Motions

Regional Ambulance Services

Mr BELL (Mount Gambier) (11:30): I move:

That this house calls on the government to strengthen ambulance services in regional South Australia and to recognise—

(a) the poorer health status of South Australians in regional South Australia;

(b) the shortage of volunteers to maintain ambulance services in regional South Australia; and

(c) the additional cost for ambulance services that is borne by people living in regional South Australia.

Having grown up in regional South Australia, I am well aware of the struggles facing people living in these regions. Every Australian has a right to access quality healthcare services. However, for people living in rural, remote and regional South Australia, timely access to the services they need and/or desire may not always be possible because of distance, transportation issues and service availability. This means that many of the 380,000 people living in regional South Australia may have unmet healthcare needs and this leads to poorer health outcomes.

Recent headlines put the spotlight on Yorketown and Quorn, but it was not long ago that it was Port Augusta and Mount Gambier. These hospitals join a long list, from Kingston and its leaky roof to the plight of Hawker's solo GP. South Australia's rural population contains some of the most poorest and most disadvantaged in the country. Accessing even basic health services is a challenge for many.

More recent issues, such as increasing needs for mental health, disability, adolescence and child health services, are poorly developed and supported. The feeling outside metropolitan Adelaide is of relentless and mindless cost saving to finance the new Royal Adelaide Hospital. It staggered me to understand that the new Royal Adelaide Hospital's art budget was over $2 million when in Mount Gambier we are crying out for a renal dialysis upgrade of just $1 million.

But we are here today to talk specifically about ambulances and ambulance cover. I want to commend the many volunteers and professionals with the South Australian Ambulance Service who have more than 1,100 career staff and more than 1,500 volunteers. There are 111 ambulance stations and 80 volunteer teams throughout the state. In the 2014 financial year, SA Ambulance Service responded to more than 265,000 incidents and answered 184,000 triple zero calls. That is one call every 2.85 seconds.

SA Ambulance Service has a fleet of 417 vehicles, including 253 traditional stretcher-carrying vehicles. It has access to aircraft from the state rescue helicopter and the Royal Flying Doctor Service, which in the South-East is a very welcome addition, with flights occurring daily from Mount Gambier to Adelaide transporting some of our most vulnerable and at-need patients when specialty services are not available down there. Ambulance stations in South Australian regional areas are largely staffed by volunteers, with 80 volunteer teams across 18 regional team leader areas and six operational management regions. There are 22 regional career ambulance stations staffed by paid paramedics across the state. Volunteer ambulance officers and paid paramedics frequently work together on cases as required.

This year, the number of operational volunteers increased by 32 people and the number of new volunteer recruits remains relatively stable at 281. All in all, the Ambulance Service—and I can speak specifically of the South-East—does an amazing job, in both a paid professional capacity and a volunteer capacity. I think it is the volunteers who certainly carry a fair load, particularly in more remote or perhaps regional areas of the state and particularly the South-East, like Penola, Robe and Kingston, where the first response is from a trained volunteer and then backed up with paid paramedics when they can get there normally, obviously with distance, some time later.

Quite interestingly, when I was talking to our local ambulance officers, who are very proud of the work they do, about their facilities, particularly in Mount Gambier, they rate them very highly. In fact, demand is growing so strongly that the vacant block of land across from the ambulance station will be tagged for an expansion that is coming up soon. In the South-East, 75 per cent of the work that is done is with elderly patients, and with the boom in retirement villages in the South-East, particularly Mount Gambier, that workload is only set to increase. One of the officers said, 'Years ago, we used to have busy nights—now every night is busy,' such is the workload.

If there is one area both sides of government need to focus on it is training and retaining volunteers to make sure that we have a continual, highly trained team of volunteers ready to be first responders in those outer lying areas. That is one area where we do need to continually invest money going forward, recognising that volunteers do contribute heavily to keeping our community safe. Another area that needs to be looked at is the cost of ambulance cover. We used to have South Australian ambulance cover that would cover all of Australia; now your ambulance cover is for South Australia only, unless you opt in for interstate coverage.

I compared the cost of cover in South Australia and Victoria, and people will know that Mount Gambier is very close to the border. Family ambulance cover in South Australia is $161, plus $30 if you want interstate cover, so nearly $200 for a family with interstate cover. The same family cover in Victoria is $92, so it is half the price. If you live in any of these postcodes—5290, which is Mount Gambier; 5291, which is Mount Gambier East or West; or 5262, which is Frances—the Victorian government will allow you to have Victorian cover, which obviously covers interstate as well. It is quite amazing that nearly every second person I talk to in Mount Gambier has Victorian ambulance cover because it covers you Australia-wide and it is half the price compared with South Australia's cover.

There are some areas that will need continual attention. The cost of ambulance cover needs to be reduced and brought down to a more manageable level, and the time and effort put into volunteers and upgrading those facilities needs continual work. With those words, I will conclude my comments.

Mr HUGHES (Giles) (11:39): I rise to amend the motion, but I do thank the member for Mount Gambier for bringing this to the house. Our ambulance services and health services in regional South Australia are incredibly important. I move to amend the motion as follows:

After—That this house calls on the government to strengthen ambulance services in regional South Australia and to recognise—delete parts (a), (b) and (c) and replace with the following:

(a) the dedication of volunteers across the state to maintain ambulance services in regional South Australia;

(b) due to a range of social and economic factors, people in regional areas of Australia have statistically poorer health outcomes than those in metropolitan areas, and country South Australia is no exception; and

(c) the state government, through Country Health, is committed to working to overcome these statistics. Over the past four years the government has upgraded in every major regional hospital, invested in new technologies including telehealth, increased patient transport assistance and investigated new models of care to help improve health outcomes for people across country South Australia.

As said, when it comes to health, statistically the outcomes for country South Australia differ from those in the metropolitan area.

The member for Mount Gambier touched upon some of the reasons: access to services, distance and a number of other factors. One of the main contributing factors, not just in South Australia but across Australia, is socio-economic status. Generally speaking, there are higher income levels and higher socio-economic status in the metropolitan area. There are a lot of people in regional South Australia who get by on lower incomes. All the evidence points to socio-economic status as being a very important determinant of health and health outcomes, and addressing those differences is complex and challenging.

Over the past four years, every major regional hospital has been upgraded and the government has invested in new technologies, including telehealth, increased their patient transport assistance and investigated new models of care to help improve health outcomes for people across South Australia through the Country Health SA Local Health Network. Investments have been made to increase our services closer to home through the provision of local services such as renal dialysis, chemotherapy, mental health care and cardiac rehabilitation. Clearly, there is still more to be done, but the improvements I have seen over a number of years have been very significant. The upgrade of health facilities in some of the communities that I represent has been outstanding.

There have been some real success stories when it comes to taking different approaches. The investment in telehealth-based country cardiology services has led to a 22 per cent reduction in mortality for country heart attack patients, which means that country patients now have the same survival rate as metropolitan patients. Technological improvements and different ways of delivering services will have a good result for those of us who live in country South Australia.

As the statutory provider of emergency ambulance services across the state, the SA Ambulance Service plays a critical role in South Australia's health system, providing emergency and non-emergency ambulance service 24 hours a day, seven days a week, to both metropolitan and regional areas. Ambulance services are delivered to regional communities through a combination of paid staff and volunteers, with volunteers making up the majority of staff within regional South Australia. As the member for Mount Gambier said, over 1,500 volunteers work in our ambulance service, which is an incredible voluntary input.

SA Ambulance Service also has the capacity for air retrieval of critically ill and injured patients in regional areas, utilising fixed-wing and rotary-wing assets, as well as the capability to dispatch paramedics via helicopter. While SA Ambulance Service aims to provide most regional communities with 24 hours a day seven days a week service, in practice the ability to maintain a service to many communities depends upon the availability of volunteer staff. However, recruiting new volunteers anywhere in Australia is becoming increasingly difficult, and this is no different for SA Ambulance Service.

Those of us who have a lot to do with volunteers in a whole range of organisations know the struggle these days to get additional volunteers. It is for this reason that the government recognises that ambulance services in regional areas need to be strengthened. In order to address this issue, SA Ambulance Service currently has a number of strategies either planned or underway. Once long-term strategies have been identified, intensive local and regional consultation will occur to identify the most appropriate and pragmatic solutions.

For example, a recently approved new graduated authority to practise and training program is being introduced by SA Ambulance Service, and will include a tiered system of operation for volunteers. The new approach expands the roles available to volunteers in order to improve volunteer recruitment and retention, and allow volunteers the opportunity to progress through each clinical level within a time frame that suits them, so it is being tailored to meet the needs of particular volunteers.

Finally, I must address the member's motion that 'additional costs for ambulance services are borne by people living in regional South Australia'. This statement is fundamentally incorrect; in fact, standard fees apply for services provided to both metropolitan and regional areas. It was interesting to make the comparison between South Australia and Victoria. The comparison is not entirely fair. Victoria is a small state with a very high concentration of population.

During one of the recent times I was in the APY lands, we had to buy seven brand-new, customised ambulances to service that area. You can imagine what happens to ambulances in the APY lands and other parts of remote South Australia. They do not last long on the roads up there. It is good to see that some significant expenditure is going on at the moment in the APY lands to improve the roads. When you are looking at an area with a population of 3,000 over a land mass in the APY lands that is the size of England, to then make the comparison with Victoria when it comes to delivering ambulance services is not entirely fair.

It would be interesting to go and have a look at some of the other states, though. Western Australia might be a good example. I would probably be one of those people who would argue that our that ambulance services could be funded in a different way. I think there would be a few people on this side of the house who would believe that ambulance services should be funded out of general revenue so that it is available to people. There are people who end up, through no fault of their own, without ambulance cover and they get picked up by an ambulance, and the bill can be very significant. I think we should be looking at other ways of funding ambulance services, because it is an essential service. I thank the member for bringing this motion to the attention of the house and commend the amended motion to the house.

Mr KNOLL (Schubert) (11:49): Here we are again on a beautiful Thursday morning and here we are again with a government that chooses to amend a motion and try to hide from the issues we face in country South Australia, rather than dealing with the issues at hand. I do feel sorry for the member for Giles because every time we bring a motion such as this and talk about poor infrastructure in the regions and poor health services in the regions, they trot him out as the token country Labor member to push back on what we are trying to get the people of South Australia to understand, and that is the truth about what is happening in country South Australia.

I am fairly certain that he agrees with what we are talking about, but unfortunately what happens is they trot him out with this amendment that just seeks to whitewash over the problems that happen in country South Australia because, as the Premier himself said, there are not any votes out for there for him, so he may as well just ignore it and he will not pay any electoral consequences. It is absolutely disgusting.

I do really feel for the member for Giles because we know that he feels the same way we do. We know that he sees firsthand the issues and the poor second-rate service that people in country South Australia get. He is just gagged and is not able to say it, but that is okay. We are here for you. Member for Giles, we are here and we will speak truth in a way that unfortunately you cannot, or maybe you could but unfortunately the Labor Party does not allow dissent—one wrong word and all of a sudden you are sitting on the crossbenches.

This motion moved by the member for Mount Gambier says that the poorer health status of South Australians in regional South Australia is something this house is calling on the government to recognise, and in response they say, 'No, no, hang on. Basically everything is okay in South Australia. There are no issues in country South Australia when it comes to regional hospitals.' The amended motion essentially tries to say, 'Well, it's not our fault that there are issues in country South Australia in relation to second-class health care.'

In fact, what is called here part (b) of the motion states that due to a range of social and economic factors, people in regional areas of Australia—I like the use of 'Australia'—have statistically poorer health outcomes. So, you admit that South Australian country areas have poorer health outcomes but in the same sentence you say that it is not your job to fix it: 'We can't do anything about it. There are statistical, social and economic factors. We'll just blame those things.' You cannot identify a problem and then stand up and say, 'We're not going to do anything about it. Here are the problems. They're entrenched, they're ingrained. We can't do anything about it so we'll just whitewash over what's going on—

Members interjecting:

The DEPUTY SPEAKER: Order! The member is entitled to be heard in silence.

Mr KNOLL: 'We'll just whitewash history.' We see it happening at the moment with the celebrations around cultural Marxism and anniversaries. Once again, what we see here is an attempt to whitewash what is really going on in country South Australia. The Liberal Party, as the champions of country South Australia, will not stand for it and that is why we have put this motion to the house. We want to bring light to this extremely important issue.

At the same time, we also want to acknowledge the great work that the South Australian Ambulance Service, especially the volunteers, do in our regional areas. There are more than 1,400 volunteers who make up a network of over 70 country volunteer teams as part of the SA Ambulance Service. These volunteers provide professional emergency ambulance and patient transfer services within their communities. It is an extremely important initiative that helps to bring together and build social capital within regional South Australia, build community spirit within South Australia and it deserves to be supported at every single turn.

I want to put on the record at this point my desire and certainly the Liberal Party's desire to encourage people to get involved with the SA Ambulance Service's volunteering program because there are a huge number of benefits. Apart from the satisfaction of getting out and getting involved and helping your local community, there are opportunities to complete a Certificate IV in Health Care (Ambulance), which is recognised all across the country. There are opportunities to undertake training to further help your first aid and your ability to respond in emergency situations.

As volunteers have put it, they find it extremely rewarding. They find it an extremely important part of their lives and of being part of their community. We in the Liberal Party thank them today and every single day for the great work they do and we encourage more people to get involved to help encourage and strengthen this very vital service in regional South Australia.

Country South Australians are as entitled to taxpayer-funded investment in hospitals and health services as those in metropolitan areas. We pay tax as well. We live in the same state and we deserve and are entitled to the same level of care. So when the government puts an amendment on the table that says, 'Yes, we acknowledge you are getting second-class care, but no, we are not going to do anything about,' that is absolutely disgusting.

We have a metrocentric mindset from this government and have had for the life of this government. We know we have it when we hear the comments from the Premier, who basically washes his hands of country South Australia because there are not any votes in it for him. In the 2017-18 budget, what we see is the best example of that. In what was considered a pretty last-minute, cobbled together plan, they put $1.1 billion of health spend on the table, but how many dollars of that $1.1 billion were slated for capital investment in country hospitals? Absolutely none—not one single dollar from $1.1 billion worth of spending—especially after we have seen $2.4 million spent on the new Royal Adelaide Hospital.

What country people do not understand is why that figure cannot be spread around a bit. We are 30 per cent of the population; why can we not get access to 30 per cent of that capital spend considering how much capital spend there already has been in the city areas? This motion goes on to mention the fact that there has been investment in a number of major regional hospitals in South Australia, and I will accept that there has been some money spent in about a handful of hospitals across country South Australia. However, there is one region in particular that is very close to my heart and the member for Stuart's and the member for Chaffey's, and that is the broader Adelaide Plains, Barossa Valley, Murraylands region.

Do you know how money has been spent in our region? Nothing. In fact, what we have at the Mount Pleasant District Hospital is the fact that they have been allocated aged-care beds with money that they were given from the commonwealth, which they cannot get approved. They have been asking for a simple upgrade out in the back area after the community had raised the vast majority of the money to start the upgrade, but they cannot get anywhere.

In my area, in the Barossa and Districts Health Advisory Council, which includes the Tanunda and the Angaston hospitals, we have $2 million in a fund ready to go. That money has been raised by the local community on the understanding that it would help to supplement government capital investment to upgrade the health services in the Barossa Valley. Once again, I am going to put on the table my call that there needs to be not just a little bit of investment in my region but a lot of investment in upgrading the healthcare facilities in the Barossa. A single hospital would work. A single hospital would also provide efficiencies to the government, efficiencies that they are desperately looking for considering that Transforming Health has actually now cost money rather than save money.

Here we have a plan on the table that includes significant investment from the local community. It includes about half a dozen ideas the local community have had to actually help the government save money, including council putting land on the table for nothing, including the fundraising efforts of local health trusts, including builders willing to come on board and donate materials, and people willing to come on board and donate their professional skills to make this thing happen. But what we get from the government is a business case that is not released to the public. No information is given to the people of the Barossa and the broader surrounds about what the government's plans actually were. We are just kept in the dark. Year after year, report after report we are kept in the dark.

I know that in regional Country Health my region is the top priority but, looking at the actions of the government, no-one would know. No-one would know, and that is an absolute disgrace and it is one of the reasons why we as a party have put on the table a plan to fix the backlog in country capital works by ensuring that all money raised in local communities is spent in those communities, that we act with urgency to address higher risk repairs and maintenance at country hospitals, that we implement a country hospital capital works renewal strategy and that we develop arrangements to retain part of the private patient income to local hospitals for the benefit of local services.

We have a plan on the table for country hospitals in South Australia. At the next election, in March next year, South Australian people in country areas will be able to decide between a concrete plan that we have put on the table and the fact that they have got a city-centric government that has offered them nothing in the 2017-18 budget.

Mr WHETSTONE (Chaffey) (11:59): I rise to support the original motion put forward by the member for Mount Gambier, which refers to the ambulance services in regional South Australia and the poorer health status of South Australians living in our regions. When referring to regional ambulance services, many South Australians might remember the state government's decision that SA Ambulance Service's ambulance cover would no longer cover interstate ambulance services. This is relevant to the member for Mount Gambier and his electorate. It is also very relevant to the electorate of Chaffey because we are on the border of Victoria and South Australia. This decision was met with outrage by all people living close to the border.

People from both sides of the border travel over the border; they shop, they play sport, and some go to school across the border. Many people depend on the ambulance service if they are in a workplace. A lot of businesses and farms are situated on both sides of the border, and not having ambulance cover that was relevant on both sides of the border, was absolute nonsense. To the credit of the state government, they backflipped and reversed that decision. It was good news. Every farmer, sportsperson and community member breathed a sigh of relief because it would have potentially meant they would have to pay for two lots of ambulance cover. As the member for Mount Gambier said, ambulance cover is much more expensive in South Australia than it is across the border.

There are regional health challenges. I have seven hospitals in the electorate of Chaffey. A lot of those hospitals are slowly being downgraded, and staff numbers and services are in decline. We are seeing a lot of those hospitals being turned into retirement villages, nursing homes and the like. I have to congratulate the small communities that raise money through raffles, fundraisers and bequests. People depend on regional health services. People put up their hand and say they are going to help their community, not only by raising money but also, on behalf of their family, by bequeathing money to make sure those hospitals remain relevant.

Reflecting upon the $41 million upgrade to the Berri hospital, that was a great addition to the Riverland and the Mallee, but it was met with some resistance. The $41 million soon turned into just over $36 million because, all of a sudden, the government said that they had found savings in the tender process. Builders became desperate because of the downturn during the drought. I asked the government, as I asked the minister at the time: where are the savings? Show me where the savings are. He could not tell me where those savings were. So really it was an upgrade, but it was a downgrade with the budget. We still missed out on the community health service upgrade and the hydrotherapy pool service that was meant to be put in place.

It was a sad indictment that the government saw fit to downgrade a hospital upgrade for the sake of a budget that they would rather put elsewhere. As the member for Schubert said, the recent South Australian budget saw absolutely nothing go out to the regions—not a cracker—yet we see the election looming. The now deposed health minister all of a sudden had to backflip on the Transforming Health initiative. We have seen services upgraded, reinstated and put back in place to the tune of over $1 billion. I think it is outrageous that we can see that happening in Adelaide, a one-city state, by a government that seems to represent the city and forget about the regions.

There is a lack of transport in the regions and little capacity to get to these hospitals unless you are in the back of an ambulance. There is no public transport in most instances. Luckily for the Riverland, the Red Cross has taken over the Medical Bus transport service from the Berri Barmera Council. We have regional health patients dealing with the PAT Scheme. The online PAT Scheme has presented challenges. In the recent transformation going online, it is clunky and hard to use. It is a terrible system. People who are computer illiterate cannot use it. We have issues with access to the internet. People have all sorts of issues when trying to deal with the PAT Scheme. We have doctors speaking out against the PAT Scheme because it is very, very hard to use. As I said, it is a very clunky system that is not user friendly.

The online system is unreliable for patients to put in their claims. It is also unreliable for GPs and specialists who refer patients through the PATS online system. The subsidy system is too complicated and needs to be replaced with a much simpler process, something that is easy to use; an indexing system could be the way to go. There are limitations in subsidies for youth and unemployed patients.

The complexity of PATS does not really help them; it deters them from using that PAT Scheme, which really is a sad indictment. One particular doctor at the Loxton and Districts HAC advised the regional health inquiry committee that it was a challenge to use the PAT system online and he had doubts that it was any easier for either patients or consulting specialists to use. He said:

The process for a GP…I found laborious and difficult, even for me, let alone for a patient trying to go online and work out how to submit a claim. It also requires a specialist that has seen the patient and then also registered online to be a provider of PATS information. I can't see any specialists being bothered to do it…

Coming back to the focus on the health system in the Riverland in recent years, we had an operating theatre at the Waikerie hospital noncompliant. The operating theatre was noncompliant because of an air conditioning unit not working. We had doors that were not compliant, yet SA Health said, 'Well, we're not paying for it. If you want to fix up your operating theatre, you find the money yourself,' so they did.

The community came together and raised the funds ($140,000) to upgrade the air conditioner and upgrade the doors so that they could keep that operating theatre in operation, because we know that once any part of a hospital or any part of a community services becomes noncompliant it very rarely ever gets back up again. Congratulations go to the community of Waikerie. They stepped up and they got that upgrade up and running, and they still have their surgery. If we look at Loxton, we see the same thing. They had an upgrade to the call bells and the bathrooms at their hospital. They were told, 'No, we are not paying for that.'

These issues were noncompliant, yet Country Health, through SA Health—and I am sure that was all part of Transforming Health to save money—said, 'We are not paying for these upgrades.' However, I thank the minister, who backflipped and ended up coming good with some of the money for those upgrades. I want to talk about the Marshall Liberal team's recently released welcome health policy, which recognises the need for local communities to have a stronger input into local health service decision-making and being able to spend their own funds on their own hospital in their own time.

This motion is about ambulance services in regional South Australia, and I commend the volunteers and the paid ambulance officers for the great work that they do. It is not an easy job, particularly in regional South Australia. I have also heard of ambulance officers saying that they could not take critical patients in an ambulance on the Browns Well Highway. The reason they cannot take ambulances there is that the patient would be bounced around that badly in the back of the ambulance that it would be unsafe for an ambulance to travel on that 20-kilometre section of road.

When the ambus pulls up at the Berri regional hospital, I have heard that there are no extra staff and no extra doctors. These nurses and doctors are having to work in their own time to be able to deal with the onslaught of these people coming in, so it really does make you wonder. I want to commend the great work that ambulance officers do, both volunteers and paid staff. They attend sporting functions, they attend community events and they do a great job. They do a great job to keep our country communities intact and safe, delivering them in a medical emergency. I commend the original motion to the house.

Mr VAN HOLST PELLEKAAN (Stuart) (12:10): I rise to support the member for Mount Gambier in the unamended motion. It reflects very poorly on the government to come in here and use their numbers to change the intent of motions from opposition and other members of parliament. The member for Mount Gambier has done a great deal of work with regard to the issue of ambulance cover for South Australians when needed interstate. He represents the highest number of constituents within South Australia very close to a border.

Of course, many of us have the same issue with our constituents. The electorate of Stuart, which I represent, borders three states, as does the electorate of Giles. The electorate of Chaffey has a very high population very close to the Victorian border. This is an issue that affects all of us and is very important. The government did backflip and, as often happens here, the opposition knows that it contributed to getting the government to change its mind, which is a positive thing. I am sure the government knows that it saw that what it was considering doing was not the right thing to do, so the government did the right thing and changed its mind. It actually does not really matter; we did get a result.

What I want to say is that we got a temporary result. We need to get this issue fixed permanently, and there are some other issues with regard to ambulance officers that are very important. We get extraordinarily good service from professional and volunteer ambulance officers across our state, but it is getting harder and harder to get volunteers to step up to do it. That is true in general across a whole range of work in community areas, but it is harder than it needs to be with regard to ambulance officers.

I know an enormous number of volunteer ambulance officers as friends and as constituents. They come to me regularly. The most recent time, by coincidence, was an email from a friend and volunteer ambulance officer in Jamestown saying that they have such a small corps of people that, as they cannot get more people up, trained and qualified as volunteers, the small group already there is getting burnt out way too fast. She was saying to me, 'We just can't keep going this way.'

It is unfair on the existing volunteers, and it is unfair on the volunteers who are trying to get trained, and there are some good people who have stepped up and who have offered their services, skill, free time and that sort of thing. They are finding it so cumbersome and so difficult to get through the training process, and one of the reasons is that it is hard to get a training course made available in a regional area if there is not a sufficient number of trainees who are going to attend.

If you are in an area where the population is low and it is hard to get volunteers anyway, of course it is going to be very hard to get the sufficient number to run the course, and then you have actually turned off those few who are willing to participate. They go away and say, 'Gee, I would like to, but it's going to take me two or sometimes three years to get through this training, so what is the point?' Quite understandably, the person says, 'Maybe I will offer my time, skill and capacity in another area instead.' You cannot blame them for that. They are the reasons why we are low on volunteers.

There is another thing that puts volunteers off, and I have to say that I continue to be very angry about this issue. It used to be that volunteer ambulance officers in regional areas could come to an agreement with a local community organisation that was running a significant event, an event of the size or type that meant it was appropriate to have volunteer ambulance people, or any ambulance people, available on site.

The local ambulance station, full of volunteers, could come to an agreement with the local community organisation that might be running a rodeo, a significant concert, a motorsport event or something like that, and they would say, 'Don't worry. You need ambulance here. We will come and we will bring our ambulance. We will be there for the entire event as volunteers and, in return for that your community event, will donate some money back to the ambulance to help with our training and equipment and to help us do a better job as volunteers.'

Only a few years ago, the government stopped that. The government said, 'Oh, no, we're not having this anymore.' The government said that any donation that goes to ambulance cannot go from the local community group to the local station. The money must go into SAAS centrally and then SAAS will decide if ever it wants to distribute it back out. So, guess what? Those volunteers in the local town, who were prepared to give up their whole afternoon and evening to be there in uniform with their ambulance to offer the support that was needed, say, 'What for now? We're happy to help, but this is a community fundraising event.'

I am talking about not-for-profit community events where the money goes back into the local community, but the government and SAAS have prevented any of that money going directly back into the volunteer ambulance station that provides the service that allows the event to proceed. It is a ridiculous and crazy situation. It must be addressed and it is having a seriously negative impact upon people's willingness to volunteer because they are asking, 'What for? We want to do this because we want to look after our community, and there has been a way to make it all go around so that everybody got a benefit.' The money from the community event would allow the local branch to do a better job over time, so that is something that absolutely must be addressed.

There are many aspects of the member for Mount Gambier's motion I would like to address, but in the short time left let me touch on a few country health issues. I was alarmed to learn a statistic about seven years ago that the difference in average life expectancy between metropolitan people and country and outback people was 17 years. That is an alarming statistic. It is also worth putting on the record that at the time it was the same difference in life expectancy between Aboriginal and non-Aboriginal people in our state, and that is unacceptable as well, completely unacceptable.

What I was so surprised about at the time, knowing the statistic as it related to Aboriginal versus non-Aboriginal people, was to find out that metropolitan versus country statistic at the time was the same number. Both those statistics are completely unacceptable and neither of those statistics have improved significantly in the last several years and that is a great shame on our system. I am not pointing my finger at anybody particularly, but that is a great shame on our system.

Picking up on the comments I heard from the member for Chaffey and the member for Schubert, it does come down to resources. We on this side of the chamber have a very different attitude to the government's attitude when it comes to country health. The government spends an enormous amount of money on health, and I have believed for a long time, and I have said it in this place quite a few times, that the health portfolio is the toughest portfolio, so I take my hat off to the people who step up to take on that job.

It is the toughest of all the portfolios but, when it comes down to picking priorities, the fact that the job is so hard, the fact that the health portfolio is difficult, that the money is so tight, that you cannot turn people away, that you budget for the number of people who might need the care and you cannot say, 'I am sorry we have reached a quota for the month or year,' and that you have an extremely high, in excess of 10 per cent inflation rate in the health industry, all make it tough. What would not be tough would be to give country people access to the support and services that they need in the same way as city people.

I understand that country people will come to Adelaide for care and health, as they always should. We do not do cardiac surgery in the country and I do not advocate that we ever do. Anybody from the country who needs cardiac surgery is going to have to go to the city for that; that is just as it is, and it makes sense. But city people go to the country, too. They have family in the country, they go on holidays in the country and they participate in community or sporting events in the country. Country people deserve as much support as city people do.

The comments that the member for Schubert and the member for Chaffey made are spot on: the share of government funding going to country health services is insufficient and insufficient by comparison with the share of health services that go to metropolitan people. That is an issue that absolutely must be addressed. There are 17 hospitals that the people of Stuart access: Port Augusta, Leigh Creek, Kapunda, Eudunda, Jamestown, Booleroo, Orroroo, Peterborough and Burra, just in the electorate. There are another eight just outside of the electorate of Stuart, which are the closest hospitals to my constituents in Stuart. Their closest hospital is just outside.

There are 17 hospitals that provide tremendous support, but the people who work in those hospitals, as great as they are at what they do, tell me that they are getting worn down by government policy.

Mr BELL (Mount Gambier) (12:20): I would like to thank all the members who have made a contribution to this motion to strengthen ambulance services in regional South Australia. Getting back to the core of what we were talking about, I thank both the paid officers within the Ambulance Service and, perhaps more so, those who volunteer countless hours to being the first responders in some of our regional and remote areas where a paid staff member is not stationed.

I think that some very important points were raised in the debate, and I would certainly like to highlight the member for Stuart's comments about local fundraising going into local ambulance services. That is certainly pertinent to my area and I thank him for those words. With that, I will move that the motion be accepted.

Amendment carried; motion as amended carried.