Motions

Transforming Health

Ms BEDFORD (Florey) (11:01): I move:

That this house establish a select committee to inquire into and report on the benefits, costs and impacts of Transforming Health and in particular—

(a) the scope of policy issues that Transforming Health was designed to address (including federal healthcare funding cuts) and whether they were addressed adequately;

(b) what other issues Transforming Health should have addressed;

(c) the adequacy of the model of care proposed by Transforming Health, based around three tertiary hospitals and 'centres of excellence' supported by ambulance transfers;

(d) the adequacy of consultation with clinicians and the community on Transforming Health and alternative models for consultation and engagement;

(e) the degree to which a focus on primary health care could improve the overall effectiveness of the healthcare system;

(f) the degree of difference between public expectations and the capacity of the healthcare system, as currently resourced, to meet them;

(g) whether, having regard to its revenue base, the federal government is funding an appropriate share of the state's healthcare budget (and what the state should be doing to address this); and

(h) any other relevant matter.

Today, I move for a formal parliamentary inquiry to be conducted into Transforming Health. This motion represents a genuine effort to see our health system become better and truly functional by examining and reporting on the benefits, costs and impacts of the aftermath of the Transforming Health initiative.

I urge all members to consider the importance of this motion for our electors and accept that it is, of course, a matter for the house to determine on behalf of our electors as to whether this inquiry should be undertaken and the manner and form it should take. From the outset, I indicate to the chamber my willingness to discuss amendments that would advance this inquiry and the purposes I outline for it today.

In moving this motion, I am conscious of that fact that this may be an uncomfortable topic—uncomfortable for those responsible for the formulation and implementation of Transforming Health, uncomfortable for me as someone who felt, on the face value of the information given to me at the time, that it was a policy that should be given a go, and I think potentially uncomfortable for the new government whose own policy remedies post election will be tested by the testimony the inquiry might hear or the findings the inquiry might make.

I expect this inquiry will uncover mistakes made under the banner of Transforming Health that could have been avoided, mistakes such as the reduction of services at Modbury Hospital without explanation to, or a social licence from, the north-east community I have represented for the past two decades. Through that time, my community has seen other experiments, or attempts to rein in health expenditure, not go as planned. The Healthscope period at Modbury Hospital that preceded it, threatening similar privatisation measures at The QEH, were indeed dark days.

I also expect that this inquiry will raise questions that will challenge the current government. Transforming Health did not arise in a vacuum. It arose in part as a result of the significant reductions in real terms of federal funding for health care imposed by the federal Coalition government.

In my view, this is an underacknowledged inconvenient truth. The federal government's role in the provision of aged care and dental care cannot be ignored any longer and will be part of the challenges we face in the years to come. Expectations must be met with honesty. There are legitimate questions to be asked of some of the health policies the state government is now pursuing. I for one am not convinced about the merits of reintroducing health boards, particularly in the metropolitan area. I am yet to see whether the Liberal Party will back my call for universal ambulance cover or how they will deliver their commitments to restore services at Modbury Hospital.

I expect this inquiry will raise questions from the community that I will have difficulty answering, especially if the committee does not go ahead, and if it does they will want answers if the deliberations do not lead to positive outcomes. But this is exactly why I believe we must proceed with the inquiry. Health care is a complex area of public policy, but too often it is dominated by short-term politics rather than long-term policy development conducted in depth. In my view, we have lost the ability to discuss health care outside of the hyperpartisan context that has alienated so many in the electorate.

Too often, genuine discussion and evidence-based policy comes second to other demands. Too often, meaningful engagement with community and clinicians is reduced to spin, stats and soundbites for the media cycle and yet another round of glossy brochures. Too often, expert opinions are wheeled out not to inform debate but rather to close down alternative views that do not match preconceived notions. Too often, individual issues are politically weaponised with simplistic solutions that fail to address complex policy needs and prevent mistakes from being acknowledged and lessons being learned.

The Transforming Health initiative—probably the most significant program of healthcare reform attempted in decades by a state government—ultimately fell victim, in my view, to the politics of the day. In this sense, whatever its original intent, it was doomed to failure. As concerns arose pre-election, the opposition of the day quickly adopted them as their own policies and this, in turn, fostered an increasingly adversarial attitude. In the constant battle for political mileage, the chance for genuine discussion was lost.

I believe universal access to quality health care, like universal access to education and training, is a defining element of a decent society and the two things people most expect from their government. I believe South Australia is smart enough and prosperous enough to deliver world-class health care to all its citizens. What concerned me then, as a member of the former government, and what concerns me now is that the quality of our political debate makes these ideals almost impossible to achieve. Our healthcare system must be guided by a clear, cogent, cohesive and cooperatively developed policy framework based on a shared vision and agreed values.

I think we all have to take responsibility for a public debate that has become unnecessarily adversarial, no matter the merits of the case. This must change. I propose the motion because I want us to rule a line under the public acrimony that ultimately enveloped Transforming Health and to ensure that it is unbiased evidence, not spin, that informs future policy discussion about health care in this state.

I am not a health professional. I and my family and the community I represent are consumers of health services and we all know or are related to health professionals we trust. In the past, before Dr Google, I needed to understand and learn how to support a healthy life, and whenever it has been necessary I have had to learn how to facilitate recovery from serious illness and sustain and maintain recovery. If I needed to understand something, I sought good advice and several opinions. I asked and I informed myself. All knowledge is a learning experience.

The formation of the policies underpinning Transforming Health must be the starting point of any deliberations to evaluate the position we now find facing our health system, a continually evolving system that is called on to address our needs in times of illness and vulnerability in a world where we are living longer and undergoing more sophisticated and technologically advanced treatments and procedures. We need to understand what Transforming Health was trying to achieve, how it hoped to achieve it and what data and information led to the policies that were put into place.

SA Health has undergone radical changes from many sides: the move to the new RAH at the same time a new records management system was implemented, just to name two, and the stresses being placed on front-line staff cannot be underestimated. To the wonderful health professionals who work on the front line and allied health care providers and the volunteers who support hospitals not far from the front line, I say thank you for your professionalism, dedication and perseverance. Caring for the complex human physically, mentally and psychologically is a big task. None of us can imagine what we would do without you.

I say to the health professionals that, while it may seem we take you for granted, the stories I hear about you have led me to propose this motion because I have been led to the conclusion that without action the system will not improve to the level we all want to see, and we want to make your workplaces safe and happy. To the people who use the health system, I say thank you for sharing your stories and experiences and frustrations. It is because of you and on your behalf that I put the motion to the house.

It is the ongoing, and almost now acknowledged as the new normal, visible sign of ambulance ramping that has prompted me to this course of action. We are not being honest if we keep saying to ourselves that it is going to be okay and then list all the excuses and reasons we think it will improve without honestly examining where we are and how we got there.

Only with honest evaluation can we set new aspirations and targets to establish what needs to be done to achieve the best-integrated and safest health system we can provide. Safety is at the heart of the need to make informed change. If the front-line staff are doing their job, surely it is incumbent on us to truly consult with them to establish what has happened and how they believe things need to be changed.

Was engagement with front-line staff really how we arrived at Transforming Health, or was it with the best of intentions, for it is at our peril that we act irresponsibly, that the initiative was produced around a dollar amount and then tailored as well as possible to fit it? If all this front-line information has already been put to use with Transforming Health and putting it into place, then it needs to be consulted again, for it is the front-line staff who are dealing with the aftermath and are best placed to identify how to streamline service delivery and eliminate unnecessary waste.

Clearly, everyone understands that it is necessary to spend public health dollars responsibly and we all accept that there must be continual monitoring of service delivery. However, we should not accept the open slather, cost-cutting measures that would see us return to the pre Medibank days, when there was a definite two-tier health system, seeing people forced into private health insurance they just could not afford.

What is fair about the now Medicare system is that the levy is calculated on income. We must maintain a strong and vibrant public health system that delivers, dare I say it, the best care, first time and every time, close to home. The health model we had needed improvement and will always need improvement. We need change for the better, not change for change's sake, a change into the unknown or a change that leaves us and the system in a worse condition.

The first step was to acknowledge Transforming Health had not worked as had been hoped. Now we are at the stage of working out how to make urgently needed improvements and, unfortunately, we cannot wait until new CEOs take up their positions and for the new government's return to the policy direction of health boards to be put into place. A new policy, or should I say return to a former policy, implemented into a system already on life support is a recipe for further trauma and stress for the front-line staff and the public using the hospitals we are charged to provide.

A parliamentary committee can do the research and report now to assist new senior management with changes. Preventative health measures must be improved, and how aged-care issues are to be handled is also of major concern. Immediate improvements to communication and information sharing with GPs—that is, on hospital discharge and with GP liaison—are important. I note that all this happens in Family Doctor Week. I acknowledge the role of the AMA and all they do. The role of the GP must be recognised and enhanced in the community.

This inquiry, if supported by the house, provides a chance for a political reset and a chance for us all to work together and find common ground in one of the most complex and important areas of public policy and service delivery. It provides a chance for us to show this state can be a leader and to show the South Australians we each represent that it is their interest we put first, that we can work together for the common good and that, no matter where we sit politically, when it comes to health care we all agree it is the community that counts. I commend the motion to the house.

Debate adjourned on motion of Dr Harvey.