Motions

Modbury Hospital

Mr GARDNER (Morialta) (11:29): I move:

That this house—

(a) condemns the Weatherill Labor government's decision to cut services at Modbury Hospital and in particular, the removal of emergency surgery, the downgrading of the hospital's emergency department and the closure of its high dependency unit;

(b) notes that as a consequence of these changes, life-threatening emergencies are now diverted to the Lyell McEwin Hospital and other hospitals and, accordingly, that some north-eastern Adelaide residents now have to travel further and wait longer to access emergency department services; and

(c) recognises that Labor government's Transforming Health plan is changing the focus of Modbury Hospital from a general community hospital for the people of the north-eastern suburbs to an elective surgery and rehabilitation centre for the whole of northern Adelaide.

This is a very important motion for the people of my electorate, particularly those living in Highbury (north of the river) and some of the Hills communities for which Modbury Hospital is often the first hospital of call. It is also important for residents of Rostrevor, Athelstone and all the other suburbs in Morialta because there are flow-on effects of the changes to Modbury, as there are across the whole of the north-eastern suburbs.

This is a tremendously important motion for the people of the north-east, and the lack of interest from the government in dealing with the challenges that Modbury Hospital is now facing is notable. I fear that the lack of interest from the government would come as an absolute shock to residents of the north-east, who turned up at their polling booths at the last election in seats like Newland, Florey and probably Wright—I was not on the polling booth so I did not see—to see signs put out by the Labor Party which said 'Save Modbury Hospital, Vote Labor'.

Of course, what does the Labor Party do when they attain government? They betray the people of the north-east. They cut services to Modbury Hospital. They portrayed themselves before the election as the saviours and champions of Modbury Hospital and then displayed their true character after the election when, just as they did at the Repat and at Noarlunga, they were willing to betray those communities, and instead of supporting those services, they withdrew them.

Labor's downgrade of key services at Modbury Hospital is part of its discredited Transforming Health experiment. Under Transforming Health, Modbury Hospital will no longer be a general community hospital; it is becoming a centre for rehabilitation, day surgery and outpatients. Before Transforming Health, life-threatening emergencies were treated on-site. After Transforming Health, life-threatening emergencies are diverted away from Modbury, or are stabilised and then transferred.

Before Transforming Health, there was a high dependency unit on site. After Transforming Health, there is no ICU or HDU backup on site. Before Transforming Health, there was a 24-hour emergency surgery at Modbury. After Transforming Health, there is no emergency surgery, no 24-hour on-site anaesthetic service or theatre team. Before Transforming Health, there were acute surgical wards. After Transforming Health, there are no acute surgical wards. Before Transforming Health, there was access to a range of medical wards, but after Transforming Health they have lost two-thirds of their medical beds and now only short-stay, low-acuity beds are available.

Before Transforming Health, there were acute cardiology beds. Now there are no cardiology admissions. At the 2014 election, Labor promised a $46 million upgrade of Modbury Hospital. That budget was subsequently cut by $14 million. Before the 2014 election, a redeveloped Modbury emergency department opened with 40 treatment and assessment bays. Now, there are only 29 bays operating. Downgrade after downgrade, cut after cut: that is what this government has done to Modbury Hospital. That is what this Labor Party has done to the people of the north-east—not with them, but to them.

The emergency department has been downgraded. Modbury's emergency department no longer deals with life-threatening cases which would involve hospital admission. Lyell McEwin is so overcrowded that it was subject to a safety notice in late 2016, and it frequently diverts patients to Modbury. The dedicated ambulance shuttle from Modbury to Lyell McEwin stopped operating on 31 March. The number of patients who attend the Modbury ED has not changed significantly and the cases seen by the ED are more complex, not less. As Dr Davidson, head of the Modbury emergency department said in October last year:

…we now have no acute services beyond the ED, other than general medicine, so the loss of intensive care and anaesthetics, particularly out-of-hours, makes a difference to the care that the ED specialists can provide.

SA Health's own data has confirmed that, under Transforming Health, the performance of the Northern Adelaide Local Health Network has deteriorated. Modbury's surgery focuses on day surgery involving up to 23-hour hospitalisation, only about one-third of Modbury's previous load. Without critical backup for both treatment and diagnosis, emergency cases have to be diverted to other hospitals. Older patients and other complex cases are more likely to have care scheduled at another hospital. Again, quoting Dr Davidson last year:

…basic hospital admissions can no longer be admitted at Modbury Hospital…

Many country hospitals have access to general surgeons, and not to be able to offer this basic service, to me, is a failure of adequate care.

We also understand that the ED is having trouble recruiting staff and covering overnight shifts. There has been a loss of ability to train and teach medical students, specialist trainees and nurses. Again from Dr Davidson:

…there is still the daily battle for staff, managing problems, and morale is at an all-time low.

When Transforming Health was announced, Modbury Hospital was going to host an eye hospital for the whole of Adelaide. The government has cancelled those plans and now has no plans for an eye hospital. SA Health has recently tried to withdraw the inpatient medical emergency team and have the emergency department staff take on the hospital emergency call-out role. It is dangerous to plan for senior ED staff to leave their patients in an emergency department and be busy for hours in a separate building.

Under Transforming Health, under this government, the cardiac inpatient unit at Modbury Hospital was closed. The member for Playford promised that cardiac outpatient clinics would continue. In a news release dated 7 October 2015, he stated:

…all current specialty outpatient services accessed at Modbury Hospital will remain…

Initially, the outpatient department still performed echocardiograms, stress tests and urgent clinics for chest pain. Until around a month ago, the hospital offered urgent clinics for chest pain each week. The chest pain quick access clinic has been terminated: now, a cardiologist visits Modbury once a fortnight.

In the 2017 budget, Labor promised $250 million for The Queen Elizabeth Hospital as they scrapped Transforming Health, but only $9 million for Modbury Hospital. Labor plans to build a $9 million eight-bed emergency extended care unit at Modbury by 2020. The unit may act as a holding bay for patients awaiting transfer. It will not undo the significant negative impact that Labor's chaotic Transforming Health agenda has had on Modbury Hospital.

I was very pleased several weeks ago when the Liberal Party announced a series of policies to improve services at Modbury Hospital if we are successful in the election in March next year. After the Liberal Party policy was released, the government announced a review of Modbury services in September 2017. The government said that it would take two weeks: it has still not settled. At Modbury Hospital, the main impact has been in the area of surgical services. Complex surgery has been transferred to Lyell McEwin and other hospitals, emergency surgery has been withdrawn and the HDU has been closed. The lack of an HDU means that often less complex surgery cannot be provided at Modbury because the person has other high-risk factors, particularly a person with asthma or an elderly person.

A Marshall Liberal government will invest $20 million in Modbury Hospital to begin undoing the damage of Transforming Health and reassert Modbury's role as a community hospital. If we are elected, we will establish a four-bed high dependency unit at Modbury Hospital. It would reduce risk to patients with more than one condition, making more procedures possible at the hospital. It would provide a base for a medical emergency team within the hospital. It would reduce the need for ambulance transfers to other hospitals. It would ease the pressure on the Modbury emergency department, and it would ease the pressure on Lyell McEwin.

A Marshall Liberal government will also support surgical teams on site to undertake emergency surgery for both emergency department presentations and patients within the hospital who need critical care. We would redistribute its surgical services across the northern hospitals, with Modbury taking a larger volume of the lower complexity surgery. The redistribution will be driven by the new health board, allowing people to get care closer to home and easing overcrowding at the Lyell McEwin. We will increase the length of stay allowed for surgical inpatients at Modbury from 23 hours to 72 hours. If the hospital admission criteria were made more flexible, a larger range of cases could be undertaken at Modbury because the risk of a longer stay can be managed at Modbury.

Modbury Hospital is an important hospital for the people of the north-eastern suburbs. It is a hospital that anyone living in the north-east is likely to have had contact with. I had contact there for the first time in 1989, in I think year 6 or thereabouts, when I broke my arm at a child's birthday party that the Minister for Transport and I were both at, I was taken to Modbury Hospital and given excellent care. It has certainly always been a positive connection in my life and my family's life.

So many people in the north-east use these services. When I speak to the Liberal candidate for Newland, Dr Richard Harvey, he often tells me about the impact and importance of Modbury Hospital for his family and the important role it has played in the life of his three children. Modbury Hospital is tremendously important, but what state has this government brought it to? Let me tell you: this morning, at 8am, every inpatient bed at both Modbury and the Lyell McEwin Hospital was occupied. Modbury Hospital had 123 inpatients, three more than the hospital's all-beds capacity of 120. Lyell McEwin had 421 inpatients and one patient waiting for a bed, 45 more than the hospital's all-beds capacity of 377.

When every treatment bay is being used in an emergency department, a Code White is declared. On Monday afternoon, 30 October this year, the Lyell McEwin ED was Code White for 16 hours straight. During that period, the Modbury Hospital ED was also Code White for seven hours straight. Yesterday, Wednesday 1 November 2017, the Lyell McEwin ED was Code White for 12 hours straight. During that period, the Modbury Hospital emergency department was also over capacity for six hours straight. These are the consequences of what has been wrought by this government upon the people of South Australia, the people of the north-east and Modbury Hospital.

This is a government supported by marginal seat members of parliament who campaigned on defending Modbury Hospital. The only person on that side of the house who seems to be coming even close to taking an interest in defending the needs of their constituents and the residents of Modbury Hospital is the member for Florey, who has had to leave the Labor Party in order to do so. The fact that the Labor Party is so desperate to get her back, I think we have seen, has led to them now having a review—a review that was promised with results to be delivered in two weeks and improvements to come, fixing the errors wrought through the Transforming Health process. It was promised weeks ago that it would be within two weeks and it has not come up yet. The government obviously is still deciding how much they want to put towards reclaiming the member for Florey.

While it would be a worthy outcome if all these political machinations did indeed result in better services for my constituents and constituents across the north-east, is it not telling about this sort of government that we have in South Australia that this Labor government's only reason that it is being dragged kicking and screaming to returning these services to the people of the north-east is that they want the member for Florey to be the Labor candidate for that seat? What an appalling indictment of the government. They should have known that they went to the last election with their posters, with their A-frames, with their corflutes saying, 'Vote Labor in Newland. Vote Labor in Wright to save Modbury Hospital,' and then they, of course, are the architects of its destruction by cutting and withdrawing services.

This motion is important. It calls attention to the failure of those members to stand up for their community and the failure of this government to deliver the services needed by people in the north-east. If the government does not want to vote for or against this today, if the government wants to move it off, or if the government wants to move against it, then this is the standard to which they will be held to account. I hope that the review the government is putting in place to try to satisfy the member for Florey will indeed see good outcomes for our constituents and our residents, but what an indictment that it has taken this long. I note that they still have not promised to do anything as a result of it. They still have not even delivered this review. I commend the motion to the house and I hope all members will support it.

Mr SNELLING (Playford) (11:43): I will just say at the outset that the government understands that the member for Florey will be moving an amendment. The Labor Party party room will have to have an opportunity to consider that amendment and so, after the member for Florey has moved that amendment, we will be seeking to adjourn this debate, but I will say that we certainly do oppose the motion as it is currently drafted. I think the impoverishment of this debate and the impoverishment with regard to health policy when it comes to the South Australian Liberal Party is very sad.

I could speak at length about the long history of the Liberal Party and Modbury Hospital, their decision in the 1990s to privatise the operations of Modbury Hospital and the complete disaster that that proved to be, in that the government, when it was elected, as quickly as possible made the decision to bring the operations of Modbury Hospital back into government hands. There are other speakers who can speak to that point and highlight the utter hypocrisy of the opposition when it comes to Modbury Hospital.

I do want to address specifically the motion. The member for Morialta talks about rehabilitation, outpatients and day surgery as if these are dirty words. He talks about downgrading Modbury Hospital because the government has made a specific decision for Modbury Hospital to have a particular focus on those areas, and he sees those things as being somehow pejorative.

If the Liberal Party in this state took any trouble to have a good look at the health demands of the South Australian population and where this state is not doing as well as it should it is in precisely those areas. It is in having more surgery as day surgery so that people have the opportunity not to have to stay overnight in hospital, so that they can go home, and in fact so that we can reduce the waiting list for elective surgery. The more day surgery we can do, the more surgery we can do and the shorter the waiting lists, the shorter periods people have to wait to get the surgery they need.

With regard to rehabilitation, I am just amazed that the member for Morialta should see rehabilitation as being somehow second best in our health system. It just goes to show the complete lack of understanding or even really interest in health policy in this state from the Liberal Party, because anyone who understood health policy and took an interest in health policy would know how critical rehabilitation is. It is the engine room of our health system. It deals with people and it makes sure that people who have been injured or been unwell, who have suffered a stroke or an amputation, can get back to leading normal lives.

That might not be important to the member for Morialta. He loves to focus on the sexy side of health care, the life-saving interventions. He thinks that that is the be-all and end-all. I have a message for the member for Morialta and for the Liberal Party in this state: it is not. Our health system is so much more than just the high-end, critically ill people. It is increasingly the people with chronic illnesses, whose life circumstances are severely compromised because they cannot get access as quickly as they should to day surgery, because they cannot get access to an outpatient appointment as quickly as they should, because they cannot get the rehabilitation that they need in an appropriate environment, so instead of being in a tertiary hospital they can get quickly out of a tertiary hospital and start getting the treatment they need so that they can get back to living as normal a life as is possible.

I absolutely stand by the decisions this government made with regard to Modbury Hospital because it was about making sure that Modbury Hospital was delivering the health services that the people of the north and the north-east need. It is no good having an intensive care unit and emergency surgery at Modbury Hospital if patients cannot get access to an outpatient appointment, if they cannot get access quickly to the elective surgery that they need, if they cannot get access to the rehabilitation they need after a severe illness, such as a stroke or an amputation, or if they have been in a terrible car accident and they need to spend months in rehabilitation so that they get home as quickly as possible.

The member for Morialta pours scorn on the local members of parliament in that area because they have stood by what is right. As difficult as it is, as difficult as health policy and changes and health reform can be, those local members have taken difficult and courageous decisions to stand by the reform project that the government has undertaken to drag our health system into the 21^st century and to make sure that people are getting the sort of health care that they absolutely need and the changes that we need to make to our health system so that they can get those services that they need.

The opposition in this state carry on as if they really have no expectation of ever having to sit on this side of the house and take responsibility for difficult decisions. They are happy to play political games and try to win a few cheap brownie points by making political mischief, but what it really shows is that the opposition Liberal Party in South Australia actually have no considered position and no considered policy when it comes to health policy in this state. We saw that in their '2036' document, which had a few platitudes but actually nothing of any substance.

At the last election, they were called out by Liz Dabars, the Secretary/Chief Executive Officer of the Australian Nursing and Midwifery Federation, for having effectively no health policy. What have we seen over the last four years? A pretty disgusting attempt by the opposition, including dragging public servants and doctors and nurses before parliamentary committees, to intimidate and bully people who are prepared to stand up and back these important reforms.

It may well be that one day, and I am not sure it will necessarily be in my lifetime, this Liberal Party in South Australia will have an opportunity to sit on this side of the house and someone from their side will have to sit in the seat of health minister. It will be very interesting to see how that person deals with the complexities of a modern health system because up to now the only thing that the Liberal Party have offered is basically to preserve everything in our health system in aspic so that nothing ever changes: 'We want to just keep everything as it is. We don't want anything to change.'

The problem with that policy is health care changes, the nature of health care changes and is incredibly dynamic, and the health needs of our population are constantly changing as well. If you make no changes, if you just leave the configuration of your health system essentially the same or similar to what it has been since the 1950s, then you will be letting down the people of South Australia, because unless the health system and the configuration of the services in our hospitals change then they cannot keep up with technology change and treatment change in our hospitals, and they certainly cannot keep up with the fast-paced change of the health needs of our population.

Our population is getting older. There is a massive increase in chronic illness, and to deal with those challenges the health system needs to change to be able to meet those challenges. You cannot meet those challenges with a hospital system that was basically configured in the 1950s. I completely oppose this motion and I look forward to hearing the amendment of the member for Florey.

Mr GOLDSWORTHY (Kavel) (11:54): I am pleased to speak in support of the motion that the member for Morialta has brought to the house because it is accurate. It is an accurate summation of what is taking place at Modbury Hospital. Whenever there is an opportunity to speak about Modbury Hospital, I usually avail myself of that opportunity because, as I have highlighted in the house before, if the towns to the north of my electorate—Lobethal, Mount Torrens, Birdwood and Gumeracha—do not avail themselves of the services of the Gumeracha hospital, patients normally look to Modbury Hospital for healthcare services.

Those towns in the northern area of Kavel, due to the redistribution of electoral boundaries, are coming out of Kavel and going into the seat of Morialta, so upon the re-election of the member for Morialta in March next year he will have the pleasure of representing those tremendous northern Adelaide Hills towns.

I listened to the member for Playford's contribution. He talked about the impoverishment of health care and health policy. Well, if ever there was an architect of the impoverishment of healthcare services at Modbury Hospital, it is the member for Playford because he was the minister for health for quite a number of years. I find it quite interesting that the member for Playford himself would highlight those issues.

We have seen what an absolute debacle Transforming Health has been over a number of years, so much so that some months ago, when I spoke on issues relating to health, I recounted that, if my memory serves me correctly, the current president of the Labor Party, federal member Mark Butler, wrote a letter highlighting his concerns about what was taking place in relation to Transforming Health. If I am incorrect, I am happy to come back and correct the record. However, I think it is the case that the president of the Labor Party highlighted his concerns about what was taking place with health services, particularly at The QEH, from memory, and the impact that Transforming Health was having in cutting services right across a whole swathe of the western suburban area.

The member for Morialta raised some very important issues in highlighting the motion that he has brought to the house. I do not necessarily need to traverse all those issues, but we have seen some hypocrisy in how the government in more recent times has been dealing with health services. That goes to some issues that the Hon. Stephen Wade, shadow minister for health and wellbeing in the other place, highlighted just on the weekend. The Hon. Stephen Wade put out a press release on this issue. It is headed, 'Weatherill cutting the heart out of Modbury'. I will quote:

Last month Jay Weatherill promised community consultation into a review of services at Modbury Hospital—now we learn that at the same time the Government was silently cutting cardiac outpatient services.

This latest cut to services at Modbury Hospital highlights that the Weatherill Government is pushing on with Transforming Health in all but name.

We all remember the press conference that was held by the Premier and the then health minister when they said that Transforming Health is all finished and that they had carried out everything they wanted to do under Transforming Health. However, we know it has not stopped; it continues. As the Hon. Stephen Wade in the other place highlights, the government is pushing on with that policy initiative in all but name—Transforming Health in all but name.

The other interesting thing that I think needs to be raised in the house is that we had a set up with the ambus, the ambulance bus, that was meant to transfer patients from Modbury to Lyell McEwin. If ever there was an example of a shambles, the ambus certainly was that. If my memory serves me correctly, when it was first rolled out I do not think anybody was licensed or qualified within the health service to drive the thing, so there was a problem from the outset that they did not have an experienced person who could drive the ambus.

I understand that the services of the ambus were cancelled some months ago. The ambus does not operate from Modbury Hospital to Lyell McEwin Hospital anymore, and that is probably because patients realised it was no good going to Modbury because the government has pulled the guts out of the services at Modbury and they may as well just keep travelling in the car up to the Lyell McEwin. As the member for Morialta accurately pointed out, there has been a Code White at both Modbury and the Lyell McEwin Hospital.

On a couple of final points, the member for Newland and the member for Florey, when she was a member of the Labor Party, put out material into their electorates. I guess the member for Florey's position has changed considerably as she is no longer a member of the Labor Party and now an Independent member.

Mr Gardner: She's free.

Mr GOLDSWORTHY: She's got some newfound freedom. That's right, John. But the member for Newland is still locked in to the Labor Party position on Modbury. He has put out some material into his electorate that, as time has gone on, is not accurate. I think it is the responsibility of the member for Newland to accurately communicate to his electorate what is taking place at Modbury Hospital.

In contrast to all that, the Liberal Party has made some outstanding policy announcements in relation to Modbury Hospital. The Marshall Liberal government will establish a four-bed high dependency unit at the hospital to enable the return of more complex surgical cases to the downgraded hospital. The return of a high dependency unit will reduce the risk to patients undergoing treatment at Modbury and enable a wider range of surgical procedures to be performed at the hospital. The high dependency unit will help restore the local community's confidence in the Modbury Hospital and reduce the number of people needing to travel to Lyell McEwin Hospital in an emergency.

We have seen just this week, as the member for Morialta highlighted, a Code White in the ED at Lyell McEwin, so they are at capacity, if not over capacity, in dealing with emergency presentations. For the members of the government to try to lecture us on health policy, I think, is a bit rich. It is not a bit rich, it is enormously rich, if I can use that phrase. Transforming Health has been a complete failure. We know it, the community knows it, the medical profession knows it, and the only way to restore good health policy back into our health services is to elect a Marshall Liberal government in March next year.

Ms BEDFORD (Florey) (12:03): I move to amend the motion as follows:

Delete (a), (b) and (c) after 'That this house' and substitute the following words:

(a) recognises Transforming Health has changed the focus of Modbury Hospital and as a consequence some north-eastern residents now have to travel farther and wait longer to access services; and

(b) welcomes the consultation to evaluate current services as part of a review to reinstate services at Modbury Hospital.

Health is, of course, the largest expenditure this state faces, and there can be no greater trust for us on behalf of our constituents than to look after their health care. I think a lot of truths have been spoken here this morning, and I believe that people in Transforming Health originally thought that the changes they were making would streamline and enable services to be delivered with the best service the first time, every time.

Unfortunately, it has not seemed that way, and there are many reasons for that. I think the member for Playford has mentioned a lot of them. Health care has changed over the years. People are living longer, with greater demands, and no-one can anticipate what is going to happen in health care. This is why I very much welcome the review that is taking place. The member for Kavel may think that this is a revelation to me in my newfound circumstances, but I can assure him I have been watching Modbury Hospital and actively representing its best interests since 1994, and he may not even have been alive in that year; I do not know.

The year 1994 saw me become active on the hospital. My own family were using it. In the year 2002, when the government changed hands we eventually got the outsourced management back into government hands. It would be fair to say a lot of things did not quite work out at Modbury Hospital the way those people thought in good faith they would have.

I think the important focus we should have now is on the consultation process that is going on. The difficulty with that, of course, is that not everyone is going to agree on the exact details of the best way forward, but I do feel that there is a general consensus in the community that Modbury Hospital needs to be able to see not only sick people but those who are slightly sicker, with the very sick always going to have to go to a larger hospital where the amalgamation of some services means that there will always be someone on call or there all the time to assist them.

We are never going to be able to get every single thing right with health. That is a great tragedy for some people, but the important thing is that we have our population knowing where they can go to access services when they need them. It is also important that we recognise that the staff of Modbury Hospital have worked diligently and without question over the years to provide the service they have to the community. There was a time in this place when I had to keep saying, 'You would think no-one who went to Modbury Hospital survived,' when we know that hundreds and hundreds of people have received the best care and the care that puts them back on their feet as quickly as possible.

What we want to avoid, though, is having people in ambulances moving between sites if we can possibly do that. I am very hopeful that the doctors will come to some sort a consensus position on how best to look after the residents of our area and to support the staff at both Modbury Hospital and the Lyell McEwin health service—because they are also stretched—to make sure they are delivering the best care first time, every time, and that these consultations and evaluations will take place in good faith.

I do not like the fact that meetings are being called at very short notice. I understand that the review was to be given a short time frame, and I understand the reason for that, but it is going to be almost impossible to have the sorts of meetings that people are asking us to have with two or three days' notice. As you know, doctors are very busy people, and it is not always going to be possible to accommodate that.

I am very much looking forward to seeing the community activity on Sunday 5 November, followed by meetings with the health minister at Modbury Hospital on the evening of 6 November and, not long after that, being able to see the sort of outcome I want to see—and that I know the members on both sides of the houses want to see—which is that people receive the care that they need closer to home as a matter of course rather than as some sort of accident of timing or planning.

The fact that brickwork is falling off the hospital is not helping, of course. That means there might have to be some sort of major infrastructure work undertaken out there, and that is going to take away money that would be so sorely needed for front-line services. It is also important that we realise that the sorts of services we are asking for reinstatement would underpin current services at the hospital, such as the GEM ward and the day surgery. If multiday surgery is something that comes back to the hospital, then of course that sort of unit that we are talking about would be able to help look after those patients as well.

With regard to flow-through in hospitals, I do not know how medicos do all that. It is beyond me, but if teachers can organise timetables, I am sure people on the front line of hospitals can organise flow of services. They do, and we are so grateful for their service. We are also very grateful for the extra money that has been spent on paramedics in the Ambulance Service, which is the front-line part of Transforming Health.

Again, I bring to the house's attention my call for an examination of the provision of universal emergency ambulance services to underpin Transforming Health, such as other states are able to do. We have seen large expenditures of money in education, which of course are very welcome. It would be nice to see some way of organising the expenditure needed for a universal emergency ambulance cover as well.

But, of course, health is not just a state issue. It is a much larger issue than that. The changes that we have seen here in Australia since the Medibank days—the reintroduction of taxation exemptions for private health insurance, the way that private health insurance premiums have skyrocketed, the nexus between private health provision and public patients, and the importance of GPs in the role of primary health care—all need to be examined, with the very important issue of aged-care services not far behind what we are looking at today as our population ages and lives longer.

I know that in our area of Modbury we have a large number of retirement villages and nursing homes in the catchment area that are very close to the hospital for that very reason, and the services we are talking about reinstating at Modbury Hospital underpin all those cohorts of patients and make their journey through the health system a lot less stressful.

The idea of having acute services at the Lyell McEwin health service, with rehab and so forth at Modbury, is a terrific idea. We need to make it work, and that is the difficulty. We do not want to be transferring people backwards and forwards between places or hospital sites if we can possibly avoid it, and I think this is the important part of the process that is underway now. It is going to be very difficult to get something like that in place very quickly, but the government has given me an undertaking that they are looking to do something sooner rather than later.

Mr Gardner: Don't trust them.

Ms BEDFORD: I think it is up to all of us to make sure that the community gets the right outcome. I can only take their voicing this as a way forward in goodwill and in good faith. If I find out that that is not the case, it would be very disappointing, not only for me but for everybody in this house and the wider community altogether. It is really important that we do not lose out in the cut and thrust of what has gone on here today.

There has been truth on both sides of the debate this morning and there has been a little bit of a stretch of both as well, but we all want to land in the spot where the residents in our community are getting the services that they need, and we are only going to do that by using the truth and the absolute truth. As unfortunate as it may be for some people, it is the way that we will get to the position that will see the services that we need in the right place at the right time.

I am pleased to see that the minister has been able to resolve the SASMOA position this morning. I am looking forward to working with the people involved with SASMOA and the medicos who are in the hospitals delivering the services that we need. I will also be speaking to the ANMF to see how I can best support them. The nurses, of course, are the backbone of the system of health that we have at Modbury Hospital. They have been so loyal to the hospital over so many years.

I am going to do all that I possibly can to make sure that the delivery of whatever the outcome is, even if it is not the best possible outcome I can get at this very moment, will not be the last word that is ever said about health in this place by me or anybody else. Just as we have had to try the Transforming Health changes and see how they have gone in the community, we are going to have to look at what the consultation brings for us in the north-east as we underpin services at the Lyell McEwin Hospital as part of the Northern Adelaide Local Health Network.

The Hon. K.A. HILDYARD (Reynell—Minister for Disabilities, Minister Assisting the Minister for Recreation and Sport) (12:13): I move:

That the debate be adjourned.

The house divided on the motion:

Ayes 22

Noes 16

Majority 6