House of Assembly Fifty-Third Parliament, Second Session (53-2) 53 2 Parliament of South Australia House of Assembly published Bills Health and Community Services Complaints (Miscellaneous) Amendment Bill Health and Community Services Complaints (Miscellaneous) Amendment Bill Health and Community Services Complaints (Miscellaneous) Amendment Bill Second Reading Second Reading Adjourned debate on second reading. (Continued from 9 August 2017.) Mr KNOLL House of Assembly Schubert Mr KNOLL (Schubert) (17:16): I rise to speak to the Health and Community Services Complaints (Miscellaneous) Amendment Bill and to say that I will be the lead speaker on behalf of Her Majesty's Loyal Opposition. I indicate—and I do not like to keep people in suspense, unlike the statistician this morning who took his time to shine in almost Oakeshott proportions— Ms Chapman House of Assembly Ms Chapman: It was like a moment in the sun, wasn't it? Mr KNOLL House of Assembly Mr KNOLL: —yes—that we will be supporting the bill, not to the tune of 61 per cent but more like 99 per cent. The bill would amend the Health and Community Services Complaints Act 2004, which provides a legal framework for making complaints against health and community service providers. Under the act, the Health and Community Services Complaints Commissioner (HCSCC) operates as an independent statutory office that assists health service providers and users to resolve complaints against both registered and unregistered health practitioners. In 2015-2016, the HCSCC responded to 2,186 complaints and investigated 86 matters relating to the code of conduct for unregistered health practitioners. The bill would amend the act in four ways: it would allow the National Code of Conduct for Health Care Workers to be implemented, it would enable volunteers to be subject to complaints under the act, it would allow the commissioner to obtain information from professional and other associations, and it would prevent a person on an interim or final order from providing services or promoting themselves as a healthcare provider. The national code, which would replace the state code of conduct, protects the public by setting minimum standards for all unregistered healthcare workers. If workers fail to meet the standards of conduct and practice and appear to pose a threat to public health and safety, the code allows disciplinary action to be taken against them. States and territories have agreed through COAG to legislate the code of conduct. I am advised that only New South Wales and Queensland have legislated at this point. The bill would also allow the commissioner to publish public statements identifying persons who breach the code of conduct or commit a prescribed offence. Currently, volunteers cannot be required to participate in HCSCC proceedings under the act. Instead, complaints relating to a volunteer who works for another person or body are treated as complaints against that other person or body. Under this bill, however, volunteers who break the code or pose a risk to public health and safety would be required to participate in proceedings and may be subjected to the act's disciplinary procedures. Associations, such as the Australian Association of Social Workers or the Australian Register of Naturopaths and Herbalists, may hold information that would be valuable to the commissioner. The bill would allow the commissioner to obtain information regarding health practitioners from professional and other associations. Prohibition orders issued against unregistered health practitioners in South Australia following the HCSCC's investigations include preventing those practitioners from providing healthcare services. In a past episode observed by the commissioner, a person who was subject to a prohibition order continued to offer services to the public, potentially accepting payment for future provision. The bill seeks to avoid this by preventing a person on an interim or final order from providing health services or offering to provide health services for12 weeks or a shorter period. The only real concern that we have with the bill is in relation to the clause that enables volunteers to be subject to the complaints proceedings under the act. Our real concern lies in this. According to Health and Community Services Complaints Act: health service means— (a)	a service designed to benefit or promote human health; or (b)	a service provided in association with the use of premises for the care, treatment or accommodation of persons who are aged or who have a physical disability or mental dysfunction; or (c)	a diagnostic or screening service; or (d)	an ambulance service; or (e)	a service to treat or prevent illness, injury, disease or disability; or (f)	a service provided by a health professional; or and this is the bit that interests us— (g)	a service involving the provision of information relating to the promotion or provision of health care or health education; or The act goes on: (h)	a service of a class included within the ambit of this definition by the regulations; or (i)	a social, welfare, recreational or leisure service if provided as part of a service referred to in a preceding paragraph; or (j)	an administration service directly related to a service referred to in a preceding paragraph, Our real concern lies in this. Can I say from the outset that in the medical community there are differences of opinion. I want to put aside some of the most contentious opinions, such as whether or not people should be vaccinated. For instance, there are disagreements about how often people should take antibiotics. There are different decisions made in relation to proposed diets that people should undertake. There are issues around the provision of alternative health treatments. Essentially, there are disagreements in the broad about what kind of health service should be provided. For instance, there will be health professionals who would want to prescribe medical cannabis as a form of pain relief, whereas others may believe that is not appropriate. As I understand it, from my discussions with the shadow minister, there are 14 associations which regulate certain kinds of health services, from surgeons and physicians to Chinese medical practitioners. For those, they have a professional body that helps to regulate the way they should operate. There is also a series of other health professionals who provide supposedly lower risk services who are not regulated in the same way, but again there are still standards by which they need to operate. If they are a health professional, then they are covered by this act. What is happening here is that we are bringing volunteers into this. These volunteers are providing a health service if they are providing a service involving the provision of information relating to the promotion or provision relating to the promotion or provision of health care or health education. Our question becomes this: are we limiting free speech for those who would seek to promote alternative health treatments or health lifestyles by including volunteers providing a health service that is merely providing information? Could this be a situation where somebody who provides an unpopular opinion as a volunteer—they are not being paid, nor are they part of any professional regulated organisation—will be brought under the control of this bill and silenced for providing a minority opinion? The Health Complaints Commissioner has the ability to get someone to cease and desist the provision of that service. We could even go so far as to say that a volunteer is providing a health service under this act if they are handing out pamphlets that advise people against getting an abortion. Would those people then be subject to undertakings under this act? That is really where our concern lies. We appreciate what the government is trying to do and the fact that they are trying to ensure that a person who is providing a health service, even in a volunteer capacity, is subject to the same rigour as those who are health professionals and paid to do it. However, because a health service can be as simple as just providing information relating to the promotion or provision of a healthcare service or health education, we may end up bringing a class of volunteer into this that may be unwanted and may also go against freedom of speech and the ability of people to have alternative minority opinions, regardless of how abhorrent some other people may think those opinions are. With those few words, we are happy to support the bill. Mr SNELLING House of Assembly Playford Mr SNELLING (Playford) (17:26): I rise in support of the bill. I think I can provide reassurance to the member for Schubert that it is not the intention of the bill to restrain freedom of speech. The bill is about protecting potential consumers of health services. It goes back to 2009 when the then health minister received complaints or a report from the Health and Community Services Complaints Commissioner that various people were supposedly offering health services where they made incredible claims about providing cures for cancer and so on. Because these practitioners, for want of a better word, were operating outside of the normal registered health practitioner provisions, they could do so unregulated and with little capacity for the state to intervene and to protect possible consumers. There was a Social Development Committee report and, as a result of that, the parliament made amendments to the health practitioners act I think it was at the time to enable the Health and Community Services Complaints Commissioner to issue orders to prevent these practitioners from operating outside the boundaries of the law by continuing to offer their quackery to consumers. People were spending thousands of dollars on these people out of desperation and they were being swindled by these highly unethical operators. The bill will provide for a national scheme to operate so that, if a dodgy operator had had a ban placed on them in one state, that would be able to be enforced in other states in a nationally consistent way, and I think that is welcome. With regard to the issues raised, I will leave it to the minister to perhaps reassure the parliament of what the intentions are, but it is certainly the case that a person operating in a voluntary capacity can cause as much potential harm to a patient as someone operating in a professional or paid capacity, and it is entirely appropriate that the law should seek to encapsulate volunteers. It really only encompasses volunteers who are providing services and not people who are merely expressing an opinion. I would be very surprised if the intention of the legislation were to pick up anti-vaccination campaigners and the like. It is really about people who are purporting to be a health practitioner who are providing a service in the scope of the law and being able to prevent them from continuing to provide that service if it is considered to be dangerous or if they are merely seeking to exploit the vulnerable. With those words, I heartily endorse the bill. Going through the COAG Health Council, in my experience, takes an incredibly long time and a lot of work. It is very good to see this piece of work coming before the parliament. Mr WHETSTONE House of Assembly Chaffey Mr WHETSTONE (Chaffey) (17:29): I rise to speak on the Health and Community Services Complaints (Miscellaneous) Amendment Bill. The bill will amend the Health and Community Services Complaints Act, which provides the legislative framework for making complaints against health and community service providers. The bill will amend the act in four ways: it will allow the National Code of Conduct for Health Care Workers to be implemented, it will enable volunteers to be subject to complaints under the act, it will allow the commissioner to obtain information from professional and other associations and it will prevent a person on an interim or final order from providing services or promoting themselves as a healthcare provider. Currently, volunteers cannot be required to participate in the HCSCC proceedings under the act. Instead, complaints relating to a volunteer who worked for another person or body are treated as complaints against that other person or body. However, under this bill, the volunteers who break the code or pose a risk to public health and safety would be required to participate in proceedings and may be subject to the act's disciplinary procedures. I know the point about volunteers participating in the HCSCC proceedings will be explored in further detail. The bill, as I understand it from stakeholder feedback, will generally provide greater patient safety in our health system. Anything that improves safety in our health system is welcome. I have worked with the office of the South Australian Health and Community Services Complaints Commissioner on a number of occasions to assist constituents. Sadly, it is very emotional when people's loved ones are ill and they come to an MPs office with concerns. In many cases, those concerns are about the wellbeing of people or the expediency of the health system in attending to those people; I understand that. Those people usually have one thing in mind, and that is the care and health of their loved ones. The HCSCC is a statutory office established by Health and Community Services Complaints Act, and it was opened to the public in October 2005. Essentially, the service assists people—service users, carers and service providers—with complaints about health and community services in South Australia. This includes government, private and non-government health and community services. The health needs of metropolitan and regional South Australia, as we know in the regions, are vastly different. The regions do not want to see the centralisation of health services. Of the some 31,500 people in my electorate, almost 60 per cent in the Riverland and the Mallee are over the age of 40. This compares with the Australian population, where 45 per cent of people are over 40. What is clear from these statistics is that the region has an ageing population that will need further investment in health infrastructure going forward. I say this with a fair bit of understanding because, sadly, I am over the age of 40 and I have worked on the land for the majority of my life. People who have worked on the land have greater health needs. They wear themselves out at younger age, and in a lot of instances suffer a large number of farm injuries and farm concerns from working on their own, with overlifting and overexertion. I acknowledge the disparity with regional farmers in regional centres, with people working on the land, perhaps on their own, and we see a lot of injury. What is clear from these statistics is that the region has an ageing population and, having an ageing body, I am an example. This is not complemented by the lack of public transport, which is a real concern. Another of the great complaints is that when people have to travel from regional centres, from one town to another—and I will use the Riverland as an example, as we have six or seven or eight small communities or towns and we have one centralised, main hospital—in a lot of instances they have to travel 20, 30, 40, or 50 kilometres perhaps without having their own vehicle, so it often comes down to having to get a taxi, having to ask a friend or having to ask family members. These are some of the challenges that regional people have to endure when seeking health services, so it is important to provide adequate health services in each town. I understand that we cannot have the full gamut but, if each town cannot have the health services, they need to have the public transport or some form of community transport so that they can get to appointments, to health services, to the specialists and to the doctors they rightfully deserve. They pay their taxes. They do live in the regions and they do live in a more sparsely populated area, but they have the right to good health care. While the $36 million upgrade to the Riverland General Hospital has been welcomed, there is continued community concern that the services in other hospitals in the region are being centralised. There is nothing surer. If the hospitals are not losing services one way or another, they are losing front-line staff and front-line specialists. It is centralisation by stealth, and that is of real concern. Reducing the need for patients to travel to Adelaide for specialist care is another issue. I understand that most specialised medical services or providers are in Adelaide. I get that. Again, it is about the support mechanism being in place for them to do that. We have the PATS system, which has gone from a manual system to a mostly online system. It has become more clunky than ever and it is very hard to use, and in a lot of instances people who are isolated do not have access to the internet. Again, there is another disadvantage when needing to access health services. The regional hospital at Berri does have those added extra services. Former minister Hill came up with a budget of just over $40 million for a redevelopment of the hospital, but all of a sudden they found cost savings—down to $36 million. Sadly, the cost savings they found were actually a reduction in services. That is something that sticks in my throat and sticks in the craw of every Riverland and Mallee person. When we find savings, it is normally to the detriment of providing services. I have spoken about PATS and I have spoken about Country Health funding repairs for compliance in hospitals and services within the Riverland area. It is about regional communities having ownership of those health services, it is about them raising money and it is about putting services in place from money that has been fundraised, donated and bequeathed to those hospitals. It should not have to be that way. What I would like to know is just how much bequeathed money was put into the NRAH. How much bequeathed money is put into the Modbury or the Lyell McEwin or The Queen Elizabeth or the Noarlunga hospitals? I would like to know. That would be an interesting question for the minister, or the minister representing the minister, to give me a little bit of detail on. Luckily for the government, we have dedicated and passionate volunteers. We have health advisory councils, and I have a representative on all my HACs. They do an outstanding job, and I thank them for that because they keep me abreast of the vast range of concerns that the hospitals have, that the medical providers have and that the community has. I thank them for that and for being my eyes and ears in and around those hospitals. Obviously, retaining medical staff is always a challenge. I note that many concerns have been raised in the past regarding a shortage of health professionals, such as the great work done by nurses and doctors, those front-line services. We need good administration, too. Good administration complements what the front-line service people are doing—nurses, doctors, radiologists, those involved in day surgery procedures. It is all about small medical centres that provide an outstanding service even though they are dealing with a reduction in support right across the board. There is always a need for more specialists to visit the Riverland and Mallee, so I urge any of those doctors who want a great experience to come up to the Riverland and spend a small part of their life there—please come up. We have a lack of community Aboriginal health services in the Riverland. There is nothing surer than that, and it is one of the great bugbears within our health services in the Riverland and Mallee—it is something the HACs report back to me on regularly—as well as the mental health services provided at the Berri hospital. We see a lot of people come to Berri from all over the state because beds are full elsewhere. The mental health service is providing a great service not only to the Riverland people but to South Australia, and I commend them for that. in conclusion, I commend the bill to the house and look forward to the bill passing. The Hon. C.J. PICTON House of Assembly Kaurna Minister for Police Minister for Correctional Services Minister for Emergency Services Minister for Road Safety Minister Assisting the Minister for Health Minister Assisting the Minister for Mental Health and Substance Abuse The Hon. C.J. PICTON (Kaurna—Minister for Police, Minister for Correctional Services, Minister for Emergency Services, Minister for Road Safety, Minister Assisting the Minister for Health, Minister Assisting the Minister for Mental Health and Substance Abuse) (17:41): I thank the honourable members for their contribution to this debate. As has been outlined, this bill amends the Health and Community Services Complaints Act 2004 to include the National Code of Conduct for Health Care Workers, agreed by the COAG Health Council, in the regulations under the act and to make some other minor changes. It is intended to make South Australia's current code of conduct consistent with the nationally agreed approach. As outlined by the member for Playford, both in his initial speech and in his speech now as the deputy whip to the government, the most significant change to the act will be to enable interstate orders to be recognised and enforced in South Australia and vice versa. There are also some minor changes to the act and some of the language is tidied up; however, in essence the intent and most of its contents will remain unchanged. The Health and Community Services Complaints Commissioner is an important statutory office established by this government that provides the public with an independent, impartial, free and confidential service. I know that many members of parliament will have interacted with the commissioner, helping their constituents, since enactment in 2004. The commissioner may investigate complaints against government, private and non-government providers. This is a vital role in ensuring that health and community services are held to account and provide a level of service that South Australians expect and deserve. This bill will strengthen the commissioner's ability to fulfil that role. One element that was particularly noted by the member for Schubert in his remarks was responded to quite eloquently by the member for Playford, but I will make some comments about it as well. This is about the element of volunteers. The proposal in regard to volunteers is specific in that the functions of the act, in terms of them having to comply, are as part of investigations. So if there was a volunteer at one of our health services, then that would not apply to them. What this seeks to apply is a section of the act that deals with unregistered health practitioners. As the member for Playford outlined, this came into the act back in 2009 to deal with, to put it bluntly, quacks—to put it bluntly, people who are seeking to exploit vulnerable people in our society with made-up, fictitious and completely bogus claims of healthcare cures, preying upon people at their most vulnerable time. I think it is entirely appropriate that a volunteer to one of those quacks should be subject to the provisions regarding the code of conduct relating to unregistered health practitioners. If you are a volunteer providing volunteer support to somebody in that role and you breach the code of conduct, then you absolutely should be subject to scrutiny by the Health and Community Services Complaints Commissioner. The idea that this is somehow an attack on free speech—I thought I was listening to the Institute of Public Affairs there for a moment—is completely bogus. This is about people who are exploiting vulnerable people in our community, who are providing them with false hope of false cures, and, sadly, there have been reports of this in this state over previous decades. The people who do this are some of the most disgusting people you could possibly imagine, that they would seek to exploit people at their most vulnerable time. I think that they absolutely should be subject to the code of conduct, both in terms of those practitioners who are unregistered (essentially, quacks) as well as volunteers who might be falling into the same category or providing volunteer support to people who would do such things. They should absolutely be subject to the code of conduct outlined in this act, and that is what we are seeking to do in this. It is not in any way trying to limit free speech, except for when it is clearly going to the point of exploiting vulnerable people, and that is something that this parliament should take very seriously. I endorse the bill to the house. Bill read a second time. Committee Stage Committee Stage In committee. Clauses 1 to 4 passed. Clause 5. Mr KNOLL House of Assembly Mr KNOLL: I accept the assurances from the minister and the member for Playford, although I do not necessarily appreciate the fact that we are not even allowed to ask questions anymore without being slagged off. One would have thought that we were in Stalinist Russia. The Chair House of Assembly The CHAIR: Order! Can we just get on to the questions about the bill before us? Members interjecting: The Chair House of Assembly The CHAIR: Order! If you have something to— Mr KNOLL House of Assembly Mr KNOLL: Although I suppose I am happy to be part of— The Chair House of Assembly The CHAIR: Order, member for Schubert! If you have a problem, you speak to the member elsewhere. We are dealing with the bill. You are on clause 5. What is your question on clause 5? Mr KNOLL House of Assembly Mr KNOLL: I understand that a volunteer needs to be connected to a health practitioner to be part of this, or least that is the indication that the minister gave in his speech. The clause I was referring to regarding what constitutes a health service is in the current act. Health professionals who are subject to the act currently have been subject to that provision since 2004, I assume. I am happy even to take it over the last financial year: I think it was said there were about 2,185 investigations sent over to the commissioner; how many of those complaints, if we have that information, relate to providing information or education? This is under paragraph (g) in the act as to what a health service constitutes. Were any of those investigated? The Hon. C.J. PICTON House of Assembly The Hon. C.J. PICTON: It is great to be here in South Australia and not in Stalinist Russia. Let me say that from the outset. I did not get to experience Stalinist Russia, I have to admit. My good friend Nick Champion, the member for Wakefield, often says that if you reference the Nazis you have clearly lost the argument, and I think that maybe the same case can be made if you start referencing Stalinist Russia. In regard to the question of how many complaints have been made about information or education, we do not have those stats right at hand, but we are happy to chase them up between the houses. I understand that, in terms of the specifics of the breaches of code of conduct by people who are unregistered practitioners or, as I like to call them commonly, quacks, there have been seven orders made against people who fit that category who have breached the code of conduct and do not fit one of the other categories of registration under the health registration practitioners act, and that has been over the course of the last four or five years. Essentially, this seeks to extend that to volunteers who might be providing volunteer services in that capacity where they might breach the code of conduct. Clause passed. Remaining clauses (6 to 11) and title passed. Bill reported without amendment. Mr KNOLL House of Assembly Mr KNOLL: Not to speak on behalf of the minister directly but, given that these provisions are already in the current act and that there would be a reasonable amount of history to suggest whether or not this commissioner has used his powers to go after people who are providing contentious information, I think that that would go a long way to suggesting to us that this component of it is appropriate. I thank the minister for his assurances to provide us that information between the houses. Third Reading Third Reading The Hon. C.J. PICTON House of Assembly Kaurna Minister for Police Minister for Correctional Services Minister for Emergency Services Minister for Road Safety Minister Assisting the Minister for Health Minister Assisting the Minister for Mental Health and Substance Abuse The Hon. C.J. PICTON (Kaurna—Minister for Police, Minister for Correctional Services, Minister for Emergency Services, Minister for Road Safety, Minister Assisting the Minister for Health, Minister Assisting the Minister for Mental Health and Substance Abuse) (17:52): I move: That this bill be now read a third time. Bill read a third time and passed.