Health Care (Governance) Amendment Bill

Second Reading

The Hon. D.C. VAN HOLST PELLEKAAN (Stuart—Minister for Energy and Mining) (15:55): I move:

That this bill be now read a second time.

I seek leave to have the second reading explanation inserted in Hansard without my reading it.

Leave granted.

Today I rise to introduce the Health Care (Governance) Amendment Bill 2018 into Parliament.

This Bill is the first part of the government delivering on its election commitment to establish a new governance and accountability framework for the public health system. These changes will devolve decision making in the public health system through the establishment of metropolitan and regional governing boards; put responsibility and accountability at the local level, with strengthened oversight; and improve patient safety and hold governing boards accountable for delivering real progress.

This framework will provide a greater focus on accountability and transparency within the public health system. The Minister in the other place outlined that the public health system, with an expenditure budget of more than $6 billion in 2017-18, approximately 38,600 employees (as at June 2017) and around 77 hospitals and health services in a large and diverse state, is too large and complex for it to operate optimally with all authority and accountability resting on one person—the Chief Executive of the Department for Health and Wellbeing. But that is the situation since the former Labor Government abolished the boards with the introduction of the Health Care Act in 2008.

In opposition we were approached by communities and clinicians who repeatedly told us how disengaged from decisions about their local services they feel. It is therefore of no surprise that when this Government introduced legislation to establish boards of management for hospitals that local communities and clinicians welcomed this change. If I may quote some of the headlines from regional papers following the introduction of the Bill into Parliament:

the Border Watch: Regional board management reform welcomed

the Port Lincoln Times: Boards to give locals more input into health

the Penola Pennant: Health reform welcomed

the Loxton News: State's new health boards welcomed.

Devolving decision making in the public health system recognises that health care needs and challenges vary between areas within metropolitan Adelaide and across regional South Australia. Decisions made as close as possible to the area and people affected, and with the full and effective involvement of local health professionals, will be better decisions.

The election commitment will be implemented in two stages. The first stage is this Amendment Bill which will establish governing boards and allow board chairs to be appointed early in the process. It is intended that the boards will be fully operational by 1 July 2019.

The second stage is to establish a new governance and accountability framework for the public health system which will be reflected in new legislation to be introduced into Parliament later this year or early next year.

This Bill will allow for incorporated hospitals, known as Local Health Networks, to be established under the Health Care Act 2008 and to be governed by a board.

To summarise, the governing boards will be responsible for the delivery of their local health services within their geographic area. The governing boards will consult with local service providers and the community to ensure that the services provided are reflective of local needs and priorities and are able to be provided within the resources available. Governing boards will be required to operate within a clinical governance framework to ensure that these services are safe, high quality and accessible.

The governing boards will also be responsible for the oversight of Local Health Network budgets. The governing boards will appoint their Chief Executive Officer, who will be responsible for managing the operations and affairs of the Local Health Network health services and will be accountable to, and subject to direction of, the governing board.

The governing board will be accountable to the Minister for Health and Wellbeing for the oversight of the delivery of health services in accordance with a service level agreement negotiated between the Local Health Network and the Department for Health and Wellbeing. The governing boards will also be required to comply with any policy frameworks issued by the Department and any directions given by the Minister for Health and Wellbeing.

The governing boards, through the annual report for the Local Health Network, will demonstrate their progress against the key performance indicators outlined in the service level agreement and what measures they have instituted to ensure the engagement of communities and health professionals in service delivery.

Governing boards will be established for each of the Local Health Networks as they are currently constituted, except for Country Health SA:

Central Adelaide Local Health Network,

Northern Adelaide Local Health Network,

Southern Adelaide Local Health Network, and the

Women's and Children's Health Network.

In country SA, six new regional incorporated hospitals will be established, based on the current regional boundaries operated by the Country Health SA Local Health Network being the:

Barossa Hills Fleurieu Local Health Network,

Eyre and Far North Local Health Network,

Flinders and Upper North Local Health Network,

Riverland Mallee Coorong Local Health Network,

South East Local Health Network, and

Yorke and Northern Local Health Network.

They will take over the functions of providing health services for their particular areas from Country Health SA Local Health Network from 1 July 2019.

The governing boards will be small in number, consisting of between six and eight members, chosen through a merit based process. Governing board members will be positions of significant leadership and responsibility in the health system and between them will have knowledge, experience and expertise across health management, commercial management, financial management, the practice of law, the provision of health services, clinical governance, Aboriginal health and any other experience or expertise that will enable their effective performance.

At least two members of each governing board will be clinicians to ensure clinical input into health service decisions. In order to maintain independence, a Local Health Network employee can not apply for that Network's governing board. Employees of the Department will not be eligible.

Governing boards will be able to establish committees to assist them in performing functions such as engagement with local clinicians and the community to ensure inclusive and representative advice to the governing boards. They will be required to provide clinical and community engagement strategies.

Should there be issues with a governing board's performance or Local Health Network under the control of the governing board the Minister will have the ability to appoint an adviser for a period of time. The role of the adviser is to work with the governing board to improve its performance or that of the Local Health Network.

The Minister for Health and Wellbeing may also appoint an inspector to inspect, investigate and assess the administration, operation and governance of Local Health Networks. Similar to provisions in other jurisdictions where boards operate, this is a reserve power or power of last resort, and it is envisaged that this power would only ever be used where it is demonstrated for some reason that the relationship between the Minister and the governing board has broken down completely, and the board or Local Health Network has failed to cooperate with a direction given by the Minister or the Chief Executive of the Department.

In the event that a governing board has failed to perform its functions effectively or comply with a direction given by the Minister or the Chief Executive of the Department, the Minister has the ability to dismiss the governing board and appoint an administrator. Where the governing board is dismissed this action must be tabled before both Houses of Parliament within 12 sitting days of the dismissal. It is hoped that the appointment of an administrator would only be used as a last resort, and that measures such as appointing an adviser to assist the governing board would be able to turn things around before this action was necessary.

This Bill is the first of two pieces of legislation to be brought before Parliament in relation to governance of the public health system.

Another Bill will be introduced to replace the Health Care Act 2008 to ensure that the governance and accountability framework for the public health system is relevant for today. That Bill will ensure that the provisions governing the public health system acknowledge appropriate frameworks for such matters as risk management, clinical safety and quality, and policy and legislative governance. This will require a thorough review of the roles and functions of all aspects of the public health system within the context of the introduction of governing boards.

This is expected to include consideration of the role of the Department as a system manager of the South Australian public health system; devolution of functions and resources to Local Health Networks to support local decision making and service delivery; reviews of services provided statewide; regional support services across the new regional Local Health Networks; and consideration of how the current 39 country Health Advisory Councils can best operate in the new governance framework. There will also be consideration of the need for statewide performance monitoring, which currently occurs through the Health Performance Council, established when the previous boards were abolished.

The framework will ensure that the roles of the Minister, the Chief Executive of the Department and the governing boards are clear, and it is expected to inform the service level agreements for the governing boards under which they will operate from 1 July 2019.

The system changes in governance are wide ranging and of such significance that an oversight committee will be established, chaired by the Chief Executive of the Department for Health and Wellbeing, and include independent advisers with experience in health reform in interstate jurisdictions.

An expression of interest process including a public advertising strategy and executive search was commenced concurrent with the introduction of this Bill into Parliament. The advertising for suitable candidates to the position of Board Chairpersons prior to the passage of the legislation was to ensure that candidates could be appointed to this very important role as soon as practicable following the passage of the legislation. This would allow these Board Chairpersons to be involved in activities, including the appointment of Board members, to ensure a smooth transition to the new governance arrangements from 1 July 2019.

The appointment process for the appointment of Board members will be undertaken by the end of the year or early next in the lead up to the commencement of governing boards by 1 July 2019.

This Bill introduced today is the first step to reform the governance of the public health system. The introduction of governing boards is to ensure that services provided by Local Health Networks better meet the health service needs of the population within their geographic area. This does not mean that boards have to provide all services to serve their population – in fact it would not be sustainable for health services to do so. However, the devolution of decision-making in relation to health services will provide opportunities for governing boards to work cooperatively with governing boards of other Local Health Networks on local and statewide initiatives for the provision of services.

The Government will introduce a further eight amendments to the legislation in the House.

I will detail the Government's view at the relevant clause.

One amendment seeks to remove the requirement introduced by an amendment in the Legislative Council that at least one Board Member have expertise, knowledge or experience in Aboriginal Health. It is the view of the Government that it is not appropriate to mandate one skill.

The third amendment represents a substantial modification of an amendment in the Council which required the disclosure of interests for Board Members. The Government considers that the level of disclosure is not consistent with the risk and will act as a disincentive for potential Board Members.

The Government's amendment provides the highest probity standards of any health board in Australia.

The fourth amendment clarifies that the review will be commissioned three years after 1 July 2019, the date that the boards will become operational.

The fifth amendment clarifies that expenses should be declared 60 days after the payment or reimbursement of the expense.

The seventh amendment clarifies that the Annual General Meeting (AGM) should be public.

This Bill is the fulfilment of a clear commitment of the Marshall Liberal government. We look forward to working with communities, clinicians and stakeholders to deliver strengthened governance and better health services for all South Australians.

I commend the Bill to members and look forward to discussing it in the Committee stage.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

3—Amendment provisions

These clauses are formal.

Part 2—Amendment of Health Care Act 2008

4—Amendment of section 3—Interpretation

This clause provides a definition of governing board to insert for the purposes of the measure. The definition of Department is also updated.

5—Amendment of section 4—Objects of Act

This clause proposes to amend section 4 of the Act by adding an object of the Act to facilitate the efficient and effective governance and oversight of incorporated hospitals through the establishment of governing boards.

6—Amendment of section 5—Principles

This clause proposes to amend section 5 of the Act to provide that health services should be provided as part of an integrated system that achieves an effective balance between local decision-making in relation to incorporated hospitals and health system planning, integration and management.

7—Amendment of section 7—Chief Executive

This clause proposes to amend the functions of the Chief Executive of the Department in section 7 of the Act consequentially on the transfer of direct responsibility for the administration of incorporated hospitals from the Chief Executive to the governing boards and hospital chief executive officers. This amendment removes reference to the Chief Executive being directly responsible for the administration of incorporated hospitals. This clause also then inserts an additional function of the Chief Executive to contribute to and implement statewide service plans that apply to incorporated hospitals.

8—Amendment of section 11—Functions of HPC

This clause proposes to amend the functions of the Health Performance Council (HPC) in section 11 of the Act to include reference to governing boards of incorporated hospitals such that the HPC should, in the performance of its functions, seek to obtain, to such extent as is reasonable and relevant in the circumstances, the views of governing boards. The amendment also proposes to include governing boards in the group of entities that cannot be directed by the HPC.

9—Amendment of section 18—Functions

This clause proposes to amend the functions of a Health Advisory Council in section 18 of the Act such that those functions may include the provision of advice to the governing board of an incorporated hospital about any matter referred to it by the board.

10—Amendment of section 30—Hospital to serve the community

This clause proposes to amend section 30 of the Act to include the governing board for an incorporated hospital among the entities that may determine that an incorporated hospital, in addressing the health needs of the community by providing health services, may focus on 1 or more areas or sections of the community.

11—Substitution of section 33

This clause proposes to replace section 33 of the Act to make provision for each incorporated hospital to be governed by a board (a governing board). Proposed new section 33 specifies that an incorporated hospital is to be governed by a governing board and outlines a number of specified functions of governing boards. A governing board for an incorporated hospital must comply with any directions of the Minister and any directions of the Chief Executive in governing the incorporated hospital.

Proposed section 33A requires the governing board for an incorporated hospital to develop and publish a clinician engagement strategy to promote consultation with health professionals working in the incorporated hospital and also a consumer and community engagement strategy to promote consultation with health consumers and members of the community about the provision of health services by the incorporated hospital.

Proposed section 33B provides for the composition of the members of governing boards (appointed by the Minister) to be 6-8 persons who collectively have, in the opinion of the Minister, knowledge, skills and experience necessary to enable the board to carry out its functions effectively. Proposed section 33B(2) specifies relevant types of experience that should be included in board appointments while proposed section 33B(3) requires that at least 2 members of a governing board must be health professionals (as defined in section 33B(9)). Proposed section 33B(4) requires that at least 1 member of a governing board has expertise, knowledge or experience in relation to Aboriginal health. Further, proposed section 33B(5) provides that a person is not eligible for appointment to a governing board of an incorporated hospital if the person is employed to work at the incorporated hospital, provides a service to the incorporated hospital or is an employee of the Department responsible for the administration of the Act.

Proposed section 33C provides that a member of a governing board for an incorporated hospital is to act impartially and in the public interest in performing the member's duties.

Proposed section 33D provides that a member of a governing board must disclose their interests in accordance with Schedule 3A (as inserted by clause 15).

Proposed section 33E provides for the appointment of a chief executive officer for each incorporated hospital by the governing board of the hospital after consultation with the Chief Executive of the Department. The chief executive officer of an incorporated hospital is responsible for managing the operations and affairs of the hospital and is accountable to, and subject to the direction of, the governing board for the hospital.

Schedule 3 also makes provision in relation to governing boards under proposed section 33F.

12—Insertion of Part 5 Division 10

This clause proposes to insert a new Division 10 into Part 5 of the Act. This Division will make provision for inspectors for the purposes of inspecting, investigating and assessing the administration, operations and governance of incorporated hospitals. The clause provides that inspectors may, at any reasonable time, enter the premises of an incorporated hospital (including the premises of the governing board of an incorporated hospital) and, while on the premises, may—

(a) inspect the premises or any equipment or other thing on the premises; and

(b) require any person to answer any questions, orally or in writing; and

(c) require any person to produce any documents or records; and

(d) examine any documents or records and take extracts from, or make copies of, any of them; and

(e) seize any documents or records that, in the opinion of the inspector, constitute evidence of a breach of a provision of the Act.

The clause provides offences for a refusal or failure to comply with a requirement of an inspector and also for hindering or obstructing an inspector, or a person assisting an inspector, in the exercise of the powers conferred by this section.

13—Amendment of section 93—Confidentiality

This clause proposes to amend section 93 of the Act so that the confidentiality requirements of that section apply in respect of a member of a governing board.

14—Insertion of section 102

This clause proposes to insert new section 102 providing for review of the operation and effect of the amendments made to the Health Care Act 2008 by the measure to be undertaken within a reasonable time after the third anniversary of the commencement of clause 11.

15—Substitution of Schedule 3

This clause proposes to substitute Schedule 3 of the Act with a new Schedule 3 and a new Schedule 3A.

New Schedule 3 will make a number of provisions in respect of governing boards for incorporated hospitals.

Clause 1 provides for the appointments of the Chairperson and Deputy Chairperson of each governing board by the Minister.

Clause 2 provides that a term of office of a member of a governing board will be fixed in the instrument of appointment up to a maximum of 3 years. A member may be reappointed for additional terms but may not hold office for more than 9 consecutive years.

Clause 3 provides that a member of a governing board is entitled to remuneration, allowances and expenses determined by the Minister and these must be published by the Minister on a website available to the public at no charge. This clause also requires that the Chairperson of a governing board must ensure that travel or entertainment expenses incurred by the board in respect of the performance by a member of the member's functions and duties are disclosed on a website accessible to the public at no charge not more than 60 days after the day on which they are incurred.

Clause 4 provides that the Minister may remove a member of a governing board from office—

(a) for breach of, or non-compliance with, a condition of appointment; or

(b) for misconduct; or

(c) for failure or incapacity to carry out official duties satisfactorily.

Clause 5 provides that the office of a member of a governing board becomes vacant if the member—

(a) dies; or

(b) completes a term of office and is not reappointed; or

(c) resigns by written notice to the Minister; or

(d) becomes an insolvent under administration within the meaning of the Corporations Act 2001 of the Commonwealth; or

(e) is convicted in South Australia of an offence that is punishable by imprisonment for a term of 12 months or more, or is convicted elsewhere than in South Australia of an offence that, if committed in South Australia, would be an offence so punishable; or

(f) is removed from office under Schedule 3 clause 4.

Clause 6 provides that an act or proceeding of a governing board is not invalid by reason only of a vacancy in its membership or a defect in the appointment of a member.

Clause 7 provides that a member of a governing board will not be taken to have a direct or indirect interest in a matter for the purposes of the Public Sector (Honesty and Accountability) Act 1995 by reason only of the fact that the member has an interest in a matter that is shared in common with health practitioners generally or those engaged in or associated with the provision of health services generally, or a substantial section of health practitioners or those engaged in or associated with the provision of health services.

Clause 8 provides that a governing board for an incorporated hospital must hold a meeting between 1 October and 31 December in each year at which the annual report of the incorporated hospital for the previous financial year is presented to members of the public and any member of the public in attendance at the meeting is entitled to address the meeting. This meeting must be advertised in advance of the meeting in accordance with the clause.

Clause 9 makes provision in relation to the procedures of a governing board.

Clause 10 provides that a governing board may establish committees or subcommittees as the board thinks fit to advise the board on any aspect of its functions, or to assist the board in the performance of its functions.

Clause 11 provides that the Minister may appoint a person to be an adviser to a governing board if the Minister considers that the adviser may assist the board to improve the performance of the board or the incorporated hospital governed by the board.

Clause 12 provides that an adviser appointed to a governing board is to provide advice to, and otherwise assist, the board in the performance of its functions. An advisor is entitled to receive notice of board meetings and copies of the papers of the board and may also attend and participate in any meeting of the board (without entitlement to vote or be present at the time that a vote is taken).

Clause 13 provides that the Minister may, at any time, dismiss all the members of a governing board if satisfied that—

(a) the board has failed to perform its functions effectively; or

(b) the board has failed to comply with a provision of the Act; or

(c) the board has failed to comply with a direction of the Minister or the Chief Executive of the Department.

Clause 14 provides that, if the members of a governing board are dismissed under clause 13 or for some other reason there are no members of a governing board at any time, the Minister may appoint the Chief Executive or other qualified person to administer and perform the functions of the board subject to any conditions specified in the instrument of appointment.

Clause 15 provides that a governing board may, with the approval of the responsible Minister or, if relevant, a responsible public sector instrumentality, make use of the staff, services or facilities of an administrative unit or another public sector instrumentality.

Proposed new Schedule 3A provides for the members of the governing board for an incorporated hospital to declare certain specified interests at the time of their appointment (in an initial return) and at each financial year (in an ordinary return). The Minister must maintain a register of interests containing the information provided by members and the register is to be able to inspected and copied by members of the public. The Schedule also limits the publication of information sourced from the register of interests.

Mr PICTON (Kaurna) (15:55): I rise today to speak on the Health Care (Governance) Amendment Bill 2018 and indicate that the opposition will be opposing this bill. It will be opposing it for a number of reasons, most particularly because this bill is not going to do anything to help patients in South Australia.

The bill is not going to do anything to improve our hospitals and it is not going to do anything to improve our healthcare services provided to people. In actual fact, it is going to harm those services and it is going to lead to more costs and more fragmentation—problems which are going to be seen again in our South Australian healthcare system and which we have seen time and time again when we previously had health boards in this state.

Members may remember that we used to have boards similar to what is being proposed in the legislation here, and we did have significant problems. There were problems with accountability, there were problems with duplication, there were problems with costs and there were problems with silos between the health boards and their structures. There was no ability for the health minister, who is responsible to the parliament and responsible for improving our system, to be in control of what was going on in our healthcare system. That is what the new government want to seek to return to.

Unfortunately, we heard some very sad tales when we previously had health boards. For those members who may not recall, essentially the structure we had in place in South Australia prior to the passage of the Health Care Act 2008 was that we had three levels. There were local hospital boards across country South Australia; we then had regional health boards, particularly in country areas, so we had two levels of boards looking after the same hospitals; and then we had central control through the minister and the department and obviously through funding sources, such as the Treasury.

It really was a very complex system that was in place, and there were blurred lines of accountability in the country, for instance, between the local health boards, the regional health boards and the central office. There were constant battles between health boards in terms of wanting to make sure that they had the best and brightest services at their particular health board, without taking a helicopter view of making sure that the best services were in place and that the best allocation of those resources was in place across the state to make sure that we had the most sensibly laid out health system possible.

Unfortunately, this is one of those matters where it is easy for the opposition to say, 'There are issues in the health system. We'll just bring back those boards and suddenly all the problems will be fixed. This is one of the first things they have done, and it's obviously in their 100-day plan that they were going to introduce this legislation.' Apparently, there is no reason why that is the case at all, because the government has signalled its intention that this legislation is not going to be enacted until July 2019.

While there is this desire to rush this legislation through the other place, and now this place today, there are not going to be health boards in this state for another 11 months. There is not going to be one health board in place for 11 months, so there is absolutely no reason why this legislation needs to be in place now. In fact, the government itself has acknowledged that there are significant problems with this legislation. There are significant issues that have not been remedied, thought through or resolved in terms of how they are going to deal with them.

Because of that, the minister has said that he is basically going to bring back another act to get rid of this proposed act that we are rushing through the parliament now before any of this takes place. So this bill—this whole legislation—is going to be completely rewritten, according to the minister, before any of it is enacted. Really, the actual point of this legislation is highly questionable. According to the minister's own words, there is still so much more work to do in what he calls stage 2. This rushed bill, this rushed piece of legislation they are bringing to the house today, is stage 1. Stage 2 is working out how on earth they are going to make this work, because they do not know.

We had a long briefing with the minister and his officials on this bill, and there was point after point after point, question after question after question, where the minister did not know the answer to how things were going to work under this legislation. The officers had no idea how particular things were going to happen. It is all deferred off with, 'Well, that's a stage 2 matter.' This is going to be all worked out in stage 2, where we replace in its entirety this legislation that we are debating here today.

So the idea that the government has a plan, the idea that the government knows what it is doing in terms of how this is going to be implemented, is highly, highly questionable. What we do know is that this is going to be incredibly costly. It is going to cost taxpayers a significant amount of money to put in place this legislation: to put in place all these officers in these boards across the state and not only that but to duplicate all the behind-the-scenes bureaucracy that is going to be needed to run 10 different health boards across the state that, according to the legislation, will all have their own ability to set their budgets and determine their service mix, etc.

All of that is going to need to be replicated because so much of that is centralised at the moment to reduce that bureaucracy, to reduce that duplication and waste. We are now turning the clock back and sending all of that back out to the regions, and there is going to be significant cost with regard to that.

This was borne out just this week in the hearing of the Budget and Finance Committee of the other place when the Chief Executive of the Department for Health and Wellbeing was asked about what the cost of this legislation is likely to be. He said that the cost, at a very minimum, is going to be $3 million a year. We know that because that is what the board members are going to be paid under this legislation: $3 million not to open anymore hospital beds, not to improve any out-of-hospital services, not to have any more doctors or nurses but just to pay board sitting fees—$3 million a year or $12 million over the forward estimates.

But he said that that is just a minimum. The maximum that he estimates at this point in time that this could cost would be in the order of $20 million a year, once you add in all those functions that would have to be devolved out to the regions. So this could be up to $20 million a year of additional cost that would not deliver any extra service to the people of South Australia. That would work out to be $80 million over the forward estimates, spent just on this shuffling of the bureaucratic deck chairs.

Unfortunately, there is not going to be any benefit to any patient from that expenditure. We have asked the government repeatedly: is there a provision of extra funding that is going to go to the Department for Health to ensure that this funding does not have to come out of the expenditure that would go to our hospital system? The government have said, 'We are not sure; that's going to be up to the budget to determine.' They have no idea whether or not they are going to get extra money from Treasury to pay for these board fees and all these extra bureaucrats they are going to have around the state, or are going to have to be cutting services, putting additional savings measures in place that will impact upon front-line health services, just to pay for this extra bureaucracy of up to $20 million a year.

It is a significant worry for the people of South Australia, and a significant worry for this parliament in considering this legislation, that we are essentially signing this cheque for up to $20 million a year for extra bureaucracy and we do not know whether the government is going to chip in for that from general consolidated revenue or whether the health department is going to have to carry the can for that extra bureaucracy.

That extra money could be providing a whole lot of things out in the community, and I am sure that all members in this house would want to see additional health services provided in their particular communities. The minister is going to be in a real bind now because there is a significant likelihood that he is going to have to chip in for all this extra bureaucracy from his existing budget. That is going to cost people in the long term.

I mentioned that previously we did have health boards in place and that there were a number of issues around those. I was involved in the drafting and the passage of the original legislation in 2008. It came after some very frustrating and very worrying trends that we saw across our public hospital system, particularly in country areas, where our system was not working as one. We were not getting appropriate safety and quality standards applied across our hospital system. We were not seeing appropriate contracting being put in place and we were not seeing the appropriate deployment of capital works being undertaken.

For instance, I strongly recall that we had a very significant issue in regard to colonoscopy machines. There was a very serious safety and quality lapse by one of our country hospitals in terms of the cleaning, safety and quality management of those colonoscopy machines to the point where hundreds of people had to be tested for HIV and other diseases because we were not sure whether they had been contaminated by previous patients.

That was a scary proposition that those people had to face. It became more and more evident that the safety and quality procedures in place at that hospital and under that health board were lax, and were not in place to the required standards, and that we did not have a consistent approach to managing these safety and quality issues across our country healthcare services. That was one of the first issues that popped up that caused the government to consider changing along these lines. One of the other issues that was identified was in regard to contracting.

We had another country hospital that was involved in some, let's say, very shady contracting arrangements that were putting taxpayers at risk because those boards had the ability to contract with whomever they liked about the provision of services. That was a very significant issue that the state had to confront. They were not contracts that had gone through all the appropriate Public Service standards and Treasurer's Instructions that we would want to see. That was another reason why the government took the approach that it did at the time to bring in a more centralised, less bureaucratic approach, but also one that maintained a standard of those financial controls, safety and quality controls and capital works controls, across the whole state. That will not be in place upon the return to health boards.

It is also going to be inevitable that we are going to see increased competition between health services to the point where we are going to see every health service wanting to do every single thing. That sounds great on the face of it and sounds great in terms of everybody wants to have every whizzbang thing at their local hospital, whether it is in the city or the country, but it does not make sense from the perspective of a sensible and effective allocation of funds, which are always more limited than you would like, across the state. It does not make sense in relation to making sure that we are getting patients treated in the most logical places across the state.

That is inevitably what is going to happen. We are inevitably going to see each of those boards moving in a different direction, each of those boards designing their own protocols, their own ways of managing patients, their own determinations as to what the best management of patients is, and we are going to see a very fragmented system. We are going to see normal people as they are going about their business, passing through artificial lines that the health minister has drawn on a map between where local health boards are, and when they cross over those lines, they are going to see varying services.

They are going to see varying service standards, varying service approaches and also not a consistent and high-level quality service that would be sensible if we were planning things across the whole state. If we were saying that this particular hospital is going to be a centre of excellence in one service and another hospital is going to be a centre of excellence in another service, rather than every hospital trying to do everything and none of them doing it very well, we would see a significant level of fragmentation.

I think that is particularly going to be an issue in the country. One of the things that worries me about this legislation is that we are splitting up Country Health SA into six parts. Currently, there is one organisation, Country Health SA. It is managed centrally so that there is a consistent level of safety, quality, financial control, capital works and all sorts of different controls that people would want to make sure are in place in their hospitals and consistent across the state.

That is now going to be split up across the whole state. We are going to have these six organisations. They are going to have their six back offices, they are going to have their six boards with their different decision-making, they are going to have their six sets of clinical leadership, they are going to have their six sets of contracting that they are going to be putting in place and their six sets of capital works plans and service level plans that they are going to be doing. What we are going to see is fragmentation across that. What we are unfortunately going to see is people not being able to be guaranteed a consistent level of approach across that.

A number of doctors I have spoken to have seen the benefit of having a country health service combined and they have said that they are concerned about it, particularly when we have a lot of doctors who do outreach in different country communities. They are able to contract together now. For instance, if you are providing a service in the Riverland and a service at Port Lincoln, you are dealing with Country Health SA. You know what the standards are. In the future, you may well have to contract with different health boards to provide the services and they could be completely different arrangements in place. That is a concern, particularly in the country.

I think the government has tried to spin this legislation to say that it is going to be great because you are going to have your local health boards back and everyone is going to get a say and so on. Unfortunately, they are not bringing back the health boards. They are not bringing back the local boards that were in place so, for those people who think that is happening, I hate to tell them that is not happening. They are bringing in regional boards. A number of people have also raised concerns with me that, if you live in an area with one significant hospital and a number of minor hospitals, this board is going to be dominated by that larger hospital.

All the focus, all the representation, is going to be on that larger hospital and not on what is going on in your smaller hospital. In actual fact, the idea that this is going to somehow provide those smaller communities with representation may well in fact be the reverse and it may well end up centralising more services in that larger hospital that will be more dominant in that particular health region. That is something I know a number of people have been concerned about. I think we will see that play out as this legislation is implemented.

They are a number of the central concerns that we have about this. Essentially, we believe that patients are best served by a system that is going to work together, and this is not going to be a system that is going to work together in any rational way. It is going to be split up and fragmented. The government is going to be focusing a significant amount of energy on setting up these bureaucratic structures over the next year or two rather than focusing on improving those health services. You only have to look at some of the distraction we have already seen in the government.

We have seen the revelations around what has happened in the Northern Adelaide Local Health Network with the appointment of the CEO there, where clearly the new government have not had their finger on the pulse in terms of being able to manage some of the risks in appointments. The person who has been appointed to the Northern Adelaide Local Health Network has significant questions to answer about his involvement in a health service in New Zealand, a health service where he has been asked to appear before internal investigations, a health service where the problems in the hospital stretched to having now to go and remediate $30 million worth of mould damage in the hospital, which has been singled out for criticism by the New Zealand Prime Minister.

We have hired that person to work in northern Adelaide on the recommendation of a New South Wales-based recruitment company alone, without any independent verification from this government or by the minister or his chief executive. Those risks are only going to increase now that they are going to health boards. We are going to see less accountability centrally as more and more of these appointments are made hands-off from what is going on centrally, and we are not going to see accountability in what is going on.

As I said, there is a self-imposed deadline in this legislation, and we know this because the government have said that they are going to completely repeal this legislation before it even comes into effect. The health minister is on record stating that everything being discussed and debated in this house now is up for debate again when an entirely new bill is introduced in just a couple of months' time. He said:

Parliament will have an opportunity to revisit all the issues in this bill later in the year. Of course, I would want parliament to be comfortable with this bill, but members can be assured that they will have the opportunity to revisit the issues in this bill when the second bill is presented.

My question to him is: why are we doing this? Why are we rushing in this bill just because someone plonked it in your 100-day plan? It is clearly underdone. You clearly have not thought through a lot of the issues.

There were some very sensible debates and some very sensible amendments put forward by Kyam Maher in the other place trying to improve what has been a very poor piece of legislation from the government and trying to seek to implement what they have sought to hold out as a standard of accountability and transparency that they want to see as part of this. A number of those were opposed by the government, and I note that the Minister for Energy is seeking to repeal here in this house a number of those amendments that were supported by the government.

Clearly, this work has been underdone. Clearly, it does not meet the transparency and accountability standards that the government set and made clear at the election, and this is just the latest example of the government rushing to meet a deadline without doing the background work, as well as without properly consulting—and that is a very important point. When this legislation was first introduced as the Health Care Act in 2008, there was about 12 months of consultation leading up to that event. There were exposure drafts that were put out to every health organisation in the state seeking their views.

It was able to be debated at the AMA council, at ANMF board meetings and at a whole range of different places around the state, where people were able to put their input into them. Country communities were able to have their input into this before it was even introduced into the parliament. Unfortunately, we have seen almost no consultation whatsoever with this. We saw the legislation introduced before any consultation whatsoever had happened, and since then we have just seen a number of rushed meetings where none of the issues identified has been addressed in the bill and where there has been no true involvement of those organisations in drafting this bill.

I think in a very disturbing way we saw a breach of an election promise in the drafting of this bill. When the government were in opposition, they released their policy on bringing back health boards, and in black and white one of the commitments that they made in that policy said very clearly, 'We will be consulting people on what the boundaries of the six country health boards and local health networks will be.' They said in black and white that they will be consulting, but there has been no consultation since the election with anybody about what those boundaries are going to be.

They have basically just adopted the boundaries that were in place already as an internal mechanism in Country Health SA for their own management of things, and they have not done any consultation. As far as I am aware, we have not had any council being consulted about this. We have not had any RDAs consulted about this. We have not had a broad public opportunity for feedback into what those boundaries are going to be. That is basically entirely because they have rushed this legislation. They have not done the consultation they promised to do.

The only consultation it seems that they did was the minister claims that before the election, back when he was in opposition, he sent a letter to the health advisory councils saying, 'We are planning on having six boundaries along the lines of what Country Health SA already has. Let me know of any issues.' That is the only consultation that has apparently been done in this regard. That is clearly a breach of their election policy to do that consultation on the health boards. I would say to them that I do not think it is too late to do that now. It is appropriate that in the 11 months we have until any of this comes into effect that they should do that consultation.

Since these boards are not coming in anytime soon, there is no reason why they cannot start that consultation and talk to regional communities about whether these boundaries are the correct ones, or about whether people have any differing views. I am sure that there would be issues with those boundaries. I am sure that any number of councils or RDAs across the state would have a number of views they would like to put forward, but they have not been given that opportunity by this government.

In fact, so many of the stakeholders we have spoken to in our preparation of this debate and the debate in the other place said that the first they heard of the bill was from the opposition, and that is an indictment. As members would know, we have almost no resources in opposition, yet we have been able to consult with people across the state about this legislation. The government, with the massive resources they now have, did not consult with any of these people. They did not send an email out to organisations such as the AMA. Talk to the AMA and they will definitely tell you what they think of that lack of consultation. In fact, the AMA said to us:

In considering our response to this new Bill, the AMA(SA) has consulted its records on the Health Care Act 2008. The draft bill for this Act was released for public consultation on 2 July 2007. The then the Minister for Health, John Hill, presented to the AMA(SA) Executive Committee on the Bill on 14 August 2007 in advance of its introduction in Parliament on 27 September 2007…

The AMA(SA) will be strongly urging an improved consultation process for this latter Bill, and for substantially improved engagement on the current Bill, and any subsequent implementation.

Clearly, the AMA is saying, 'Look at what happened under the Labor government: we were properly consulted. The minister came and presented to us. We had the opportunity to have feedback before it was presented.'

In relation to this bill, you just lob it into the parliament and we hear about it from the opposition. That is the way that this government is operating. That is an example of the lack of consultation. This is not some minor organisation. This is the Australian Medical Association: you would think that they would be at the top of the list of people you would want to consult about this bill, and they heard about it from us. We talked to another organisation, the Australian Psychological Society. They said to us:

The APS is concerned about the absence of stakeholder consultation for the proposed Health Care (Governance) Amendment Bill…for South Australia. In particular there has been an insufficient amount of time provided for stakeholders to consider and comment on the broader impacts for health consumers in SA.

This is especially fraught due to the absence of information detailing the issues or an analysis, including an economic analysis, comparing the new model with the current system of governance.

Here you have an organisation saying, 'Not only did you not consult us but actually there is nothing that sits underneath this. There's no economic analysis, and there's no detail as to why these particular things that you put in this bill are there.' As I understand, people who have raised these issues with the minister have basically been told, 'Don't worry. It's all in stage 2. You don't need to worry about these issues,' all these really important issues about how on earth this is going to work, 'because we'll think about all of that in stage 2'.

The government tries to claim that it wants to be open and accountable, but we saw direct contradiction to those claims when the government rejected amendments in the bill in the other place aiming to increase transparency and accountability. The government is claiming that this bill is about local input and local representation, but that is not what is really happening here: the government is trying to distance ultimate responsibility away from the minister, very unfortunately.

We also saw in the other place a clear attempt at evading discussions on the costings for the so-called 'stage 2' of reforming the government's framework. In answer to any question of substance on what the government was planning to do with the governance restructure, the answer was always, 'That's a stage 2 consideration. We haven't even turned our mind to that yet.' These were very fundamental questions. I hope that when we get to the committee stage the minister representing the Minister for Health in this place will be able to give us more information on what the government's actual plans are, whether it has actually thought these issues through, rather than just trying to rush something through.

It took us a while to get the health minister to eventually admit that there are indicative costings for this planned reform, but he was not planning on revealing them to anyone. However, luckily, the chief executive essentially did that in the Budget and Finance Committee this week, and we know that up to $20 million a year is going to bureaucracy. It is ludicrous that the government thinks that it can ask parliament to vote on the process of completely transforming the governance of our health system but hide the figures on what this is going to cost the taxpayer.

It is only reasonable to ask ahead of voting on this legislation exactly how many resources are being directed away from more important work in our health system to make this restructure happen. The opposition asked this question, as I said, on Monday, and we did find out that $80 million would be the top of the range estimate over the forward estimates of what this could cost, but we do not know whether that is going to come from consolidated revenue or whether that is going to have to be found from cuts within the health system itself.

There are so many answers we are still waiting to hear from the committee stage in the other place regarding how these boards are going to work in practice, and we are going to tease out all those issues in this place. We do not know how the government plans to manage the formation of service level agreements, and in particular what happens if there is a dispute between SA Health and the boards on the content of their service level agreement. This is a key function of what the government is proposing in this bill.

You are going to have these boards, you are going to have SA Health and the minister, and what they do, what the boards do and what they deliver, is essentially worked out in a service level agreement. At the moment, that is straightforward because you have a centralised, streamlined, governance model where the minister is accountable for everything that is going on. But what happens in the future if a board does not want to meet the requirements of the department or the minister in what its service level agreement is? What happens if the board says, 'Well, we can't deliver these services for the amount of money you are giving us'? What is the ability to resolve that difference and who has the ultimate say? None of that has been worked out by the government in this.

Ultimately, a good board will be constantly advocating for more funding and resources towards its local health network, and it is yet to be revealed how these competing interests will be managed. Similarly, we still are not clear on whether boards must have the approval of the SA Health chief executive when hiring a local health network chief executive. The government claimed during the committee stage that this was not the case and that boards would have the ultimate decision, but we want to confirm that the government has received independent advice on this point.

In fact, this was one of the issues I raised with the chief executive when I met with him recently, and even he was not sure what the arrangement was going to be in terms of who had the ultimate say in this regard. We are particularly concerned about this, given the significant amount of stakeholder feedback we received on this very point, and I will repeat some of the submissions that were read out in the other place for the benefit of members here. The Australian Nursing and Midwifery Foundation said, and I quote:

The chief executive officer for a hospital board is then in an invidious position that they are appointed by the board only after approval by the CE of the department and they are then subject to direction of the CE but accountable to the board and also subject to their direction. This conflicted position should, in our view, be clarified with single stream accountability.

Essentially, what they are saying is that these CEs are now going to be working for two masters. On the one hand, they have to report to the CE of the department. It appears from the legislation that their ultimate hiring has to be signed off by the CE of the department and they are also subject to their direction, but the recommendation for appointment comes from the board and any directions can also come from the board.

How on earth are they going to manage that? Who are they ultimately responsible to? One thing we know is that there will be disputes about funding and services in the health system in the future—that is a given. What the government is setting up here is a process whereby we do not know how they are going to be resolved, how they are going to be managed or who is ultimately in charge of those hospital services. The Australian Medical Association said:

The function of the boards is of interest, including expected governance and strategy functions, as well as compliance with directions from the minister and CE of the Department for Health.

Would this structure mean 'all care and not enough responsibility' for the Chief Executive of SA Health? Does it provide too much distance of the minister from the activities at a hospital level?

Does the minister's power to appoint/dismiss the chairs and members harm the independence of the board?

Here we have the AMA, who of course were not consulted by the government in the lead-up to this, raising fundamental questions about how this arrangement is going to work between the boards, between the chief executives, between the health ministers and between the local health board chief executives. These are fundamental issues that in a year's time, in two years' time or in five years' time there will be disputes about. In my belief, they will have to be resolved before this bill passes this house or, at the very least, when this replacement bill comes in sometime in the future.

Also unclear is to what extent financial management will be devolved to these boards and what oversight over any devolution of financial responsibilities will be put in place. We are still uncertain about the impacts these governance rearrangements will have on our health advisory councils. This is something we will be addressing and putting amendments to in the committee stage.

Let me just make something clear about this at this stage: the current Deputy Premier, when she was the shadow health minister, brought to this parliament legislation to increase the powers of the health advisory councils to give them a greater say in terms of health delivery. None of that appears anywhere in this legislation. Communities across the state who believe that this is in some way giving any more power to their health advisory council, their local health representatives, are completely wrong. There is none of that in here whatsoever.

The government has the opportunity to do what they had previously wanted to do when they were in opposition, which is to do that. They could put that in the legislation. They could do what the Deputy Premier herself had called on parliament to do, and we are going to give them the opportunity. We are going to give them the opportunity to vote on exactly the same wording, almost to the exact letter, proposed by the now Deputy Premier about those health advisory councils back when she was sitting on this side of the house.

Let's see what all those country MPs have to say on that and whether they will back the increased powers for health advisory councils that the Liberal Party were so keen on when they were in opposition. They have an opportunity to vote for that and put that in the legislation. If they do not, they then have to explain that to their local health advisory councils. They have to explain it to their local communities, who are expecting the Liberal Party to do that, who are expecting the Liberal Party to stand up for those health advisory councils and give them greater power. That will be a significant test for those country members in this house.

There is a very significant issue when it comes to the country. We still have no clarity around what will happen in terms of statewide functions under the governance restructure. This is something that stakeholders have raised with us as a significant concern. For instance, the AMA raised concerns about rural workforce management under these reforms, and stated that it 'favours certain functions of statewide significance to remain centrally managed'.

We have had other stakeholders raise significant concerns that the devolution of power will ultimately result in less focus on broader policy issues, such as mental health, which will transcend local health network boundaries. Of course, mental health is another issue where there is no clarity from the government as to how it is going to be managed under this new system. It is another one of those, 'Let's push them onto stage 2. We are going to try to work that out later. Let's just rush through this legislation first' issues.

We on this side maintain our concerns regarding the bill. It is going to lead to the fragmentation and division of our health system. There were significant reasons why health boards were abolished. We saw that they were lowering standards of quality and safety, along with lessening the ability to control financial decisions. There will inevitably be a lack of focus on broader policy considerations of our health system and less coordination across key statewide services.

The government should be focusing their resources on reforms that will genuinely make things better for patients, rather than spending money adding unnecessary bureaucracy to the system—unnecessary finance officers, unnecessary HR people, unnecessary back of house operations and unnecessary governance officials—none of which need to be in place.

We are starting to see a pattern. Just like the bill, the government keeps trying to look like they have a plan for the health system, but really it is just empty promises, and we have seen that with what they have promised to do so far with a number of their election promises. They promised they were going to bring back the high dependency unit at Modbury Hospital. They have no idea how they are going to do that because that promise was fundamentally flawed. We know it is fundamentally flawed because the minister had to reveal the advice that he received pointing out all the very serious safety and quality risks with that happening. It looks like they are on track to break that promise.

We have had promises in regard to The QEH, where they promised to put $6.5 million into the cardiac labs. We are hearing that they are only going to put $4 million into that—another area where they are on track for a broken promise. We have had the Repat, where they promised to bring back elective surgery. We are hearing that they have no idea how they are going to do that. It is going to prove to be enormously expensive and there is a lot of local opposition to it from the clinical staff. They have no idea how they are going to do that, and they are on track to break their promise in that regard.

Time after time, we are seeing that this government have no plan for health and no idea how they are going to deliver their election promises. They brought out their winter management plan a month into winter. They were only ready for winter a month into winter. After we already saw significant ramping happening, they decided to release their plan for winter. We know that they are having to revise that significantly because it was not up to scratch to manage this year's winter.

They made a promise in regard to Noarlunga Hospital. We are hearing significant concerns that that is not going to be delivered as the government promised. We are not going to see overnight beds there at all. These beds are going to be shutting at 8pm. Time after time after time, the rhetoric and the promises from the government were not borne out. We are seeing again in this bill that there is no plan. There was no consultation. There is no idea about how this is going to work. There are going to be significant costs, and we do not know where the money is going to come from. We do not know what stage 2 is going to be. We do not even know why this legislation needs to pass now because they are not proposing to bring it in for 11 months.

We are seeing some of the sensible amendments that were moved in the other place trying to be walked back by the government now in their amendments that they have filed here. It will be interesting to see whether they support what they did in opposition as to whether they are going to support health advisory councils and the powers that were proposed by the Deputy Premier when she was the health spokesperson. There are a number of very significant flaws with the bill. It is going to increase waste, increase duplication and increase fragmentation, and for all of those reasons and more, the opposition will be opposing the bill.

Mr DULUK (Waite) (16:38): I also rise to make a contribution to the Health Care (Governance) Amendment Bill. With the introduction of the bill in this house, I suppose the government is taking another step to do our bit to improve the state health system that we inherited after 16 years of Labor. It is going to take a long time because the mess and the morale within public hospitals are so horrific because of the decisions of the former Labor government. In my own community, wonderful staff who used to work at the Repat are suffering from low morale, as the former government shunted staff all across SALHN.

We once again listened to the dulcet tones of the member for Kaurna in his contribution, which seemed to completely wash over his time and involvement with the health portfolio. The member for Kaurna was an adviser to the former health minister, the Hon. John Hill, and to the former federal health minister, the Hon. Nicola Roxon. He was, in his time in this house as well, intimately involved with the health policy of the former government. You would not know it from his contribution today. There was only criticism of our desire to improve a pretty broken health system.

In his contribution, the member for Kaurna said that health boards do not work. I do not know if they do or do not work, but what I do know is that what has been in place for the last 16 years certainly does not work and that it is incumbent on any government to do their bit to try to improve the lot of South Australians. I would love, for one moment, for those opposite to come on board with some of our plans—across any portfolio area, but today we are talking about heath—to support us, to give us a go, to get on board with this idea and to actually make a positive contribution to this health board.

Look at people who you think may be eminent people to serve on these boards and recommend that they serve. I think that is really important. A key part of this legislation is going to be to give a voice to regional and rural communities. I am sure the member for Giles knows some eminent people who can sit on the boards in his community. I say to the member for Giles, who is also a very decent man, to get on board and make a positive contribution to the debate here and what we are looking to do on this side of the house.

As I have said, the health system has been through a pretty difficult period. We had 'Trashing Health', which was introduced a couple of years ago and it literally trashed the SA health system. We are doing our bit to fix Transforming Health, as it was. We have had broken promises and incompetence from the former government and, once again, we are here to fix Labor's mess. Of course, one of the key objectives for us and one of our key election promises was around health boards.

One of the biggest issues that people come to see me about in my constituency is the current healthcare situation and their hospitals. It is incumbent on us to put in as much effort as we can to increase access to safe and timely care for all South Australians. People are expecting more from this government and we will certainly be delivering for them.

I applaud the introduction of this bill into this house, which of course is part of our reforms. The bill in front of us looks at changes that will result in 10 local health networks, each with their own governing board. I know that many of my constituents will be especially pleased with the introduction of a Southern Adelaide Local Health Network governing board. Local communities will once again come first and patient safety will be improved through this system.

Currently, SA Health is managed centrally. This means that it can be hard to manage the many different communities throughout South Australia. Once again, we on this side of the house know that local communities know best. As someone who lives in my electorate of Waite, through Mitcham and the Mitcham Hills, I do not know what is best for the people of Port Augusta in the member for Stuart's electorate, but they certainly know what is good for them and for those who live in that community. By people in his community directly having a say in the running of their healthcare system—experienced practitioners and people who are skilled in governance—we are giving them the opportunity to have a say in the decisions of the government that affect their daily life.

Health is a large and complex system and cannot operate optimally under centralised control. Many communities, whether regional or city, have strongly supported the re-establishment of local health boards. Healthcare needs and challenges vary between areas within metropolitan Adelaide and across regional South Australia. These changes will deliver better outcomes for patients and that is, ultimately, the first priority. The health needs of communities will be understood, with local boards overseeing the decision-making. Of course, we are seeing the reversal of minister Hill's decision back in 2008 to abolish our local healthcare boards.

In my wonderful part of the world of Adelaide, you really cannot go about your business without bumping into someone you know, a bit like it is in Port Lincoln. Indeed, in southern Adelaide we have an ageing population and a lot of retirees, and this was really brought home to me on a recent tour of the Flinders Medical Centre that I undertook with the member for Elder and the member for Davenport. During the tour they talked about the need in southern Adelaide for additional older persons healthcare services and the real strain that has been put on SALHN and southern Adelaide residents with the closure of the Repat and with facilities such as Flinders Medical Centre and Noarlunga Hospital not being able to cope with the service demand or need.

One good example is the ED at Flinders Medical Centre, which was designed, I think, to take about 60,000 to 70,000 patients through the door every year. It was explained to us on our recent visit that right now Flinders Medical Centre is seeing about 90,000 patients through that ED. The largest metropolitan hospital in Adelaide is meeting a demand that it is not and was not built to cope with. That has just been exacerbated with the closure of the Repat.

One can only assume that a decision taken by government to close the Repat would never, ever have been able to occur in a system where you had community health boards and localised health boards, because there would be people—for example people on the SALHN health board, people from the community, people with skill sets that complemented healthcare decision-making; and of course there are opportunities for community representation—who would not allow such a bad decision of government—

Mr Picton interjecting:

Mr DULUK: —because they knew the importance of community-based health care. The Repat was such a wonderful community asset. As the member for Kaurna himself is a southern suburbs MP, I have no doubt that he would have known of the importance of the Repat to SALHN health care. It is a real shame that he served in a government that did not stand up for the people of the southern suburbs.

At the March 2018 election, the Marshall Liberal Party made a commitment to establish a new governance and accountability framework for the public health system. A promise was made to delegate decision-making in the public health system through the establishment of metropolitan and regional governing boards. Once again, in this debate through the house we are delivering on these promises. The governing boards will put responsibility and accountability at a local level. Governing boards will be held accountable and must deliver real progress.

I will come back to the Repat, which is so important in this debate. From where we sit, we cannot talk about health without talking about that decision and the consequences closing it had, especially throughout the whole metropolitan health system. The former government did not listen to the community, but we are. It is great to be working with the minister in a productive way and, in particular with the members for Elder and Davenport, in listening to the community about what is needed. I know that the minister is out there at the moment with a ranging consultation, one with clinicians and service providers; at a community level, my neighbouring state colleagues and I are doing exactly the same thing.

We are listening, and I suppose that is an important part of this debate at the moment. We are not just taking selected advice or selective advice, as the former government did for their political agenda: we are being quite genuine about this. For as long as I am a member here, I will fight for my community. I know that the government will be listening to the community all the way, which is so important. I repeat that the closure of the Repat was such a detrimental decision, and I do not believe that it would have happened if we had had the board governance in place.

It is important that we keep reminding the people of South Australia about Transforming Health and why we are making the decisions that we are. We are asking the public of South Australia to be patient as we fix the issues because they are going to take time; none of them is easy. For example, one recent fix was the Chest Clinic back into the NRAH. When the NRAH was being designed, it was missed out from the old RAH. These decisions take time and finding space. I know that the member for Florey is proposing and has on the Notice Paper an inquiry into Transforming Health.

We know what a lot of the issues and problems are with Transforming Health. We urge the general public to bear with us as we go on this long and difficult journey to get our state and our health system back on track. The Transforming Health agenda was driven by health bureaucracy and did not put people first. The final report of the Select Committee on Transforming Health, which was tabled in November 2017 and chaired by the Hon. Stephen Wade in the other place, expressed concerns about Transforming Health. In June 2017, the previous government announced that the Transforming Health program was completed, having achieved significant reforms. However, the November report states:

Transforming Health is not completed in the sense that of the 52 Clinical Standards it was designed to achieve, only 10 have been achieved thus far and there is no clarity as to whether the remaining standards will be achieved in the foreseeable future.

The report goes on to state:

There is also no evidence that Transforming Health is completed in terms of dealing with the 500 avoidable deaths that the Government asserted was the key reason for Transforming Health.

That is avoidable deaths within the public hospital system. Transforming Health did not deliver any cost-saving measures despite needing to reduce the expenditure of health care. The former government obviously closed the Repat, and this decision was made under the disastrous Transforming Health.

The report also raised the concerns of clinicians about increased demand on outpatient departments with the closure of the Repatriation General Hospital and the relocation of rehabilitation services from Hampstead to The QEH. The report states:

Evidence suggests that inadequate planning—described as a 'scramble'—of outpatient facilities at the NRAH has further compounded the problem.

This policy has left a gaping hole in southern health care and, indeed, in statewide services. As far as I am concerned, patient care was not the top priority of Transforming Health, and this contributed to patients' experiences of appalling failures of quality of care. For examples of that one has to look no further than the disastrous Oakden scandal, the chemotherapy dosing saga and, of course, the prostate cancer bungle as well.

It is our desire to re-engage with the South Australian public, to re-engage with clinicians—the many good clinicians who were pushed aside by the bullying of the former Labor government and the upper echelons of SA Health bureaucracy—and of course to re-engage locally and across the state with South Australians to restore confidence in public health, which is a vital and important community asset. That is why the South Australian Liberal Party will put a greater focus on the quality and the value of care.

I commend the hard work of minister Wade in the other house, especially in opposition. I had the pleasure of working closely with him on several projects, and he diligently and assiduously went about mounting the case for why Transforming Health was such a shambles. He did not stop at saying why it was a shambles; he came with reasons and solutions for what needed to be done to unscramble the eggs and to fix some of the issues, and putting health board governance into production is a way of doing that. That is so important.

One thing that I hope we will see with health boards coming into play is a more efficient health sector, which is so important, so that we can see a bit of competition between the different health regions and look at a new way that health does procurement, the way services are provided and the manner they are provided as well. I think it is really important that we take a holistic approach to healthcare provision, the way we provide it, and look at what best practice is from interstate and overseas jurisdictions as well because we can do a lot better.

With a centralised bureaucracy, you get very up-and-down decision-making. You do not get that competition that a more decentralised system brings. I think in the case of health care and the provision of healthcare services and the mixture that we provide to the general public, there is a great opportunity for there to be a greater and more robust provision of healthcare services. What we want, and this is a good way of beginning that, is to see an improvement on waiting list time, to see more staff on wards and to see a change in attitude. I suppose this is why the minister has the word 'wellbeing' in the title of his portfolio because a focus on wellness is important.

What we can do at a primary healthcare level is avoid having people go into acute care in the first place in hospitals, putting strain on the system. I think there will be a big focus on community health boards and how they promote wellness within the community at an absolute grassroots local level. I think this is a very good bit of legislation and proposed policy change. I commend this bill to the house.

Mr ELLIS (Narungga) (16:56): I rise to wholeheartedly support the Health Care (Governance) Amendment Bill 2018. I believe it is vital in order to make any inroads into the mess that is our health system that has been left to us from the previous government. I want to remind those opposite of the current state of health within this state because it sounded as though, when the shadow minister was talking, he had completely forgotten about the current situation. People in this state are shocked, disillusioned and angry at the continuing reports of failings in our system, particularly in a $2.3 billion new hospital that has ambulances ramping outside of it for lack of beds.

It has an electronic patient record system that is hindering instead of helping health professionals, and has inedible food for patients, inappropriate and insufficient facilities to properly and timely treat mental health patients and a design so precarious that archived patient records cannot be shifted where they can be accessed by clinicians because the building has been deemed not to be able to handle the weight. Have you ever heard of such a thing? Stressed staff are dealing daily with overcapacity emergency areas.

Expensive renovations have had to be carried out to fix ill-conceived design flaws, chemotherapy treatment mistakes, and waiting lists hit record lengths last year, years in some instances. Only last week we had the call to place patients across the road in motel rooms to free up beds. Management and service delivery must improve for patient safety and also for staff health and morale. It is unbelievable that we, South Australia, spent $2.3 billion, and one could mount a strong argument that we are in a worse position now than we were before. Not many bodies could manage that.

It is a fairly impressive feat to spend that much money and make the situation worse; indeed, the South Australian Labor Party might be one of the few that can manage such a feat. We are in this position for a few reasons, one being that the advice of people in the know, the advice of clinicians who work at the coal face, the nursing staff, the specialists, the very people who see firsthand the issues, service gaps and impacts on patients and their care, were not heard either through wilful ignorance or a complete failure to engage them. The advice of medical professionals was not sufficiently valued. Improvements to policy and governance must be led by doctors and medical leaders. It is not just the new RAH. That is just one hospital in the state.

There are needs in every hospital and health service across metropolitan and rural South Australia. As important as this legislation will prove to the city, it will be equally important in the country where so often in the past smaller regional health services have been treated as a secondary tier concern. For country health services, this Health Care (Governance) Amendment Bill is going to prove vital because when the system is in as deep as it is, with so many issues facing it, there is surely no such thing as having too many heads working on a solution.

The Health Care (Governance) Amendment Bill backs the message from this government on this side that decentralisation is needed and that emphasis must be placed on local input in decision-making. Local clinicians and communities who work inside our regional hospitals and health systems deserve to have a strong say in the future direction of the state's health system, and the bill ensures local boards will be accountable for the delivery of health services within their area of responsibility, including appointing and managing chief executives, controlling budgets, and actively engaging with their communities and front-line professionals.

Our doctors, nurses, and allied health staff work under great pressure, and the bill will mean that they will not have more pressure imposed by a remote head office, out of touch with local needs and challenges specific to regional areas. The bill establishes governing boards for three metropolitan health networks and six regional health networks, and legislates new governance and accountability frameworks, including boards having the power to appoint a CEO and manage their own budgets.

It has been well documented that in the past 10 years Labor doubled SA Health's head office staff. It grew four times faster than our nursing workforce, and still excessive bureaucracy resulted in budget blowouts and poor project management. Putting real responsibility and accountability back onto these boards at a local level will provide strength and oversight and improve patient safety. Health professionals and people at the coalface will be listened to and will be heard when urgent, high-risk repairs and maintenance are needed.

Being a member of the Wallaroo Health Service Planning Steering Group, I am well aware of the value of local knowledge, which is proving pivotal to responsible future planning for Wallaroo hospital, viewed as a major facility within the electorate of Narungga. This legislation will ensure that all money raised in local communities is spent in local communities, that local bequests and private donations go to where they have been pledged and, in doing so, restore faith and connection between communities and governance. The bill will see resources go where the need is greatest and not wasted. Health is too large and complex for it to be operated efficiently under a centralised system. Under the previous government, that is what increasingly what we got.

The former government, in their eternal wisdom when it came to health, abolished local health boards with the introduction of the Health Care Act in 2008, which left health, worth $6 billion annually with almost 39,000 employees and 77 hospitals and health services, under centralised control. It went about as well as anyone could have predicted it would. The city-centric approach does not serve rural areas well. Health care varies wildly across the state and decisions are best made by those close to the area that the decision concerns, by people who know what the local community expects and, especially importantly, with input from local health professionals.

These people have been frozen out of the decision-making process since Labor removed the local health boards and, as a direct result, the maintenance and capital works backlog in neglected country hospitals are reported to be in the order of $150 million. The bill will safeguard against more rural hospitals losing services and being downgraded. Yorketown Hospital surgical services were quietly downgraded in February last year. The hospital lost its general surgery, gynaecology and urology services, and I say 'quietly' because the local health advisory council was told not to talk publicly about the imminent loss of services prior to the announcement. Let me say that included, explicitly, being advised from above not to let the local member at the time, Steven Griffiths, know of the plans.

That is incredible, but it is the sort of thing those opposite tried to impose on the people of regional South Australia and hoped they would not notice. In absolute frustration over the last 10 years, communities are becoming increasingly despondent about having no voice. It is believed that local communities lost decision-making authority over the 42 country hospitals across South Australia when the previous government removed their management boards. In their stead, HACs were designed to be the local voice for the minister, but they have been described as toothless tigers without directives on how to act, without clear lines of communication, and with no say on how funds they raise are allocated.

Locals wanting to donate to their hospital have not been sure of where their money would go. In the media late last year, Dr Max Van Dissel of the Kapunda Health Advisory Council lamented that two applications were made to use its fundraising to purchase a steriliser and an operating microscope that the local clinicians deemed essential, but both were not backed by the minister. In November last year, a doctor from the Nuriootpa Medical Centre, Dr Michael Hoopman, despaired publicly of the many battles faced by local doctors. His list included outdated facilities, the winding down of services such as obstetrics and the lack of support for patients who are experiencing mental illness. He said that he had been in the Barossa for 25 years and that numbers at the hospital had halved.

At a public meeting in Quorn in March 2017, local doctor Tony Lian-Lloyd addressed the packed town hall, describing the loss of the lifeblood of many small townships. The local hospital, diminished by stealth, was threatening the economic viability of rural doctors and, by extension, service delivery to patients. Of note were the supporting medical professionals who travelled from all over the state that night to attend from Mount Gambier, Robe, Kimba, the Barossa, Burra, Cleve, Port Broughton, Bute, Maitland, Kadina, along with local mayors and members of the Rural Doctors Association and the nursing and midwifery association.

The bill will ensure that all money raised in local communities is spent in local communities. This was part of the 49 recommendations in the final report tabled from the Social Development Committee's Inquiry into Regional Health Services in September 2017. It recognised that country people were crying out for community-raised money to go towards resourcing buildings, equipment and research in regional areas. It was recognised that country people who have been so committed and involved in the building, development and provision of country health services in their townships feel that the government had abandoned them.

The bill reconnects those local and knowledgeable people who are valuable state assets. This government has also pledged to invest $20 million to assist country communities to fill skill gaps, attract specialists and double the number of medical interns in regional SA. We are committed to fixing a broken health system. Patients in the Narungga electorate are often disadvantaged by distance and challenges in accessing doctor and specialist attraction and retention, but, just like their city cousins, they are entitled to fair access to health services. Regional areas cannot afford to lose any more services. Retaining health services is top of the list of concerns for locals, and is what I hear most about. Our increasing and ageing population creates the need for state government investment to be made.

At a health forum I ran in Wallaroo last October, then shadow minister and now Minister for Health and Wellbeing, Stephen Wade MLC in the other place, heard firsthand the local issues: the Wallaroo Hospital needing expansion to cope with demand, increased out of hours X-ray services, ramped up chemotherapy services, and help for stretched accident emergency and ambulance services, and there is much more to be done.

I urge those opposite to get on board. Support this legislation and help fix your mess, although it is not the Labor way to clean up after themselves. Just as the federal member for Lindsay, Emma Husar, makes someone else clean up her dog's mess, we have been left with a huge steaming pile of a health system to clean up, and we will get stuck into doing just that. This bill today is the start of many actions planned by this new government to improve our health system for all South Australians wherever they live. I am honoured to commend it to the house.

Dr HARVEY (Newland) (17:08): I am delighted to have the opportunity to speak in support of this bill, which is yet another example of where the Marshall Liberal government is delivering on a commitment that we took to the last election. I must say, though, that being lectured by those on the other side on health, given their track record, is really quite incredible.

When you look at some of the disasters and problems around the new RAH, Transforming Health, blowouts in EPAS and the lack of consultation with health professionals, we are really in quite an incredible almost twilight zone. In fact, I think if health was not such an important issue, the lack of shame on this issue from the Labor Party is almost awe inspiring. I think that any other reasonable person, with a record like those opposite on health, would probably rather hide under a rock whenever the issue comes up than show their face, but this is where we are.

In stark contrast, the new government is working hard to fix the mess left to us by the Labor Party in health. In fact, a very important first step in improving the health system was to get rid of the previous government. What is quite concerning, though, is that, despite the claim from those opposite that they are on a listening tour and that they have now discovered the benefits and importance of listening to the community (clearly this was not happening in government), they are clearly still not listening to what the community wants on health.

As members are aware, this bill will establish governing boards for local health networks, which will begin to decentralise the important decision-making that occurs in our public health system. The simple reality is that our state's health system, which has a $6 billion budget, nearly 40,000 employees and 77 hospitals and health services, is simply too large and diverse for centralised decision-making.

This is certainly not a reflection on the skills and knowledge of our healthcare professionals, but a recognition that decisions made as close as possible to the coalface of health care in the community will be better decisions. Unfortunately, the previous government, driven by ideology and arrogance, sought to centralise decision-making into a castle in the CBD many, many miles away from the community where the services were actually being provided.

In fact, further than simply decision-making, Transforming Health sought to centralise services much to the dismay of the local communities, such as my own that saw services stripped away from our local hospital. This bill will begin the process of reversing the centralisation. It will strengthen oversight, improve patient safety and deliver better health care for all South Australians. Specifically, the bill concerns the establishment of metropolitan and regional governing boards and establishes new governance and an accountability framework for the public health system.

The bill fulfils part 1 of our two-part commitment and will allow board chairs to be appointed shortly in the lead-up to boards being operational by 1 July 2019. Part 2 of our commitment will establish a new governance and accountability framework for the public health system, and this element of our commitment is likely to conclude late this year or early next year.

In addition to the delivery of local health services, the governing boards will be responsible for the control of the health budget for the local health network, the appointment of their chief executive officer and the active engagement with their communities and front-line health professionals. Governing boards will be established for each of the local health networks as they are currently constituted, with the exception of the Country Health SA Local Health Network.

In country South Australia governing boards will be established for six new local health networks that will be established by proclamation in line with the current regional boundaries. These governing boards will be accountable to the Minister for Health and Wellbeing for the oversight of the delivery of health services in accordance with the service level agreement negotiated between the local health network and the Department for Health and Wellbeing.

Each board will consist of between six and eight members appointed by the minister, and importantly at least two of these members will be health professionals. This will ensure that decisions made by each governing board are made with important clinical input, an important point given that insufficient consultation with health professionals was a key failure of the previous Labor government in health policy. Appointments to board positions will, of course, be undertaken through a skills-based process. In addition to at least two health professionals, boards may also include members with expertise in health, commercial or financial management, the practice of law, clinical governance and Aboriginal health.

A significant focus of the bill is to ensure that regional South Australians have access to high-quality health care and to ensure that their needs and opinions are taken into account. Whilst this is something that regional South Australia has been crying out for for some time, it is, of course, not just regional South Australians whose needs and views were ignored by the previous government. As my friend the member for King and I know all too well, the people of the north-eastern suburbs were ignored and, in fact, betrayed by the former Labor government.

The shameful decision to cut services at Modbury Hospital, which members opposite were complicit in, was symptomatic of a party that simply did not seem to care about what was happening outside the CBD. Thankfully, the Marshall Liberal government's $110 million upgrade of Modbury Hospital will restore vital services to the hospital and ensure that my community has access to the high-quality health care that the north-east deserves.

I am pleased to be a member of a government that values all South Australians. By establishing governing boards for local health networks, the Marshall Liberal government is recognising that the delivery of local health services is safest and of the highest quality when the needs, values and priorities of the local community—in fact, the community that will actually use these services—are considered and valued rather than derided and dismissed.

This is what the South Australian people wanted. It is a commitment we took to the election earlier this year and yet another commitment we are delivering on. The new government is working hard to fix the mess left by Labor in health. On this side of the house, we have a government that listens to South Australians, that is strengthening our public health system and that is delivering on its promises. I commend the Minister for Health and Wellbeing, the Hon. Stephen Wade in the other place, for his diligence and efforts in fixing our health system, and I commend the bill to the house.

The Hon. D.C. VAN HOLST PELLEKAAN (Stuart—Minister for Energy and Mining) (17:16): I do not have anything else to say, but I will close the debate, and we will go into committee.

Bill read a second time.

Committee Stage

In committee.

Clause 1.

Mr PICTON: I will start with questions regarding cost. Can the minister outline for us the expected cost in terms of the board appointments, the cost in terms of the behind-the-scenes bureaucracy that will need to be in place and the cost in terms of transition and change management? What are the estimates in place at the moment, and where will the money come from? Will additional money be provided to the department, or will they have to cut other services to meet this new cost?

The Hon. D.C. VAN HOLST PELLEKAAN: Mr Chair, could the shadow minister explain how that question relates to the title of the bill?

Mr PICTON: I think there is a long convention in this place that general questions about the entire bill can be asked at clause 1. It is entirely reasonable that a general question about the cost of the bill, covering the entire act of parliament, should be asked in this spot. I think we could go back through the last 16 years and find many occasions when that has happened.

The CHAIR: I am advised by the Clerk that it is not general practice, but it can be practised. Perhaps repeat the question for my benefit and the minister's benefit, member for Kaurna.

Mr PICTON: Thank you. Can the government outline the cost of implementing this legislation and also where the funding will come from?

The CHAIR: That is a very broad question. Honestly, member for Kaurna, I suspect that question is too broad to relate to clause 1. The cost—

Mr PICTON: Sorry, Mr Chair. I think it is absolutely imperative that this parliament should be able to ask what the cost to the state of bringing in legislation is going to be. If there is another appropriate place to ask this, then I am happy to do so, but I think it is imperative that the parliament should be able to question what the expenditure is going to be for bringing in this legislation.

The CHAIR: Is the minister happy to answer?

The Hon. D.C. VAN HOLST PELLEKAAN: I am happy to make a contribution. I agree with the principle that cost is an important thing to discuss. Whether or not asking that question in the context of the title of the bill in clause 1 is the right place we will put aside for a minute.

The shadow minister would know that there have been some estimates on cost because he in fact talked about them in his second reading speech, so he is very well aware of the answer to his question. He knows that the cost estimates were from a low of $3.6 million per year to a high estimate of $20 million per year. The Minister for Health has made it very clear that those cost estimates were ascertained before the last election, so they relate to the election commitment and not to the finetuning the government has done since coming into office that relates directly to the bill.

The shadow minister also asked where the money is going to come from. He alluded to that in his second reading speech, and the very obvious answer is that it is going to come from the budget. The reality is that the actual cost I expect will be somewhere in between the high estimate and the low estimate that was done before the last election.

Mr PICTON: Is the minister saying that there will be additional funding provided or that the health services will have to find the funding from within their own resources, within their own budgets, to meet this additional cost?

The Hon. D.C. VAN HOLST PELLEKAAN: That is a question that will be answered on 4 September when the budget is released.

Mr PICTON: What consultation did the government undertake on the bill before it was introduced to parliament?

The Hon. D.C. VAN HOLST PELLEKAAN: Again, I am not sure how this relates to the title of the bill, but if the shadow minister wants to get his questions out of the way and not come back to them later that is something I am happy to help him with. The bill before parliament is quite limited, as its purpose is solely to allow for incorporated hospitals to be governed by a board. As such, no consultation was undertaken prior to the introduction of the bill into parliament. However, offers of briefings on the bill were made to professional bodies and other stakeholders after the bill was introduced into parliament. This is not an unusual practice.

In attendance at this briefing were the Health Services Union, Ambulance Employees Association of SA, Professionals Australia, Public Service Association of SA, SA Salaried Medical Officers Association, Australian Nursing and Midwifery Federation (SA Branch) and the Australian Medical Association. The Minister for Health and Wellbeing also had a subsequent discussion on the bill with the Health Consumers Alliance of South Australia.

In general terms, most of the concerns raised related to broader changes foreshadowed as part of the review of the government's accountability framework for the public health system. As these changes are more widespread than the establishment of boards, there will be broader consultation on the amendments prior to their being introduced into parliament. The Minister for Health and Wellbeing also met with the health advisory councils and the Country Health SA Governing Council chair and presiding member groups.

Mr PICTON: What consultation has occurred in relation to the boundaries for the Country Health regions?

The Hon. D.C. VAN HOLST PELLEKAAN: Of course, the answer to that question is incorporated in the last answer that I gave. As the shadow minister said in his speech, the now Minister for Health actually engaged with the health advisory councils on exactly that issue before bringing this to parliament. The shadow minister has asked a question that he gave the answer to in his second reading speech.

Clause passed.

Clause 2.

Mr PICTON: There is an essential issue here, in relation to this bill, about stage 1 and stage 2. This is apparently is stage 1 and apparently a stage 2 is coming. I am wondering if the minister can outline when stage 2 is coming and what the process is behind it. Why have this stage at all when this is going to be replaced by another bill?

The Hon. D.C. VAN HOLST PELLEKAAN: Broadly, among other things, this bill is about enabling the government to appoint the chairs for the boards and the board districts. One of the reasons that the government wants to get that done but not move on to some of the other work immediately as part of this bill, is that we want these boards to have some genuine decision-making authority and some planning authority in their own areas.

It would be inappropriate for the government to say that we want to devolve local decision-making to boards so that they can decide what their priorities are and how they believe it best to operate in their regions, the six country regions and the three metro regions. It would be inappropriate to say that we want them to have that sort of responsibility and authority and simultaneously say, 'Here's how you're going to do it.' That is not our way in government.

We honestly want the chairs and their fellow board members to have that sort of authority, but we want to appoint the chairs now and we want to work with those chairs and potential board members to develop the ways that they believe will work best in their regions. The development of that work is, among other things, then what will come in what you call the second stage.

Mr PICTON: Is it the government's intention that we will not actually see all sections of this act commencing in the future because stage 2 is going to replace this act before all these sections are turned on?

The Hon. D.C. VAN HOLST PELLEKAAN: What number question is this?

The CHAIR: This is the second one.

Mr PICTON: I know it feels tough.

The Hon. D.C. VAN HOLST PELLEKAAN: No, this is not tough, shadow minister. This is more about principle than you will ever understand.

Mr PICTON: Sorry, but that is a personal reflection, Mr Chair.

The CHAIR: Are you raising a point of order?

Mr PICTON: Absolutely, yes.

The CHAIR: A point of order has been raised. Does the shadow minister feel offended?

Mr PICTON: He has essentially said that I would never understand a matter of principle. I think he should withdraw and apologise.

The Hon. D.C. VAN HOLST PELLEKAAN: To clarify, what I meant was that this is more about principle with regard to devolution of decision-making in health than you will ever understand.

The CHAIR: That is not exactly what you said, minister.

Mr PICTON: Are you going to withdraw and apologise?

The CHAIR: The shadow minister feels aggrieved by your comments. Will you withdraw and apologise?

The Hon. D.C. VAN HOLST PELLEKAAN: Yes, if he is aggrieved, then I withdraw and apologise.

The CHAIR: Thank you. Minister, question 2.

The Hon. D.C. VAN HOLST PELLEKAAN: Following the passage of this bill, a proclamation will be issued to bring the act into operation on 1 July 2019. The act cannot be brought in earlier than this date, as it amends section 33 of the Health Care Act 2008, thereby transferring responsibility for the administration of the local health networks from the Chief Executive of the Department for Health and Wellbeing to the governing boards.

There is still work that needs to occur in relation to the governance and accountability framework for the public health systems as well as the transfer of functions from the department to the boards before they become operational. This work is likely to lead to further amendments to the Health Care Act 2008 that will be introduced into parliament early next year.

Clause passed.

Clauses 3 and 4 passed.

Clause 5.

Mr PICTON: In this section, essentially the objects are changing so that one of the objects is going to be the 'efficient and effective governance and oversight of incorporated hospitals through the establishment of governing boards'. I think that raises the question of how they are going to be efficient and effective in the delivery of these services.

I think that goes to one of our strong concerns—that we are going to see significant fragmentation of services across the state, and there is not going to be ability to centrally plan or deliver services that are more appropriate to be delivered across the state rather than in particular local areas. I am wondering if the minister can outline how the objects of this section will be met to avoid that fragmentation and also ensure that those statewide services can be delivered.

The Hon. D.C. VAN HOLST PELLEKAAN: There will be service level agreements, as is clearly set out, between the boards and the minister essentially, and those service level agreements will be entered into with a very clear understanding of statewide services that need to be delivered versus local services that need to be delivered. Local will mean not only for that board area but also, perhaps, different services within board areas as well.

Clause passed.

Clause 6.

Mr PICTON: Essentially, this is saying that you are going to try to have an effective balance between local and statewide planning. I am wondering if there have been any decisions made yet or even any planning yet done on what the statewide services that are not going to sit in local health networks under local boards will be. There are a number of statewide services already; what is going to be the management of them? How will they be governed? Will they have a separate board, or will they essentially report to the chief executive?

The Hon. D.C. VAN HOLST PELLEKAAN: That work has started, but of course that work cannot be completed until the board chairs and the board colleagues are in place, so I am not in a position to outline for you in detail what you would really like to know. But that will be made available when it is available. Suffice to say that the work has started but cannot be completed until this bill has passed through parliament.

Mr PICTON: Specifically, one of the issues that has been raised is in terms of mental health services. There are a number of them that at the moment clearly cross region boundaries in how they are delivered. What can the minister provide to us in terms of how mental health services are going to be managed under this new framework?

The Hon. D.C. VAN HOLST PELLEKAAN: The answer is the same as to the last question; that is, it is a very, very important service, as you say, but there is nothing more to share with you at the moment. It is not being withheld: it is one of the things that is being worked on.

Mr PICTON: Another very significant service that we have in South Australia is the ambulance service. There was previously, until the passage of the Health Care Act 2008, an ambulance board that covered that. Is it the government's intention to have an ambulance board, or is it the government's intention to attach that to one of the local health networks or to keep it reporting centrally?

The Hon. D.C. VAN HOLST PELLEKAAN: Same answer again.

Clause passed.

Clause 7.

Mr PICTON: This section relates to the powers and responsibilities of the chief executive. This goes central to a number of concerns that have been raised particularly by the Australian Nursing and Midwifery Federation in terms of what the power balance between the chief executive, the chief executive of the hospital and the local health board is going to be. Who is ultimately in charge of the system? My question is: who is going to be in charge of the management of the local health CEO, or are they going to be effectively reporting to two masters: the health CEO centrally and their local health board?

The Hon. D.C. VAN HOLST PELLEKAAN: The chief executive of the department would only be able to direct the board, but the CEO of the board is responsible directly to the board. The CEO of the department would not be able to direct the CEO of the hospital.

Mr PICTON: Can you say that again?

The Hon. D.C. VAN HOLST PELLEKAAN: Just to make that clear, the CE of Health can direct the board, but not the CEO of the hospitals. The board directs the hospitals, Health directs the board and the board directs the hospitals. Is that clear?

Mr PICTON: Sort of. Essentially, my question is: say I am the CEO of an incorporated hospital, say Central Adelaide Local Health Network. You are the Chief Executive of SA Health and the Deputy Speaker is the chair of my local board. Am I responsible to both of you? Who has ultimate management of my position and my running of the hospital? Am I effectively reporting to two masters?

The Hon. D.C. VAN HOLST PELLEKAAN: As I thought I said, no, you are not reporting to two masters. You would report to the board.

Mr PICTON: Is there not a conflict with that in that the chief executive centrally of SA Health can direct the hospital and also has the ultimate sign off in terms of the CEO of local health network positions? Ultimately, even though day-to-day management might be to the board, that person would still have some responsibility centrally, under this proposed legislation, to the CEO of SA Health?

The Hon. D.C. VAN HOLST PELLEKAAN: Shadow minister, I am advised that there is no harm in consultation across these borders, but at the end of the day the CEO of the hospital officially reports to the board and the board only. That does not stop the CEO of Health or anybody in the system having consultation, discussing issues, but when it comes to actually who is in charge and where the lines of authority are, the answer is the same as the last one I gave. The example that you raised if hypothetically you were the CEO of the hospital, you are directed by the board and the board chair.

Clause passed.

Clause 8 passed.

Clause 9.

Mr PICTON: I move:

Amendment No 1 [Picton–1]—

Page 4, after line 9—After the present contents of clause 9 (now to be designated as subclause (1)) insert:

(2) Section 18—after subsection (3) insert:

(4) Without limiting subsection (1)(b) or (ha) and despite subsection (2), an incorporated HAC established in relation to the provision of health services at a particular site of a hospital is entitled, without limitation, to provide advice to the Minister, the Department or the governing board for the hospital about the provision of health services at that site.

(5) Where an incorporated HAC has been established in relation to the provision of health services at a particular site of a hospital, steps must not be taken to give effect to a significant change in the level of health services provided at that site in 1 or more areas of health care unless the HAC has given its consent for the steps being taken.

(6) Where an incorporated HAC has been established in relation to a designated entity, the HAC is entitled to receive monthly financial statements for the designated entity within 21 days after the end of each month.

(7) In subsection (6)—

designated entity means—

(a) a hospital or, in a case involving a HAC established in relation to the provision of health services at a particular site of a hospital, the undertaking at that site; or

(b) SAAS; or

(c) any other body involved in the delivery of health services in connection with this Act.

As I outlined in my second reading speech, this amendment comes directly from the Health Care (Health Advisory Councils) Amendment Bill 2008 that was moved by the member for Bragg who, of course, now is the Deputy Premier.

The Liberal Party, when in opposition, was very clear that they wanted to see the health advisory councils have more power. They wanted them to have more say over local health services. I believe that is consistent with a lot of the rhetoric that we have heard in the lead-up to the election and a lot of the beliefs that people have had about what the policies of the Liberal Party would be. We have not seen that reflected in this legislation. It does not appear in this legislation. There are no increased responsibilities or powers for health advisory councils, so the idea that the boards are being brought back at a local level is entirely false because the previous boards are now the health advisory councils and they stay the same powers as they did previously.

I am sure that this was just an oversight by the current government. I am sure they had intended to bring this legislation that they had previously brought to the parliament and I am sure that all of the country MPs would be very keen to see this in their communities. I have helpfully brought back this legislation that was supported by so many members of the current government and brought it back for your consideration for adoption as part of this legislation, consistent with your previous policy to bring these health advisory councils and increase their power.

The Hon. D.C. VAN HOLST PELLEKAAN: Let me say that it was not an oversight to leave this out, and we do not accept this amendment. The reality is that for the shadow minister to try to pretend that when one of our colleagues put a particular amendment in this place 10 years ago in a totally different context that it should still automatically apply today is ridiculous. The reality is that the current Deputy Premier, then shadow minister for health, member for Bragg, put that amendment forward at the same time that the then government was removing hospital boards. The member for Bragg wanted HACs to have more powers because the then government was watering down the authority of local people with regard to contribution to the direction of local health services. To pretend that it still applies now is ridiculous, so why would the shadow minister think it would apply now?

Mr PICTON: Thank you very much to the minister. As a mere mortal, I can only go to the words of the Deputy Premier herself when she said to the parliament introducing this legislation:

These three initiatives which the opposition—

now the government—

presents not only reflect many voices in country communities, but also we suggest they are modest in the area of reform that could occur in relation to governance...if it is genuine in its commitment to consult with the people of South Australia in the regional communities, to carefully consider and accept these modest areas of reform as some recognition of the concern of these communities.

I am sure that the Deputy Premier is solid in her commitment to her previous commitments to this house and I am sure that will be reflected when we vote on the matter.

The committee divided on the amendment:

Ayes 18

Noes 24

Majority 6

The CHAIR: Member for Kaurna, do you wish to speak further to clause 9?

Mr PICTON: I just have one question for the minister. Does the minister see any increased role for health advisory councils whatsoever?

The Hon. D.C. VAN HOLST PELLEKAAN: Potentially, but not necessarily. One of the foundation principles is that we are not trying to set up the opportunity for these boards to have these responsibilities in their area and simultaneously tell them what they have to do in their area. We made it very clear going to the election that we would not be disbanding HACs.

As a very broad statement, there are some good things about HACs and there are some bad things about HACs. We want the boards to be able to make the decisions about whether they want to keep HACs in their area or not, or whether they want HACs to have more responsibility or less. It would have been completely wrong of us to say, 'We want to set up the system with greater responsibility for local governance in local areas and, by the way, this is how we expect you to govern.' Of course, there need to be some overarching principles with regard to statewide services with regard to interaction with SA Health. To answer your question, the local board will decide if they want local HACs to have greater authority, greater responsibility or less.

Mr PICTON: What will be the process by which those boards will be able to decide, as you have said, whether to abolish HACs or give HACs more power or less power under this legislation?

The Hon. D.C. VAN HOLST PELLEKAAN: That is one of the things still to be resolved, but the proposal is that the minister could not abolish HACs without significant consultation. Again, what this is really about is wanting the boards to have the authority to make those sorts of decisions in their areas, rather than us at this point in time saying to every board that will come, 'This is exactly how we expect you to govern,' because clearly that would be totally against the spirit of what we aim to achieve.

Clause passed.

Sitting extended beyond 18:00 on motion of Hon. D.C. van Holst Pellekaan.

Clause 10 passed.

Clause 11.

The CHAIR: Minister, you have three amendments. Do you wish to move them en bloc or individually?

The Hon. D.C. VAN HOLST PELLEKAAN: I move amendments Nos 1 and 2:

Amendment No 1 [EnergyMin–1]—

Page 6, lines 36 to 38 [clause 11, inserted section 33B(2)(g)]—Delete inserted paragraph (g) and substitute:

(g) Aboriginal health or other fields that, in the opinion of the Minister, will enable the effective performance of the board's functions.

Amendment No 2 [EnergyMin–1]—

Page 7 lines 1 to 2 [clause 11, inserted section 33B(4)]—Delete inserted subsection (4)

Amendment No. 1 specifies that persons with knowledge, experience and expertise in Aboriginal health will be considered for appointment to the governing board. Amendment No. 2 is consequential to amendment No. 1 and deletes clause 11(4) requiring that one person with knowledge, experience and expertise in Aboriginal health must be appointed to the governing board.

The intent is not that the governing boards are to be representative boards. The role of the boards will be to ensure the strategic oversight of an incorporated hospital and monitor its financial and operational performance. This will include ensuring that the hospital has effective clinical and corporate governance frameworks in place and that its resources are applied equitably to meet the needs of the community within its geographic area.

Mr PICTON: As I understand it, these amendments essentially change what was an amendment in the other place whereby at least one person from each board would have to have some experience, background or knowledge of Aboriginal health. It is not everybody, it does not have to be their sole area of knowledge, but there is at least one person on every board who has some knowledge of that, given we know how important our Aboriginal health challenges are.

As I understand, this provision is in place in the New South Wales legislation. The New South Wales boards have to have at least one person who has some knowledge of this. What harm does the minister see in having at least one person who has some knowledge or some experience of Aboriginal health? The effect of his amendments, as I understand, is that a board may or may not have such a person.

The Hon. D.C. VAN HOLST PELLEKAAN: There is no harm, to use the shadow minister's words, but what we are trying to do is actually improve the process. What we are trying to do is ensure that each board, in each area for which it is responsible, has flexibility with regard to the way that it delivers what is one of the very important responsibilities it will have and that is with regard to broader Aboriginal health, some cultural understanding and a range of other things that connect to health delivery.

We want to be sure that every single board is able to do that in the way that is appropriate for its area, but we want to take away what is currently a prescriptive structure in the way that they do it. It is not about lessening the service that will be provided. It is about providing greater flexibility so that each board can do it even better in its own area.

Mr PICTON: If there is no harm, why not keep it and have at least one person? As the minister has outlined, these boards will be making some very serious decisions about Aboriginal health and about how those health services apply Aboriginal funding and services. If you have a room full of people who do not have any experience in that area, I fear that we may not have good decision-making in this area, particularly if you are going down the path that the minister is outlining of additional flexibility in this area. I would have thought it is even more important to at least have one person, not as a representative from the Aboriginal Health Council or something like that, but somebody who is able to bring to the table some knowledge or expertise in this very important and specialised area.

The Hon. D.C. VAN HOLST PELLEKAAN: The government's intention is not to rule out the possibility of having a person like that. The government's intention is to give the board as much flexibility as possible to deliver the service the right way in its area.

Mr PICTON: If the government's intention is not to rule out such a person being on a board, in what circumstances does the government think it would be a good idea to have a board without such a person, to have no people on the board who have any knowledge or expertise in terms of Aboriginal health? Effectively, what your amendment is saying is that you want to have some boards where it will be the case that there will not be any of those people.

The Hon. D.C. VAN HOLST PELLEKAAN: As I said, this is about strengthening the service: it is not about weakening it. It is not about saying that a person who fits that description cannot be there. What we want to do is build on that. We actually want all members of boards to be able to have some training and some skill and be able to deliver that service more broadly. We are going to have a relatively small board with a lot to do and we are not walking away in any way whatsoever from delivering service to Aboriginal people to ensure that they get the right health or that health services are delivered appropriately to Aboriginal people.

What we do not want to do is lock a board into a particular structure. We want the board to have a wide range of skills to contribute to the way that health services are delivered. It might well be—and, in fact, we hope it will be—that all boards can learn more and have more skills in that particular area.

Mr PICTON: I will just say briefly that the opposition strongly opposes these amendments and cannot see a circumstance in which you would want to have a board without at least somebody who has some experience or expertise in Aboriginal health. I think it is very disappointing that the government is moving down this path.

The committee divided on the amendments:

Ayes 22

Noes 19

Majority 3

The Hon. D.C. VAN HOLST PELLEKAAN: I move:

Amendment No 3 [EnergyMin–1]—

Page 7, lines 32 to 35 [clause 11, inserted section 33D]—Delete inserted section 33D and substitute:

33D—Disclosure of pecuniary or personal interest

(1) A member of a governing board who has a pecuniary or personal interest in a matter being considered or about to be considered by the board must, as soon as possible after the relevant facts have come to the member's knowledge, disclose the nature of the interest at a meeting of the board.

Maximum penalty: $25,000.

(2) A member of a committee who has a pecuniary or personal interest in a matter being considered or about to be considered by the committee must, as soon as possible after the relevant facts have come to the member's knowledge, disclose the nature of the interest at a committee meeting.

Maximum penalty: $25,000.

(3) A member of a governing board or a committee who has a pecuniary or personal interest in a matter being considered or about to be considered by the board or the committee—

(a) must not vote, whether at a meeting or otherwise, on the matter; and

(b) must not be present while the matter is being considered at the meeting.

(4) Subsection (3) does not apply if—

(a) a member of a governing board or committee has disclosed an interest in a matter under subsection (1) or (2); and

(b) the board or committee (as the case requires) has at any time passed a resolution that—

(i) specifies the member, the interest and the matter; and

(ii) states that the members voting for the resolution are satisfied that the interest is so trivial or insignificant as to be unlikely to influence the disclosing member's conduct and should not disqualify the member from considering or voting on the matter.

(5) Despite a provision of Schedule 3, if a member of a governing board is disqualified under subsection (3) in relation to a matter, a quorum is present during the consideration of the matter if at least half the number of members who are entitled to vote on any motion that may be moved at the meeting in relation to the matter are present.

(6) The Minister may by instrument in writing declare that subsection (3) or subsection (5), or both, do not apply in relation to a specified matter either generally or in voting on particular resolutions.

(7) The Minister must cause a copy of a declaration under subsection (6) to be laid before both Houses of Parliament within 14 sitting days after the declaration is made.

(8) Particulars of a disclosure made under subsection (1) or (2) at a meeting of a governing board or committee of a governing board must be recorded—

(a) in the minutes of the meeting; and

(b) in a register kept by the board which must be reasonably available for inspection by any person.

(9) A reference in subsection (3) to a matter includes a reference to a proposed resolution under subsection (4) in respect of the matter, whether relating to that member or a different member.

(10) Subsection (2) applies to a person who is a member of a committee and also a member of a governing board even though the person has already disclosed the nature of the interest at a board meeting.

(11) A contravention of this clause does not invalidate any decision of the Board.

(12) Section 8 of the Public Sector (Honesty and Accountability) Act 1995 does not apply to a member of a governing board.

(13) In this section—

committee means a committee or subcommittee established by a governing board under Schedule 3 clause 10.

This amendment is essentially removing an amendment that was put in in the other place. We do not believe that the amendment from the other place is appropriate. It is about an obligation for personal disclosure on the part of board members. We are not suggesting that board members should not have to disclose anything. We are not suggesting that there should be some opportunity to hide, but essentially what has been proposed for health governance board members' disclosure is a parallel with what is required for members of parliament, and we think that is overkill.

If that were to remain in place, it is very likely that we would impede the willingness of people to even apply or consider being on a board. That would not be because those people would have personal interests they are ashamed of or because they were involved in any activities that they should not be; it is just that having to disclose every single property, every single company, every single interest, every bank to which they owe money, hypothetically, and on and on—as we do, and for members of parliament it is entirely appropriate—would be overkill for board members. They should have to disclose but not to that level.

Mr PICTON: We are pretty disappointed by these amendments. I think it would be good for the committee if the minister outlines what the differences are between what he is proposing from the Legislative Council's version of the bill you would have to disclose, and what, under his amendment, you would not have to disclose.

The Hon. D.C. VAN HOLST PELLEKAAN: The key difference in principle is that what we propose for these board members is that they would disclose anything and everything where they have a conflict of interest, whether that be a financial one or a personal one, as opposed to what came back to this chamber from the Legislative Council, which was a disclosure of absolutely every interest that that board member has. We do believe it is important that conflicts of interest be disclosed—of course it is—but not every single interest that that board member might have.

I say again that it is appropriate for members of parliament, but not necessarily for board members. Interestingly, what is in the bill that came back to us from the other chamber, which is what we hope to remove, includes an incredibly high penalty for these people, in fact a higher penalty than would apply to members of parliament. We think it is entirely over the top. We are trying not to have any crack available for any potential board member to not disclose a conflict of interest, but we do not believe that they should have to disclose all their personal interests that do not have a conflict with their work as a board member.

Mr PICTON: Thank you. I do not think that quite answered the question in going through each of the things that they would not have to disclose but, be that as it may, can you outline why you think that that is a better approach when, essentially, this is going to be, as I understand it, a self-determination of what is a conflict of interest. If you have a wide range of interests, of holdings, of memberships, etc., you would be able to pick those that you think might be a conflict of interest and have to declare them. The public, the healthcare consumers in that area and the people who are concerned about the governance of health in that area, would not have the opportunity to know what else you have not determined is a conflict of interest.

These are very broad and very large organisations. CALHN has well over a billion dollars in turnover and they deal with a lot more than, say, local government would generally deal with in terms of financial affairs, and we do require members of local government to perform this and to disclose. I have not seen any evidence of a lack of people nominating to be members of parliament or to be local councillors because they have to disclose their interests. When it comes to potentially billions of dollars, I think it is in the community's interest to know the full range of interests—

The CHAIR: Member for Kaurna, do you have a question?

Mr PICTON: I do. Why does the government not believe that is the case and is there not a risk that people may not disclose all their interests that potentially could conflict?

The Hon. D.C. VAN HOLST PELLEKAAN: Shadow, what we are proposing we believe is the right place for this to land. We do not believe that the highest disclosure possible in the land is the right way to go with this particular board. There will be a public register of the disclosures of conflicts of interest. The conflicts of interest will be in the minutes. What is proposed by the amendment that came back from the other place is a higher level of disclosure than the State Procurement Board or the State Superannuation Board has. We think it is not necessary for a health governance board. We think this is the right place to set the bar.

Mr PICTON: You said that there will be publication of this register obviously, but how will people know what has not been disclosed, given that they only have to disclose a limited number of things that they personally perceive to be a conflict of interest? How will people know if there is something else that may turn up later in one of the contracts that a board may sign or other financial arrangements that a board may have that turns out to be a conflict of interest? How do you know what is not on the register?

The Hon. D.C. VAN HOLST PELLEKAAN: First of all, I did not say the register would be published. I said it would be publicly available; that is certainly what I meant to say. But the reality is that it is exactly the same as the State Procurement Board, and the shadow's question with regard to a potential conflict of interest later if the board enters into some spending or something like that, to the best of my knowledge, works fine for the State Procurement Board, so we are confident that it will work well for health boards.

The committee divided on the amendment:

Ayes 23

Noes 19

Majority 4

Amendment thus carried.

The CHAIR: Are we still on clause 11?

Mr PICTON: Still on clause 11. There is quite a lot in clause 11. It is always frustrating when there is so much in one clause and you only get three questions. New section 33E in clause 11 is in relation to the appointment of a chief executive officer for an incorporated hospital. It provides:

The governing board for an incorporated hospital may, after consultation with the Chief Executive appoint—

Does the chief executive, as part of that consultation, have a veto right over the appointment or, if the Chief Executive of SA Health says, 'I don't like this person,' the board can still appoint them anyway?

The Hon. D.C. VAN HOLST PELLEKAAN: There is no veto right. It is the board's decision.

Mr PICTON: So essentially the consultation has no bearing really in terms of the legislation. What is meant by the consultation? What ability does the chief executive centrally have to influence this decision, or is it really just a notification that this is the appointment that is going to be made.

The Hon. D.C. VAN HOLST PELLEKAAN: Essentially, that question goes to the definition of consultation. Consultation is not about giving anybody a veto right. Consultation is not about saying that they are going to go off and make their own decision without any reference to the CE. Consultation is consultation, but at the end of the day it will be the board's decision.

The CHAIR: Last question.

Mr PICTON: Last question. In relation to provisions that state that somebody is unable to be a member of a board if they work at a hospital, how far does that reach? Does that reach to a GP who would be providing services at the hospital? Does it reach to a contractor who may work with a hospital and provide services in a contract relationship, even a supplier or a local bakery that may provide food to the hospital? Is it a situation where any connection that you have involving any financial relationship with a hospital prohibits you from being a member of that hospital board?

The Hon. D.C. VAN HOLST PELLEKAAN: The proposal is very clear with regard to employees being excluded from being members of a board. Beyond employees, issues such as the shadow mentions, and no doubt many others, will be considered on a case-by-case basis. It would actually be impossible to try to have one rule that would cover all those things. It would be part of the consultation. There would be due diligence done to look at potential board members. The reality is that if somebody were ever a patient in a hospital, at the extension, it could be that they could never be on the board because they had once been a patient or that one day they might be a patient if you took it to the extreme—and I am not suggesting that the shadow wants to do that.

Mr Picton: That is why we need to clarify where the line is.

The Hon. D.C. VAN HOLST PELLEKAAN: The line is at the employee. That is where the line is, but every single person who would potentially be a board member will be assessed in a wide range of ways, including skills and capacity, and ability to deliver, all the way through to potential conflicts.

Mr PICTON: If I can sneak in a quick follow-up.

The CHAIR: This would be a supplementary.

Mr PICTON: Yes, a supplementary. If the line is an employee, does that mean that a GP who provides services to a hospital, but is not an employee at the hospital, could be a member of the board? And does it mean that, for instance, a temporary contract worker who provides services to the hospital, but is not an employee, could be a member of the board?

The Hon. D.C. VAN HOLST PELLEKAAN: Shadow, the answer I gave before still stands, but let me go into a little bit more detail with the two examples that you gave. A GP who is not an employee but who does rely upon that hospital for his or her income would most likely—in fact, I would venture to say almost certainly—be excluded because of the likelihood of a conflict of interest.

The contractor who you said might work part-time at the hospital and gain some income to his or her contracting business through a service that is provided to the hospital may well be excluded. It comes back to the answer I gave before. There would be an assessment about what the conflict of interest is. Does one exist? How great is it? Would it have an impact upon that person's capacity to contribute to the running of the board in a really sensible way? Employees are still ruled out, but people with conflicts of interest who are not employees would be dealt with on a case-by-case basis. Clearly, if that conflict is seen to be too great, then that person would not be able to be a member of the board.

Clause as amended passed.

Clause 12.

Mr PICTON: In relation to clause 12, it is setting up a series of inspectors who may or may not be appointed by the minister to inspect particular things in hospitals and health services. These inspectors will have quite amazingly broad powers to examine documents, to require any person to answer any questions, to require any person to produce any documents, to inspect premises, to examine documents, to seize documents—these are quite extreme powers.

These are powers probably well in advance of what many of our law enforcement agencies have, at least without a warrant. What are the protections in place for people about how these powers will be exercised, both from a confidentiality perspective or even from the viewpoint of protecting people's legal rights in having to answer questions?

The Hon. D.C. VAN HOLST PELLEKAAN: These are powers of last resort in the hands of the health minister. It is a power that we would all hope would never be necessary to be called upon, but it is a power of last resort. It is a power that is comparable to that which exists in other states in similar situations.

The issues you raise with regard to confidentiality and legal rights of course will be dealt with appropriately. I cannot tell the shadow, if the inspector happens to be brought in to investigate this particular issue, this particular board, and wants to question these particular people, how the inspector will go about it. Of course I cannot pretend to know that, but the reality is that it would be done within the full context of the law and respectfully and appropriately with regard to everyone involved. I say again that this is not a power the minister would ever call on to use lightly. This is only if necessary.

Mr PICTON: With respect to the minister, he says that these powers would be used appropriately. We make legislation not for the best case scenario when everything works; we make legislation for when things do not work and to protect people in unforeseen circumstances. This is setting up a series of powers that these inspectors would have in our healthcare situation, where people are concerned about the confidentiality of their patient records, where people are concerned about protecting their information and, I am sure, where employees, doctors, nurses and other people are worried about protecting their legal rights.

Basically this section sets up those powers but no protections. Are there any legal protections, and why has the government not considered it, or is this something we are going to consider later down the track?

The Hon. D.C. VAN HOLST PELLEKAAN: Shadow, I say again that this power would only ever be used by the minister in the most extreme circumstances, where some extraordinarily adverse event has occurred. You used the words 'unforeseen circumstances'. The government believes that it is better to have the capacity for an inspector to do whatever is necessary within the law, if necessary, to deal with unforeseen circumstances, rather than to have unforeseen circumstances arise but not have the power or the authority to deal with them appropriately. None of the protections with regard to confidentiality, or anything else that exists in the Health Care Act, are overridden or removed by virtue of this.

Mr PICTON: What recourse would a patient in a hospital have if an inspector was coming to inspect their documents and they did not want that to happen and that was being used under this legislation? What recourse would a nurse in a hospital have if they are being forced to answer questions as part of an investigation? Are there any legal recourses available to appeal those decisions by an investigator using these quite significant powers?

The Hon. D.C. VAN HOLST PELLEKAAN: I say again that none of the protections of the Health Care Act are undermined in any way by what is proposed in the bill. Normal judicial review and normal protections would all be there. The inspector, of course, would be bound by all the normal confidentiality obligations. The fact that an inspector seizes information or asks for information to be provided to him or her in no way allows the inspector to use that information for any purpose other than for that investigation, and the inspector must keep it confidential under all circumstances, other than for the direct use of that information with regard to the specific investigation that the minister has asked the investigator to undertake.

Clause passed.

Clause 13.

Mr PICTON: Following on from the issues in relation to the inspectors and the lack of protections for people, the minister mentioned that the normal protections of confidentiality would apply in relation to those powers used by the inspector but, from what I can understand in relation to this section, the confidentiality requirements of the Health Care Act have not been extended to cover the inspectors, and this would be an opportunity to do that in this amendment being made to section 93. Why has that amendment not been made to make sure that those inspectors are covered by the confidentiality provisions of the Health Care Act?

The Hon. D.C. VAN HOLST PELLEKAAN: The answer to that question is covered in clause 13(1)(a), and that is that it is envisioned that the inspector will actually be an officer—or potentially an employee, but more likely an officer—of the department and so automatically covered by those obligations.

Mr PICTON: With respect to the minister, that is not what the legislation says at all. The department is set up, according to the Health Care Act, quite separately to how the inspectors are going to be set up. They have their own division of the act and there is nothing there to say that an inspector is an officer of the Department for Health and Wellbeing. From my reading of it, there is nothing here that would extend those protections to the inspector. An inspector could be appointed who is not an officer of the department. Hence, I would ask if you could consider whether the inspector should be added to clarify the situation in regard to how they deal with confidential information.

The Hon. D.C. VAN HOLST PELLEKAAN: Clearly, this is an important question. There are provisions in the Health Care Act for inspectors to go into private hospitals. What is proposed in this bill is exactly the same as the provisions that exist with regard to private hospitals under the Health Care Act. The government does feel that they are appropriate and consistent. The reality is that whether it is a private hospital or a public hospital, the issue of confidentiality and the other issues you have raised concerns about should be dealt with in exactly the same way.

Mr PICTON: Can the minister clarify where in the act the inspectors will be covered in terms of their confidentiality, by nature of the existing inspectors in relation to private hospitals? I cannot find that information in the act.

The Hon. D.C. VAN HOLST PELLEKAAN: The reality is, as I mentioned, and I think it was the first answer in this series of questions, that it is expected that it will be an officer or an employee who is brought in, if necessary—remember that these are last resort powers—to do an investigation, brought in as an investigator. That is exactly what is expected by the government, that is exactly what is expected under this act and that is exactly what is catered for there in clause 13, proposed section 93(1)(ab). The reality is that there is no watering down in any way, from the government's perspective, with respect to the confidentiality and other appropriate obligations that you have raised concerns about in relation to any inspector, whether they be an officer or an employee or, hypothetically, any other category of inspector.

Clause passed.

Clause 14.

The Hon. D.C. VAN HOLST PELLEKAAN: I move:

Amendment No 4 [EnergyMin–1]—

Page 9, line 25 to page 10, line 5 [clause 14, inserted section 102]—Delete inserted section 102 and substitute:

102—Review of Act

(1) The Minister must, as soon as practicable after 1 July 2022, appoint an independent person to conduct a review of, and prepare a report on—

(a) the operation of this Act, including the extent to which—

(i) the objects of this Act have been attained; and

(ii) the principles of this Act have been applied; and

(b) any other matters determined by the Minister to be relevant to a review of this Act.

(2) A person appointed to conduct a review and prepare a report under this section must have expertise in health care administration or health service delivery.

(3) A review and report by a person appointed under this section must be completed within 6 months of the person's appointment.

(4) The Minister must, within 12 sitting days after receipt of a report under this section, cause a copy of the report to be laid before both Houses of Parliament.

The effect of this amendment is to provide for a review of the Health Care Act 2008 as soon as practicable after 1 July 2022. The review is to be conducted by an independent person, with copies of the review report to be tabled before both houses of parliament. The effect of this amendment is to cause a review of the governance arrangements of the public health system three years after the arrangements come into operation.

The minister in the other place has indicated that the boards will assume responsibility for the management of local health networks from 1 July 2019, and as such it is more appropriate for a review of the arrangements to be held after three years of operation rather than when the legislation is proclaimed.

Mr PICTON: It seems clear on the first look that essentially this amendment to this proposed section is about, firstly, pushing the deadline for the review out beyond the next election, quite obviously and, secondly, broadening the scope of what it is looking at to look at the entire Health Care Act rather than the setting up of the boards. There are obviously a lot of things in the Health Care Act apart from what we are talking about in this bill.

I will ask the member—and I do not expect him to change his political time line by moving the date—whether the government would consider keeping a narrower scope, rather than a broad review of the entire Health Care Act, which I think could turn into a massive exercise. I think what the Legislative Council was looking for was a review of these changes that were being made in the establishment of the boards.

The Hon. D.C. VAN HOLST PELLEKAAN: There are two things there. I completely refute the suggestion that the timing has anything to do with the election. As I said very clearly, it seems appropriate to do it three years after the board has come into operation, not three years after the act is amended. If, hypothetically, there were some sort of election-based political imperative to do with this, we would bring it forward because we expect this to be successful. We expect that this will be a good, positive, sensible, successful move for South Australians; otherwise, we would not be doing it. Therefore, quite naturally, if there were any political imperative at all, which there is not, we would want the review to be before the election because we fully anticipate that it would be very positive.

In terms of the other issue with regard to the scope of the review, I understand what the shadow is proposing, but just consider for a minute: if we had a narrower view, I am sure the shadow would be saying it was too narrow and that we should broaden it out so that all things could be considered. We do think that it is appropriate that a wider rather than a narrower range of issues can be considered by this review so that the review can be as fulsome and appropriate as possible.

The CHAIR: Any further questions, member for Kaurna?

Mr PICTON: We will just note that we will not divide on this, but we do oppose this amendment and will do so in the other place as well.

Amendment carried; clause as amended passed.

Progress reported; committee to sit again.

At 18:57 the house adjourned until Thursday 26 July 2018 at 11:00.