Motions

Repatriation General Hospital

Dr McFETRIDGE (Morphett) (11:38): I move:

That this House urges the Weatherill Labor Government to immediately reverse the disastrous decision to close the Repatriation General Hospital at Daw Park; and to—

(a) ensure it continues as a vital medical precinct for residents in the Southern Suburbs;

(b) ensure South Australian veterans have a dedicated hospital which supports their unique needs and provides them with a caring and sympathetic environment;

(c) recognise the significant contribution to our nation by veterans;

(d) provide seniors with quality and accessible health care; and

(e) preserve the special care provided to patients approaching death at the Daw Park Hospice.

This is all about maintaining and retaining that wonderful veterans' hospital, the Repat. What is a hospital worth? Well, if you build one down the road down here, it is the most expensive hospital in the world, the third most expensive building in the world. What is the Repat worth? The Repat is a spiritual home of our veterans. We know that, with the changes in veterans' affairs, the Gold card and the White card, things have changed. We do know now that veterans are attending a lot of private hospitals, thanks to the federal government.

We do know that the buildings at the Repat are tired. They do need refurbishing. This government has spent $42 million on the Repat in the last 10 years. What is that hospital worth on the books? What is the Treasurer going to say to this house when the bulldozers go through that place? When the bulldozers go through the Royal Adelaide down here, what is that worth on the books now? They are bulldozing billions of dollars of state assets now and what for? With the Repat, we have a long history at the Repat.

On the SA Health website today, it says that the Repat General Hospital is a 250-bed acute public care hospital, specialising in the care of war veterans. Then it lists those veterans' guarantees, about which I have spoken in this place many times, including the complimentary cappuccino. You will never, ever replicate that anywhere else. I know there is a veterans' health discussion paper out there. It will never, ever replace what that veterans' guarantee has in place.

The 250 acute beds, where are they going? I think there is a net loss of about 510 beds. We cannot afford to lose any beds in South Australia. Yet, under this government's Transforming Health we are not only going to lose beds but we are going to go to the national average which will mean that about 650 acute beds will be lost from our system. If you look at the calculations that are being used to calculate numbers of beds and staffing used by the Australian Institute of Health and Welfare, if we reduce our number of beds, then what happens? You reduce the number of doctors by about 130 and you reduce the nurses by 500; 500 nurses in this state will lose their jobs as a result of this government's intention to transform our health system.

What are they transforming it into? An absolute mess. They have been there 14 years and they are transforming it into an absolute disaster for South Australians of the future. We know South Australians are dying in our hospitals because they are waiting in EDs longer than they should, not because of our doctors, certainly not because of our nurses, but because the system is not working properly—and that is from the Australasian College of Emergency Medicine.

Let's read what was in today's paper in an opinion piece by Emeritus Specialist Robert Black, a specialist at the Repat, President of the Mitcham RAAF Association and a past president of Adelaide Legacy. I know Robert from my veterans' affairs portfolio. Robert says in the paper today:

The announcement that the site of the Repatriation General Hospital (RGH) Daw Park is to be developed by a consortium including the RSL has been greeted with mixed feelings. While the return to a veteran home focus is welcome, the loss of a capacity for thousands of community health services, associated with projected closure of the Repat, is not. Nor is there any logical reason to cease veterans' mental health services, either as outpatients or in Ward 17.

The proposed move to Glenside was justified on the grounds that: (1) health services would not continue at Daw Park (they will); (2) the PTSD Centre of Excellence needed to be on government-owned land (not so interstate); and (3) veteran comorbidities needed to be provided onsite (they are not, but they are at Daw Park, and could be in the future).

Dr Black continues:

Repatriation hospital services have changed over the past century. Until the 1970s, veterans had free hospital care at RGHs only for their 'entitlements'—that is, for those conditions related to (war) service. In the past 20 years those 'entitlements', in the form of the Gold or White Card, have drawn veterans away from RGH into the private-health sphere, due to market forces. The proportion of veteran inpatients at RGH Daw Park has dwindled, and community patients have predominated. Thus closure of the Repat is not so much a disaster for veterans as a disaster for community health services, and for its diligent and caring staff—

including the nurses—

Yet veterans with mental health conditions such as PTSD have ensured that they are sent to Daw Park, and admitted to Ward 17, despite these market forces. Not just Vietnam and World War II veterans, but younger, so-called 'contemporary veterans' are occupying those beds. And Daw Park has been their safe haven. Even if they like it better at Glenside, there will be fewer beds.

Furthermore, it would seem that comorbidities will not be managed at Glenside—so sick older veterans with mental health disorders may be shunted elsewhere, to new RAH or to private hospitals. The RSL plan includes acute and mental health services, and will provide shelter for homeless veterans, the most vulnerable among those who have served our nation. But if they need inpatient psychiatric management rather than being treated onsite or at FMC, they will require a DVA-funded taxi or ambulance to get treatment at Glenside or elsewhere. As the RSL and veterans plan to return to Daw Park, the illogical decision to close its health services, and to shift the PTSD unit to Glenside, should be reviewed, and preferably reversed.

That is by Emeritus Specialist Robert Black. It is a disaster that that is actually happening. What we do need to recognise is that the veterans in South Australia deserve better than they are getting from this government.

Just as importantly, for the purposes of the Repatriation Hospital, the broader community in South Australia is going to be missing out. You cannot close that facility, you cannot move those 3,500 arthroplasties and neurological surgical procedures somewhere else without having some effect. The 170,000 outpatient appointments, where are they going to go? This government in its Transforming Health policy is creating a massive crisis in health for this state. We see people waiting in our hospitals day in, day out. They are waiting to get in, they are waiting to get out.

We see our nurses working harder every day. We see our doctors struggling under the load. We know that our patients are wanting the best service they can possibly get and we know that our doctors and our nurses want to deliver that service. If we close facilities like the Repat, we cannot ensure that that is going to happen. I do not see any guarantee from this government that Transforming Health and transforming the Repat into what the RSL is proposing is going to do anything other than inhibit the delivery of those health services in South Australia. This is a very sad thing; this is a very bad move for this state. I ask the government to rethink this now.

We would be more than happy to work in a bipartisan way on this site to make sure that we deliver long-term solutions for long-term problems in this place because we know that people in our health services, whether they are in the private sector or the public sector or whether they are volunteers, are working their backsides off. They are absolutely working their backsides off to make sure that they are delivering the best that they can under these trying circumstances. Let's not make it any more difficult. Let's remember the veterans; let's remember the Repat. Lest we forget.

The Hon. M.L.J. HAMILTON-SMITH (Waite—Minister for Investment and Trade, Minister for Small Business, Minister for Defence Industries, Minister for Veterans' Affairs) (11:45): This is an interesting motion. I am sure that the member has put it forward with the best of intentions, but I just want to straighten a few things out during this debate, as the Minister for Veterans' Affairs but also as one of the local MPs, the member for Waite. Anyone who thinks that we can expect our doctors and nurses to work in very aged and very old facilities indefinitely needs to rethink their position on health. The whole object here is to put our nurses, our doctors and our patients into the very best of facilities.

The government is going to provide a first-class Royal Adelaide Hospital. It will be one of the best hospitals in the world when it opens and it will be first class. The community had that debate about whether we would rebuild the Royal Adelaide Hospital where it was or build a new hospital, and the new hospital argument won that election. In Waite, when someone has a heart attack or a car crash, a serious injury, and is taken to hospital, they do not go to the Repat: they go to the Royal Adelaide or they go to Flinders.

That leads to my next point: there is going to be a great renewal of Flinders, with around $170 million being spent to build new rehab facilities there and many millions more spent on new facilities in other hospitals in the network. That is good for everyone in the community and it is good for our doctors and nurses, but it is also good for veterans, and this is a very important point because if the opposition is arguing that veterans need a dedicated veterans' hospital they are wrong. They need to recognise that the world has moved on.

The Gold card changed everything. When this first came up, I was the newly-elected member for Waite in 1997, and the person who raised it was the Liberal Party health minister Dean Brown. When the Liberal Party decided to privatise Modbury, the other issue on the table was if we should sell or close the Repat? There was a feisty debate in the party room. I was quite concerned about it as a newly elected member because, at that time, nearly 50 per cent of the patients at the Repat were veterans. That figure today is around 7 to 8 per cent; 92 to 93 per cent of veterans are using other hospitals in the network.

In fact, I went to the Tea Tree Gully RSL and they did not want to talk about the Repat, they wanted to talk about Modbury because that is the hospital they use. They have a Gold card and they can use any private or public hospital in the country virtually free of charge, so we need to renew the facilities at hospitals that veterans actually use, and it is not the Repat any longer; it is at other hospitals in the network, including country hospitals where a lot of our veterans live.

It is a flawed argument that veterans need dedicated hospitals; they do not anymore and that is true in most states in Australia. They are important patients, like all others. They have special benefits through gold cards and other devices that quite rightly recognise their service, but they do need renewed rehab facilities and great facilities at The Queen Elizabeth, at Adelaide, at Lyell McEwin, at Flinders and at other hospitals in the broader network. They no longer need a dedicated hospital.

There is one special matter and that is post-traumatic stress and Ward 17. I am very concerned about that. As a veteran myself, I have been there often. It needs renewal. Transforming Health has provided a vehicle for that renewal. Without Transforming Health, I do not think we would have got the $15 million to build a new PTS centre of excellence at all, which is now going to be built at Glenside.

I was looking for advocates to convince me that that should be rebuilt, by the way, at the Repat. I would have been very happy to champion that cause as an Independent member in the Labor government, but I could not find anyone with qualifications, experience or authority in this field to back me up. Every doctor, every senior academic, every senior professional in the field, including, I hasten to add, many of the people who work at Ward 17, generally came to an agreement as part of the consultative process that it should be done at Glenside. It is the best place for the renewed Ward 17.

What we are going to get is a new PTS centre of excellence at Glenside, where it needs to be. Veterans are going to get renewed facilities at the hospitals they are actually using. Services are going to be relocated, not closed, from the Repat to other hospitals in the network. They will be available for all, including general community use. Then we had minister Snelling's terrific announcement on the weekend that the Repat itself was to be renewed and reinvented. Not only will there be a medical practice at the Repat site, but the rehab facilities that are presently there that are generally fairly new and in good condition will, I am certain, be made available to the private health sector as part of the RSL's renewal at the site.

As well as that, the existing private hospital facility at the site is remaining there. That means that veterans who have the Gold card will still be able to access the rehab facilities, the private hospital and the medical centre at the site as they always have. Not only that, the Repat site is to be renewed, refreshed and revived under the RSL's leadership. We are going to see aged and supported accommodation there with, I am sure, veterans having first right of refusal or access to it as a matter of priority. We are going to see childcare centres built there; we are going to see all sorts of other facilities there for veterans, whilst preserving the chapel, the museum, the SPF hall and other things that make it such a special site for veterans.

It is very simple, as a local MP, where you land on these matters. If you land on the side of the politics, you will always land in the mud. If you land on the side of what is best for the people in your community, you will stand on top of the mountain. Let me tell you that the best interests of my community in Mitcham, and the community at large, are served by making sure that, when they have an accident and when they need our outstanding doctors and nurses, they will go to see those wonderful professionals in brand-new state-of-the-art facilities that are ready to receive them, not in buildings that were constructed in the 1940s because somebody thinks no change is a good idea.

We all know that the health system nationally is under pressure. The federal Coalition have a plan: stop funding public health and get the states to increase taxes, charges and emergency services levies to pay for it. I do not think it is a very good plan. They are publicly stating that; it is a fact. We need to properly fund our healthcare system, and it needs to be both federally and state funded.

Mr Whetstone: You are so not a Liberal.

The Hon. M.L.J. HAMILTON-SMITH: It is just a fact, I say to the member for Chaffey. Prime Minister Turnbull said it, along with others, so—

The DEPUTY SPEAKER: Order! I just want to remind members it is unparliamentary to interject or to respond to them, and I will insist that members be heard in silence. The member for Waite.

The Hon. M.L.J. HAMILTON-SMITH: Thank you, Madam Deputy Speaker, for your protection. The overarching point here is what is best for people's health. As the Minister for Health has claimed all along, we need to ensure that our first priority is the best possible health care we can provide. Part of that needs to take account of the resources we have available. Nine hospitals in Adelaide was always too many hospitals. If you were starting with a blank sheet of paper, you would build fewer than nine hospitals, and you would make sure they were large, well equipped, and that our doctors and nurses had everything they needed.

It takes courage to propose change in politics. I have been in this game for 18 years, and I have seen so many ministers on both sides squib and shy away from the tough decisions. Making change is always hard. There is always someone ready to complain. I note that the opposition has done a wonderful job of harnessing a small number of distressed people about the Repat decisions and using them for their political advantage.

Members interjecting:

The Hon. M.L.J. HAMILTON-SMITH: I think you will find that the mainstream veterans community and the mainstream advocates and stakeholders in health are with the government on this issue, particularly after Sunday's announcement. You are on the wrong side of the argument. If you are seriously contending that a future Liberal government will put between $600 million and $1 billion into building a general hospital at the Repat, so that we have Flinders, Lyell McEwin, QEH, the Royal Adelaide and a new general hospital for $600 million to $1 billion at the Repat, if that is what you are contending—because that is what some on your side of the argument have argued—let's see your budget. Let's see what impact that would have on the facilities that we are providing for our doctors and nurses and for our patients at other hospitals in the network.

I simply conclude with this remark: what the government has proposed is the best thing for the mums, the dads, the families and the children in my electorate of Waite. It is the best thing for veterans, because they do not live close to the Repat; they are going to other hospitals in the network. It is the best thing for South Australia. The right thing to do is what the government has proposed. Frankly, I am very surprised that the opposition has been so negative about this instead of proposing a constructive transforming health agenda of their own. You have to have ideas of your own if you are going to criticise.

Time expired.

Debate adjourned on motion of Hon. T.R. Kenyon.