reviews of rehabilitation and healthcare services in this state. I sat opposite Dean Brown in an office to be informed that the care being delivered at Julia Farr services needed to change. It was care that we were delivering to the brain injury patients of South Australia in what we considered to be world-class conditions, and under a Liberal government, those changes were driven, and the nurses ran with them without complaint but with a lot of heartache.

We were told by the public that we would never achieve the world-class rehabilitation standards outside of that setting; we were told by people that the way that it already was, was how it should stay; we were told to fight; but we kept going, we kept moving and, over a transitional period lasting half a decade, the brain injury services moved to Hampstead Centre and there they have replicated what is excellent healthcare.

This is change; this is what happens: it is consultation; it is communication. Transforming Health did not start last year; it started with lean thinking principles; it started a decade ago. It is been happening every year, and I have stood with my clinician friends and with my colleagues as we have been devastated by the challenges faced by us, and we have continued to move forward and we have done it, and we have achieved best outcomes for patients, and that is what the healthcare services in South Australia will continue to do.

The important thing is that we have stable and solid leadership. We have consistent support from within parliament. We have had two leaders in this party in the last 20 years. That is stable, that is solid leadership. We have had a health minister in place for three years, pulling this together from the top. It is not the minister who is making up these changes in Transforming Health; he is being guided by healthcare professionals and clinicians. I have been absolutely relentless in my challenging of every single step of Transforming Health. I have lost count of the hundreds of emails I have sent to the minister, and I have lost count of the number of times I have asked him to back up—

Mr van Holst Pellekaan interjecting:

The SPEAKER: The member for Stuart is called to order.

Ms COOK: I have lost count of the number of times I have asked him to back up and validate the evidence that has been put in front of us. I have challenged numerous parts of Transforming Health. I have taken the answers back, the discussions back. Whether I personally like them or not, I have been very open and very frank about that, and I have taken that back to hundreds of clinicians who, every time you criticise the healthcare system, you shoot between the eyes.

Mr Bell interjecting:

The SPEAKER: Is the member for Mount Gambier interjecting or is he talking to himself?

An honourable member: He's talking to himself.

The SPEAKER: He is talking to himself? Good, I am reassured. Member for Fisher.

Ms COOK: If anybody in this place denies that every person in South Australia is entitled to access to the best possible health care from the best people in the best facilities, then they are kidding themselves; they are not serving their people properly. What the minister has done here is maintain this consistent approach with us, with firm leadership.

We have consulted with our people, and we have taken the answers back to the minister. I support him in the work of rolling out Transforming Health, leading our healthcare system, which is one of the most challenging and yet one of the most rewarding parts of our government. I am proud to be here representing the clinicians whom I call my friends and I call my colleagues. I totally oppose the motion.

Mr KNOLL (Schubert) (14:50): If the member for Fisher was so confident in Transforming Health why did she not take it to the people of Fisher in the by-election we had last year? If the member for Fisher is so confident that the Labor Party looks after nurses and front-line staff, why is it that whilst we have had a 43 per cent increase in nursing staff over 10 years we have had a 158 per cent increase in health bureaucrats over the same period? Talk is one thing, but actions show a completely different truth.

Today, we are talking about a motion of no confidence in the minister. Our Westminster system of government demands that ministers are accountable for the actions of their department when implementing government policy. With power must come accountability. In the minister's hands a decision is made, and so responsibility must also be placed. With a few noble exceptions we have seen this principle erode in recent times, and honour and pride give way to self-interest and self-preservation.

I take no joy in what we are doing here today, but in using the parliament to try to revive this important principle we seek to restore the public's confidence in our embattled health ministry. Not only has the minister presided over the pitiful execution of a flawed strategy, as has been previously highlighted, he has also wasted criminal amounts of money in the process. For every cent wasted, that is one cent less that can be spent on relieving people's pain or relieving someone's illness.

In a state with an ageing population, the proper management of the health budget is one of the government's most fundamental and important tasks, and failure in this regard speaks to a wider incompetence. This incompetence is manifest in the Enterprise Patient Administration System, or EPAS. Originally billed at $220 million, covering all hospitals, it has now cost South Australians an extra $230 million and it covers only three hospitals—only covers three hospitals. More galling than that is that one medical officer described it as something that has clearly not been designed for improving patient care; it seems likely it has been designed for increasing revenue.

We see the much vaunted new Royal Adelaide Hospital, first proposed as a $1.7 billion project now costing an extra $644 million, as well as potentially being delivered over a year late. Think of the number of knee replacements and cataract surgical procedures. We could take an axe to our waiting lists here in South Australia with that billion dollars of funding unlocked.

We hear the rhetoric of the member for Fisher about frontline health service numbers, but it is the extra 1,200 bureaucrats that she failed to mention—1,200 bureaucrats extra over the last decade. This fact is compounded by comments from the South Australian Salaried Medical Officers Association when they say that one of the challenges they face daily as employees is the ever increasing need to fight the bureaucracy of SA Health over a relentless stream of new bureaucratic processes and controls over doctors that have the effect of undermining care and the doctors' ability to provide efficient and safe care to patients.

So, we can sit here and talk about nurses all day long, but nurses are nowhere near the problem: they are the backbone of our health system. It is the ones sitting in the back offices that are making it hard for them to do their job. Just today, we see that after six years the state's biggest department, the Department for Health and Ageing, still does not have a gift register. At a time when public cynicism in our political system is at an all-time high, this basic failure of administration is inexcusable.

Whether it is the new Royal Adelaide Hospital debacle, EPAS, the Oracle procurement system and the debacle down at Camden Park, the Repat Hospital closure, downgrades at TQEH and Modbury, SA Pathology cover-ups, patient record breaches, the failure to institute a gift register, the fabled 'ambus' or the closure of Hampstead and St Margaret's, everything this minister touches fails. But perhaps what is most scary is what is potentially still to come because, if this minister is willing to butcher metropolitan hospitals in this way, think about what he is going to do to Country Health when it comes to the country in South Australia.

When the member for Light was a minister undertaking reform, he lost the confidence of his sector. He lost the ability to bring people with him on the reform journey, and he did the right thing and he resigned. What we are seeing now is that the same thing is happening with the Minister for Health: he has lost the confidence of the majority of the sector; he has lost the confidence, most importantly, of the public.

This is a minister who has run out of followers and, as the saying goes, a leader without followers is just some guy taking a walk. It is time for the Minister for Health to do that. It is time for him to take a walk, restore confidence in the public health system here in South Australia and resign.

The Hon. S.C. MULLIGHAN (Lee—Minister for Transport and Infrastructure, Minister for Housing and Urban Development) (14:56): After that contribution, you would really think some of these right-wing backbenchers should be on the front bench on that other side. I rise to speak against this motion and I rise to speak in favour of better services for our community in the western suburbs. I have been very concerned to ensure, in the time that I have been both a resident and a candidate, as well as a member of parliament representing our community in the western suburbs, that we receive the best possible services, whether it is in health, education, policing or other areas of government responsibility.

These are challenging times in managing these services across our communities. These are challenging times because we know what—

Mr Williams: Only because you are incompetent.

The SPEAKER: The member for MacKillop is called to order.

The Hon. S.C. MULLIGHAN: —the challenge is in health: we have increasing demands from our population; we have more and more presentations to hospital; we have an ageing population presenting with more complex and more expensive ailments to treat; and we also have more complex, more advanced and more expensive treatments to deal with those ailments.

We thought we were making some progress when, under the former federal Labor government, we reached a landmark funding arrangement where we would have more money invested from the commonwealth government to all states and territories, to help all states deal with those sorts of challenges that I have just outlined. But, of course, we have had a complete revocation of that commitment from the current federal government.

While we have had a few handfuls of change thrown at the states in the recent arrangement from the latest COAG deal, we are still left with a fundamental problem. But I am glad to say that there are some federal members of parliament who realise how serious and how important this challenge is across all of our states. I speak of the federal member for Hume, Mr Angus Taylor, an assistant minister in the current Turnbull Coalition government, who has singled out South Australia as being a state with the confidence and the courage to address this problem, to engage in the hard, difficult policy reform to ensure that we are delivering the best possible health services we can, within the constraints that I have just outlined.

When it comes a little closer to home, when we are talking about the western suburbs, people would understand that we are a little reticent when it comes to changes in the health services which are being provided to our community. The best example is the revocation of palliative care beds from the Philip Kennedy Centre by Southern Cross Care in 2013. When I was a candidate in the lead-up to the state election, with the member for Port Adelaide also in the approach to the 2014 state election, who did we go to to try to have that problem redressed and resolved? We went to Jack Snelling. We went to the Minister for Health. What did he do? He stumped up money in excess of a million dollars to try to convince that non-government organisation to continue providing quality health services—

Mr Pisoni interjecting:

The SPEAKER: The member for Unley is warned for the second and final time.

The Hon. S.C. MULLIGHAN: —to the western suburbs. So, when it comes to form, the Minister for Health does have form. He does have form sticking up for those residents in the western suburbs and delivering better health outcomes to them.

Of course, you can contrast that form with the form of somebody who the opposition leader has held up as a shining light for advocacy and advice in the healthcare system, Stephen Wade—that person who has been caught out time and time again making false claims and misstatements, and disseminating false information to the community and to the media for shallow, base political purposes. He has been caught out, he has been held to account time and time again, and what has been the response from the Leader of the Opposition? Nothing—no expression of leadership, no expression of remorse. There has been no change to the arrangements over—

Mr Marshall interjecting:

The Hon. S.C. MULLIGHAN: You had your chance and you have failed. We know that the Leader of the Opposition was going to move this motion two days ago on Tuesday. That is when it was due. I assume he put it off for two days to give himself an extra 48 hours to polish his speech. Well, he did polish something, and we know how it has turned up. It was a very average performance.

When it comes to Stephen Wade, when he puts out those lies and mistruths to the communities of the western suburbs using the sorts of terminology that the member for Schubert and the deputy leader and leader have already used—'downgrade', 'closure', 'devolution'—we know that that is not true. St Margaret's has not been closed. The emergency department at The Queen Elizabeth Hospital is not being closed. It will still be available 24 hours a day, seven days a week, but that is not in the interests of the Liberal Party. Those sorts of facts are not in the interests of the Liberal Party. They are interested in coming into communities and inciting fear and concern for base political purposes.

I am happy to know that those residents, our constituents in the western suburbs, know the form when it comes to health services in the west. They know that it has been a Labor government that has already committed $130 million into The Queen Elizabeth Hospital, the construction of a 200-bed inpatient facility, the construction of a three-level inpatient building with 72 beds, and a new 20-bed older-patient mental health facility.

When we learnt that there were changes afoot in Transforming Health across a metropolitan area, of course we asked the question: what will be happening to The Queen Elizabeth Hospital? An extra $22 million of expenditure. We still have the Minister for Health and his department down in the western suburbs talking to allied health professionals, talking to clinicians, making sure those changes will lead to better services and better patient outcomes for our constituents, continuing the good form that the health minister has in sticking up for residents in the western suburbs.

Of course, this debate is not just a reflection or an attempted reflection on the Minister for Health: it is a reflection, as we have already seen, on the Leader of the Opposition. What have we seen in recent weeks? We had a shambolic last couple of weeks of sitting. We had Mr Ridgway in the other place freelancing on the planning bill and, most recently, we had Mr McLachlan in the other place saying on all of that effort that we put in for police, all of that effort that we put into making sure bikies do not peddle drugs and do not deal guns throughout our community, we should back off on that, and we should go soft on bikies.

What did the Leader of the Opposition do? He did nothing, but I am glad to say someone did do something. The member for Stuart went into the media and advocated for a crackdown on firearms. That is what leadership is. That is what somebody with some guts and some gall and some conviction would do for a political party—set the record straight and give the people of South Australia some confidence that they could have a leader of a political party with some talent and some conviction.

Unfortunately, we are not stuck with that. We are stuck with a leader whose greatest contribution to the body politic of this state is having a soy-green Frappuccino named after him in an inner-eastern suburbs café. And congratulations—because you can wave around your 85-page vacuous document (that is what the Leader of the Opposition does) but it is so lightweight that if you dropped it onto the carpet, it would make less noise than cotton wool touching felt.

He is a complete lightweight. No policy leadership in health, no policy leadership across his backbench, and his speech today has shown this for nothing but what it is: a vacuous, shallow attempt at political grandstanding. I would urge members to vote against this motion.

The house divided on the motion:

Ayes 19

Noes 23

Majority 4

Motion thus negatived.