Motions

Transforming Health

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (10:57): I move:

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

(a) the downgrading of the emergency department and intensive care unit services at The Queen Elizabeth Hospital;

(b) the reduction in The Queen Elizabeth Hospital's cardiac services; and

(c) the degradation of the hospital's current services by a lack of proper provision for the transfer of rehabilitation services from the Hampstead Rehabilitation Centre site.

I move that this house expresses its concern at the systematic reduction in acute health services for the people of the western suburbs through the government's Transforming Health program and, in particular, the reference to a number of services that have been abolished, reduced or downgraded at The Queen Elizabeth Hospital.

Let me start by saying that an important area of acute hospital care that has been provided to both our civilian and returned service population for decades now is at the Repatriation General Hospital, which is geographically in the western districts of metropolitan Adelaide. It provides a significant breadth of services, including high care and acute care.

It is of great concern to people on our side of the house that the government has pressed ahead with the intended closure and sale of this site. We have mental health facilities there that were upgraded in the lifetime of this government—the building of Ward 18. The only freestanding Ward 17 left in a repatriation general hospital in Australia is about to be bulldozed, and what facilities will be available will be in a small facility at the back of the Glenside Hospital, which is currently being rebuilt.

This is against and contrary to the recommendations of many in the psychiatric care industry, particularly transferring patients suffering post-traumatic stress to the Glenside site without there being medical services there. We could list a long list of services currently offered at the Repatriation General Hospital for civilians in the western districts, including mental health and, of course, a very highly regarded and well-recognised service for people who lose their limbs and the rehabilitation services that go with prosthetics. I think that is damning enough of this government's decision in its Transforming Health plan to condemn the government in this motion.

However, today I particularly want to address the downgrading and reduction of services at The Queen Elizabeth Hospital. Most members would be familiar with the services provided at this acute-care facility and understand that, in the western part of Adelaide, we have a catchment of 250,000-odd people who will be left with this as their only major acute hospital service within a reasonable location to them.

Of course, we have promises of a new Royal Adelaide Hospital going from one end of North Terrace to the other, whenever that might open. It is already two years late and, I think, about $400 million over budget. Nevertheless, hopefully it will open eventually, but it will cost us $1 million a day and, of course, it will have a very significant reduction in the number of beds available to provide care. I am still of the view that it is the government's clear intention that old people and really sick people will not go to the Royal Adelaide Hospital, that it will be the boutique provision of services for international health tourism, which the government wants to try to make some money from. I am still of that view.

Nevertheless, let's consider what has happened at The Queen Elizabeth Hospital. It was opened in 1954 and it has Her Majesty's title on it. She visited Australia, and South Australia in particular, shortly after her coronation, which I think we should be grateful for. Indeed, I cannot believe that the Deputy Speaker is old enough to have been here to—

The DEPUTY SPEAKER: No, The Queen was here at parliament.

Ms CHAPMAN: Yes, I'm sorry. I will withdraw that.

The DEPUTY SPEAKER: I was alive in 1954, but I was not in South Australia.

Ms CHAPMAN: I am sure you would have still been in nappies, Deputy Speaker, because you could not possibly be that old.

The DEPUTY SPEAKER: And I don't remember that.

Ms CHAPMAN: Obviously, it has developed into a very large number of medical and specialist services and it now employs some 2,500 staff. The hospital deals with over 40,000 emergency presentations every year. Its inpatient admissions are at 36,000 each year and it undertakes some 16,000 surgical procedures each year. It is a high-functioning service in high demand, which obviously deals with the western districts.

Just in the time that I have been here in the parliament, I can recall the former minister for health (the Hon. John Hill) telling this parliament that the provision of services in South Australia for kidney transplants and treatment was world-leading. The professionals and specialists at The Queen Elizabeth Hospital undertook that groundbreaking research and work, which was well recognised.

The minister of the day stood here about 10 years ago and said that we needed to strip that service out of The Queen Elizabeth Hospital, notwithstanding that they were immensely proud of this at their hospital, and rebuild the facility at a cost of $15 million down at the current Royal Adelaide Hospital in the full knowledge that they had already announced that they were going to bulldoze that hospital eventually and build a new one at the other end of North Terrace.

I am still at a complete loss as to why it was necessary for him to come into this parliament and tell us that there needed to be a 'cultural change', whatever that means. It sounds like some sort of penetration into the minds of all the people who were doing kidney transplants. That service had to be taken down and its facilities rebuilt—$15 million utterly wasted. Those facilities will now be bulldozed because the minister decided he needed to have a cultural change in those who were providing this specialty service in that area. It was a beautiful facility. They had special air-conditioning arrangements to reduce germs or toxicity into the area where there were people who were vulnerable to infection after they had kidney transplants and the like. Nevertheless, that is what they did.

I also remember going down to the opening of a beautiful new facility for medical research, built on Port Road relatively adjacent to The Queen Elizabeth Hospital to provide for medical research. I do not know whether there is anybody left in it now because, of course, since then there have been further facilities and an amalgamation of medical research onto North Terrace. I do not know what is even happening in that building anymore, or whether it even has any tenants. It just seems to me shameful that there has been an expansion of services down there in that time and that now we are looking at a cascading reduction.

Just to highlight the duplicity of the government in this area, prior to the 2014 election the government promised that it would, under its Transforming Health, put in $125 million to provide for capital works for the redevelopment of The QEH. This was going to be their sop, I suppose, to what was coming. After the election, after they had won the election, they then downgraded that and said that the money was going to be redirected to other hospitals and that only $20 million was going to be spent on capital upgrades to rebuild the facilities that they had abandoned with the closure of St Margaret's, Hampstead hospital and the Repatriation General Hospital.

So, 'You are not going to get what we promised you before the election. You are now going to get a $20-million makeover,' reminds me of one of those TV shows where they strip everything out of the middle and put in new furniture and then flog it off for something better. At the moment, what is happening is that there is short shrift in relation to the provision. With respect to the car parking, the conditions down there suggest that the relocation to The QEH will need a capital of about $120 million, not the $29 million, particularly as the car parking is already difficult and the government plans will see a net loss of 34 car parks.

I do not know who in the Department for Health is managing this, but Ms Vickie Kaminski, the head of SA Health, said to the ABC just this week, on 15 May, that the new RAH outpatient facilities will be unable to meet the expected demand. She then suggested that The Queen Elizabeth Hospital outpatient services will be used to support the new Royal Adelaide Hospital, increasing the pressure on The Queen Elizabeth Hospital.

They cannot have it both ways. They are stripping down the services at The Queen Elizabeth Hospital. They have botched the new Royal Adelaide Hospital process for its redevelopment down to the other side of North Terrace. They say that they are not going to be able to accommodate all that outpatient demand in the new Royal Adelaide Hospital and that The QEH is going to be a backup, but on the other hand they are stripping it down to a skeleton.

With respect to the emergency department, everybody knows that if you want to do any surgery of substance at an acute hospital you need to have a high level of both emergency department support and ICT. The government's continued reduction of the ICT has meant that it has continued to downgrade the level of work that can be done. The emergency department has been downgraded, with life-threatening emergencies being diverted to other hospitals.

Let me remind the house that, according to the Australian Institute of Health and Welfare, the people who live in the western districts are the oldest, sickest and poorest people in Australia—in our area of western districts in metropolitan Adelaide. These people not only face those challenges as a cohort in the sense of population but with that comes a high level of comorbidity of treatment. Someone who might have a heart attack, who is otherwise healthy and the heart condition is identified as the only area of health concern in their profile, obviously has a much better chance than someone who might have diabetes as well, or who might have had strokes, or who might be frail or vulnerable in some other way, in which case a heart attack could, of course, be lethal.

The government's own figures show that ambulance trips for western suburbs patients ending in critical care will on average rise from 11 minutes to 21 minutes. Furthermore, almost half of the most serious cases come to the emergency department under their own steam; that is, ambulance cannot triage them. They are still going to be brought in by their families, relatives or neighbours to have that attention.

On rehabilitation services, the bulk of these are currently provided at Hampstead Rehabilitation Centre, which will be crammed into the unworkable spaces at The QEH. For example, our spokesperson on health, the Hon. Stephen Wade in another place, advises me that the spinal injuries unit from Hampstead Rehabilitation Centre will be squeezed into two buildings with about one-quarter of the internal space, meaning not even enough room in the corridors for two wheelchairs to pass and a loss of an open campus that facilitates mobility and family time.

So, rather than adding to The Queen Elizabeth Hospital, the government here are insistent on compressing incoming services into a reduced facility, and a knock-on effect of course will be that the hospital's current core services will be displaced for purpose-built facilities. They will be smaller, they will be less suitable and there will be less opportunity to have service provision at these premises; of course, that means a major problem for patients.

On cardiac services, it is fair to say that when I say that the people in the western suburbs are in the sickest profile in Australia, they are clearly the epicentre for cardiac disease, with 64 heart^-related admissions per 10,000, and the eastern area and the Hills are one-third lower than that. One of the highest concentrations of older Australians anywhere in in the country is of course in that western area. Notwithstanding that, and the need for an expansion of service for our mature aged, The Queen Elizabeth Hospital is losing at least 24 and possibly all the 30 cardiac beds. Both The QEH cardiac catheterisation laboratories and surgery will close, and the Lyell McEwin Hospital, the nearest other hospital other than the new Royal Adelaide, will be adding one catheterisation lab while The QEH loses two.

I do not know whether the health department or the current minister think we cannot add up in here, but on all these counts there is a continued diminution of service, while there is a corresponding increased demand for service. We have even had out, on this issue, Mr Kevin Hamilton, a former Labor member of parliament in the western districts. Understanding how severe this will be, he is now fighting the government publicly and continuously, with his wife, to oppose the stripping of services in this area.

You would think that the Australian Labor Party would have more sense than to start having a fight with their own, who are turning against them. They should hang their head in shame.

The DEPUTY SPEAKER: The member for Colton I go to next.

The Hon. P. CAICA (Colton) (11:12): Thank you very much, Deputy Speaker. I found that quite galling, to be honest with you. The member for Bragg can rewrite history how she likes, but I recall that back in 2002, just before becoming a member of this place, when the plans of the Liberal Party were clear on The QEH—that was, to transform it into the vision they had for our health system, to turn into another Modbury Hospital. How dare—

The DEPUTY SPEAKER: Hey, hey, hang on!

The Hon. P. CAICA: Well, Modbury Hospital at that time, when it was in private hands, Deputy Speaker. How dare the member for Bragg actually make out like she cares for the people of the western suburbs? It is the biggest load of nonsense I have ever heard in my life. Now, Deputy Speaker—

Mr Pederick interjecting:

The Hon. P. CAICA: I sat through hers without saying a word, so you can do the same, big boy.

Mr Pederick interjecting:

The DEPUTY SPEAKER: The member for Hammond! You will need more than my protection in a minute.

The Hon. P. CAICA: It appears to me at the very least that those opposite are trying to score political points on The Queen Elizabeth Hospital—indeed attempting to score political points on the whole Transforming Health process. They continue to spread misleading information entirely designed for no reason other than to frighten the people of our western suburbs. I will tell you what: I am a bit cranky, because I was born at The QEH—

The Hon. S.W. Key interjecting:

The Hon. P. CAICA: And my colleague the member for Ashford—born in 1954 actually, the year—

The DEPUTY SPEAKER: Hang on! There was no need for that. That is outrageous!

The Hon. P. CAICA: —it opened. Talking about downgrading of the services there, as a person who raised a family in the western suburbs—and you know that with young boys, and the same with young girls—you often find yourselves at hospitals for a variety of reasons, for a variety of operations. Every operation that our two kids had at The QEH and that I had over that period of time will continue to be able to be performed at The QEH. Ninety-plus per cent of all the required health needs of people in the western suburbs will continue to be able to be met by those in the western suburbs.

I will not be lectured by the member for Bragg, who rewrites history and does not care one iota about the working people of the western suburbs. We have members opposite inferring that The Queen Elizabeth Hospital's emergency department is closing: it is not. We have members opposite telling the local community that their health services are being downgraded: they are not. We have members opposite implying that The Queen Elizabeth Hospital is closing when it is not—in fact, if there were ever any likelihood of it closing it would be if ever they came into government.

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. All the changes are based on sound clinical evidence and data and driven by clinical quality principles that will ensure safer, better health care for South Australians right across the system.

I know that the member for Bragg has never sat in cabinet—and maybe she might never—but the reality is that when you sit around cabinet for the period of time I did you knew something had to be done to our health system, that we could not continue to have it operate in the same way. That is what Transforming Health is about. It might well be argued that there was an economic principle to that as well, because health can be a black hole, but the reality is that it is underpinned by sound clinical health principles. It is the right thing to do.

There will continue to be intensive care specialists on site at The QEH and they will continue to provide care to patients. The emergency department of The QEH 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. One of the aspects of the scaremongering by the Leader of the Opposition and those opposite is that people actually start to believe it, and it makes it very hard to convince people otherwise.

So I repeat: the emergency department at The QEH will continue to be staffed by doctors and nurses who will provide emergency care to the local community 24 hours a day, seven days a week, and 90 per cent plus of the presentations that go there will be able to be properly looked after by the clinicians and nurses and the excellent staff at that emergency department.

Only patients with once-in-a-lifetime, life-threatening emergencies, such as a trauma from a severe car accident or a stroke or heart attack, which account for a very small percentage of patients currently taken by ambulance to The QEH emergency department, will be taken directly to major metropolitan hospitals like the Lyell McEwin and the Royal Adelaide Hospital. For everyone else emergency care will still be provided at The Queen Elizabeth Hospital. The cardiac service will continue to provide outpatient, outreach and ambulatory service to patients. Contrary to the concerted fear campaign being launched by those opposite, the community will continue to access health services at The QEH, such as treatment for ongoing conditions like diabetes, heart disease or kidney disease.

The one point the member for Bragg made that was remotely correct, for her, was the fact that in the western suburbs, unlike in the eastern suburbs, we have people suffering from what are essentially industrial and work-related diseases. The Queen Elizabeth Hospital is the right and appropriate place for treatments of conditions like diabetes, heart disease and kidney disease to continue. That is a good thing for our area and our hospital.

In fact, I am advised that the people of the western suburbs will have full access to kidney and other renal care services, with inpatient services provided at the new Royal Adelaide Hospital, and the continuation of all kidney and renal outpatient services currently provided at The QEH, including dialysis. The people of the western suburbs will also continue to have full 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 that some people who require once-in-a-lifetime, very complex, multitrauma and specialist care will instead be taken to a major metropolitan hospital—the right and appropriate place for them to be taken. In most instances, for people who live in the western suburbs, this will be the new Royal Adelaide Hospital, which is about 10 minutes in normal traffic conditions from The QEH and much less in an ambulance. Bear in mind that the ambulances are intensive care units on wheels, and the best place for patients to be stabilised before they get to the place where they will get the care that they require.

The QEH 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 day surgery centre will mean shorter waiting times for the people of the western suburbs. It will also mean fewer elective surgeries are bumped. I get a lot of constituents who come and tell me about being bumped from elective surgery, as currently happens, because the clinical team is pulled away for an emergency surgery.

The dedicated elective surgery centre will ensure that clinical teams can specialise and see enough patients to maintain and improve their highly specialised skills, meaning safer and higher quality services for people of the western suburbs. This is a matter that I have raised on numerous occasions with the Minister for Health, because that is where we do our business on this side, talking directly and not promoting nonsense in the media and in the community. We are continuing to work with clinicians and staff on the planned transfer of rehabilitation services from Hampstead Rehabilitation Centre to Modbury Hospital and The Queen Elizabeth Hospital. After listening to the clinicians, staff and consumers, and I expect perhaps the odd local member or two, on the planned transfer of services to TQEH, the Central Adelaide Local Health Network will establish a number of working groups to discuss and address a number of matters that were identified during consultation.

These working groups will include clinicians, staff and consumers. This is a positive step forward to ensure that the transfer of services provides the best possible care for patients. While the opposition continue to complain and spread misinformation, we are getting on with ensuring we provide the best possible care to the people of the western suburbs.

Let me remind you, Deputy Speaker, although you do not need reminding, and those opposite who keep saying we are downgrading our hospitals, that since 2002 this Labor government has upgraded every major hospital across the state. We have invested almost $2 billion to upgrade every metropolitan public hospital and every major country hospital and, through Transforming Health—

Mr Duluk: Except the Repat.

The Hon. P. CAICA: —we are investing an additional $250 million in new capital investments across our metropolitan hospitals. Don't tell me you care about people, because you don't.

This is unlike the opposition—the party that privatised Modbury Hospital, the party that wished to privatise The Queen Elizabeth Hospital pre-2002. This is the same party that continues to oppose the state-of-the-art, brand-new Royal Adelaide Hospital, and they are now gnashing their teeth at the fact that the opening of the new RAH is just a few short months away. Once again—

Mr Pengilly interjecting:

The DEPUTY SPEAKER: Order, member for Finniss!

The Hon. P. CAICA: No, you are a policy-free zone. Tell me—

The DEPUTY SPEAKER: Order, member for Colton! Member for Finniss, you will be called to order and warned, which means in question time your time will be limited, so you need to weigh up whether you want to be here for question time or not.

Mr Pengilly: I might work on it, Madam Deputy Speaker.

The DEPUTY SPEAKER: Okay, the next time you make a noise, you will be called to order.

The Hon. P. CAICA: Unlike the opposition, we know that reform is required and our changes are based on improving the quality of health care in this state. Those opposite have chosen to respond only with negativity. They would prefer to put unfounded fear into the people of the western suburbs. If they ever came up with a policy on health, that would be novel.

On the other hand, this government is 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 and by upgrading our hospitals and investing significantly in modern healthcare facilities.

The people of the western suburbs have nothing to fear—nothing to fear except the election of a Liberal government. The Queen Elizabeth Hospital will always be part of the western suburbs. I am proud of the western suburbs, I am proud of TQEH, and it will continue to provide the high-quality healthcare services the local community expects and deserve.

The DEPUTY SPEAKER: Member for Hammond.

Mr PEDERICK (Hammond) (11:22): Thank you, Madam Independent Deputy Speaker. I rise to speak on the motion from the deputy leader (the member for Bragg):

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

(a) the downgrading of the emergency department and intensive care unit services at The Queen Elizabeth Hospital;

(b) the reduction in The Queen Elizabeth Hospital's cardiac services; and

(c) the degradation of the hospital's current services by a lack of proper provision for the transfer of rehabilitation services from the Hampstead Rehabilitation Centre site.

I want to speak about what has been happening under Transforming Health. Certainly, on this side of the house we have been extremely concerned about what has been happening in the metropolitan area with downgrades across the board. Even with the new Royal Adelaide Hospital, we see that they cannot build a hospital, on a clear-field site, that has a big enough emergency department. It is totally outrageous.

I heard only the other day that this hospital was planned as they built it because the planners were not given the time to draw up the plans for the whole hospital. What a disgrace! No wonder it had 50,000 faults to be remedied during the construction. It is an absolute disgrace that a hospital that will have 30 per cent of regional patient use does not have an emergency department that will be fully functional. It is just ridiculous and shows the disjointed way in which this government works on the health system in this state.

What will happen with The Queen Elizabeth Hospital is that it will no longer be a general community hospital: it will be a rehabilitation and a multiday, elective surgery centre. Under Transforming Health, there will be a cut in capital works spending of more than $100 million, down to $22.4 million. There will be a downgrading of the hospital emergency departments. We have a theme here, Madam Independent Deputy Speaker, and you are used to this out at Modbury.

Patients with life-threatening conditions, stroke and heart attack will bypass the hospital. The member for Colton admitted this, and this is exactly what will happen. I have talked about this many times in this house, where paramedics will basically need a scroll-down list to come down from the back of their ambulances. They will have to be alert as to what day of the week it is as to where they take a stroke patient, a heart patient or a patient with some other life-threatening condition.

What is happening under Transforming Health is that specialists are being cut from hospitals and being put in one central hospital, depending on which day of the week it is. It is going to be a real tragedy. Haematology and inpatient respiratory beds will be relocated to the new Royal Adelaide Hospital. Both of its cardiac catheterisation laboratories will close and its cardiac inpatient capacity will be heavily reduced or even closed under the plan. Most of the services provided at the Hampstead Rehabilitation Centre are supposed to be integrated into The Queen Elizabeth Hospital site.

I have just talked about the new Royal Adelaide Hospital emergency department not being up to speed even before it is opened. The Queen Elizabeth Hospital's emergency department is being downgraded, with life-threatening emergencies diverted to other hospitals. As I was just discussing, in a medical emergency when minutes matter, you may have to drive farther and wait longer to get the help that you or your loved one needs.

The government's own figures show that ambulance trips for western suburbs patients needing critical care will on average rise from 11 minutes to 21 minutes; that is almost double, and that is the government's own numbers. Almost half of the most serious cases that come into the emergency departments do so under their own steam; ambulances cannot triage them. As a country member, I know that a lot of the time we do our own emergency travel when we can because sometimes it is quicker to get in the vehicle and drive yourself, or a friend or your partner can drive you, to the local hospital.

In regard to rehabilitation services, the bulk of the rehabilitation services currently provided at the Hampstead Rehabilitation Centre will be crammed into unworkable spaces at The Queen Elizabeth Hospital. For example, the spinal injury unit from Hampstead Rehabilitation Centre will be squeezed into buildings with about one-quarter of the internal space, meaning there will not even be room in the corridor for two wheelchairs to pass, the loss of an open campus that facilitates mobility and family time and, rather than adding to The Queen Elizabeth Hospital, the Labor government is compressing incoming services on top of current services that are available there.

The number of beds at The Queen Elizabeth Hospital will fall by 28, from 311 beds to 283 beds. The knock-on effect will see a number of the hospital's current core services displaced from purpose-built facilities. They will be put into smaller unsuitable facilities, including palliative care and geriatric care. The Labor government's plans do not meet the health minister's commitment that the facilities at The Queen Elizabeth Hospital for rehabilitation will be as good as, if not better, than those at Hampstead. Labor's plans have been widely condemned by clinicians and clients.

The most recent South Australian government plan for The Queen Elizabeth Hospital, the latest of 12 plans, was released for consultation in November 2016 but has not resolved all the issues yet. In regard to cardiac services, the western suburbs is the epicentre of cardiac disease. There have been 64 heart-related admissions per 10,000 people in the western suburbs, whereas in the eastern suburbs and Hills they are one-third lower. The western suburbs has one of the highest concentrations of older Australians anywhere in the nation.

The Queen Elizabeth Hospital is losing at least 24 and possibly all of the 30 cardiac beds and both of its cardiac catheterisation laboratories and surgery will close. The Lyell McEwin Hospital is adding one catheterisation laboratory while The Queen Elizabeth Hospital loses two. The head of SA Health, Vickie Kaminski, stated that the new Royal Adelaide Hospital's outpatient facilities will be unable to meet the expected demand. She even suggested that The Queen Elizabeth Hospital's outpatient services will be used to support the new Royal Adelaide Hospital, increasing pressure on The Queen Elizabeth Hospital service. That was mentioned on ABC 891 on Monday 15 May 2017.

Since the last election, the state Labor government has cut more than $100 million from the capital works budget for redeveloping The Queen Elizabeth Hospital and redirected that money to other hospitals. The $20 million being spent on capital works is primarily to rebuild the facilities that will be abandoned with the closure of St Margaret's, the Hampstead hospital and the Repatriation General Hospital, and it is an absolute disgrace that Daw Park is being shut down.

Clinicians have also suggested that the relocations to The Queen Elizabeth Hospital will need about $120 million in capital investment, not $20 million that the government has allocated. Car parking at The Queen Elizabeth Hospital is already difficult, and the government's plans will see a net loss of 34 car parks.

In relation to the background of The Queen Elizabeth Hospital, it is a 311-bed acute-care teaching hospital and has a catchment of 250,000 in western Adelaide. It opened in 1954 and, as previously stated, there are more than 2,500 staff employed. There are over 40,000 emergency presentations, 36,000 inpatient admissions and around 16,000 surgical procedures each year. These are vital services to the western districts that will be cut by the state Labor government.

As regional members, we see the cuts being made to city hospitals and, as Transforming Health is being rolled out across the country, we fear—as we have done for decades—what is in store for country hospitals. Most recently, we have seen the proposed cuts to services at Yorketown Hospital, and we have seen the Keith and District Hospital threatened with closure because of a lack of funding from the state Labor government.

Between 25 and 30 years ago, I was on the steps of this very place protesting that the Labor government wanted to shut down the Tailem Bend District Hospital—my local hospital. We have a lot to fear in this state. We have a lot to fear about hospital closures and downgrading services. The government can build a $2.4 billion hospital but cannot get it right by building an emergency department that will cope with the present demand, let alone the future rising demand.

Time expired.

Mr PICTON (Kaurna) (11:32): I am sure you will be shocked to learn that I rise to oppose the motion by the Deputy Leader of the Opposition. This motion falls into the category of crocodile tears because we know that of all the people who care about The Queen Elizabeth Hospital those opposite do not fall into that category.

This is a situation where we need to look back at the previous Liberal government and their plans to privatise The Queen Elizabeth Hospital and compare that to what has happened under this government, which has been an investment of $136 million to upgrade The Queen Elizabeth Hospital and to significantly improve health care for people in the western suburbs of Adelaide. I have seen that through my own family. My grandmother, who lives in the western suburbs of Adelaide, has received excellent care in The Queen Elizabeth Hospital. She has been treated in some of the new hospital buildings that have been built under the term of this government.

We know that there are excellent doctors, nurses and other allied health professionals who work at The Queen Elizabeth Hospital and, thanks to the investments of this government, some 300 new beds have been put in, providing care for people in that area. We know that the alternative would have been to go down the Modbury Hospital route and to privatise the running of The Queen Elizabeth Hospital. We can see what happened to Modbury Hospital in terms of the services that were degraded there over time, and the lack of upkeep and cleaning that happened under a for-profit management of Modbury Hospital. That same thing would have happened at The Queen Elizabeth as well and that would have been very detrimental to people in the western suburbs who rely on that hospital to provide them with good care.

I think it is important to reflect upon the work that has happened at The Queen Elizabeth Hospital. The first stage of the upgrade there involved the construction of a 200-bed inpatient building to replace outdated ward facilities, which is a huge investment. The second stage involved the construction of a three-level inpatient building, comprising 72 inpatient medical and surgical beds, a new 20-bed older patient mental health facility, ambulatory rehabilitation facilities, renal dialysis and haematology and oncology ambulatory care facilities.

Also, there is a new research building, and I think we can all acknowledge the fantastic research that happens at The Queen Elizabeth Hospital, and they have a fantastic building under this redevelopment for that work to now continue with a new multistorey car park, and we certainly know how important it is to have good access to car parks for hospitals, as well as a significant upgrade of site infrastructure engineering services. All those upgrades have been completed under this government.

We now have more upgrades happening to improve, in particular, a lot of the rehabilitation services in the hospital because we see a very strong future for The Queen Elizabeth Hospital. Some of the comments of those opposite suggested that this is somehow going to be downgraded from a community general hospital to a rehabilitation hospital in the future, and nothing could be further from the truth; that is completely incorrect. This hospital is going to continue to provide 24/7 emergency care for people in the western suburbs which is vitally important.

It is going to continue to provide inpatient services for people in the western suburbs. It is going to have a dedicated specialist service for multiday surgery and increase the provision of elective day surgery procedures for the western suburbs, which is very important for people who need to get those surgeries done. There are countless people in the western suburbs who will be looking forward to having those services at their local hospital in the future. Having a separate dedicated elective surgery centre will mean fewer postponements due to emergency surgery as well as shorter waiting times and better planned and managed care for people in the western suburbs.

In the future, there will also be a significant centre for rehabilitation for people in the western suburbs at The Queen Elizabeth Hospital, as well as emergency services, important inpatient care services, the expansion of elective surgery, other services such as mental health and rehabilitation, and research. That is a bright future for services in the western suburbs, and we know that it is because of the people on this side of the house fighting for those services that we will continue to see important health services take place in the western suburbs in the future.

I particularly note the excellent speech earlier by the member for Colton, who is a dynamic champion of The Queen Elizabeth and has been fighting for services there for a very long time, and the same goes for the members for West Torrens, Lee, Port Adelaide and Ashford, and the member for Cheltenham, the Premier. All those members in the western suburbs have certainly been fighting for The Queen Elizabeth Hospital for a very long time, and we thank them for their efforts.

A few other comments were made in some previous speeches about other aspects of our health system, particularly about the new Royal Adelaide Hospital which, as any member who has had a chance to go and visit it would know, is an amazingly well-designed and thought-out new asset for this state and will be something that will serve the people of this state for a very long time to come.

It has been meticulously planned to ensure that we have much better health services provided for people in this state in the future. The 800 beds are going to give us the capacity we need. The emergency department is going to give us the capacity that we need. The 700 overnight beds in the new Royal Adelaide Hospital are all single rooms, which is going to give tremendous flexibility in the way in which we deliver health care but also improve infection control for people across the state who need that care.

It is a hospital where building on a new site has been able to deliver these improvements, whereas building on the existing site would have meant that we would have had building works underway there for 15 or more years, causing disruption for doctors, nurses, patients and families trying to use that site. Anybody who has been to the current Royal Adelaide Hospital recently will know how important it is going to be to ensure that we get the proper care for people in the new hospital as soon as possible.

I am delighted that we now have a time frame for the move in September, for the new hospital to open, and I think, once people get to see it—and I understand there are going to be some tours happening in the future—people will understand what an important improvement this hospital is going to make. There were some comments earlier that the emergency department will not be big enough. Nothing could be further from the truth. This emergency department at the Royal Adelaide is significantly larger than the current Royal Adelaide Hospital.

Mr Pederick interjecting:

Mr PICTON: It includes significantly more treatment spaces and areas for people to be treated than the current Royal Adelaide Hospital and has been planned in a much more seamless way to ensure that—

Mr Pederick interjecting:

The DEPUTY SPEAKER: The member for Hammond is called to order.

Mr PICTON: —to ensure that when people come into the emergency department they are able to get the radiology they need, they are able to get the pathology they need, they are able to get all the scans, diagnostics and care that they need, and they are able to easily transport to operating theatres if that is what they need, or intensive care if that is what they need. All of this has been able to be thought through in a new hospital, whereas the alternative idea that was proposed by those opposite was to try to rebuild on the very cramped, small existing site, which would have taken at least 15 years and, we believe, would have cost much more and would have caused a lot more disruption.

You would have ended up with a product at the end of the day that would not have significantly improved the care for people. You also have to look at the other important care that is being provided for people across our metropolitan area. There are significant upgrades happening at the moment at the Flinders Medical Centre. We have transformed the Lyell McEwin Hospital from a very small community hospital to a major tertiary hospital for the northern suburbs. Also, as the minister was just outlining, this week we have had a redevelopment of the Noarlunga Hospital down in my community, which is going to significantly improve the elective surgery being offered to the southern suburbs community.

Deputy Speaker, as I am sure you are very well aware, we have also had a significant upgrade at Modbury Hospital in terms of the emergency department and a lot of the facilities in that hospital as well. All across the state we are seeing these significant upgrades to our services because we regard our health system as vitally important. We will look after people in the public health system. We believe in public health. We believe that you should not have to have private health cover to get good treatment. We will always look after those hospitals across the state, including The Queen Elizabeth Hospital.

Mr PENGILLY (Finniss) (11:42): I can hardly believe what I was hearing from the member for Kaurna. In the lead-up to the last federal election, his good old factional mate, the federal member for Port Adelaide, Mark Butler, had a good old crack at the current state government when he called on the Transforming Health expedition (so to speak) to be forgotten about. He complained long and bitterly about the cuts that were proposed for The QEH by Transforming Health. So, it is a bit rich for government members to get up and oppose the motion put up by the member for Bragg, which happens to be a very good motion.

There are one or two members over there that have had some involvement in health over the years, either working in the health industry or in other ways, but I am not sure that they know much at all about the administration of health or the actual necessities of health or how well it has run, particularly at The QEH. People like Professor Horowitz and Dr Zeitz and Co. do not go out lightly and raise issues that are alarming them in relation to hospitals such as The QEH, with the Transforming Health process and the dumbing down of the health system to accommodate the Transforming Health scenario. Yesterday, I was interested when the health minister himself talked about the Modbury Hospital in this place. That is getting dumbed down, and it is surely going to get dumbed down if the health minister becomes the member for Ashford, I can tell you. You will have dumb and dumber working together. It is unbelievable.

My memories of The QEH go back some 41 years. My father got ill quite suddenly and went to The QEH for diagnosis and associated treatment. In fact, he was diagnosed with lung cancer and died six weeks later, which was a great shock to us. I have never forgotten the care he got at the The QEH. The treatment he was given at the time probably only served to make him even more ill unfortunately, but that is just the way things are. The QEH at that time was, and it still is, a marvellous institution. It provided everything, and they are going to dumb it down. There is a plan to dumb it down, which is just plain crazy in my view.

They do not have to go through this crazy exercise of doing what they want to do to it. The reduction in The Queen Elizabeth Hospital's cardiac services is going to be a nightmare. What we are being told continually by the government, week after week, month after month, is that the new Royal Adelaide Hospital will be the great saviour of health in South Australia. We will wait with interest to see when and where it opens.

Only this morning on ABC radio I was listening to the breakfast program when I was driving in here. They were talking about the potential for chaos at the Royal Adelaide Hospital. I certainly do not wish chaos at the opening of the Royal Adelaide; in fact, I would like to think that it will open and be successful. But in putting that up as the shining masterpiece of this Labor government, they are seeming to strip the guts out of everything else just to make it work. That is what annoys me intensely.

They are forgetting what is actually required at hospitals. By moving things around, they have just fallen into this trap of believing that Transforming Health is the answer to all the ills of South Australia's health system. It is not. It will not be, and I guarantee that in 10, 15 or 20 years we will see everything revert to how it has been, because it is a tried and true formula. It is not perfect by a long shot, but there is little or no input from people who are involved in hospitals.

The government wiped out the boards. You got rid of the boards, so there was no input there. You put in health advisory councils, which have no power to take control over anything. They have no power on budgets whatsoever. You have stripped the guts out of the health system to satisfy the bureaucrats who have completely conned you. That is what has happened with this government; they have conned you completely on health. They have done you over.

They have got their way. You can see them rubbing their hands together up in Hindmarsh Square, saying, 'We've got this government exactly where we want them.' That is what you have done. You have centralised health into Hindmarsh Square. You have pulled the guts out of Country Health. It is just a shame. It is a crying shame for the people of South Australia what this government has done to health, no more so than what is proposed at The Queen Elizabeth Hospital.

As the member for Bragg says, there is a degradation of the hospital's current services by a lack of proper provision for the transfer of rehabilitation services from the Hampstead Rehabilitation Centre. I know what the Hampstead Rehabilitation Centre is like. I have had friends who have spent months in there. It is not an ideal situation. Much of it is old. It is archaic in the way it operates, but I really do not know that doing what you want to do to The QEH is going to change much at all in the way of rehabilitation.

As the member for Bragg has indicated, The QEH is no longer going to be a general community hospital. It has a catchment of some 250,000 people. I heard the member for Colton get up and passionately argue his side of the debate on this matter. I am sure that he means well. It beggars belief that those members from the other side of the house, those government members who cover areas in the western suburbs, can just sit back and allow everything that is happening to happen.

The member for Florey, bless her heart, has fought like blazes for Modbury Hospital. Forever and a day she has fought for her local hospital and its services, she has fought for her community and she has been shunned by the Labor Party yet again—pushed to one side, completely slotted and bulldozed out to allow the current Minister for Health to bulldoze his way into that seat. God help all who sail with him on that effort, because I think the member for Florey will be seen as looking out for her community and constituents first, as she has always done. She should not be put down in such a terrible manner—by the current Minister for Health being pushed in, pushing her out of her position as the member for Florey. I think it is disgraceful.

Getting back to the motion, The QEH is going to lose 24 or possibly all the 30 cardiac beds, and The Queen Elizabeth Hospital cardiac catheterisation laboratories and surgery will close. The Lyell McEwin is adding one cath lab, while QEH loses two. The head of SA Health, Ms Kaminski, said that the new RAH's outpatient facilities will be unable to meet the expected demand. She even suggested that The QEH's outpatient services will be used to support the new RAH, increasing pressure on QEH services. That was on the ABC on Monday 15 May—this very week.

You are just not getting it right. You have not got it right. You are going to dumb down The QEH at the expense of sending everybody to the new RAH, that wonderful new pie in the sky. We will see how it all works. Since the last election, this state Labor government has cut more than $100 million from the capital budget for redeveloping The QEH and redirected that money to other hospitals. Well, guess where that has gone? The $20 million being spent on capital is primarily to rebuild the facilities that will be abandoned with the closure of St Margaret's, Hampstead hospital and the Repatriation General Hospital. Do not get me started on that.

Clinicians suggest that the relocation of The QEH will need about $120 million in capital investment, not the $20 million that the government has allocated. It is an embarrassment, a shame and a slur on that western suburbs community that they are having their very own local community hospital downgraded to that extent. I support the member for Bragg's motion. It is a good motion and I sincerely hope that it gets up on the floor of the house.

The Hon. T.R. KENYON (Newland) (11:52): I will speak briefly on this. I am very disappointed that the member for Bragg would bring this motion in—a member of the party that has almost no interest in the good provision of public health, a party that generally would prefer that people had private health insurance and, if they could not afford that, they would have none at all, and that sees no role for the public sector in the provision of health care to citizens. She comes in and complains about a public hospital when those of us on this side of the house certainly regard those on that side of the house as having no real interest in this subject anyway.

I particularly would like to talk about paragraph (c) that talks about the rehabilitation services taken from Hampstead. This has been a particular interest in my electorate of Newland, simply because a lot of those rehabilitation services have been transferred to the Modbury and it has been very successful. We have a wonderful new building that is very well staffed by some excellent people, but that in and of itself is not the be-all and end-all. Improved results are the be-all and end-all, and we know from research and experience that improved results come from having rehabilitation as close as possible to the point of operation, in both time and physical location.

The improvement we are seeing at Modbury, where there is an increase in the amount of elective surgery going on, is that rehabilitation services are starting almost immediately. Those people who have had any experience with a knee operation (which, happily, I have not, but I know people who have because of playing rugby, and that is common) know that knee operation rehabilitation starts almost immediately. If you visit someone who has just had a knee operation, you will notice that their knee joint is being moved around on a machine, and that is to start movement almost as soon as the operation is finished. The research and the clinical experience is that the sooner you start rehabilitation, the better the results you will achieve.

It makes sense that the rehabilitation will be moved to those centres, such as Modbury, that are doing more and more elective surgery. People can be closer to home and they are easier to visit. Generally, you are in rehabilitation longer than you are in the actual hospital for the operation. The rehabilitation needs to happen more regularly and for a longer period of time, and the closer to home that is, the better for people undergoing those services. That has been moved closer to people in the north-eastern suburbs as a result of the changes that are being made at Hampstead, and that is a very good thing.

The building itself at Modbury was recently completed and it is outstanding. Madam Deputy Speaker, you were there on opening day and had a tour around the centre, as did I. The members for Wright and Torrens were there as well. We were able to see that the facilities are excellent. We are seeing a new wave of design of hospitals with a lot more light and a lot more open space. For those people who have been lucky enough to look around the new Royal Adelaide Hospital, exactly the same design cues are coming in: more light, more access to outdoor areas, more open and airy space, which makes it a much more pleasant place to be.

There are a lot more individual rooms and a lot more individual attention. We are seeing that at the Modbury Rehabilitation Centre, albeit on a smaller scale than you see at the new Royal Adelaide Hospital, and that is a wonderful thing. The rehabilitation pool is of particular interest. I put my hand in the water and it was quite warm, which is relevant to people doing rehab. They are not there to exercise, they are there to rehabilitate, which is obviously a less active pursuit than swimming, recreational water sports or whatever else it might be.

The rehabilitation gym is outstanding. It is very well set up, from the most basic arrangement of having support for the patient in the roof and being able to move around with the assistance of that support—almost a gantry crane-type of arrangement, which helps to bear a lot of the weight of a patient, so they can gradually start putting weight on their body—moving through to parallel bars and all the other things. There is plenty of room, plenty of open space and lots of areas for people to start learning to walk again, to exercise their joints fully, build muscle strength, build joint strength and all those things that are required when someone has either gone through surgery or is recovering from an accident or some other injury.

The Modbury Rehabilitation Centre is right next door to Modbury Hospital, which is useful if that is needed. It is next to the GP centre, which provides plenty of services to the community and it seems to be well used. It is very clear to me that the rehabilitation centre at Modbury and the rehabilitation itself is an excellent development for constituents not only of Newland but also of the wider north-eastern suburbs. It is something to be encouraged. To condemn it now, in this motion, as somehow a retrograde step is ignorant of the facts and ignorant of the importance of rehabilitation being close to the areas where the elective surgery is being undertaken.

With those words, I add my opposition to this particular motion. I think this motion is opposition for the sake of opposition. It is finding a fault and trying to make a political point out of something that is very serious, where there is a requirement for a well-functioning health system that functions as well as those in other states.

We found, when we started the whole Transforming Health process, that the South Australian health system was not functioning as well as systems in other states. I do not think that is reasonable. It needed to be reorganised in a way that made it perform as well as those in the Eastern States, if not better, and Transforming Health was an important part of that process. To attack that process for the sake of making some political points, as this motion does, really does not deserve the time of the house.

Mr WHETSTONE (Chaffey) (12:00): I, too, rise to support the member for Bragg's motion. I do agree with the member for Newland that we cannot take the health system lightly. What I do take very seriously is the government's approach to the health system in South Australia. Obviously, we are going through a health transformation at the moment, or Transforming Health, as the government is calling it. On this side of the house, our view is that the government's model currently is not working. The model that the government is proposing in Transforming Health has turned out to be an absolute sham, a centralised sham.

Overall, investment is getting close to $3 billion, when we talk about all the Transforming Health initiatives that are in a state of play at the moment, whether we talk about the upgrade (or downgrade) of the four metropolitan hospitals and the installation of the NRAH. Sure, it is going to be the centrepiece of our health system but, goodness, it is a $2.3 billion investment. It is the third most expensive building on the planet, yet we cannot even get it right and we cannot even open on time. We think that we have put enough experts around the table for these projects.

Today, we are going to talk about The QEH. As a young fellow, I visited The QEH on many occasions, usually because I was trying to perform above my capability. I was also on the Public Works Committee when we had the 529^th report on The QEH Transforming Health project, which was $20.4 million, GST inclusive. That showed the $22.4 million cost of basically transforming a general hospital into a rehabilitation centre. It is going to have an impact on the western suburbs, it is going to have an impact on the health system and it is going to put more pressure on other hospitals. It is going to put more pressure on the working model of what South Australia expects; that is, a satisfactory health system.

When we had the hearing in the Public Works Committee, the department came in and I asked a few very simple questions, and I only wanted one answer. As it turns out, I think I asked nearly 40 questions for one answer. Over and over again I got the same old spin: 'We have more beds per head of population than anywhere else in Australia.' Again, I said, 'I want a simple yes or no: are we reducing the number of beds? Are we reducing the capacity of the hospital?' Again, I got all sorts of spin from the representative from Health.

The centrepiece of what was happening at The QEH was the hydrotherapy pool and the rehabilitation services that were going to be implemented at The QEH. Again, I agree with the member for Newland that, for people who have injuries, particularly sporting injuries, rehab is essential to bringing back their quality of life and working through what they have just been through, which is trauma, which is something that is detrimental to the longevity of life. I now know that those rehabilitation services that were provided to me today are the telltales: knee replacements, back fusion, many broken pieces of equipment within.

I think it is essential that rehabilitation is supported, but what I am concerned about is that it is almost a downgrading of a public hospital. What we are seeing is that the emergency department and the ICU services will be reduced; they will be downgraded. There will be reduction in the cardiac services and degradation of the hospital's current services by a lack of proper provision under the transfer of rehabilitation services that will come from other hospitals—obviously from Hampstead—to The QEH.

There will be other pressures put on that hospital, because I am sure that as we centralise our health system elsewhere, we know that the Lyell McEwin and Modbury have had money spent on them, but we also know that the government has a model to reduce bed numbers. It is about putting more pressure on our front-line services, the great work that doctors, nurses and staff do. They are being put under more pressure every day as this Transforming Health initiative is rolled out. I think it is an absolute disgrace that we are seeing more and more services reduced in regional South Australia.

We look at what Country Health is doing to our health system. We look at the backlog of maintenance that is not being addressed. We look at the downgrading of services right around the state, and yet we spend billions of dollars on a centralised model that is now being put into question. There is no doubt that the taxpayers of South Australia would feel that they are getting the raw end of the stick. They are getting the pointy end of the pineapple right at this minute, because what we are seeing is a huge investment on North Terrace—for what? We have not even been able to get the doors open. We are looking at emergency departments that do not have capacity. We are looking at the huge pressure that is being put on those frontline services.

Regarding ambulances, ramping just seems to be a standard format these days. If we are going to see a downgrade in these services, if we are going to see a centralised model, how many more ambulances are we going to have to put into service? What sort of pressure is going to be put on those ambulance services? How much farther will someone in need have to travel? The service has just been closed at The QEH, so you have to travel up to the new RAH, or you have to be taken out to the Lyell McEwin, or you have to go to Noarlunga Hospital.

Why is it that all of a sudden we are going to create a new model in which we plan to reduce services, reduce bed numbers and reduce nurse and doctor numbers? I do not understand. At the very same time, one of the great heartbeats of South Australia is the regional health service. Country Health is also being impacted. It is an aftermath, or almost a tsunami, that is happening here in South Australia. It is sad to say that we have one large capital city and that is what this government is focused on.

The issue with The Queen Elizabeth Hospital under Transforming Health is that it is controversial. Yes, it is diminishing our health services. Yes, The Queen Elizabeth Hospital is being transformed into a rehabilitation centre. Yes, that is important, but the people of the western suburbs have to ask themselves: are we winners or are we losers? I do not live in the western suburbs. I live in regional South Australia. We are getting dudded in regional South Australia, and I feel that the people in the western suburbs of Adelaide are being dudded by the downgrade of The Queen Elizabeth Hospital.

Again, I will not back away from how important rehab services are, but I do come forward when I see a lack of cardiac services and outpatient services. We look at this fantastic model of Transforming Health—it is not working. The rollout of it is already flawed. I think The Queen Elizabeth Hospital is just another example of how this government is mishandling, mismanaging, misinstitutionalising what South Australia needs.

It needs a functional health system for all South Australians. The western suburbs are being dudded. Regional South Australia is being dudded as I speak. I am concerned. I am speaking on behalf of the people of potentially most of the western suburbs—the central suburbs of Adelaide—but I also speak on behalf of regional South Australians, because they are feeling the brunt of what a government is hell-bent on doing, which is centralising a health system. It is clearly a model that is not working. It is clearly a model for which South Australians will pay dearly for many, many years to come.

Mr DULUK (Davenport) (12:10): I also rise to speak in support of the member for Bragg's motion:

That this house expresses its concern at the systematic reduction in acute health services for the people of the western suburbs through the government's Transforming Health Program...

The member for Bragg is 100 per cent correct. For all members on this side of the house who support this motion, we know what this government is doing to health services across the board, from The QEH to the Repat and its closure, down to Noarlunga and, of course, all the way through Country Health as well.

In his contribution, the member for Finniss remarked on some of the words of the federal member for Port Adelaide, Mr Mark Butler, and his concerns with Transforming Health and the closure of The QEH. I am really glad there is someone in the Labor Party who also thinks that Transforming Health is a bad thing. In Mr Butler's letter to the health minister back in April of last year the federal member for Port Adelaide—and of course The QEH is within his constituency—says, and I quote:

I am concerned that the proposals relating to The QEH are undermining the Western suburbs community's confidence in the Hospital's services. The withdrawal of some acute services (especially cardiology) from The QEH before the new Royal Adelaide Hospital has commenced operations and demonstrated its ability to provide high quality acute and emergency care to our community is causing a high degree of unease.

He goes on to say:

As a former Commonwealth Minister for Mental Health and Ageing, I am especially familiar with a number of services that will also be heavily impacted by the proposed shift of rehabilitation services from Hampstead to The QEH. As Chair of the Advisory Council to the NHMRC Centre of Research Excellence on Frailty, which is based at The QEH, I am particularly concerned about the negative impact the proposed shift will have on the first-class geriatric unit at the Hospital; but also on palliative care and respiratory services.

Those are not my words condemning the proposed removal of facilities at The QEH; they are not the words of anyone else on this side; they are the words of the federal member for Port Adelaide, and that really should say it all about what is really happening at The QEH and what the Labor Party is doing.

In recent weeks, we have seen highlighted, both in the house and out in the public domain, this government's failure in health care, this government's absolute failure to deal with the care of—particularly at the moment—older persons in state care. Of course, we are talking about the fiasco that is at Oakden and the disgraceful handling by the government and the bureaucracy of the care for our most vulnerable. One of the constant defences that this government, and particularly the Minister for Mental Health and Substance Abuse, uses for not providing an adequate response to questions from this side of the house is, 'I am not a clinician; so therefore I cannot come to the house and provide proper answers in relation to services and treatment of patients.'

I actually agree with the minister on this one: she is not a clinician. I am not a clinician, the member for Colton is certainly not a clinician and neither is the member for Kaurna. But I would like to talk a bit about some clinicians who do have a lot of experience in the health system, which is very important. Professor Warren Jones, the retired professor of gynaecology at Flinders hospital and a very well-respected man within his profession, has been a key critic of Transforming Health, because he knows what Transforming Health is doing right now to our hospital system, and he knows the impact it will have in the long term on patient care in South Australia. Warren Jones, going back to February 2016, said:

Under Transforming Health The QEH emergency department will be progressively downgraded to a drop-in centre able to deal only with minor emergencies and chronic problems. The intensive care unit will also be downgraded so that patients requiring life support or complex monitoring will be transferred into the city. Indeed, severely ill people including those with heart attacks and strokes, will not treated at The QEH, they will be transferred or taken direct to the Royal Adelaide Hospital. Specialist training positions will be lost, and senior specialists will progressively leave the hospital making some services unsustainable and unsafe. The stress and inconvenience for western suburbs residents, many of them elderly, of travelling to the city centre for treatment or to visit relatives is unacceptable and cruel.

Again, they are not my words but the words of Professor Warren Jones, a clinician with years of experience who knows the health system in South Australia. They are his words and they are his concerns in regard to what the government is proposing at The QEH. Believe it or not, his words ring true as to what is happening in your electorate, Deputy Speaker, at Modbury Hospital and, of course, at Noarlunga Hospital as well. We are also seeing that in my own community with the closure of the Repat.

I go on and bring to the attention of the house the words of Associate Professor Elizabeth Dabars from the Nursing and Midwifery Federation in regard to what is going on with Transforming Health and The QEH. Back on 18 January 2017, she said on FIVEaa:

…what's going to be discussed is the appalling closures that are both being undertaken and proposed at both the Royal Adelaide Hospital and The Queen Elizabeth Hospital and as recently as late yesterday we understand that there's also some possible closures being proposed at the Flinders Medical Centre…this may well extend and expand over there as well. However at this stage the meetings are planned at the Royal Adelaide Hospital and Queen Elizabeth Hospital and what we're going to be saying to the nursing staff which has been reflected in our conversations to date…Transforming Health…[we have an] issue [with] the execution, [we think the execution] is appalling; we think that the issue has become one of cost cutting.

It appears to us that Treasury has just come in and said, Look, you've gotta make the savings that you promised', but the problem is that they haven't actually achieved the efficiencies that they were saying that they would be able to achieve under Transforming Health…the bottom line is that those closures are just fundamentally unsafe for patient care…we're very concerned about the safety issues for patients, we believe that their actions will compromise patient care, we believe that the fact that they have stopped by their actions there will be people no longer cohorted or grouped in appropriate areas—will mean that there would be more deaths amongst the patients…what we're going to be saying to our nurses…[is that we have] professional obligations…

She goes on to criticise Transforming Health.

These are senior clinicians, senior representatives of people who work in our health system, who are concerned with these proposed changes. So, when the member for Colton and the member for Kaurna and the member for Newland stand up in the house today in this debate, which they have, and say that the Labor Party is out there fighting for their constituents, that is absolute rubbish. It is absolute rubbish that that is occurring.

Where is the member for Elder, fighting for her constituents with the closure of the Repat, saying she will never, ever close the Repat? Every member on the Labor side of the house, they have not stood up for their constituency. Where is the member for Finniss and the member for Reynell fighting to save Noarlunga Hospital?

Members interjecting:

Mr DULUK: Sorry, I apologise; the member for Fisher. I apologise to both the member for Fisher and the member for Finniss for that comment. Where is the member for Fisher, fighting for her community? The reality is they are not. The sad part is that in their heart of hearts all those members know that this government is doing the wrong thing. That is the sad part about it. As you know, Deputy Speaker, what the government is doing to your community is the wrong thing. Deep down I know that the member for Elder knows that the closure of the Repat is a bad thing. My community definitely knows it is a very, very bad thing.

We all know that in recent weeks the Minister for Mental Health has been hiding behind the fact that she is not a clinician for her reason not to act in certain ways regarding the treatment of older persons at Oakden. I put on the record today the senior clinicians in this state who do not support Transforming Health, who do not support the downgrading of The QEH, who do not support the removal of the wonderful cardiology unit at The QEH.

We on this side of the house understand that the western suburbs are one of the oldest communities not only in South Australia but in the entire nation, and we understand that those people who live in the western suburbs need access to health care in their community. What is happening at The QEH is unacceptable, what is happening across the board is unacceptable and the Labor members of this parliament should hang their heads in shame at supporting the closure of the hospitals in their communities.

Mr BELL (Mount Gambier) (12:20): I rise to support the member for Bragg's motion:

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

(a) the downgrading of the emergency department and intensive care unit services at The Queen Elizabeth Hospital;

(b) the reduction in The Queen Elizabeth Hospital's cardiac services; and

(c) the degradation of the hospital's current services by a lack of proper provision for the transfer of rehabilitation services from the Hampstead Rehabilitation Centre site.

Unfortunately, this is becoming an all too familiar scenario in South Australia, particularly with health. What I fear most is that what we have seen in regional areas is going to start biting into metropolitan services. The cost of $1.1 million per day, which needs to be found as soon as handover of the new Royal Adelaide Hospital occurs, will suck the already stressed health budget of much-needed funds. In regional areas, we are already seeing what is happening by the sleight of hand, the manoeuvring and the penny pinching of this state government, and I will give some examples.

In my personal opinion, I think the Minister for Health has either lost control of the department or the department is giving very, very poor advice. In the Mount Gambier hospital, we had an 18-month battle just to get the contracts of our orthopaedic surgeons renewed. It became a farcical situation where two established doctors were not indicating whether or not the health department was going to renew their contracts and just kept doing six-month extensions.

We had a reduction in palliative care, and the community led a campaign that involved the personal intervention of the health minister—and I will give him credit for that—coming down to face our community after a community meeting of some 500 people packing out the Sir Robert Helpmann Theatre, angry at the palliative care cuts that were imposed on them by this government. The minister had the courage to come and face our community and then reinstate those services.

We had an emergency department where waiting times had blown out. I had reports in my office of people waiting 12 hours in our emergency department. All the while our HAC remained silent, yet when an internal review was ordered by the health minister, who was previously told by his department that there were no problems in the Mount Gambier hospital, the health advisory council was telling him that there were no problems in the Mount Gambier emergency department.

He had the courage to order an internal review. It was not an independent review because it was done by Country Health SA, but an internal review that found there were severe issues of inadequate supervision of junior doctors and that staffing levels were inadequate for the size of the department. Again, I do give some credit that millions have been poured into the emergency department because it was so poorly resourced at that time.

Of course, then we had the case of residential mental health beds being taken away. There were meant to be 10 reduced from Whyalla and 10 reduced from Mount Gambier. The Whyalla beds were reintroduced, but there was nothing for Mount Gambier. It was a purely political decision by this state Labor government to reinstate 10 mental health beds in—have a guess which seat—the Labor seat held by the member for Giles, yet there was nothing for the South-East and Mount Gambier.

So, perhaps this government is receiving extremely poor advice, as we are seeing the Oakden scandal play out in real time and, quite interestingly, nobody has really highlighted perhaps previous ministers who were in that portfolio. I believe this department needs an absolute shake-up and revitalisation. I do not think it is necessarily the culture at some of these facilities; I think it is a culture within the health department itself. In terms of the frank and fearless advice that a minister needs, they need to be hearing it from their department, with that department taking responsibility for its actions.

Let's be honest, I think the health advisory committees are a token gesture, a toothless tiger. I can only speak for the health advisory committee in Mount Gambier for the Mount Gambier hospital, but I am less than impressed with what I see occurring there. I think there is some good news on the horizon, and that is the Liberal Party's position on regional health boards—actually handing power back to those who make the decisions closest to the action. In short, this Labor Party is living in denial. We are seeing crisis after crisis and the day of reckoning is coming—that day is in March 2018. With that, I conclude my comments.

Mr HUGHES (Giles) (12:26): I was not going to take part in this debate, as I figured my colleagues from the metropolitan area were more than capable of defending the health services in the western suburbs, even though I have had some contact with The Queen Elizabeth Hospital. The quality of the care and the professionalism of the people involved at the hospital were exemplary. However, I thought I had better get up because we hear this constant refrain about Country Health and that it is all doom and gloom and all cutbacks.

I acknowledge that the health system is an incredibly complex system. It is the largest budget item, with over $5 billion a year, so there are always going to be challenges. There are always going to be gaps. As local members, we go in to bat for our communities and try to plug those gaps as they arise. We listen to what people tell us about the health services and, in particular, about the hospitals in our regions. Fortunately, I have been around for a long time so I know what the state of the health system was in country South Australia when we inherited it from the last Liberal government.

What has happened over the years in communities like Whyalla and others in country South Australia has been an increase in the services available and an investment in facilities, investment in Berri, investment in Port Lincoln, investment in Whyalla and an increase in the availability of services. I remember the days in Whyalla when, if someone turned up at the hospital with an acute psychiatric episode, the response was often to get the paddy wagon and take that person down to Adelaide.

It was incredibly distressing for the individual, for the police and for the medical staff, but that was the situation. Thanks to a Labor government, we now have a whole ward, an acute psych ward in Whyalla, so those days are largely over. That is a real benefit to our community.

Ms Chapman interjecting:

The DEPUTY SPEAKER: Deputy leader.

Mr HUGHES: There were no dialysis services in communities like Whyalla. People had to go up to Port Augusta for those services. We now have dialysis services in Whyalla and, indeed, they are going to be expanded. The range of cancer treatment that is now available in country hospitals has also significantly increased, and that has helped those people who are facing real difficulties.

Those cancer services enable people to get treatment closer to home. When it comes to some of the investment that has happened in our major regional hospitals—and I will talk about the smaller hospitals in a minute—the surrounding communities have also benefited. Once again, in a facility like the one at Whyalla, people from Kimba, Cleve or other smaller communities are now able to come to Whyalla for cancer treatment, and there is dedicated accommodation available that was also built with the $70 million upgrade.

The federal member for Port Adelaide was mentioned in this debate, so let's talk about the role that the federal opposition played when Labor was last in power federally. They opposed the upgrades to a number of major regional hospitals. They actually voted against them. The sorts of upgrades that we have experienced in Whyalla and elsewhere would not have happened. We should mention the other things that the member for Port Adelaide had to say about the federal government cutbacks in that original Abbott budget.

There was a $1.25 billion cut, which comes into force in the 2017-18 and 2019-20 years. They subsequently reintroduced 18 per cent of that cut but, at the end of the day, it was a very significant cut to the health budget in this state, and not just in this state but in all the other states, because of the walking away from that health agreement that had been entered into by all the states with the then federal Labor government. That came on top of Abbott promising there would be no cuts. They were incredibly significant cuts, but we will never hear those opposite talk about that.

As a government, we have significantly increased the funding for PATS. There was a 33 per cent increase in PATS funding. This represented an additional $2.5 million a year in funding for PATS, and the system has been simplified. I am someone who still has some criticism of PATS. I think sometimes common sense at the bureaucratic level goes walkabout, given some of the issues that come over my desk.

We try to address that, and there has to be some responsibility at a ministerial level to ensure that there is common sense and a degree of flexibility when it comes to decision-making. I fully acknowledge that there needs to be consistency, but consistency should not come at the expense of common sense. I am sure those of us from the country can recount examples of where common sense has gone missing, so we need to constantly work on improving the system, but there have been improvements.

A lot of the challenges for many of the communities out in country South Australia have been about those smaller hospitals. They are incredibly important to their communities because of the health services that are provided, but they are also often the most significant employers of people in smaller country communities. There are challenges with the maintenance of some of those facilities. I know that in my patch, if there was any suggestion that there was going to be closure, I would go on the war path. Given I have the member for Stuart next door and we have a bit of an overlap, I am sure he would go on the war path.

It is incredibly important for those communities that we maintain those smaller country facilities. There is a recognition that there are some challenges there. An independent consultant was employed to have a look at the broader maintenance issues of facilities in the country. There is a recommendation that $110 million of expenditure needs to occur, and that will get due consideration in the budget process.

I thought it was important to get up and say something about Country Health—that it is not all doom and gloom and cutbacks. It would enhance the credibility of us all if we tried as accurately as possible to paint the real picture. By all means, flag the deficiencies, but you will have far greater credibility if in doing so you also acknowledge that there has been significant investment and significant improvement. As a country resident, I look forward to the opening of the new RAH in September. I think it is going to be a fantastic facility. It is going to be a fantastic facility for people from country South Australia because a lot of people from country South Australia—

Ms Chapman interjecting:

The DEPUTY SPEAKER: The deputy leader is thinking out loud again.

Mr HUGHES: —go to the RAH. Unfortunately, through my extended family, I have had experiences with the current RAH. I recall the days when I was still working in the steel industry, finishing my shifts and coming down to the RAH for my partner at the time who suffered extremely serious injuries as a result of a car crash. Even back then, in the early 1980s, it was a rabbit warren of a building. Even back then, the facilities were not up to scratch. Unfortunately, my partner's niece recently passed away at the RAH as a result of an infection. The staff were fantastic. Their professionalism and care was exemplary.

The DEPUTY SPEAKER: Unfortunately, the member's time has expired.

Mr PISONI (Unley) (12:36): I rise to support the motion:

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

(a) the downgrading of the emergency department and intensive care unit services at The Queen Elizabeth Hospital;

(b) the reduction in The Queen Elizabeth Hospital's cardiac services; and

(c) the degradation of the hospital's current services by a lack of proper provision for the transfer of rehabilitation services from the Hampstead Rehabilitation Centre site.

I want to focus predominantly on paragraph (b) of the member for Bragg's motion, the reduction in The Queen Elizabeth Hospital's cardiac services, because we as a family have experienced the tremendous work The Queen Elizabeth Hospital does in that area, particularly in an emergency situation.

My father, who celebrated his 90^th birthday in January, is typical of those who live in the western suburbs, even though he has not always lived in the western suburbs. Those in this chamber who know me know that I grew up in the northern suburbs, but there is some history to that. My father is an Italian migrant who came out to Australia and ended up in Adelaide in the early 1950s. He was one of those people in those days who would take any job. As he did not speak English when he first arrived, he could not be particularly fussy, so a lot of his early work was casual work on the pick and shovel.

His first proper job was at Holden's at Woodville, which is right in the middle of the western suburbs. He lived in the western suburbs at that time, along with many other migrants from southern Europe, many of them Italians and Greeks. Then he moved to the Elizabeth plant when it opened, and he and his new wife (my mother) decided that it would be terrific to move out to a new subdivision in the suburb of Salisbury just a stone's throw from the factory at GMH.

My mother always had dreams of living by the beach, so after his retirement and for the last 20-odd years now they have lived in the western suburbs at Semaphore, not very far from the beach, and downsized to a two-bedroom home. About 10 years ago, my father was rushed to The Queen Elizabeth Hospital with heart pain and had stents put in. I visited him at that time and he was full of praise for how quickly he was attended to and the outcome.

We were all very concerned for him at the time but, after a short time recuperating, he left the hospital as fit as a Mallee bull. I am sure my country parliamentary colleagues would know that term very well. He returned later to The Queen Elizabeth Hospital with cancer of the bladder, and that was also monitored and dealt with. As I said, he is fit and healthy and only just recently started using a cane to walk, but he still spends a few minutes every day with barbells in the backyard, toning his muscles, as he was wrestler in his younger days.

So, we have personal experience of how important it is to continue to have those services delivered at The Queen Elizabeth Hospital. We, the four boys, were very concerned that we might have lost our father at that time. The hospital being so close to where my father lived and the fact that there was access to the emergency room and the services, we believe, is what saved his life. It also gave him the confidence to get healthy, get well, get back home and get on with his life after dealing with that situation.

I would like to just pick up on a few points that have been made by previous speakers. The member for Davenport correctly pointed out the opposition the federal member for Port Adelaide, Mark Butler, had to the downgrading at The Queen Elizabeth Hospital. I note that he made that fuss before the last federal election, but we have not heard from him since. It just shows how the Labor Party operates; they push buttons at particular times in the electoral cycle and then, when it does not matter, you do not hear from them again. That is exactly what we have seen with Mark Butler.

Kevin Hamilton, a former Labor member in the western suburbs, is so concerned about the downgrade of The Queen Elizabeth Hospital that he has been out there with his wife holding community meetings. In the western suburbs, these are the people who have built the South Australia that we know today. They were the people who worked in the factories, many of them from non English-speaking backgrounds. They worked in the factories that generated the wealth that expanded the South Australian economy during the Playford period.

I acknowledge the former premier's portrait that overlooks us in the parliament every day. He transformed the South Australian economy from that of a primary producer. One of the things that I explain to the kids, when they come in for a tour, is that the carpet in this place, with the wheat and the grapes, reflects the economy as it was when this chamber was first built. Mr Playford expanded the economy and brought manufacturing to South Australia, and the result was an economy that no longer relied simply on the weather and what was produced off the land. That provided many, many jobs for the new Australians who made Australia their home.

They are the people who went through their adult lives with the hospital. Their children were born at The Queen Elizabeth Hospital, their children attended The Queen Elizabeth Hospital when they had health issues and they have attended The Queen Elizabeth Hospital themselves. They are the people who are going to be mostly affected by this disastrous Transforming Health program. Remember that this Transforming Health program is only in place to pay for the hospital that this government is building, because the cost has blown out. It is going to cost over $1 million a day to operate the hospital before we put any doctors in there. That is just for the payback to the investors, the return on investment, and for those people who are keeping the hospital clean and keeping the lights on.

Of course, all of the medical staff will be employed by the Department for Health and that is an additional cost to the more than $1 million a day that taxpayers will have to find for the next 35 years. It is an extraordinary situation that this is the third most expensive building in the world here in Adelaide, a city that has a population of just 1.1 million or 1.2 million people, depending on where you align the suburban boundary, and a state population of 1.7 million people.

The member for Giles said he was looking forward to the opening of the hospital so that his constituents could come down and use it, but I ask him: where are they going to stay? Currently, there is accommodation for country people at the existing Royal Adelaide Hospital site. Where is that accommodation facility for those people who will need to come down and use the facilities at the new Royal Adelaide Hospital?

In supporting this motion, I remind South Australians that at every election the Labor government tells us how they are going to improve the health services in South Australia, but since the last election we have seen nothing but a downgrade of the health services in South Australia. I urge members of this house to support this motion.

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (12:47): I just wish to say that I appreciate those who have made a contribution on this motion. The stripping of services at The Queen Elizabeth Hospital remains deeply disturbing to those on this side of the house. We will continue to fight for the people in the western area to ensure that they have these cardiac ICU and emergency services restored to ensure that they are able to have the acute services that they desperately need. I thank all speakers and invite you, Madam Deputy Speaker, to call on the vote.

The house divided on the motion:

Ayes 18

Noes 21

Majority 3

Motion thus negatived.