Bills

Health Care (Governance) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 12 May 2021.)

Mr PICTON (Kaurna) (12:01): Continuing my brief remarks from yesterday in relation to this piece of legislation, I believe I was just getting into the issue of country health care in relation to the governance arrangements. A key promise that the government made to country regions was, 'You have been ignored; we are going to listen to you,' which has not turned out to be the case. Part of that was putting in place these country boards, which were supposedly going to be representative and listen to local communities, but what we have seen is the state of country health services getting much worse, sadly.

We are seeing significant issues everywhere across country South Australia, particularly people feeling very disenfranchised by the governance arrangements. They are not being listened to by the government, by the minister, by the department, by the boards or by the local health networks. We have a system that has been set up where, legally, all these responsibilities are sitting with these six local hospital network boards; however, there is this shadow organisation that the government has set up, called the Rural Support Service, which is effectively the old Country Health SA department.

The Rural Support Service has well over 100 employees, most of whom on 1 July 2018 (or 2019, but I cannot remember off the top of my head) switched their name badge from working for Country Health SA to now working for the Rural Support Service. This shadow organisation of the Rural Support Service is established not in legislation, and you will not find it anywhere in here, but is put underneath the Barossa Hills Fleurieu Local Health Network.

Under that local hospital network sits this whole organisation that is meant to look after all country South Australia and provide services to all the other local hospital networks, which is a very strange governance model indeed. If you read this legislation, those local hospital networks are meant to look after their local area, but here we have one particular local hospital network that has this additional bureaucracy under it that is looking after everybody. They have then established another shadow set of governance arrangements where this Rural Support Service has a reporting structure to CEs and board chairs of the other local hospital networks, none of which is in the legislation either.

This legislation is so deficient in the way that it has been structured and so deficient in the way that this government has gone about this process that we have had to set up this whole shadow governance arrangement, which does not even appear anywhere in the legislation, whose existence is not discernible for anybody outside the health service and that is not in keeping with the legislative functions those local hospital networks are meant to have. It is no wonder, when we go around and speak to country communities, that people feel that this has made no difference whatsoever. In fact, things are getting worse, not better, since this government was elected in terms of country health services.

We have a system that is very opaque. We have a system where their local hospital network boards are very broad in scope, as I mentioned yesterday. They are not about specific local hospital areas, and they do not even have the appropriate backup and services of people working for them. They check into Adelaide all the time. They check in with Hindmarsh Square to check with these people from the Rural Support Service for the vast majority of their questions on human resources, financing and medical advice.

A whole range of areas sit within that Adelaide function rather than being devolved to the country regions, which was the promise that this government was elected upon. As I mentioned yesterday, it is no wonder we have a huge problem at the moment with Port Lincoln, which has been raised by the doctors in terms of the working arrangements there but also in terms of nurse safety. As you know, Deputy Speaker, we have significant workforce issues across Eyre Peninsula that are going unaddressed.

We have had issues in Whyalla, as the member for Giles has been raising consistently, in terms of the safety of people in the Whyalla Hospital. There has been a huge litany of assaults on our frontline nurses there. We have had big issues on Yorke Peninsula in terms of doctors pulling out of staffing arrangements in Yorke Peninsula hospitals and having to use locums there. We have had issues in Port Pirie with doctors pulling out and needing to use locums. We have had issues at the Balaklava hospital, which the member for Frome has been raising—very serious issues on a number of fronts.

One issue at the Balaklava hospital is that we have had an aged-care facility there that has been sanctioned for noncompliance with federal regulations. Surgery has also had to be pulled out of the Balaklava hospital, which has happened under this government's watch. We have had times where there have not been any doctors available at all at that hospital, including recently.

The nurses union raised concerns about that, where a relatively junior nurse had to be responsible for everything in the hospital over a long weekend because the government not only did not provide a local doctor but they did not even provide a locum doctor to assist that hospital that weekend. Any urgent cases had to be sent to Adelaide and travel to the Lyell McEwin. That is the state of country health services at the moment.

If we look across at Waikerie, they have currently had their birthing services closed. The government and the minister are saying that this is a temporary closure of those services, but it looks like this is becoming a permanent closure of those services at Waikerie, so mothers in the Waikerie region are having to travel a lot further to get the care that they need.

If we look down at the South-East in terms of what has been happening with the ongoing saga at the Keith hospital, this is a perfect example where the governance arrangements have been used by this government to ping-pong issues across the board, to not resolve things, and to use local hospital networks as a blame game not to do things.

This government clearly made very significant promises to the Keith community in regard to the Keith private hospital, which has always of course provided public inpatient services. The Keith hospital board jumped through every possible hoop the government set in terms of getting consultants' reports, getting work done and putting up a business case for a not insubstantial amount of money in the end that was being proposed, and the government failed to address that and failed to enact that for the first almost three years that they have been in office.

Only now, under public pressure, have they been forced to provide some longer-term funding to the Keith hospital. I was down at Keith late last year, along with the member for MacKillop, and there was a lot of public anger. This is a community that overwhelmingly voted for the Liberal Party, overwhelmingly believed the promises the Premier was making—but they are not being delivered. The excuse given was, 'Oh, well, we have to wait for the Limestone Coast hospital network board to consider this.'

This gets back to the problem we talked about yesterday. The boards do not set their own budgets, so while this problem was being parked with the Limestone Coast local hospital network board, they did not have the budget to be able to say yes to it without an additional amount of funding being given by the state government. It was a real buck pass between levels of authority within this governance system, when really it was the responsibility of the minister and the Premier to make sure that sufficient funding was being given so they could deliver the promise made to the community.

The only other alternative would be that the Limestone Coast local hospital network would have to cut funding from somewhere else in the health budget. We know that they have been seeing a significant increase in the number of cases, particularly at the Mount Gambier hospital, so there is no fat to cut there; they would have to close or cut some other service within the health network to provide for the Keith community, to provide what the Premier promised at the last election. Clearly that was not going to happen.

Eventually, it took public pressure to force the government to provide some additional funding for that to happen. However, once again it shows the government finger-pointing down to the local board as an excuse for not taking action on an issue.

Also in the South-East, we have had huge issues at the Mount Gambier hospital. The staff there are under tremendous pressure, in particular in terms of mental health cases at the hospital, and we know there has not been sufficient support put in place to address those concerns. That has been raised time and time again with very little action happening. We see the occasional ribbon-cutting, but we do not see sufficient staff to help with those potentially violent incidents that are happening at that hospital.

From the South-East right across to the West Coast, there are very significant issues occurring in terms of our country health services, and you only have to look a bit closer to home in the Speaker's electorate in Strathalbyn. The government made a decision—which I think was unprecedented, if you look around other states—to close a huge number of emergency departments in the COVID period, saying, 'We've got these emergency departments and there is aged care here. We can't have them both open because there is an infection risk to aged care, so we are going to close the emergency departments.'

I believe that all-up nine emergency departments were closed from March or April last year. The vast majority of those have now opened, but we still have some that remain closed. Inexplicably, we have the ability for aged-care residents to, hopefully, all be vaccinated by now this long into the rollout, but the Strathalbyn emergency department is still closed. We have the ability for 50,000 people to go to the football, but we do not have the ability to open the Strathalbyn emergency department.

This is not about the design of these departments but more about the funding and staffing arrangements. You could see there was great inconsistency; some emergency departments that were combined with aged-care facilities stayed open throughout the entire pandemic, no problems whatsoever, but some were closed. They have kept the Strathalbyn one closed and, once again, this is now in the ballpark of the buck-passing between the government and the local hospital network.

When the minister is asked about this, he says, 'These are questions for the local hospital network board to consider.' Never before in the history of this parliament would we have accepted that the closure of an emergency department is not the decision and responsibility of the minister, yet here we have the town of Strathalbyn with its emergency department closed and the minister is not even able to make a commitment but tries to make it appear it is not even his decision as to whether that reopens or stays closed in the immediate future.

We know that this theme connects with the ramping issue that we talked about yesterday, where we see significant cases that occur in Strathalbyn. There is a shortage of ambulances in the Fleurieu region and there is now no local hospital emergency department for people to be able to go to. That increases the pressure on the ambulance service.

We now know that people wait outside the ambulance station garage for treatment because that is the only place to go in Strathalbyn if you want to get treated. You wait for the volunteer ambulance officers to come and take you somewhere else—that is what the medical treatment in Strathalbyn has come to right now under this government and these governance arrangements that they have put in place. It is absolutely out of touch with what was promised before the last election. It is out of touch with what the community expects and hopes for in their services.

Sadly, we have seen people dying in the Strathalbyn community who have not been able to get the care that they appropriately need. We also see huge pressure across other hospitals and I mentioned some. The ANMF has been undertaking a tour and in the last couple of weeks they have put out a statement, 'Country nurses and midwives squeezed beyond limit', in which they state:

Nurses and midwives across country SA are being squeezed beyond their limits and are fearful about the dangers this presents to the people in their care and their colleagues.

'…nurses and midwives in the country are beside themselves with fear and concern for the welfare of their patients due to the safety and security risks they face daily.

Nurses and midwives from country hospitals including Berri, Barmera, Waikerie, Strathalbyn, Victor Harbor and Murray Bridge have spoken to me, frequently in tears because every day they go to work they are not sure what they may face. Everyone deserves to be able to go to work not fearing for their safety.'

Consistently working short staffed and double shifts, with unpaid overtime, is taking its toll.

Nurses have been raising their concerns with local management and in many cases the Local Health Network (LHN) CEOs on these issues for months, yet little to no improvement is being experienced.

'The time for platitudes is over. It is now time for the LHN CEOs and the Minister for Health to step up and act.'

Services have changed in the regions with significant increases in Emergency Department activity and other practice changes that are not being adequately recognised and staffed. In those instances where the need for additional staff is recognised, there are simply no additional staff to draw from. The regular workforce is then asked to work longer and harder.

Elizabeth Dabars, the Secretary/CEO of the Australian Nursing and Midwifery Federation, said:

Nurses and midwives are operating on empty. All their goodwill has been used up. They are exhausted.

So we see that this is not located in just a small number of country areas. People are now at breaking point across a whole range of country communities and country hospitals. As was referenced, concerns are being raised with the local hospital network CEO and board and nothing is happening. The minister pushes all these issues back to them and it becomes a blame game with nothing resolved, except for the fact that the situation is getting worse. Staff are burnt out and are leaving and the last thing we need in regional areas is to lose more good staff in our hospital system that we desperately need.

Workforce issues in country South Australia are some of the most critical issues that the health system faces. We are losing staff in droves, particularly at the moment due to the mismanagement of contractual relationships between doctors and local hospital networks and SA Health. We are losing GPs working in our hospitals and we are now having to fly in and fly out many more locums to the point where these locums are being paid sometimes thousands of dollars a day, which is a completely unsustainable situation.

We need to work with our GPs, we need to work with our nurses and we need to be training and developing the next generation of staff in our regional hospitals, but this government has no plan to do that, is running on empty and is pushing the responsibility down to local hospital networks, which clearly do not have the resources and the budget to be able to fix it. It is extremely disappointing.

Only the other day I was at Victor Harbor, and I was invited there by the southern progress group from the Fleurieu Peninsula who are based in Victor Harbor. This is a women's group who meet to discuss issues of prominence for their community. An issue which has been raised time and time again in their community is the issue of palliative care services. They have all experienced issues in terms of a lack of palliative care services in that community in Victor Harbor.

Everybody knows the demographics of that area. We have a growing population and a significant elderly population in Victor Harbor, yet we have a very small number of people working in palliative care in that region. There are a couple of nurses, who I think are doing an incredible job who are clearly at the end of their tether in terms of providing in-home palliative care services. At the same time, we do not have any inpatient palliative care services in that region whatsoever.

It is very clear that in other areas in country South Australia where there is low inpatient demand, it is possible to care for people in an inpatient palliative care setting where that is required because there are the staff, the beds and the facilities available to do that, but not in Victor Harbor. Their hospital is under the pump, and demand is growing due to the growing demographics and there is no plan from the government to improve those services.

I am sad to say I was the only member of parliament who was there on that occasion. The local member of parliament, the member for Finniss, sent a member of his staff to attend but was not there in person to hear an outpouring from well over 100 people who attended this meeting of the concerns that they have in relation to palliative care. I heard some really heart-wrenching stories. It was a shame that there were no other members of parliament there to hear these concerns, particularly as we will be talking about issues relating to end-of-life care in the coming weeks.

Clearly there is an issue. Usually, we try to get more people cared for in the home, but the lack of available support in Victor Harbor means that almost everybody is only being cared for in the home but they do not have enough support because there is only a limited number of nurses. Therefore, family members are taking on an outrageous amount of burden that they cannot cope with and they have nowhere else to turn for help.

The local hospital network board was not listening. We have a very odd-shaped local hospital network area that covers that. As I said, they include this massive bureaucracy that used to be in Country Health SA. They go all the way from the Barossa to Kangaroo Island. Kangaroo Island is always a bit miffed that they are not even in the name of this local hospital network board yet they are included in the area.

We did not have representatives from the board there to hear people's concerns about this issue but, even if they were, clearly they cannot address it unless they get the funding from the government to do so. They cannot address it unless Stephen Wade and the Premier make decisions to ensure that the local hospital network has sufficient funds to meet the service demands in that area. That is absolutely not what is happening, particularly in country hospitals at the moment.

I have focused a lot on what is happening in terms of emergency department care across South Australia, but the other key way that people interact with the health system is in relation to elective surgery and outpatients. This is an area that is massively suffering at the moment and it is further exacerbated by the issues that we see through the governance arrangements that the government is putting in place.

We have again this crunch that is happening where staff are being told, 'You have to meet criteria for getting your elective surgery patients done, but we are going to give you less budget to do it.' The buck is passed to the local hospital network boards, which are given this impossible task to do, and we are now seeing the results from that in that we have growing overdue elective surgery waiting lists.

In September-October last year, the Minister for Health triumphantly announced that they had addressed the long waits since COVID and they had reduced the waiting list right down for overdue patients. Unfortunately, almost as soon he announced that, it started to go back up again. Since then, we have had increase after increase in the number of overdue patients.

There are well over 2,000 overdue patients right now. I believe it is something in the order of 2,200 or 2,300 overdue elective surgery patients. These are patients who have been waiting sometimes many years, when you add up all the different steps in the process that they have had to wait to get the care they need. Many of them are in excruciating pain while they are waiting.

Unfortunately, we are now in a situation where we have buck-passing as to who is to blame. The local hospital networks clearly do not have the budget to address it, and these patients are suffering. In addition, we also know that there is an issue in terms of outpatient appointments. Outpatients, of course, generally need to be seen before they get onto the waiting list in the first place. So you have a waiting list to get onto the outpatient list, and then you have a waiting list from there to get onto the surgery list.

The government's response to growing outpatient lists has not been to increase the number of outpatient appointments. What they are doing is trying to kick people off the list to start with. They have a process underway by which they are screening people off, sending them back to their GPs and telling their GPs, 'You've got to reassess them before we put them back on the list.' For example, if I am a patient who needs a significant hip operation and a GP has recognised that need and put me on the list, say, two years ago to see a surgeon for an outpatient appointment, as this appointment is coming up, they are saying, 'Go back to the GP and check.' What the health minister said was, 'Some people might just need physio.' I think that is an insult to the assessment that was made originally by GPs—that GPs would be putting people on these lists who need physio rather than operations.

But you also cannot make that assessment properly unless you have actually seen the patient and the surgeon has properly diagnosed that patient. Sadly, what is going to happen through this process is that people are going to get lost off the list entirely. There will be a miscommunication. The letter will not get to the GP, an appointment will not be made and then in a year or two years' time the patient is going to say, 'What happened to my appointment?', and they are going to be told, 'You got pushed back to your GP. Sorry, weren't you told about this?' It is entirely predictable what is going to happen. But the good thing is that the government will then spin it and say, 'Oh, look, we've reduced the waiting list,' but they have not actually reduced it by caring for more people; they have reduced it by kicking more people off.

That is only going to worsen people's situations. That is only going to lead to more pressure inevitably on our emergency departments when people do not get the care that they need and their situation worsens. Ultimately, they might make the figures look good through cutting people off the list, but that will not ultimately address the situation.

Another thing the government has been trying is a privatisation by stealth of elective surgery, where they have signed contracts with private hospitals all around Adelaide to take public patients off the waiting list. There are, of course, some benefits for some patients out of this, but there are some significant drawbacks as well. If you have a health system where not just patient care is provided but also teaching for the next generation and also research, this diminishes the role of public hospitals to send those patients out. It is more difficult to teach the next generation, particularly if you are sending all the easier cases out to the private system, which does not provide that teaching of the next generation there.

Another significant concern that has been raised with us by surgeons is that there is not the continuity of care that you would ordinarily expect within the public health system. Normally, you would expect a surgeon to be responsible for the patient, to be responsible for their follow-up care, to know what has happened, to know how the operation went, to know what they need to do afterwards to make sure that they are looking after themselves. But here we have the situation where patients are just being farmed off. They get the operation, they are sent back and then surgeons are none the wiser as to how the operation went and what follow-up care needs to be provided.

Once again, that risks patients being lost in the system. Once again, that risks further increased pressure down the track where patients inevitably might end up in a worse situation than if they had been properly followed up. That might mean that they end up back in emergency departments needing follow-up care. Once again this is something which sounds good but has significant long-term problems.

Clearly even doing that is not addressing the issue, because we are now seeing those waiting lists go up, and the overdue lists go up as well. The total waiting list now is of the order of 20,000 people who are waiting to get an elective surgery operation, which is a significant number of South Australians who are waiting in pain for something they need.

This is another area where those service level agreements between the local hospital network and the chief executive can now be vetoed by the minister under this legislation, which is going to have a detrimental impact if insufficient budget is being provided. However, in terms of responsibility of the local hospital networks, they are being told, 'You just go and fix it.' They cannot do it if they do not get the budget that they need to do so.

We have also seen further savings being pushed down to local hospital networks in the form of hotel services. 'Hotel services' sounds like staying in the Hyatt or something, but this is actually about the food services people need when they are in hospital, and it is about the cleaning services that they need to clean their rooms, so they are quite essential to the running of a hospital.

In the government's first budget they put in place budget savings that had to be applied across local hospital networks for hotel services. They basically said, 'We are going to cut the amount of funding that we provide you to deliver food, to deliver cleaning.' What we have seen in those hospitals that have had that applied to them, which include the Flinders Medical Centre and the Lyell McEwin, is a deterioration in the service being provided to patients.

We have seen a deterioration in food. We have seen case after case at the Flinders Medical Centre of the most disgusting, the most vile, putrid food that you probably would not even feed to your dog. That food has been photographed by patients and sent out to the media because they are so disgusted with what they are being given. Nobody expects silver star service when they are in a public hospital in terms of the food. We all know the jokes about hospital food, but I think people expect that it should be edible, that it should have a level of nutrition to make sure that people can get better and get well. We do not want to have a situation where we are giving people something that is absolutely disgraceful because we are trying to make budget savings.

At the same time that is happening we are now seeing the government waging a war. They are not content with just their war with paramedics; they have a war with the lowest paid workers in our healthcare system: the cleaners, the people who work in food production, orderlies and people who do surgical assistance. These are the people who, behind the scenes, keep the healthcare system running. These are healthcare heroes.

We have all been talking up over the past 18 months how people like cleaners are heroes, people who had no choice but to turn up to work throughout the whole pandemic. Now this government's response is to wage a war with them industrially, because they want to pull out of their agreement all the protections around their employment, and they want to pull out from their agreement protections against privatisation of their work company.

Very clearly there is an agenda in place. The Treasurer, the Hon. Rob Lucas, has been asked about this, and he said essentially that he wanted to keep those options open. What we see is a movement towards privatisation of those essential workers in our healthcare system we have been lauding as heroes. You cannot on one hand say how great our hospital cleaners are and they are heroes and on the other say, 'We're going to pull out your industrial conditions and we're going to threaten you with privatisation of your jobs.' It is absolutely disgraceful. It is yet another example of this government's rhetoric not meeting their actions and being anti essential workers in this state.

These people are essential. They keep our hospitals running. Without them, our hospitals would fail to operate, yet this is another example of what is happening here in the system where again the local hospital networks cop the blame for what is being run, how things are operating. Once again it is decisions being made by the cabinet, by the Premier, by the Treasurer and by the health minister, the Hon. Stephen Wade, about how they are embarking upon cuts to frontline hotel cleaning services and food services, or potential privatisation of those services and cutting the employees’ conditions, which are being sent down to the local hospital networks because the legislation says that the chief executive is the employer.

Clearly, the responsibility still sits at the central level for that, but the blame they try to seek goes to the local level. When there is an issue where Flinders Medical Centre food has been disgraceful, they do not send out Stephen Wade or Rob Lucas to defend that; they wheel out somebody from the hospital to try to defend that. We had a woman who ingested glass in her food at Lyell McEwin Hospital, which was a disgraceful impact there of the cuts we have seen, but it was not Stephen Wade or Rob Lucas going out to defend it; it was somebody from the hospital being wheeled out to defend it. The blame sits at the local level, but the responsibility for these decisions sits centrally at the cabinet level.

This is only one area where this government is threatening privatisation. Remember, they had a promise and a commitment that they were not going to have privatisation of our healthcare system, that they were not going to have a privatisation agenda whatsoever, but we have also seen a significant threat made around SA Pathology, which was only stopped once we were significantly into the pandemic, when they withdrew their threat to privatise SA Pathology. Before the pandemic people probably did not know what SA Pathology was; now we see how essential it is.

All those warnings were there beforehand, that if you privatise SA Pathology it would weaken our ability to deal with a potential pandemic. They were content with proceeding down a path where they were considering privatising SA Pathology, which would have left us in a perilous state, relying no doubt on interstate services rather than having that sovereign capability here in South Australia. Thankfully, that is off the table for now, but I do not think any of us can believe that it is properly off the table for the future.

We also saw in the first budget a threat to privatise patient transport at Modbury Hospital. I think that is on the backburner at the moment, but clearly patient transport is another area where this government has been looking at the potential to privatise. Once again, this is a decision made at a central level and people at the local level cop the blame for it.

We know the minister held a meeting with private ambulance providers, where there was discussion as to whether there would be further outsourcing of patient transport, and I think that is another area we should be significantly concerned about in relation to our ambulance service going forward, particularly where we know that a lot of those people who provide patient transport through our ambulance service also then have the ability to respond to emergencies when we have significant demand. If you are privatising out the easy bits to private companies, you are not only threatening the quality of that service but also leaving us open in terms of emergencies, having that additional capacity there when you absolutely need it for significant major emergency events, which sadly we are seeing all the time now with the crisis in the healthcare system.

We are also seeing this privatisation happening in another area, which is a bit of a shadow governance arrangement happening here as well—not in this legislation, but an organisation the government has set up as an adjunct office to the health portfolio is this body called Wellbeing SA, which was originally intended to be about preventative health care but has morphed into a body that now seems to be focused on outsourcing in-home hospital services. That is the largest thing they appear to be doing.

Nowhere in this legislation is the governance for that body put in place, but we are seeing a shift from the local hospital networks. Once again they cop all the blame for how things go in their local areas, but they are now being told, 'You have to use this central service that we are setting up for Hospital in the Home, which is not being run by the government. We have now contracted this out to Medibank and to Calvary to provide this service in people's homes.' All our local hospital networks, particularly the city ones, provide Hospital in the Home already. There are fantastic nurses, in particular, who provide those services.

The government did not say, 'We want to expand the great work that you are doing already.' In fact, you only need to look at the work that I think the Central Adelaide Local Health Network's Hospital in the Home program did during the pandemic in supporting many people who had COVID-19 in their home rather than having to go to hospital. We are not expanding that; we are replacing it with a new private model, run by Calvary and Medibank, who are going to do that for you.

I think what we fear, and what the people who work in our health system fear, is a gradual erosion of the work that is being done out of hospital by our local hospital network boards, its being moved into Wellbeing SA and privatised through Wellbeing SA in the community. This is a significant concern. Every time the government looks at additional service offerings, it seems to be a 'private first' mentality.

Nothing sums that up more than what happened with the Urgent Mental Health Care Centre recently. The government got funding from the commonwealth government to set up the Urgent Mental Health Care Centre in South Australia, and that is great. It is fantastic that we got that funding from the commonwealth government. I hope we get more funding from the commonwealth government to do similar things in the future.

The government was then faced with a choice. The natural choice would be: let's set this service up; let's connect it to our hospitals and the rest of our healthcare system. The government made a choice to put it out for tender and to make the public sector compete with the private sector to deliver it, which I think is a very unusual proposition for new service offerings. The government then weighed up two offerings, one from the Central Adelaide Local Health Network, our public healthcare service, and another from a consortium of a local NGO and an American company that does not have a presence in Australia.

Despite the fact that the public option included more services, more hours of operation and more clinicians and clearly had a better connection and had worked through the model with our local clinicians already in the healthcare service, they decided to go with the private model instead. So now we have a private model which, from all reports, has seen a very small number of patients, has very limited opening hours of operation and is very disconnected from the rest of our healthcare system. I hope that it works well. I hope that it works better than we have seen so far.

However, it is clearly a decision by this government, at the central level, that they are going to make the decision to go private first. Once again, we have a difference between this legislation, which is supposedly about the devolution of decision-making authority to the local level, and the decision we have here to contract it out and then pick a private provider who is going to give the people of South Australia fewer services, fewer staff and fewer opening hours.

The people who will get the blame at the end of the day for the people stuck in an emergency department when we have this centre empty—of course, it will not be Stephen Wade; he is not going to put up his hand and cop the blame—will be the local hospital network, who missed out on the tender and who probably should just have been given the money to set this up anyway, without having to go to tender at all. The government will blame them for not caring enough for the people in their hospital, even though it is a decision that has been made centrally by the government, by the minister and by the department that has put them in this situation because of their preference to go private first in terms of the way that they are operating.

This is a healthcare system that is under significant pressure. This is a healthcare system that is facing pressures like we have never seen before, yet we do not have flu cases. Thankfully, due to the good work of Professor Spurrier and the people of South Australia, we do not have COVID cases. If we were to have flu cases and COVID cases, heaven forbid the situation we would be in.

What we absolutely need to do now is make sure that we run a significant vaccine rollout program to get people vaccinated to make sure that we are protected, because eventually we will open our borders and we do not want to be in a situation where we have significant COVID cases coming into our emergency departments and putting additional pressure on the already overburdened emergency departments.

Clearly, though, we have seen a slow vaccine rollout and a vaccine rollout that has been slower than other states. There are eight jurisdictions in this country and we are currently, I believe, sixth on the tally out of those eight jurisdictions. That is not good enough. We need to lift our performance here in South Australia.

This is yet another area where the governance arrangements that the government has put in place have made it clear that they are buck-passing between the local hospital networks and the central decision-making. We have a situation where the central decision-making is pushing all those responsibilities down to the local hospital network. Victoria has recently overtaken us on the per capita state government rollout and has now set up 28 vaccination clinics across the state. In 17 of those clinics you can walk in without an appointment. In South Australia, we have one.

What the government has basically said is, 'We are going to make the local hospital networks do the vaccine rollouts themselves.' So the local hospital networks have now had to scramble to set up clinics and we have seen one set up centrally by the Central Adelaide Local Health Network. Another two have been promised, in the northern suburbs and the southern suburbs, that are meant to be set up by the Northern Adelaide Local Health Network and the Southern Adelaide Local Health Network, but those buildings are currently sitting empty right now.

I do not know the reasoning behind that. Is it because they have not been given enough funding for the local hospital networks to set them up? Is it because they were given notice too late by the state government to set up those clinics? Clearly, we have the supply. The latest commonwealth report shows that we have 56,000 doses sitting in fridges in South Australia. We want those in the arms of South Australians; we do not want them sitting in fridges. A vaccine sitting in a fridge provides no benefit to the community whatsoever; they need to be in people's arms to protect our community.

Clearly, we have the supply, but we do not have the ability to deliver that supply. We have one centre opened in the city under Central Adelaide Local Health Network that has the ability, apparently, to deliver 3,600 doses per week. We have 56,000 doses sitting in fridges. We have a lot more supply than the capability to actually deliver those vaccines. South Australians have been very keen to be vaccinated to the point where, earlier this week when there was another media presentation about this, it was revealed that the earliest appointments for vaccines being offered were all the way out to August.

More needs to be done, but I fear this is another situation where the governance arrangements and the buck-passing between Hindmarsh Square and the local hospital networks is letting us down in terms of getting on with this program. There is no reason why we could not be setting up these sites now and getting them up and operational. Clearly, there is some stumbling block in between the governance arrangements that is making that happen. Why has there not been central leadership in terms of doing this?

We know that the governance of the vaccine program is being led by the Deputy Chief Executive of the Department for Health and Wellbeing, Mr Don Frater, who is also the chair of the task group, but obviously there is a communication breakdown between that group and what is going on at the local hospital network level to get that up and operational. People want to get vaccinated; we just do not have the ability for that to happen.

Sadly, I fear this is another example of the buck-passing that is happening between the local hospital network boards and the state government under their devolution model, where the minister is happy to be there when it is good news, but if it is bad news, somebody from Central Adelaide Local Health Network, as we saw earlier this week, has to go on the radio and defend what is going on in terms of the slow rollout. The local hospital networks have to go in, step up and defend the situation. Clearly, that is an emerging issue but it is all connected to this governance arrangement that we are talking about in relation to this legislation.

One amendment in this legislation, which we are thankful for, happened in the upper house. It was the government's original intention to remove completely the Health Performance Council from operation in this state. This is a body which has overseen the performance of our healthcare system, not just hospitals but broadly in terms of our performance when looking after people in this state. Over the past two years, while this legislation has been floating around this parliament, the government have been trying to abolish the Health Performance Council, which is one of the few potential oversight bodies of the delivery of health care and, I believe, has had a good record.

That is not to say that it could not be improved, but it has a good record in terms of looking at the broader questions about delivery of health care and the health of the population generally. I believe it was set up back in 2008 and it was particularly meant to be a body that would report after elections, so the minister had the ability to say, 'Here's the expert advice on what we should be doing to make sure that we can improve our system,' and to look at some of those bigger questions that get missed in the day-to-day running of the healthcare system, which is obviously a very complex thing to do. Why would the government seek to abolish that?

Now that they have finally agreed that they will not abolish it, because they could not get it through the upper house without it being taken out, we have seen some very dangerous steps being taken, firstly that they have significantly weakened the number of people on the Health Performance Council. They have pushed a number of people off the Health Performance Council and they have reduced the number of people on the council. There is a larger percentage now of public servants on the Health Performance Council, so you have less independence in the running of it, and they pushed out the person who was providing the governance support to it. What is it that has particularly grieved them to take that action against this body?

One area might be that they are particularly aggrieved that a few months ago a report was raised around the treatment of Aboriginal people in the healthcare system. We understand it did not sit well with people in SA Health, that somebody dared to say that there was institutional racism in our healthcare system. Maybe that is one of the reasons why the Health Performance Council has been punished by reducing its numbers and kicking out executive staff. Originally, there was a threat to abolish it, but it seems now the intent is to significantly weaken it.

This ties in with the fact that this government has had an issue with other avenues of oversight of our healthcare system, one of which is that we have had a body since 2002 that represented consumers in our healthcare system. Consumers generally have been one of the few areas where there is not a voice. There is always a voice for our workers. We have very strong representative bodies for all the different professions in our healthcare system, but the patients, the consumers, the people who need care, quite often do not have that same level of representation.

So the Health Consumers Alliance was established. Obviously, it had to get seed funding from the state government to establish itself on an ongoing basis because you are not going to charge every hospital patient to set up that sort of body. Over a significant period of time, it has represented consumers in the healthcare system. This government, leaving their first budget, made the decision to completely scrap the funding for the Health Consumers Alliance. That has now led to that body being completely abolished and our state being the only healthcare system in the whole country that does not have a representative body for health consumers. Every other state has a body that independently speaks up for patients and consumers, except now here in South Australia under this government.

One of the critical amendments that I believe this parliament should consider when we get to the committee stage is to make sure a requirement is put in place upon the government to put in place an independent body that they support to provide representation and support for consumers in the healthcare system, essentially what was happening for the past 20 years prior to this government abolishing it.

That body would be independent, but it needs to be supported by government funding, otherwise it is absolutely not going to happen. Consumers are not going to pay hundreds or thousands of dollars a year in membership fees to be part of a body representing them, particularly when the healthcare system represents the people who have the least amount of money in our system. People who have more money go privately to get their operations. These are people who are largely low-income earners or pensioners, people who need support, and they are the ones who are missing out. They are the ones who needed that voice of Health Consumers Alliance. That is a very significant issue that we have been pursuing.

I think there are a few other important issues, one of which I have touched on. In terms of the disclosure of members' personal pecuniary interests, that needs to be further addressed in the legislation. One of the issues that we raised when the legislation was originally being put in place was: what if these people who are on these boards have conflicts of interest with other roles that they have?

Obviously, if you are getting senior people with significant director's experience to be on these boards, particularly the city ones, which are dealing sometimes in billions of dollars of funding, you need to be very careful about how that process works and the conflicts of interest. This was of course an issue raised in the ICAC report, Troubling Ambiguity, which I mentioned yesterday, which said that conflict of interest was one of the areas of concern that they had about the running of the healthcare system.

The government agreed, and we got an amendment passed that said that there would be a disclosure and a register taken of members' interests. It was not quite what I believe we originally asked for, which would have been similar to what members of parliament have to do, but we have agreed to something. The trouble is that since that was put in place we have tried to provide some oversight and get access to these, and they are completely inaccessible. We are being told by local hospital networks, 'We can't send you a copy. You have to physically visit our offices. We will physically let you look at it, but you're not allowed to take notes or take photographs of it, or take a photocopy of it, and then you have to leave.'

What sort of level of oversight is that? It is like looking at some sort of secret CIA paper, where you have to put gloves on or the like. This is an absolutely ridiculous process. What we are arguing is that there should be public disclosure of these logs of pecuniary interests, to make sure that the public has the right to see the conflicts of interest that people have in the decision-making, particularly when we are dealing with many millions of dollars in the decisions that these boards are making about people's health care.

People, quite rightly, would have other interests that they might be a part of, and I think the public has a right to see those decisions. These board members are paid a significant amount of money by the taxpayers of the state. I believe the chairs are paid in the order of $90,000 a year. That is a significant amount of money, and I think that the public deserves some level of oversight for their decision-making and their pecuniary interests.

That is another amendment that we will be seeking to reintroduce, along with, as I mentioned yesterday, scrapping that loosening of the eligibility requirements for board members, which is a connected issue in making sure that we do not have issues in terms of conflict of interest arrangements over these significant board decisions.

I think it is also really important that we have transparency over governing board disputes. Clearly, one of those issues has to be in relation to where there is a decision by the minister to intervene in relation to the service level agreement dispute between the chief executive and the local hospital network, which we know is not an abstract possibility, because that is exactly what has been happening over the past two years. The minister is now seeking for parliament to give him a right to intervene and to override the disputes being raised by the local hospital network. I think the least that we can do is make sure that the public has a right to know that information and what the minister has overruled as part of that discussion. I seek leave to continue my remarks.

Leave granted; debate adjourned.

Sitting suspended from 12:59 to 14:00.