Health Care (Governance) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 18 March 2021.)

Mr PEDERICK (Hammond) (17:14): I rise to make a contribution in relation to the Health Care (Governance) Amendment Bill 2020. The background of this bill has a long history. It is the second stage of the Marshall Liberal government's commitment to decentralise decision-making in the public health system through the establishment of metropolitan and regional governing boards. The Health Care (Governance) Amendment Bill 2019 lapsed by prorogation on 19 December 2019 before it could be passed to implement the second stage of the government's commitment to decentralise decision-making in the public health system.

As I have indicated, this bill is the second stage of our government's election commitment to decentralise decision-making in the public health system through the establishment of metropolitan and regional boards. The bill will establish a new governance and accountability framework for the public health system. Governing boards have been operating since 1 July 2019 and are accountable for the delivery of health services within their own specific geographic area.

Back in 2018, the joint party room noted that the new governance and accountability framework for SA Health would be introduced in two stages. The first stage was completed on 1 July 2019 with the commencement of the Health Care (Governance) Amendment Act 2018, which established the governing boards of the local health networks. The second stage began with the introduction of the Health Care (Governance) Amendment Bill 2019—which obviously was the previous bill to this one—on 2 May 2018 to establish the new governance and accountability framework for the public health system.

The previous bill passed the other place on 18 June 2019 with a number of amendments. It was then received in the House of Assembly as the Health Care (Governance) (No 2) Amendment Bill 2019 but lapsed when parliament was prorogued on 19 December 2019. This bill seeks to reintroduce most of the provisions of the previous bill. The bill amends the Health Care Act 2008 to:

(a) revise the functions of the Chief Executive of the Department for Health and Wellbeing to focus on the strategic direction (aligned directly to government objectives) and performance of the public health system, ensuring that the roles of the chief executive, the governing boards and the local health networks are clear and avoid duplication or omission;

(b) provide the chief executive with the ability to issue binding policies and directives to the local health networks (LHNs) and the SA Ambulance Service (SAAS), setting the required standards for the performance of their functions;

(c) include provisions for service agreements, which have been in place in an administrative sense since 2016-17, between the chief executive, local health networks and the SA Ambulance Service to outline the funds allocated for services provided and detail performance measures and operational targets;

(d) require the chief executive to publish service agreements to demonstrate transparency and accountability in how the local health networks are funded and managed;

(e) provide the chief executive with the ability to take remedial action when the performance of the governing board or local health network does not meet expected standards;

(f) dissolve the Health Performance Council, with the intent to commence these provisions after current members' terms expired on 1 August 2020 to ensure any outstanding reports are delivered to the government;

(g) dissolve the metropolitan local health network governing councils (established as health advisory councils under part 4 of the Health Care Act 2008);

(h) make provision to ensure that the governing board will not be able to give directions relating to the appointment, transfer, remuneration, discipline or termination of an individual employee with the intention to leave the day-to-day management of the local health network to the chief executive officer;

(i) amend the confidentiality provisions of the act so that Wellbeing SA and the Commission on Excellence and Innovation in Health (CEIH) will be brought within the legislative scheme intended for the Health portfolio with respect to privacy and disclosure of personal information;

(j) make other minor amendments to the principles of the act and the functions of the chief executive and the local health network governing board, including amendments regarding the provision of health services to Aboriginal and Torres Strait Islander persons and health consumer engagement in the planning of health services; and

(k) make minor amendments to sections of the act to reflect the new governance and accountability framework or clarify their intent.

The bill also makes consequential amendments to the Mental Health Act 2009 to align the requirements for the disclosure of personal information with those under the Health Care Act 2008. Provisions of the previous bill that have not been included in the current bill include:

(a) the removal of the requirement for boards to record disclosures of personal or pecuniary interests in meeting minutes. This requirement is retained in response to a governance report by the Independent Commissioner Against Corruption; and

(b) provisions for transfer of assets and annual reporting of local health network governing councils that are no longer needed because the relevant issues were dealt with administratively when the boards commenced operation on 1 July 2019.

The bill also includes a broad function for the chief executive—which was advocated for by stakeholders through consultation—being a requirement to engage with consumer representatives and other interested parties in the development of healthcare policy, planning and service delivery.

In practice, this additional function is inconsequential, as the chief executive already has a similar statutory function to establish and maintain processes to consult with members of the community, volunteers and carers. However, its inclusion should alleviate the concerns of stakeholders and those members in the other place who supported these amendments in the previous bill.

In addition, one of the Commission for Excellence and Innovation in Health's four directorates, the Consumer and Clinical Partnerships directorate, is focused on developing systems and capability to build and sustain partnerships between clinicians and with communities, consumers and carers. Partnerships will enable clinical improvement (also critical improvement), foster innovation and ultimately improve the experience of healthcare delivery. The establishment of this function further strengthens our government's commitment to consumer engagement and is likely to somewhat alleviate concerns in relation to the funding of the Health Consumer Alliance.

Governing boards are required to have consumer and community engagement strategies in place under the Health Care Act 2008 to ensure that local health networks are appropriately engaging with their communities. The governing boards are in the process of developing these strategies. Legislating for direct consumer and community involvement in the service agreement development process is inappropriate. Service agreements are technical and are primarily between the chief executive and the local health network. They are informed by consumer and patient consultation that occurs under separate mechanisms, including the consumer and community engagement strategies of the governing boards.

The bill reflects the outcomes of previous consultation, including discussions with stakeholders since late 2018, through the drafting process and preceding the introduction of the previous bill. Certainly, since coming into government our government has made major inroads into supporting health in this state, and this governance bill, bringing the governance into a more decentralised system where local decisions can be made, I think is working extremely well.

This is especially so in regional areas, whether it be in my further flung areas such as the Mallee, with hospitals at Pinnaroo, Lameroo and Karoonda and, as you come closer into Murray Bridge, Tailem Bend and Mannum, as well as the Murray Bridge Soldiers' Memorial Hospital. That has picked up a bigger workload, especially in after-hours emergencies, and is well supported by a commitment at the 2018 election of $7 million for an emergency department that has been operating since late last year. I was very pleased to have had the privilege of opening that alongside the health minister, the Hon. Stephen Wade, from the other place. From all reports, it is working extremely well.

As with any emergency department, you would rather that no-one turned up, but emergencies always happen. People have road accidents, whether they be in the Mallee or on the Dukes Highway, towards Mannum or north of Mannum, and certainly with The Bend Motorsport Park. I must commend the Shahin family and everyone at On the Run for running another fantastic supercar event on the weekend. The nature of the activities that happen at the park, being motorsport, means that occasionally someone comes unstuck, and it provides support for anyone who has an accident out there. They can be rushed to Murray Bridge or further afield if they need it.

We have helipads at quite a few of our hospitals, Murray Bridge and Mannum being two in my electorate that have them. Further out, the flying doctor could also be utilised, especially in the farther flung areas of the Mallee, out to Pinnaroo for example. The sort of care that literally comes from the air cannot be beaten.

You hear stories of people being airlifted by the flying doctor, and people think that the flying doctor is just an outback service, but it is certainly not. It does a great job in the outback, but the work it does in retrieving or transferring people even closer, in almost suburban areas compared with pastoral areas, is fantastic. I know the work the medevac helicopter does is, as we all know, literally life-saving work as well. I heard one story only the other day of a newborn baby being airlifted, and from all reports that baby is now doing very well.

It is vital with the amount of traffic and freight that heads through our area. Murray Bridge is on the Over Dimensional Route; we get that traffic coming down from the Sturt Highway through the Halfway House turnoff up near Sedan and coming down through Mannum and Murray Bridge. Those bigger units, anything above a B-double, have to come that way, and obviously there is other freight that comes through.

Thousands of people are travelling up and down the road and, sadly, sometimes things go wrong and sometimes people choose to take their own life. I am well aware of some of that happening on our roads. Reflecting on what the medevac does, a lady several years ago came unstuck on Tynan Road, a road a few kilometres away from my property. Again, the helicopter could land directly on the road adjacent to the vehicles that I think had rolled and save that woman's life.

I take my hat off to everyone who works in health, especially in these times of COVID management. Their work has been absolutely vital and they must be congratulated, from Nicola Spurrier down. It has been challenging, but what people have done to make sure they keep our community safe has been fantastic. We are now working through the process of vaccination, whether it be the Pfizer or the AstraZeneca vaccine. I will certainly be getting my first AstraZeneca in a few weeks' time when I can, because I had the flu shot in this place only last week, as most of us did.

I do really commend health workers, and I certainly want to take my hat off to those who were impacted with the cross-border closures. That was a difficult time, especially for those MPs who have border communities: the member for Mount Gambier, the member for MacKillop, the member for Chaffey, the member for Stuart and I. It was a challenging time, certainly with the situation I had at Pinnaroo. Whether it was private operator Di Thornton or nurses who lived in Victoria, it made it really difficult for people to literally get across the border to work, but we worked with them and, thankfully, we got some resolutions in the end, although it was difficult.

We are trying to keep the state safe. Obviously, police operate under state borders and are working with us under the Emergency Management Act to keep everyone safe. I really want again to thank everyone in the system. I know that great work has been done by some of the universities in getting more training done in country areas, especially by Flinders University and Adelaide University, so people can get that feel for the country. It is a pretty good life and, once they see the benefits of living in the country, a lot of people stay. We have that work going on for both doctors and nursing staff because we need to boost those positions so people get a real look at the benefits of working in a regional community.

There is also telehealth work that is done with cameras—and I know they are in the Mallee and in other hospitals in my area—where a specialist can be in the city in Adelaide but do an assessment, say, for something that has happened at Pinnaroo. They can do an assessment, using telehealth to the emergency room at the hospital in Pinnaroo, and make the decision: can the person stay there? Do they need to come up by road ambulance or do they need airlifting, whether that be by the flying doctor or the medevac helicopter service?

In closing, I think this decentralisation model is fantastic to get more decisions made at the coalface, where it counts, because when they are made too far away people do not feel part of the situation. I think it is getting and will get a far better result into the future as well with local decision-making made now and into the future. With those few words, I commend the bill.

The Hon. V.A. CHAPMAN (Bragg—Deputy Premier, Attorney-General, Minister for Planning and Local Government) (17:34): I wish to speak and make a few comments to contribute to the Health Care (Governance) Amendment Bill 2020. As the fairly newly minted local government minister, I now have responsibility for the Outback Communities Authority, which, for those who do not know, covers a very large part of the state where they do not have any local government. Whilst local government does a great job for the rest of the state, it is the Outback Communities Authority that advises me and also the federal minister in relation to work it does here in the state on all sorts of areas.

One of those areas is health. Whether we are dealing with the question of how we retrofit Leigh Creek and the health clinic services to make it a viable town for the future, or whether we look at the future of the Royal Flying Doctor Service and put in submissions to get upgrades for airstrips in the outback, these are all part of the health services that are delivered. The member who has also just spoken talked about the medevac helicopter service and telehealth—all these initiatives are really important for country regions, but they are absolutely critical when we are dealing with the outback regions of South Australia.

In terms of the health boards in our Aboriginals lands, I think three different ones were established in South Australia with the advent of the health advisory councils under the previous government. One of them, the Nganampa Health Council, I know still exists and is responsible to provide an annual report to the federal health minister. I do not think it actually has any direct line of responsibility to anyone in the South Australian government, but it provides all the health services and employs people to provide those on the APY lands.

Its operational base is at Alice Springs, and I have met with them up there in the past. It is not subject to any disclosure of its minutes of meetings. It does not have any FOI capacity for information to be provided. It was given all sorts of special rules under the previous government. Can I say that in the last couple of weeks I have read the Gayle Woodford coronial inquest report, which is sickening actually. Of course, well all know that she was the nurse employed by Nganampa Health Council on the APY lands who was raped and murdered. Ostensibly, she was lured out and abducted in her own ambulance, taken away, raped and murdered in the most brutal way.

The person who was responsible has been brought to justice, but we now have a lot of recommendations published in this report. That includes the question of how we provide the services safely, particularly for nurses in this instance. Gayle was a nurse on the lands. She was lured from her home, even though there is a cage facility at the door to enable her to administer medication under a model they have up there. She was in some way lured out of that protective position. It is unknown, really, from the inquiry how that happened, but nevertheless it happened, and she was raped and murdered.

The recommendations that come from that include a number of agencies to look at how we address that in the future, but one of the questions raised was: how do we deal with the future administration of services out of hours when the clinics are closed on the APY lands and where many people need assistance? The person who went there and abducted nurse Woodford on this occasion may or may not have actually needed any service, and may not have had any injury or sickness, but there are a lot of people on the APY lands who do need after-hours service. Some of them are women and children who need attention and it provides a valuable service.

Is the conduct of one reprehensible act by this person going to result in shutting down a very important service for the other people who live on the APY lands? I hope not but, anyway, we will have to look at all of those. A number have been asked to be referred to me and the Premier and, of course, SAPOL and other agencies. They will be looked at. I am proposing, in relation to that matter, that we do bring a report to the parliament. Even though it is not a death in custody or a requirement under the act for us to give a response to the parliament, as a government I think we need to be really clear about what we are going to do in relation to these circumstances.

The Nganampa Health Council is the governing body in relation to the services on the APY lands. I do not think it is transparent, and I do not think that it is sufficiently transparent. I think there are some real questions to be asked. I have asked questions in the past in relation to the child protection space and in relation to the reporting of sexually transmitted diseases in children under five, for example. This is an issue of child abuse, and we have had royal commissions into these matters. I think these are all issues that need to be really brought out into the open.

I do not want Ms Woodford to have died in vain in a circumstance like this; nobody does. We have to think about how we are going to protect nurses and medical staff in these circumstances, whether they have an accompanying person whenever they are called out for a service. All those processes, practices and policies need to be looked at. The coronial inquiry asked us to do that, and we will do that. We will bring that back once we have coordinated how Health, police and agencies such as myself and the Premier's department might deal with it.

As other members have said, it is critical to have decision-making about health services at a local level. I think that is important. Obviously, in the 1970s we brought all hospitals and health care into state agencies after the Bright review. We took it away from local government and we have had a system like that now for 50-odd years. Obviously, we are not going to undo that, but we do have regional interests and they do need to be listened to and they do need to have representative bodies, and they need to be accountable.

When we go through the governance reforms such as those in this bill, we also need to think about how we are going to address some of those other issues, which are ugly. Nobody really wants to talk about them, let's face it. Everyone wants to be able to walk away from them, but I for one see that the circumstance in relation to the nurse who was murdered on the APY lands demands that we look at this whole question of the governance and structure of health services on the APY lands and, if there other similar health councils operating in other remote regions in South Australia, I think we need to wave some scrutiny over those as well. With those few words, I commend the bill to the house.

Debate adjourned on motion of Dr Harvey.

At 17:43 the house adjourned until Wednesday 12 May 2021 at 10:30.