Health Care (Governance) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 11 May 2021.)

Mr PICTON (Kaurna) (16:16): I rise to speak in relation to the Health Care (Governance) Amendment Bill 2020, and indicate that I am the lead speaker for the opposition in relation to this bill. This is a piece of legislation that has been in parliament longer than some people ever get the chance to serve in parliament, and we now celebrate the second anniversary since its original introduction into the parliament.

This legislation has been sitting around, not moving very far at all. It progressed slightly, then we had the proroguing of parliament and then it was reintroduced. It has been moving its way through the parliament in a glacial manner, which I think highlights the priority that the government is giving to this legislation, perhaps pointing out whether or not this is particularly important to them. It is also a broader metaphor for the government's progress in relation to our health system over the past few years.

The government originally coined this piece of legislation their 'phase 2 of governance reform'. People might recall that there was an original piece of legislation that passed in 2018 which set up this government's preferred governance model for the healthcare system. Changing this governance model was basically the central plank of how they wanted to structure the health system. It was put in what I recall was their 100-day plan of action and real change and whatever they called it back then, and part of that was to put in place governing boards for the local hospital networks and to split up Country Health into six local hospital networks and put in place boards for them.

Anybody looking at the state of the health system at the moment would see very clearly that the reforms this government have put in place, combined with their other efforts, have not led to any improvements whatsoever in relation to our healthcare system; in fact, have led to the situation getting so much worse, to the point where we are now facing multiple crises across our health system.

This bill covers a number of perhaps minor amendments in some ways to the legislation. There are updates in relation to a number of the roles of the chief executive, though, which are significant in terms of the system leader still in this dual role process that this government has put in place where we have local hospital networks that have governing boards but we still have the chief executive who employs all the staff.

So we have unique system where we have government boards that are quite often the fall guys for what goes on in the healthcare system because they do not control the budgets, they do not control the staff, they do not control what their priorities are, they do not control what the capital works are going to be and they do not control the targets they have to meet. But they are told, 'You just sort out and run the system.'

I will pick up one example from question time today in relation to the opening of beds in hospitals and whether there are unopened beds in our hospitals—and everybody knows that there are—despite the fact that we have sometimes hundreds of people waiting for a bed, either ramped in ambulances or inside the emergency department. The health minister told us that local hospital chief executives will sort that out; if there are beds that need to be opened, they will do that. Well, very clearly, they cannot always do that because they do not control their budgets.

There is a key mechanism in the legislation which the government has put in place and which they are seeking to amend, and that is in relation to service level agreements. They have said the structure is that the government will set service level agreements between the chief executive of SA Health—currently the occupant is Chris McGowan, who has just had his contract renewed for some $570,000 a year, I believe—and then the local hospital network boards and CEOs signing off. This is meant to set the targets for how the health system works. This is meant to set the budgets that they have to operate in.

Part of the problem, of course, is that the local hospital network boards have been very frustrated over the past few years that they have not been getting sufficient budget to enable them to run their health systems in an appropriate manner. They have been asked to basically do the impossible: to cut funding and to cut various areas of their expenditure while delivering improved performance. I think whistleblower Adjunct Professor John Mendoza said it very well when he spoke out before he was sacked, in that he was being told, as the head of mental health in the Central Adelaide Local Health Network, 'You basically have to cut staff and cut funding, but at the same time improve performance, see more patients and end ramping.' All those things cannot happen at the same time.

So what we had was a situation where the local hospital network boards were in revolt about this. We know that they raised their concerns with the health minister, with the Treasurer and with the Premier. We know that that is why they refused for many, many months to sign their service level agreements with the government, because they were so concerned in relation to what the impact would be of these reduced budgets that they would have to find cuts for.

Very clearly, we now have legislation before us that would give the minister the power to override the supposed agreements that would be put in place. If the minister were concerned that there was a dispute then the minister would be able to override those service level agreements and put in place his own decision-making in place of what was previously an agreement between the chief executive and those boards. Clearly, that is very concerning because this is one of the only ways in which board members can voice their concerns about the budget that they are being given in the health system.

We do not want to have a situation where ultimately the minister, who is meant to be accountable for how the system is run, is putting in place a structure where he can continually blame and pass the buck down to the local health network boards, but they have no say in the situation and now do not even get to have a say in this legislation in terms of signing off on their service level agreements. That is quite concerning.

There are a number of other elements that are of concern, one of which is that the government has been trying to seek to weaken the areas in which there can be conflict of interest arrangements between people who should be on the board. When this legislation was first put in place, I believe there was an amendment moved in the other place by the Minister for Health himself, who said very clearly that he agreed that there should not be conflicts of interest. He proposed the wording of how that should be managed, but he is now seeking to change that and backtrack in terms of exactly how that should be put in place.

We have great concerns in putting in place an arrangement where people would have conflicts of interest by sitting on boards. We believe that the current wording of the proposed amendments moved by the government in relation to conflicts of interest regarding board membership would give the ability for, say, somebody like corporate liquidators KordaMentha to sit on the board of a health network where they are engaged to provide professional services or administration. That is clearly unacceptable.

That is clearly a conflict of interest and I do not see how the government can defend what they are proposing to weaken that and put in place weaker provisions in relation to conflicts of interest when these boards are, in some cases, looking after well over $1 billion of taxpayer expenditure every year. Essentially, these governance reforms are what this government put in place to manage the system, but we can see very clearly that it has led to a worse situation now—in terms of ramping, in terms of emergency department performance and in terms of the care of mental health patients—than we have ever had before in the state's history.

One of the key things that this government has done in relation to governance of the healthcare system, which does not even appear here at all, is that they took steps never taken before of putting in place administrators of the Central Adelaide Local Health Network, not health experts, but corporate liquidators KordaMentha. They have now ended up paying them $37 million of taxpayers' money to run the Central Adelaide Local Health Network as administrators. It is completely unprecedented.

Of course, there have always been occasions when consultants have been brought in from time to time—and I do not think you would want to do that very often—but to put them in place not just to provide advice to the board, the CEO or the minister but to actually run things in our health system is completely unprecedented.

We were told that this would lead to some huge benefit in terms of the outcome for patients, but we have actually seen the opposite. We were told that they would turn the budget around, but the budget is still in a massive shortfall in that health region. We were told that this was all about the cutting back of office services but, in fact, while they may have cut the paperclip budget, ultimately it is front office services, frontline health services that are now copping the price.

We saw their reports, which are very careful in their wording, and it is clear that they talk about reducing the number of procedures that are done in the hospital system. We said to them, 'How is that possible?' They said, 'We are going to treat people better in the home, etc.' That has not happened. There are more people presenting. They said they were going to reduce the number of bed nights, which equals reducing the number of beds. That is progressing and we are seeing that in the reduction in staff that is happening right at the time when we need those staff on board.

We have paid KordaMentha $37 million to run the health system, even though that does not appear as an option for governance anywhere either in the original government legislation or their proposed government legislation. Nowhere does it say that that is a method you can put in place. We have paid them $37 million. They have now gone about a huge program of voluntary separations. They have now cut 300 staff, particularly focused on the Central Adelaide Local Health Network but some in other regions have been impacted by government cuts as well, but nowhere near the number under the management of KordaMentha at the Central Adelaide Local Health Network.

That cut of 300 staff has cost taxpayers $24 million. We do not have those staff anymore. When this is talked about the minister says, 'These are voluntary. If people want to leave, that's fine.' This is not people just deciding to leave and then we find the next person to replace them and bring in somebody new. These are people who are leaving and we are then saying, 'Your position is now abolished. It has been made redundant. We do not need that position anymore. We are never going to replace that position, and we are paying you out because of that.'

It is very different from where there have been discussions and programs around whether we help some people towards the end of their career to take a package so we can get the next person in. This is very different. This is about abolishing positions. This is about reducing staff numbers, which is as plain as day if you look at the budget papers. It was made very clear in the past few budgets, where there was a projection of massive staff cuts at the Central Adelaide Local Health Network. This has been very clear from the budget papers. It has been right there in plain sight.

We have had a reduction of 300 staff, which has cost the taxpayer $24 million. We have paid $37 million for consultants to come in and then we have paid another $24 million to get rid of the staff. Suddenly, we are up to $60 million to have fewer staff working in our health system providing healthcare services. Imagine, if we had instead put that $60 million into providing care for patients, how different the situation we see on a daily basis on our TV screens, of the ramping crisis affecting our hospitals, might be. Imagine if that $60 million were being used to provide healthcare services rather than paying out staff and paying consultants from Sydney and Melbourne to fly in and fly out of Adelaide.

Another exceptional thing about what has happened in relation to this, and the Auditor-General has noted it and raised concerns, is how this procurement originally happened. We know that this did not go through a proper procurement process to bring KordaMentha on board. The tender was skirted around and no open tender was put in place, which has raised the ire of the Auditor-General. This was a government decision to do this outside the usual competitive process and outside the Industry Participation Policy the government has in place.

There is a policy in place that we need to make sure we maximise the benefit of our taxpayer dollars being spent to South Australian taxpayers and to our economy. So, if we are spending a dollar, we want to see as much of that dollar being spent by South Australian employees and as much capital being invested here in South Australia as possible.

If you look at what happened in relation to the KordaMentha contract, it was not 75 per cent local content, it was not 50 per cent local content, nor was it was even 25 per cent local content. The bid they put in said zero per cent local content. Zero per cent of what they produced in terms of governing our healthcare system was coming from Adelaide. It was all coming from Melbourne and Sydney.

We were paying to fly people in on Monday morning and fly them out on Thursday afternoon—I do not know why they could not stay in Adelaide on Fridays as well—and then they would spend Friday, Saturday and Sunday in Sydney or Melbourne and then come back Monday morning to restart their cutting program in the Central Adelaide Local Health Network. Those are the governance arrangements that have practically been in place under this government and under the legislation they have had in place.

Even worse than that is those 300 staff are not all back office people, as you might think. You would think, 'Well, if we are going to be cutting staff, let's cut some back office people and put those resources into frontline health care,' and people might think that is fair enough. But what we have seen is that the majority of these people are frontline healthcare staff. In fact, 120 of the 300 people, almost half, are nurses—120 nurses' positions have been made redundant by this government and the vast majority of those were since the pandemic started.

We have a situation where in June 2020, when we were still bracing for the impact on our healthcare system of COVID-19, Victoria was starting to see their wave happen and we were doing everything under the leadership of Grant Stevens and Nicola Spurrier to make sure it did not happen here. What was the Marshall government doing? It was deciding to cut staff from our frontline hospital system—120 nurses, the vast majority going since the pandemic started, reducing our capability, yet we had the Premier suggesting that somehow that made sense as a good thing because demand was lower during that time, so you would abolish these positions. We saw everybody else around the country, and probably in fact the whole world, putting on more staff to prepare themselves. Here in South Australia we were letting staff go, having fewer people on the frontline.

That has been the impact of KordaMentha and their management of the healthcare system, not part of the legislation. Very clearly, despite the fact that this is meant to be the governance system, they did this workaround where they employed them as a contract but then employed them as executives holding two hats at the same time—it is likely that is the first time that has ever happened as well—and paid them a dollar or so to be executives in the health system, while we were paying people $37 million to be contractors, so they had some legal basis under the legislation to undertake their work to cut services, not as an advisory capability but to actually carry that out. It is completely unprecedented in this state, and we have seen what a failure it has been.

One more thing on KordaMentha before I leave it there is that clearly at some point in time they worked out that it was not quite as easy as they thought. Clearly, at some point in time they worked out that this was not like going into a box factory and cutting the margins on your suppliers. Health care is as complex as it gets. Running major hospitals is as complex as it gets, and there were no easy ways to make savings without eating into frontline healthcare services.

I think very clearly they worked out that they did not have the technical capability to run those services without knowledge of the healthcare system. Very clearly, at some stage they worked out, 'Well, we need to get some expertise,' so we ended up in this bizarre situation where, at the end of 2019, KordaMentha were going to bring in consultants to them. We were like Inception: we have layers upon layers, we are hiring the consultants and then the consultants are hiring additional consultants.

They were going to bring in people called 2020 Delivery. They were going to fly in from London. I believe that some of them did come for at least one trip to Australia, if not two trips, to be part of this cost-cutting program. We have no detail in terms of how much they were paid. Clearly, the pandemic put an end to this idea that we could bring in not just interstate people to run the healthcare system here but now overseas consultants to run the healthcare system.

That was the government's approach: just layers and layers of consultants while we are cutting layers and layers of nurses. If you look at the nurses who were cut, maybe you could make an argument that there is some nurse who is not providing a critical role. I would certainly question that, but maybe the government could make that argument. If you look at the FOI documents we have obtained in relation to who these nurses were and what their positions were, they include people such as emergency department nurses and people such as intensive care unit nurses.

How, during the middle of a pandemic, we would think we would be abolishing nursing positions in the emergency department and in the intensive care unit—two critical elements to any COVID response—is completely beyond me. Then further in ICU, further in cardiology, further in operating theatres, further in outpatient departments and further, I believe, even in neurology—this was a whole range of key, critical areas in which we were cutting nursing staff during the middle of dealing with the pandemic wave before the Victorian wave was about to hit in June last year.

Another critical element we have seen in relation to the management of the healthcare system and its governance—and this report came out before the pandemic hit as well in relation to November 2019—is the report from the ICAC commissioner. This was an absolutely blistering report from the ICAC commissioner into SA Health called Troubling Ambiguity.

We know that the ICAC commissioner only wrote this report because he was so concerned by what he saw in SA Health. He went to the government, he wrote to the health minister and he said, 'I would like funding to undertake a proper investigation into what's going on in SA Health because of my concerns in relation to maladministration, misconduct and corruption that could potentially be happening within your agency. This is how much money I need to get to the bottom of this.' The commissioner got a response back from the Treasurer saying, 'No, we're not going to provide you with that funding. We're not going to allow you to get the funding you need to get to the bottom of those issues.'

The ICAC commissioner obviously looked at the fact that to get to the bottom of those issues within the existing budget would completely swamp any other important work that the commissioner had on the go or needed to look into within the course of a year and said, 'If the government is going to refuse me to get to the bottom of these issues, then I will have to do what I can within my existing resources.' Hence, he wrote this report, 'Troubling ambiguity: governance in SA Health', which goes through line by line the issues he has raised in relation to the governance of the healthcare system.

The report covers cultural issues, reporting culture, bullying and harassment, attitudes and tendencies; records management, time and attendance; the scope and delivery of employment duties, inconsistency between practices and industrial agreements; the rights of private practice framework, the risks arising from unregulated rights of private practice; conflicts of interest, the policy framework and observations from investigations; clinical trials and research; special-purpose funds, historical concerns and challenges related to those funds and risks arising from those funds; and procurement.

All those areas are very considerable concerns in relation to the governance of SA Health, all of which the commissioner put on the table and in fact made very clear in doing so that he cannot make recommendations in relation to those areas because he has not had the ability to get to the bottom of them and he has not had the ability to hold hearings, as he had asked the government to enable him funding to be able to do to get to the bottom of all those issues. Hence, he had to put this report forward, which raised those issues but which did not have specific recommendations because it was unable to do so.

What was the response from the minister? The response from the minister, which I think will be remembered as one of the most farcical scenes we have seen over this government, was to trot out with all his chief executives behind him in this big show and dance about how he was going to take action and was putting in place a task force to look into it. Then we found out that he said that before he had even read the report. He announced his response to the report before he had even taken the time to consider it. It is not a very significantly long report. I believe it is 64 pages long and you could very easily read it in a sitting.

This government put the spin ahead of actually listening to those governance concerns. They then parked it all into this interagency mumbo-jumbo talkfest work group action plan delivery committee. So we have this bureaucratic committee, which is largely staffed by people from SA Health, including the chief executive and the chief executive of the largest health region on this committee, to say, 'Here's this report. You go and do something with it.' Basically, since then nothing has happened to any of this. Nothing has happened to address these concerns whatsoever.

You know that that has not happened because here we have a governance bill that has been sitting around in the parliament since 2019 and it does not address any change that came out of this report whatsoever. There is nothing here that picks up the concerns the ICAC commissioner had and spelled out very publicly in relation to his concerns. Nothing has been done. Why you would not use the fact that this bill had not progressed to take another look, to go back and put in place some changes to make sure that we were improving in relation to these procedures, is beyond me. However, here we have just the tidying-up legislation, two years on, with no significant changes.

If you look at some of the issues that were raised here, they are very concerning. They not only involve the way we treat our frontline healthcare staff but also how we treat taxpayers' dollars. We have concerns, in terms of taxpayers' dollars, about conflicts of interest management, procurement, special purpose funds, clinical trials and research, rights of private practice, and even time and attendance, whether people are actually doing the time they say they are in the healthcare system. These are all critical issues we need to get to the bottom of.

Particularly galling is that the government put in place a system where one of the people on their workgroup, or whatever they called it, that was going to look into these issues was the head of SA Health, chief executive Chris McGowan, who at the same time was facing an independent investigation by a former commonwealth ombudsman in relation to his management of conflicts of interest—which was one of the concerns that the ICAC commissioner raised generally.

So we have an issue where there was clearly a conflict in putting that person in place of that workgroup to look at this report, particularly when the report that came out from former commonwealth ombudsman John McMillan raised very significant concerns in terms of the management Chris McGowan had in relation to those matters. It said he should not have gone to meet Deloitte in the way he did, it said he should have put in place better conflict of interest management procedures when he started and it said there were forms that should have been signed that were not signed.

There was a litany of issues raised that led to him having to have coaching from the Commissioner for Public Sector Employment in relation to conflicts of interest. So we have the person sitting on this committee overseeing how to improve conflicts of interest who, at the same time, is getting coaching on managing his conflicts of interest. This is the way the governance of the healthcare system is running under this government.

Very clearly, we have a concern in terms of all those issues that are going completely unaddressed by this government, and that is flowing through in relation to delivery of healthcare services. In addition, there are areas of this that not only affect the budget and the delivery of taxpayers' money but also affect our hardworking doctors, nurses, paramedics, allied health professionals, other clinical staff, and other support staff in the healthcare system.

We have very clear concerns in relation to the reporting culture, bullying and harassment, attitudes and tendencies within the government, within SA Health, that have not been acted upon. This is leading to part of the issue we are now seeing, where we have massive fatigue, where we have staff who have no morale whatsoever in the delivery of services, where we are losing experienced people in the delivery of our healthcare services—and this is one of the reasons behind that.

Even if you do not accept the ICAC commissioner's view on it, we had a bipartisan committee of this parliament—I always forget the name of it, but there is an occupational health and safety committee of this parliament—look into bullying and harassment in SA Health that issued a damning report in terms of the number of complaints and the number of issues that have been raised in relation to bullying. Nothing whatsoever has happened on that either; there is nothing in here to address those concerns. That is now flowing through to the healthcare services we are seeing, and they are flowing through in a way that is shocking all South Australians.

Finally, we have now seen the government own up to the figures in relation to what the current ramping crisis is in our healthcare system. Very clearly, the figures that were released to the media on Friday afternoon from the government show that for each of the last three months this state set a historic record for the number of hours that ambulances were ramped outside major hospital emergency departments. It was a record in February, a record in March and a record in April. Ambulances were ramped for 2,268 hours in April. That is the absolute worst our state has ever seen. It is much more than double the rate that this government inherited when they took office.

They have doubled ramping to the worst it has ever been in this state's history and we see every day now the human impacts this is having on people. It is having an impact in a number of ways. There are people who are stuck in emergency departments who have managed to get into the emergency department but then get stuck there for days upon end. There have been reports of people stuck for five days in emergency departments, waiting for a bed in a hospital.

An emergency department bay is nowhere that somebody should be spending five days and five nights. Five days and five nights sound like a nice holiday brochure, not an amount of time you should be spending on a stretcher in an emergency department waiting for a bed somewhere. But that is a reality and it is particularly affecting people with mental health conditions. We have seen a massive blowout in the number of people who have been stuck for more than 24 hours. Regarding those mental health patients alone, the government answered last sitting week that over the last year 1,440 of those people had been stuck for more than 24 hours. It is a massive escalation and it shows what a crisis is going on inside our hospitals.

Then outside the door of the emergency department we have a massive problem in terms of ramping. Just this week we saw 37 ambulances ramped across our system at one point on Monday, and that is having a massive impact upon people who need care, who should be inside the emergency department getting the testing and assessments that they need for their condition. Instead, they are stuck in a degrading way, without the proper assessments and care they need, in the back of an ambulance.

That had a human face for all South Australians when we saw Agatha this week, who was stuck for three hours at the Royal Adelaide Hospital. Agatha is 93 years old. This is the second time she has been ramped. She had difficulty breathing, so her daughter called an ambulance. The ambulance was very late because of the situation it was facing. The nearest hospital was The QEH but they could not go there because of the serious ramping that was happening at The QEH, so they had to go to the Royal Adelaide where she was stuck in the back of the ambulance for three hours. She told her daughter that she just wanted to die rather than be stuck there any longer.

That is the situation that South Australians are now facing on a daily basis in our healthcare system. It is absolutely not good enough. For the government to accept that this has doubled under their watch, particularly when they promised that they would fix it, is an absolute indictment upon them. It comes because those patients cannot get into the emergency department because, as we have already said, those emergency departments are completely clogged with people already and those people cannot get out of the emergency department because there are not the beds for them to go into. They cannot get into the beds they need to get into because the government is cutting nurses to provide that nursing care.

We have beds that are closed across the health system, rather than opening them and providing the care that patients need, and this all flows down. Inevitably, it flows not just from the ramp but it flows into the community as well, so the next person who needs that ambulance cannot get one because we are in a crisis situation in which all our ambulances are tied up outside emergency departments, so there are not available ambulances to respond to those cases.

So ambulance response times are getting progressively worse. We have seen them worsen over the past two years. This is the only state in which funding for the ambulance service has gone down. In every single other state, the state government or the territory government is putting more money into their ambulance service, except for here in South Australia where we are reducing the Ambulance Service funding by $11 million over the past two years. Do not take my word for it; that is according to the Productivity Commission Report on Government Services that came out in January this year.

We have ambulances stuck outside hospitals and we are squeezing funding from the Ambulance Service, so this inevitably means that when people call for an ambulance there quite often is not one available to respond. We have seen cases in recent weeks and months where there have been up to 15 calls at one time that have gone unresponded to immediately because an ambulance is not available to dispatch.

On Monday, there were seven priority 2 cases, which is lights and sirens, get there in a hurry ambulance cases, and there was no ambulance to respond to them. This is now leading to an awful situation for our paramedics, who are now really copping the brunt of all this chaos and crisis in SA Health, not that they are the only ones but they are particularly at the pointy end, in that they are now in a situation where they are now losing morale in terms of their work. They are fatigued, they are not getting breaks and they are working ridiculous hours without a break.

They are very happy to work long hours, but they need a break occasionally. We here will work long hours in the parliament debating legislation, but we take a break for dinner and we take a break for lunch. They do not get those breaks when you are an ambulance paramedic at the moment. They are working straight through and eventually it breaks you down. Not only that, but it clearly has an impact on you emotionally. If you have the ability to provide the skills that patients need but you cannot get to the patients on time to provide that in a timely way, that will inevitably have an impact upon people.

We heard it here when there was a rally at Parliament House, which many of us on this side attended. To my knowledge, no-one on the government side attended the rally, but I believe Senator McLachlan from the federal Liberal Party did attend, so credit to him for doing that. However, no-one from the state Liberal Party went out to listen. We heard from an extended care paramedic about how it is really having an impact upon him, the fact that he knows he has the ability to deliver care to people in need but he cannot get there. He knows that it is a perilous situation for them.

I recently spoke to a family where the husband called an ambulance for his wife. They are both in their 80s and I believe they live in Clarence Park. He called an ambulance in the middle of the night for his wife. It took well over two hours to get there. She had had a fall and collapsed on the floor. It would have been either a priority 2 or a priority 3, so an ambulance should have been there in 16 minutes or 30 minutes, but it was there in two hours.

The ambulance had to come all the way from Stirling to get there. We are now in this situation where it used to be that if you lived near an ambulance station you thought you had a pretty good shot of getting an ambulance coming to you now. The ambulances are hardly ever in the ambulance stations at the moment. They are either responding to jobs or they are ramped outside hospitals. The idea that you go to an ambulance station and there is staff in there sitting around is completely mind boggling now.

I remember going to see many ambulance stations that we were opening before the last election, particularly ones in my electorate, the Noarlunga and Seaford ambulance stations, some of the last ones to open. There have been a couple of others where the current minister, Stephen Wade, cut the ribbon but they were funded, proposed and planned under the previous government. I am not aware of any under this government.

The facilities are great in these new ambulance stations, and they include beds for people to sleep in. The problem is it is just a fallacy. No-one who is working for the SA Ambulance Service at the moment is sleeping when they are on their shift. They are flat out all the time, and that has an impact upon people every day.

What we saw very clearly was that this government made a number of very clear promises in terms of what they were going to do. They said that they would end ramping. I have a letter Stephen Wade wrote to Phil Palmer, Secretary of the Ambulance Employees Association, on 1 March 2018, a couple of weeks before the last election. He stated:

I write on behalf of the Liberal Party to provide a response to the Ambulance Employees' Association's letter…The Liberal Party shares the Association's strong concern as to the capacity of SA Ambulance to deliver effective and safe services…The Liberal Party shares the long-standing view of the Association that our public health system must rigorously resist the trend to allow ambulance ramping to become the norm in South Australian…hospitals.

Here is the minister promising that he was going to stop ambulance ramping from becoming the norm, and not only has he not done that but he has in fact entrenched it and doubled it and made it the highest ramping we have ever seen in the history of this state. Stephen Wade also stated:

Ambulance ramping is unsafe for patients, places significant and unreasonable stress on our ambulance officers, leads to blow outs in ambulance response times and is an unacceptable waste of scarce resources.

I think everybody would agree with that, but why has he overseen the governance of a system that has allowed ambulance ramping to now double—not increase by 10 per cent or 20 per cent, not stay the same, but double to record levels under his watch? He continued:

Accordingly, if elected in March, a Marshall Liberal Government will ensure that from 1 July 2018 onwards annual Service Level Agreements…between the Department for Health and Ageing and metropolitan Local Health Networks include agreed strategies and/or tangible steps to both address ambulance ramping and strengthen the surge capacity of individual hospitals—steps such as establishing discharge lounges and improving discharge protocols.

Very clearly either that has not happened or it has been a dismal failure because the situation not only has not improved but has become disastrously worse. Clearly, with those arrangements in relation to service level agreements, which are covered in this legislation, I think the priority has been much more about cutting the funding in those service level agreements, rather than ending ramping.

I think that in those service level agreements the government could have very clearly made ending ramping a priority, and then those local hospital networks would have the ability to put resources to the task to make sure that beds were open, to make sure that resources needed were there and to make sure that discharges were happening, but that has not happened and we are now in a situation that has only got worse. Very clearly, he then also goes on to talk about how he is going to commit to workforce planning:

…if elected, a Marshall Liberal Government will require the SA Ambulance Service to complete statewide workforce planning within 12 months, in consultation with the Ambulance Employees' Association and other relevant bodies. Importantly, we would expect the SA Ambulance Service to make available to the Association the assumptions and key data underlying its planning and forecasts. Whilst the initial workforce planning may focus on, say, the next five years, the Liberal Party recognises the need to take the long-term view and end the stop-start approach to ambulance officer recruitment that has plagued the Service for years.

That could all not be further from the truth of what happened. We know what has happened, and in relation to the governance this is very clearly an area in which the health minister has reporting to him the Chief Executive of SA Health and the Chief Executive of SA Ambulance. There is a very direct line of accountability for how this works, and it has been a complete broken promise of what was proposed then. In fact, what happened is that the government worked with an international consulting group, OHR, who undertook a study in relation to the workforce needs of the SA Ambulance Service. They came up with a report, which we understand recommended hundreds of extra paramedics.

That went to cabinet and cabinet rejected it. One of the reasons we know that this happened—apart from the fact that it is one of the worst kept secrets in Adelaide—is that an FOI document obtained by the opposition shows very clearly a briefing to the chief executive about undertaking work in relation to a consultancy for work on future planning for the healthcare system. I believe they inevitably hired PwC to do that. One of the key reasons for doing that was that they said they had an urgent need for a cabinet budget process in relation to the funding and resourcing of the Ambulance Service.

Clearly, at that time, I believe in 2019, proposals were going to cabinet about the urgent funding need for the Ambulance Service. We know that since then none of that funding was ever approved. It was not approved whatsoever. The figures this government like to bandy around, about increased numbers of staff, all came about because of the funding that was put in place in the MYBR in 2017 under the previous government, under the previous minister, the member for Croydon, to hire additional ambulance officers then.

Since then, there has been no additional funding. Since then, there have been no additional commitments to staff. Since then, there has been a report from OHR that has been sitting in cabinet, or rejected by cabinet, which the government refuses to release and which clearly outlines how many more staff are needed in our healthcare system for our Ambulance Service.

The government are still refusing to release that report, despite that in 2018, before the election, they promised the Ambulance Employees Association, 'We will work with you. We will share all our data. We will make sure that there will be a great workforce plan in place.' None of that happened and it then ended in complete secrecy after that. There was no sharing of that data, with the government holding onto cabinet confidentiality. Now their response is to treat this all as some industrial relations dispute, when it is in fact about care for patients.

I do not find anywhere in the Health Care Act that states that, when employees are involved, suddenly providing healthcare services for the people of this state stops becoming an issue for the health minister and the health executives but starts becoming Rob Lucas's issue. But that is basically Stephen Wade's response: he wants this all to be Rob Lucas's problem. It is an industrial issue and, by the way, we are only releasing paramedics if the ambulance union signs off on certain things that we want.

I think that eventually there was a victory of common sense, in that they have now agreed to provide at least some ambulance officers for no concessions whatsoever from the ambulance staff. Instead of admitting their failure on that, the government have then gone out to try to claim victory, and this we understand has further enraged paramedics across the state. It will be interesting to see if those additional 74 paramedics—who are clearly desperately needed and included in the government's secret report they are failing to release—are going to be dependent upon whether or not this deal is agreed to by the paramedics at a union meeting.

If the paramedics and the union members vote no to this deal, are the government then going to say, 'We are not going to hire any additional paramedics'? They are clearly desperately needed. We should be starting that recruitment right now. We should not be waiting two weeks for some ballot. We should not have been waiting until now: we should have been hiring them when it became very apparent towards the end of last year how dangerous the situation was and how clearly more staff were needed.

There is also a need not just in relation to ramping. There is a very clear issue that if we can end or significantly reduce the ramping that has exploded under this government's watch that would certainly free up significant resources for our paramedics and help reduce response times and address the fatigue our staff are facing. But there is clearly an issue even without that. There is clearly an issue where, even on some days when there has not been ramping, there still have been very slow response times because we clearly do not have enough paramedics on board generally.

There are also additional needs for PPE, with a lot of cases in this new COVID world. That adds additional time. That is why more paramedics are needed. The first thing the government should do is release that report they have been holding onto for some time. All those promises by Stephen Wade were absolutely broken. When the government was first elected, some six months afterwards ramping was escalating then but not anywhere near the levels we are seeing now.

We saw Stephen Wade call one of his what is now becoming a famous trick of a crisis meeting or a workforce planning crisis meeting or whatever he might choose to call it. He had all the different representative groups around in a 'pic fac' as they call it in media terms, to get some camera vision. He said, 'Bring us all your good ideas on how we will fix this,' and then he basically went away and did nothing, absolutely nothing in relation to what was the problem there. He could have put in place things that addressed the issue now.

It is worth looking back at some of those recommendations made to the minister back in 2018 that could have had an impact on the health system now if he had listened to the health staff. If he had listened to the industrial bodies that represent them back then, he could have put in place things that could have prevented us getting to this crisis situation.

If you look at what the Ambulance Employees Association suggested at the time, they said, 'You need to increase the number of acute hospital beds, improve coordination, increase community capacity to manage medical patients with complex conditions outside acute hospitals, improve hospital processes and better standardisation of treatment.' They also said, 'Dedicated mental health facilities with staff to free up ED beds, significant investment in primary preventative health care, using well-funded and appropriately resourced transit wards in all metropolitan hospitals,' which is something incidentally Stephen Wade himself committed to in March 2018 but which clearly has not happened.

The Ambulance Employees Association also said, 'Improved admission and discharge performance in hospitals to improve patient flow, expand hospital avoidance measures and transfer of care policies of 30 minutes.' A whole range of suggestions were made to this government back in 2018 that they could have taken action on but they did not. We have only had either cuts or very small measures that have had no noticeable impact, one of which is this government's preferred 'wheel it out' suggestion of priority care centres. Priority care centres are their go-to: 'Look, we're doing something.'

They have set up four GP clinics we are funding to take some ambulance patients. We are sending SA Health nurses to work there, so it is quite an expensive model of care, and hardly anybody is meeting the criteria to go to these places. For much of the last two years that this has been in operation, most of these centres have only seen, on average, two patients per day. With a healthcare system as busy as ours, that is not making a significant difference and these are not the patients who are causing the significant logjams in the hospital system.

There is no significant investment in primary preventative health care, there is no significant investment in transit wards, there is no significant investment in acute beds and there is no significant investment in better discharge strategies. A lot of these things have had announcements but no follow-up, yet we have seen the cuts behind the back happening that have made the situation so much worse.

At the end of last year, the government had another warning, when they were told in a report, entitled 'Safety learning system incident review ambulance delays', covering July 2020 to November 2020, about very significant ambulance delays that were happening to patients. Step by step, this goes through looking at individual patients and their impacts over the five months at the end of last year and at how patients were impacted by the delays we saw in the healthcare system.

There was an analysis of what happened, and clearly some of these patients died, some of these patients received much worse care than they should have and some of these patients ended up in hospital a lot longer than they should have. Hospitals were a significant issue in terms of their funding not allowing enough resources to take these patients. Ramping therefore resulted and there were delays. Some of these delays were not because of ramping but because of lack of resources in the healthcare system. The summary of this report, which was provided to the government, stated:

The review highlights that the Ambulance Services' capacity to provide an adequate response to a specific cohort of patients is suboptimal at times. These patients based on an international triage and dispatch system, require a level of response that is still deemed to be an emergency, or require timely transport to the most appropriate Emergency Department. Due to an increase in demand for SAAS's services and a lack of response capacity at those times, a delay occurs, putting at risk this cohort of patients.

We have a situation where, largely, these are people who might get classified as category 3 patients. For a very long time, we had a target in place for category 3 patients, in that they should get an ambulance in place within 30 minutes; however, this government has completely raised the white flag on that now. They have said, 'We are not going to have a target at all for these category 3 patients. There is no target. We can't fail a target if we don't meet it.' I had it confirmed recently in a response to a question on notice from the Premier that we are no longer assessing how many people we see in 30 minutes for category 3 patients.

But these people do need care. These people might be somebody who has had a fall, somebody who has broken a limb, somebody who has had some sort of injury that does not require a lights and sirens response but does require an ambulance to come pretty soon. This report advised the government that the lack of response capacity at those times and an increased demand means that there is a delay, putting at risk that cohort of patients.

Recommendation 1 to address this was to increase stretcher-carrying ambulance capacity. You cannot get much clearer than that. The government had a recommendation in November last year that they should be increasing the availability of ambulances that can carry a stretcher. There are essentially two categories of ambulances: there are ambulances that can cover stretchers, which is what we generally think of as an ambulance, and then there are sprint cars, which are solo responders. They can be helpful in a range of circumstances but obviously cannot carry somebody on a stretcher back to hospital.

The government was warned back in November last year that they needed to increase that capacity for ambulances that could carry patients. They have not done so and they are still treating it as though it is an industrial relations issue rather than an issue that needs attention by the governance in this system, the minister, the chief executive and ultimately the Premier.

I will not go through all the cases, but one of them was a child who threatened suicide. They waited basically from night-time until the next morning for an ambulance. That should not be happening anywhere in South Australia, that we are so hard pressed for resources that we cannot get to somebody in such a situation in a timely way. That is only going to make the situation so much worse.

Now we are in a situation where we have heard the staff themselves having to speak out about the situation they face, which is quite unprecedented. I think we are used to doctors having some degree of ability to speak out about concerns in relation to the healthcare system but to now see paramedics speaking out I think has really shocked South Australia in terms of what they have been hearing.

We see it now as well, in that they are taking to the streets and writing on their ambulances how they are feeling about the resources that they have. I think that South Australians are seeing that and saying, 'Why is the government not taking any action? Why is the government treating this as some industrial issue, when it is actually about our safety in the community?' We have had so many paramedics speaking out that I cannot go through them all, but we have people like Jim, who said:

Patients have died, and we keep having adverse events happening and I'm telling you, the tip of the iceberg because we can't report them all if we're not even getting back to the station during the shifts to report them, there's no way to do that.

Amanda, who is a paramedic, said:

I've never seen anything like it. Patients have died. I just went from job to job…Towards the very end of the night myself, my partner and another ambulance crew were all too fatigued and short on equipment to attend a life-threat case. I'm actually at risk of just crashing into a tree if I go. And the message I have for people is you're not safe right now. I can't guarantee you're going to get an ambulance when you call up.

Paramedic Josh said:

People need to know that the community is at risk. There's delays in getting ambulances out to the public. I mean, throughout the entire 12-hour shift, there was uncovered lights and sirens jobs that we just did not have the resources to send. Basically to be able to deal with the [level of] demand of this job, the 12-hour shifts without getting breaks, the constant overtime, I found myself in a position where I bumped my hours back from full time to half time. I mean, it's not great for my financial position but I'd rather be broke than broken at the moment.

Then we had David Place, who is the head of the SA Ambulance Service and is specifically positioned within this legislation and responsible for this service. He reports to the chief executive of the health service, SA Health, who reports to the minister. He admitted that they did not have enough funding. He went on radio and admitted that there was not sufficient funding, that he needs more funding and that the funding to this date had only been catching up to CPI.

I think even that was overgenerous because, if you look at the Productivity Commission report, clearly it is falling behind CPI and is a cut in real figures compared with every other state that is increasing on real figures. He went on to say that he basically threatened staff for speaking out. He sent out a bulletin after some of these staff spoke out and said that they might be threatened with ICAC if they spoke out. If he did not say that in the bulletin itself he certainly said it on radio, where he said:

Not one call was abandoned…the second issue is, the ICAC commissioner has made it pretty clear that public sector employees need to adhere to that code so… once they breach that code, I can't necessarily protect them…

David Bevan then went on to point out:

…if you breach this, ICAC might jump on you?

David Place said:

Well, they might…these people have signed a written declaration saying they'll adhere to that code. I'm just saying… I can't necessarily protect them.

There was a clear warning then to people not to speak out, which then forced the ICAC commissioner, the Hon. Ann Vanstone, to come out and rebuke what David Place had said. She said that it was very unhelpful that he used ICAC in that context as a threat to staff. I think it is very clear that, if you look at the public sector code of conduct, people speaking out about their concerns do not breach the public sector code of conduct in any way. With respect to the ICAC commissioner, Ann Vanstone, an Advertiser article stated:

In a rare public rebuke, Commissioner Ann Vanstone QC said his comments were 'unhelpful'—and put other senior public servants on notice.

'Although it is true to say that public officers should abide by the code of conduct applicable to their employment, it is unhelpful for senior public officers to invoke the name of ICAC in an attempt to control the behaviour of their staff,'…

Later, the article states:

[Ms Vanstone]…said it was 'highly unlikely' she would ever get involved in matters of public servants speaking out about working conditions and possible operational failures.

So we had a very clear rebuke from the ICAC commissioner saying that she was very unlikely to get involved in providing any commentary on that matter.

Again, this is an issue which the governance of this healthcare system should have been picking up from long ago. We know that internally within SA Ambulance, they have been raising concerns in relation to the governance of ramping and the governance of the system that has led to ramping for some time. They have put in place in their own risk register concerns about ramping consistently over the past few years that have been consistently ignored.

One of those risks that we have obtained clearly says, 'Demand for service exceeds capacity and capability of resources resulting in adverse patient outcomes.' The status of that is 'deteriorating', and the assessment rating of that is 'extreme'. It said that potential adverse patient outcomes, including increased morbidity and mortality, were due to declining response times and failure to meet performance targets for high and low acuity patients.

Clearly, their internal assessment was that the response times were getting worse and that patients could be at significant risk. The register also went on to list ramping as being a very serious and specific risk as well, also with an extreme and deteriorating situation, as well as all sorts of other risks about fatigued officers and vehicle incidents.

In relation to ramping the register says, 'Adverse patient outcomes due to delays in transfer of care (ramping)'. It lists the inherent risk rating as extreme. It lists all the reasons why ramping is happening and states:

1. Potential adverse patient outcomes including increased morbidity, mortality and suffering as well as compromise of patient dignity due to delays in diagnosis and treatment.

This has forced paramedics to speak out about the level of care that they have been seeing because the government and their processes have completely ignored it. There is nothing in this legislation that is going to address that. There is nothing in this legislation that is going to improve any of that care for patients that they see on a day-to-day basis.

Sadly, that is not where the problems in our healthcare system end because there is also a massive crisis underway in relation to the treatment of people in terms of mental health care that I think is absolutely shameful. I referred earlier to the number of mental health patients who have been stuck in emergency departments over the past year for more than 24 hours, which is now reaching over 1,400 such patients.

This is another area where we have had health staff having to speak out about their concerns. I believe a letter was written on behalf of over two dozen doctors in the emergency department at the Royal Adelaide Hospital in relation to their specific concerns about the treatment of mental health patients in the healthcare system. The letter said:

Current efforts to reform CALHN Mental Health Services are unlikely to lead to meaningful change:

A focus on reporting incidents of restraint, one of the few requirements of the Chief Psychiatrist's Gazettal Notice, is misguided. We know that many restraints occurring in the ED are avoidable, and we know why they occur—because patients are left for many hours or days in an inappropriate environment. We have previously collected years of data to demonstrate this—for example, through the SLS system. This data was persistently ignored by CALHN…We already know that there is a clear, present and well-documented risk to patients from prolonged stays in the ED.

Here we have a situation where clearly there is a significant problem, with mental health patients suffering under some restraint treatments, shackling and the like that none of us would want to see our fellow South Australians have to endure, but they are doing it because they have been stuck in emergency departments for a lot longer than they should have been. The government's response is to blame the emergency department for doing that, but they can only do what they can do because they do not have the same facilities in the emergency department as they do in a mental health care ward to look after those patients. They go on to say:

Efforts by the CALHN Mental Health Intervention Taskforce…may improve the patient journey for consumers who are unlikely to need inpatient care and are worthy initiatives, but are unlikely to have an impact on a much more pressing issue, providing beds for the most unwell.

They said;

It is 'usual business' for the ED to have 10-20 beds occupied by mental health patients. This is approximately 25-50 per cent of the beds available for the 'likely-to-be-admitted' stream of patients; and means that the emergency department is also effectively running an acute psychiatric ward while seeing some 250 patients per day.

The emergency department continues to be forced to 'ramp' on a daily basis (with consequences for all patients, SAAS, and the community); it is not difficult to see how this could be largely avoided by resolving mental health access-block.

There is a connection of these issues. The ramping is exacerbating pain for people, but it is also being caused because of the issues with long stay mental health patients in emergency departments. This letter was written 9 September 2020—essentially three quarters ago—and nothing has happened to address that situation. It has even been reported in the media and still nothing has happened. The government said, 'Oh, we're improving things,' but clearly that did not happen.

We are now seeing a situation where the head of mental health at the Royal Adelaide Hospital and The QEH, Adjunct Professor John Mendoza, was forced to speak out because of what he said was a total failure of SA Health to address the crisis. He revealed that he was having $5 million worth of cuts imposed on his services, which will only make the situation so much worse. He also revealed that there were a number of issues that were making things work better since action was taken towards the end of last year but that they have now been largely swamped by an increase in patients and demand attributable to the pandemic, and he predicted this before the pandemic started.

However, the government ignored his advice and did not put in place measures to make sure we had an appropriate mental health response to the pandemic. So we have the government cutting mental health services, and we have the government not listening to advice that there was a clear need to make sure there would be additional resources put in place. In fact, we did an analysis showing that the mental health funding being put in place by this government in response to COVID-19 was, per capita, lower than every other state.

The response to this guy raising these concerns was that he was told he was being marched out the door. They did not listen to him, but eventually they were forced to have a summit to look at it. Adjunct Professor Mendoza did not get a chance to properly participate as part of that summit because they conveniently could not set up the IT equipment to enable him to do that.

Clearly, in relation to mental health, this government have known for some time of the crisis they are facing. Even their own Chief Psychiatrist has called it an absolute breach of human rights, yet we have seen no action—in fact, we have seen cuts. Then they are forced to have a task force, or a working group or a crisis meeting, whatever they call it, and no action comes out of that. Everyone who was in it then lined up before the media to say what a complete waste of time it was.

John Mendoza put forward a 10-point plan of very sensible measures to address this crisis. That has been ignored. It was then picked up on by a coalition of mental health groups, including the ANMF, the college of psychiatrists, the college of emergency department physicians and a whole range of mental health experts, including the lived experience network in South Australia and the Salaried Medical Officers Association. They put forward their proposals for how this could be immediately addressed to improve the situation for patients. That has been ignored as well.

The minister came out with his response the other day which did not appear to involve spending one extra dollar on mental health nor did it seem to include opening one extra bed or hiring one additional person. It did not even seem to involve stopping the cuts that were being inflicted on the Central Adelaide Local Health Network. No wonder we have a situation where we have colleges of doctors speaking out about how bad things are. We have the Australasian College for Emergency Medicine stating:

Dangerous SA hospital issues must not be accepted as 'normal'.

A state-wide plan is urgently needed to address dangerous capacity and patient flow issues leading to hospital bed block, emergency department (ED) crowding and ambulance ramping in South Australian hospitals.

Dr Mark Morphett, who is the chair of that college and a very experienced doctor at Flinders Medical Centre, wrote the month before last in The Advertiser:

The situation as it stands is life threatening and SA's ongoing ramping crisis must be fixed.

He writes about patients who are stuck in emergency departments, stating:

They no longer need to be in the ED. They have been triaged, received emergency treatment and require ongoing, inpatient care.

But as they are unable to access beds in the hospital's wards, they cannot leave.

We have also seen national reports pointing out the crisis. The Australian Institute of Health and Welfare each December releases reports ranking hospitals in terms of their performance in certain metrics. Some of those metrics involve what is called the four-hour target, which was put in place some 10 years ago as a measure to make sure that we are addressing access block and obviously improving patient care as well.

Out of all the hundreds of hospitals that are assessed, under the Australian Institute of Health and Welfare for meeting this target of whether a patient who comes into emergency is seen, treated and discharged within four hours of getting there, two of our hospitals are the bottom two hospitals in the country for meeting that target—the Royal Adelaide Hospital at 48 per cent of patients meeting that target, and the Lyell McEwin Hospital at 49 per cent. They are Nos 1 and 2 on the worst hospitals for that metric in the whole country.

You have to go all the way down to hospital 187 on the list, which is Mater Hospital in Queensland, which is at 87 per cent of people who are seen, treated and discharged within four hours. I think every South Australian would accept that a public hospital such as the Mater in Queensland would be a very busy public hospital. They can see and treat 87 per cent of people within four hours. Here, we have the bottom two hospitals at 48 per cent and 49 per cent.

If you look at the median time spent in the emergency department, clearly those long waits for people have massively blown out South Australia's performance. If you look at the median waiting time in emergency departments, No. 1 and No. 2 for the worst performing hospitals in the country are again the Royal Adelaide Hospital and the Lyell McEwin Hospital. Both have over four hours as the median time to be seen in hospital. Go way down that list to a large hospital such as The Tweed Hospital in New South Wales to find that it is two hours and 15 minutes, almost half of what we have as the median time that people spend in emergency departments.

It has become accepted practice and it has become a system where the government pushes this down to local health networks but without the budget to address it. They try not to cop the blame for it because they say it is the boards and the chief executives who are in charge of addressing it, but very clearly this is impacting real patients each and every day. The government's response is, 'We're upgrading emergency departments. That's going to fix it. We are making emergency departments bigger.' I think the Premier even went on to say, in one of his Facebook rants, 'We can't pour the concrete any faster to make this happen.'

Again, if you look at the detail of what they are proposing, under the previous government at the Flinders Medical Centre I believe we spent in the order of $300 million or $400 million on capital works. For this government's project that they keep lauding, they are spending $8 million of capital works at Flinders Medical Centre in terms of a capital upgrade. You might ask, 'How can you supposedly expand and make a massive 50 per cent increase on the emergency department with only $8 million?' Because they are not actually building anything new. They are converting existing beds into emergency department beds. They are refurbing existing wards, closing them and turning them into part of the emergency department. That is not going to address this issue; in fact, that may well exacerbate this issue.

There have been significant concerns raised by the staff at Flinders Medical Centre that this is not going to fix the issue; in fact, it might exacerbate the issue. Clearly, part of the issue has been admission to wards, getting out of the emergency department, and they are now creating fewer places for people to go at Flinders Medical Centre because we are just going to have a bigger emergency department to hold people in for these ridiculous amounts of time.

Other upgrades that they are talking about were upgrades proposed under the previous Labor government. These upgrades have been delayed by this government. If you look at the Lyell McEwin emergency department upgrade, that was meant to be open by now. If you look at TQEH redevelopment stage 3, under the original proposal, which was ticked off again in this government's first budget, that was meant to be open years before this government is now talking about it. It was meant to be well under construction right now, but they are still doing early works on the site.

This government have slowed down those projects. They include in this list an upgrade to Modbury Hospital, which they had absolutely nothing to do with, but they cut the ribbon on it when they got into government. Of course, Flinders is a switch of some beds to other types of beds. That is not going to address the situation.

We also have a massive issue in terms of the governance and the running of the Women's and Children's Hospital. We have an issue where it was raised to such a level that hundreds of doctors wrote a letter to the government in October 2019. The Medical Staff Society of the Women's and Children's Hospital wrote to the chief executive officer, Lindsey Gough, raising a litany of concerns about safety and care for people within that hospital, raising concerns about sufficient staffing, raising concerns about care for young babies and children and women at that hospital, and that has been absolutely ignored by this government.

They have had this letter for well over 18 months, and we are seeing services at that hospital not improving but going significantly backwards. We have had incidents that have been covered in the media recently. We have had a young baby with a rare condition whose family travelled from Kimba to be in Adelaide to get surgery. That surgery was then cancelled a number of times, and they could not be told when it was going to happen again, because there were not enough beds available.

I have since learnt that that baby, whose name was Willow, has since passed away, which is of course tragic, and I pass on my condolences to the family, as I have done personally as well. I am not suggesting that that happened because of that delay but it was obviously traumatic for that family. It was traumatic when that delayed surgery happened because particularly patients from the country need to be able to plan when they can get their surgery as they have their lives to plan around, but also that child clearly needed her surgery in a hurry.

Another case came out a couple of weeks ago, which was absolutely shocking to South Australians, where a family took their daughter to the Women's and Children's Hospital. She clearly had a burst appendix, their GP had said that was the case, but they were stuck waiting for hours upon hours in the emergency department without getting treatment. Their daughter's appendix burst in the emergency department when it easily could have been prevented if treatment had happened earlier.

The emergency department was overflowing, there were not enough doctors and nurses to be able to care for the people who were there, and that child suffered because of that. That child spent far longer in hospital than they would have otherwise had to if there had been the resources for doctors and nurses to be able to get to that patient and give her the care that she needed when this clearly was the case based on what was provided by the GP in a letter to the hospital at the time.

Clearly, there is an issue at the Women's and Children's Hospital. A Women's and Children's Hospital Alliance has been formed, led by a number of senior doctors, including Professor John Svigos and Professor Warren Jones, who are very well-known doctors in South Australia. Other doctors who have presented to the upper house Select Committee on Health Services have gone through in detail the concerns they have about resourcing at this hospital.

At the same time, under this governance model, this government has been going around cutting services from that hospital. They have employed various consultants, they have employed KPMG and they have employed Studer Group to go through and cut the budget at that hospital rather than investing in those services that are clearly needed. They have ignored those doctors, they have ignored those patients, and now the situation is clearly getting worse. Now it is becoming quite regular for that hospital emergency department to be running at some 200 per cent capacity, at very dangerous levels not only for patients but also for the staff working there.

We are also now in a situation where this hospital is the next to be looking at a significant redevelopment, but this new Women's and Children's Hospital is clouded in such secrecy, is clouded in so many unknown questions and unknown issues in terms of what is actually going to happen, when is it going to happen, how much is it going to cost and what services are actually going to be available for patients.

The government started the process by saying—in fact, it was their election promise to do so—'We're going to have a task force that we appoint that is going to provide us with the details on how much it will cost, what services should go in there, what the time lines will be, what the site will be, and there will be a report.' I believe it was the Minister for Energy and Mining, in answer to a question on notice, who said that that report would be released publicly, and that has never been released.

It has been 18 months since this government have had this task force report, and they have been sitting on that report and refusing to release it. That report also included a preliminary business case, which the government also refuses to release. So we have a situation where there is this secret report that they will not even share with their clinicians about what the services should be as part of that hospital. I suspect what has happened is that there was an original intention to release that report, but then they were likely shocked by the price tag that that report delivered and were told to go away and start again.

So they have started again. They have hired a whole new set of consultants. They have started a whole new process. They have whole new work groups and user groups going on, but what the doctors and the clinicians are clearly telling us is that they are being ignored and they are being told outcomes without being involved in the discussions.

What we have at the moment is a functional design brief—which is essentially the brief that asked what we were looking for in this hospital—where there are various parts of the hospital where the clinicians are refusing to sign off on that because they are so outraged by what the government is proposing. There are areas of the hospital that would have fewer services than are there at the moment, or not enough to meet the demand that is clearly going to happen in the future.

The minister himself has admitted on the radio, I believe on 14 April on FIVEaa, that it will have 25 fewer overnight beds than there currently are in the Women's and Children's Hospital. So, for an unknown price tag and for an unknown length of time of construction (whenever this will start), it is looking likely that we are going to have a smaller hospital with fewer services than we currently have at the moment. We have doctors and other clinicians in uproar at the moment about what this government is proposing.

Compare that to the new Royal Adelaide Hospital, which let's remember the current government, when in opposition, tried to stop at every turn. But now the current health minister has had a complete backflip and in promo videos says it is a world-class facility. Let's remember that that hospital included 120 extra beds than were in the existing Royal Adelaide Hospital. So it went from 680 beds at one end of North Terrace to 800 beds at the other end of North Terrace.

Here we have this government proposing to move the hospital across the city but to have 25 fewer beds in that process. Part of their justification seems to be that they think they are going to have a situation where patients will suddenly all be going to the Lyell McEwin Hospital for treatment. That is where they are going to get their treatment in the future, so we are not going to need as many overnight beds in the new Women's and Children's Hospital, except for the fact that the government is not proposing to do anything to extend the Lyell McEwin Hospital.

There is no proposed expansion of additional paediatric services at that hospital. We know that that hospital is already under the pump. There is an upgrade to the emergency department, started under the previous Labor government, which is progressing, but that is not going to address the inpatient needs of that hospital.

I think the idea that we are suddenly going to see a move of services, over the next 20 or 30 years, to the Lyell McEwin Hospital and that we suddenly will not need all the beds at the Women's and Children's Hospital is frankly a fantasy. That is why we are seeing doctors enraged and refusing to sign off on the functional design brief. That is why we have seen very senior doctors raising their concerns with the opposition, with the Women's and Children's Hospital Alliance and with SASMOA. This project is a real worry as to where it is up to right now.

We understand in coming weeks it is now facing a process where—and this highlights the governance model of SA Health—even if you have put down to the local level the services and said, 'The boards are running things,' the ultimate running of this exercise is being chaired by the Chief Executive of SA Health, Chris McGowan. That executive steering group is going to be making a decision in coming weeks as to what is going to be in the functional design brief and whether it includes fewer beds or not.

I sincerely hope that we do not end up with a hospital that is going to see less capacity and fewer services for our most sick kids and women giving birth in South Australia. Unfortunately, that is the way it is looking, and it looks like it is about the budget. This government have not even committed a budget to this project. We have only had dribs and drabs put in the budget. I believe it was $550 million and then it maybe increased to $685 million. We know it is going to be much more than that.

The minister had a brief I believe two years ago that told him it would be in the order of over $1.8 billion. Clearly, they are trying to reduce that, but the longer they delay, obviously prices will go up. There will also be an issue where inevitably we are going to need to look after these kids. Inevitably, somewhere in the health system we will need to provide services for them. That is a very significant concern.

It is not just in Adelaide that we see these huge concerns in relation to our healthcare system. You only have to go to regional South Australia and speak to people who are very disappointed in what they originally saw as an election promise from this government to restore local decision-making to their local communities. Originally, people were used to having local hospital boards and they liked that system. I think that there were clearly issues with that system that forced the changes to what we had previously in relation to Country Health SA.

I think people were expecting that the Liberals were going to put boards back in place. What they have done is put regional boards back in place. We previously had a system in South Australia where we essentially had three levels of governance of Country Health SA. We had a country health component of the Department for Health, as it was at that time, we had local hospital boards that were, under the legislation, in charge of running their hospitals, and then we had regional health boards as well that were in the middle that looked after a collection of hospitals.

Essentially, we have now put back those regional boards, which I do not think there was ever a lot of love for in regional communities. What we are hearing a lot is that those regional boards are not listening to particular communities and not out and about listening to what the needs and desires of those communities are. I do not want to blame those people because essentially again they are being put in the situation where they are trapped in a system where they have all the blame but none of the ability to impact upon the change.

When things go wrong, it is the board making that decision. But they are not in charge of the staff, they are not in charge of the budget, they are not in charge of the performance metrics and, after this legislation passes, they will not even need to agree to their service level agreement; they can just have it imposed upon them by the minister.

No wonder people are despondent about how that is working out in regional South Australia. We are seeing it at various points in terms of the running of services in this state. Look at Port Lincoln, where we have had a mass walkout of doctors. The GPs who were providing services to the quite significant Port Lincoln hospital have now said that they have withdrawn those services because they are so frustrated with SA Health and the management of SA Health that they are no longer providing services there. Now services are having to be flown in on a locum basis at massive cost to the taxpayer.

Look at the issues even in Port Lincoln in terms of the security of staff and the nurse assaults that have happened without security guards being put in place. There have been massive issues with security in Whyalla and it has taken two years of campaigning by the nurses union for the government to finally put in place enough security to protect staff up there, which it has now committed to do. I seek leave to continue my remarks.

Leave granted; debate adjourned.

At 17:58 the house adjourned until Thursday 13 May 2021 at 11:00.