Health Care (Governance) Amendment Bill

Committee Stage

In committee.

(Continued from 13 May 2021.)

Clause 9.

The ACTING CHAIR (Mr Cowdrey): Member for Kaurna, you have asked three questions. We have also had a contribution from the member for Narungga, so the committee was putting that clause 9 stand as printed.

Clause passed.

New clause 9A.

Mr PICTON: I move:

Amendment No 4 [Picton–1]—

Page 6, after line 39—After clause 9 insert

9A—Amendment of section 33D—Disclosure of pecuniary or personal interest

Section 33D(8)(b)—delete 'reasonably available for inspection by any person' and substitute:

made available for inspection on a website accessible to the public and reasonably available for inspection in hard copy by any person

This is an important amendment for providing proper disclosure of pecuniary and personal interests. Firstly, let's make very clear the fact that these health boards are presiding over, in some cases, billions of dollars of health expenditure, of taxpayers' expenditure. It is important that the public, the media and our health professionals have a clear line of sight as to whether there are any potential conflicts of interest that may arise, bearing in mind that this was an area that was significantly raised by the ICAC commissioner in the Troubling Ambiguity report that was handed down into the significant problems in SA Health.

At the moment, the provisions we have in relation to disclosing those are not working, and they are not working for the very simple reason that I think there was an understanding by the parliament when they were originally proposed that these would be readily available from the individual hospital sites. What we have since found is that those health sites are denying access to those documents and they are doing so in a number of ways.

If there is a phone call or a request made to a hospital or an LHN, an incorporated hospital under the act, to view these documents or these registers you are told, 'You have to come in. You are only allowed to view them. You are not allowed to take any notes or pictures. You are not allowed to take any copies of them, and then we will take them back and hide them away again.' That is no proper transparency over what is going on. Certainly, it does not help somebody who is living in one part of the state to find out what is going on in another part of the state, where a significant amount of travel distance would be required.

Even if you are in your own health network and you want to find out what is going on in terms of the Eyre and western health network and you live in Ceduna, the head office is, off the top of my head, in Port Lincoln and you would have to travel a significant distance. You could only view them; you could not take any notes, you could not take any pictures, you could not take any copies. That is not transparent at all, so what we are proposing is that they be made reasonably available for inspection by any person and that the paragraph be replaced by:

…made available for inspection on a website accessible to the public and reasonably available for inspection in hard copy by any person.

There is no reason why these cannot be made available on a website for people to see. The only reason that the government would oppose that provision is if they did not want people to see exactly what the conflicts were in relation to these very important boards that have carriage of billions of dollars of taxpayers' expenditure.

The Hon. J.A.W. GARDNER: I thank the member for Kaurna for the contribution. The government does not support the amendment. Under the current provisions of the act, any disclosures of personal or pecuniary interests are required to be recorded in the minutes of meetings, which are subsequently already required to be published on the internet. The board is also required to record those disclosures in a register, which is to be available for inspection by the public.

The public is free to access and peruse the minutes of governing board meetings at any time from the board's internet page. Our LHN governing boards have the most extensive disclosure and conflict of interest requirements in the state, far exceeding those requirements for the other South Australian government boards, including SA Water, the Essential Services Commission and the Super SA board. For example, the Essential Services Commission is subject to conflict provisions within its own legislation, which does not require the commission to maintain a register nor publicly report conflicts.

Provisions for the State Procurement Board defer to the requirements of the Public Sector (Honesty and Accountability) Act. This act does not require the board to maintain a register nor publicly disclose member conflicts. The TAFE SA and SA Water boards are subject to the disclosure provisions in the Public Corporations Act 1993, which also does not require these boards to maintain a register. I humbly submit that the government would urge members to vote against this amendment.

Mr PICTON: A predictable rejection from this government, in terms of providing transparency for its own operations, that we have become accustomed to over the past three years. I would be interested if the minister could provide his explanation to the committee in terms of what he believes the interpretation should currently be of what the law says in terms of 'reasonably available for inspection by any person'. Does that mean people should be able to be sent a copy if they ask a hospital board office for them? Should they be able to get a copy of them? Should they be able to take notes if they see them? What is the reasonable availability of them?

What we have seen since this legislation was first passed is I think an outrageous interpretation of that provision. It is like you are seeing a secret document from the CIA or something with the level of transparency being applied here. Could the minister outline what the government's belief is in terms of how that provision should be interpreted: should copies be made available, should reasonable applicability be to provide a copy via email or other electronic means on request?

I think that would alleviate the need for this amendment. If that is not the interpretation, then I think that clearly there is a desire from the government not to actually provide what the law was intended to do, that is, to provide reasonable access.

The Hon. J.A.W. GARDNER: I thank the member for his rhetorical device. The government remains unconvinced by his submission for this amendment to be supported. We would remind the house that what we are offering is indeed a level of accountability that is significant and that exceeds many other equivalent boards.

Mr PICTON: That is very significant, that the minister refuses to provide any detail in terms of how he and the government believe reasonable access should be provided, which I think can only lead to one conclusion: the government will continue to do as they have done so far, which is not to provide reasonable access, whether those decisions have to be appealed to SACAT or the Supreme Court or something to get what the law has already agreed, which is reasonable access to those documents.

The government's interpretation seems to be, 'We will provide reasonable access, but they will be buried in the desert somewhere and you have to go and find them.' That is reasonable access according to the interpretation of this government. The minister is not providing any definition of what he believes should be provided at the moment. I think that would be helpful to do because then there would be guidance for local health networks in terms of what they should have to do.

In the absence of that, I think the parliament should make it clearer in terms of exactly what is being described here so that they should be available on the website. There is no reason why they could not be available on the website. Each one of us has our conflicts of interest available on a public website for people to see. Each one of us has what our conflicts are totally transparently available for people. Why should people who are on boards who are paid up to $90,000 a year not have the same transparency when they are looking after billions of dollars of health expenditure?

It is totally unreasonable for the government to oppose this clause and to oppose that transparency being applied to the so-called transparent provisions, particularly when the minister points to the board minutes which, as I understand it—and feel free to correct me if I am wrong but I believe that I am not—will only note a conflict if a potential conflict arises in that meeting.

So you may have a whole range of conflicts between your provision on the health services board of a particular local health network and what that board network does, but they will only appear in the minutes of that meeting if they revolve around what was actually discussed on that particular day in that particular meeting. It is a complete fallacy to say that there is some transparency of these matters through just reading the board papers. There is not.

The only way to provide transparency is to reveal the register, which the government is refusing to do across its local hospital networks at the moment. I hope the parliament will see the importance of providing this level of transparency so that people can get an understanding of whether there are conflicts in place. We know that this is a serious issue that has been raised by none other than the ICAC commissioner and we should make sure that there are not conflicts in place.

The Hon. J.A.W. GARDNER: I have appreciated the three submissions from the member for Kaurna but remain unconvinced and point him to the information that will be made available through the minutes that will be on the website.

Ayes 19

Noes 23

Majority 4

Clause 10 passed.

Clause 11.

Mr PICTON: In relation to this clause regarding employed staff, has the government received any feedback from representative associations of staff about whether this fully covers their concerns in relation to employment arrangements and staff entitlements continuing uninterrupted?

The Hon. J.A.W. GARDNER: I am advised that this part was requested by the ANMF. I understand that the minister received correspondence in support of this clause as it is in the bill.

Mr PICTON: Have representative bodies been consulted on this clause and, if so, what are their positions?

The Hon. J.A.W. GARDNER: I understand that a range of representative bodies, as I imagine the member would expect, have been consulted on the bill. I am not aware of any advice other than that from the ANMF in relation to this clause.

Clause passed.

Clause 12 passed.

Clause 13.

Mr PICTON: This clause seeks to introduce requirements in relation to a healthy workforce culture for and among staff employed to work in the SA Ambulance Service, which is clearly at odds with what we are hearing on a daily basis from paramedics in our system in relation to how burnt out they are, in relation to workforce fatigue, in relation to stress and mental health impacts that they have, and also in relation to the bullying that we saw on the airwaves when staff were told that they might be threatened with ICAC if they spoke out about their concerns, which had to be corrected and admonished by the ICAC commissioner.

What reporting is done by the SA Ambulance Service in relation to the health, safety and wellbeing of their staff? Are statistics kept in relation to the mental health impact on paramedics? What has been the impact of the significantly higher workload and significantly higher ramping that have been experienced? What have we seen in terms of the impact on ReturnToWork claims and other compensation claims that staff have been impacted by?

The Hon. J.A.W. GARDNER: I will take that on notice.

Mr PICTON: If you are going to take it on notice, perhaps the minister can therefore also take on notice how many workers compensation claims have there been over the past five financial years in relation to the SA Ambulance Service, and how many notifications have there been in relation to staff having mental health issues because of their work over the past five financial years as well?

The Hon. J.A.W. GARDNER: I will take that on notice.

Mr PICTON: These objectives that are set sound very good and we are asking the chief executive to put policies in place to promote workplace health, safety and welfare, including bullying and harassment. Of course, you would hope that those were in place already. What is the government proposing to do to monitor how this provision is actually going to be implemented? What change are we likely to see because of this clause being introduced? What happens if the SA Ambulance Service does not meet these new objectives that are being put into the legislation, or is this not going to have a material impact and these are simply some nice words to put in the legislation?

The Hon. J.A.W. GARDNER: If it is in the legislation, then it is the law of the land. The clause inserts an obligation on the SA Ambulance Service to promote a healthy workforce culture and implement measures to provide for and promote psychosocial health and wellbeing in the workplaces for which the SA Ambulance Service is responsible.

This clause inserts an obligation on the SA Ambulance Service so that the culture and wellbeing of the workers within SAAS are a focus of the entity. This is following discussions with Dr Chris Moy, the President of the South Australian branch of the Australian Medical Association, who approached the Minister for Health and Wellbeing to seek his consideration of a similar proposed function of the local health network governing boards.

This government is committed to improving workplace culture and staff wellbeing, as well as stamping out bullying and harassment, which we believe are unacceptable in any circumstance. That is why the government was more than willing to work with Dr Moy to accommodate this request and impose the same standards for the SA Ambulance Service as for LHNs.

Clause passed.

Clauses 14 and 15 passed.

New clause 15A.

Mr PICTON: I move:

Amendment No 5 [Picton–1]—

Page 9, after line 37—After clause 15 insert:

15A—Insertion of section 98A

After section 98 insert:

98A—Consumer Advisory Fund

(1) The Consumer Advisory Fund is established.

(2) The Fund will be kept at Treasury.

(3) The money paid into the Fund will from time to time be applied by the Minister towards or related to a consumer advisory body established or recognised by the Minister.

This clause would establish a fund that should be used to promote consumer representation in South Australia—representation of patients and consumers of the health system. One of the first things that this government did on coming to office was to abolish support for consumers through the consumers health forum we had in South Australia, the Health Consumers Alliance, which had been in place for almost two decades prior and had been representing the rights and interests of patients and consumers in the health system.

We no longer have such a body in South Australia, the Health Consumers Alliance. We are the only state or territory that does not have a body such as a health consumers alliance in place. We are seeing patients impacted on a daily basis with issues across the health system. The fact that the government made it one of their first decisions shows how clearly they want to diminish the voice of consumers and want us to be behind every single other state in not having an independent body that would stand up for them.

This amendment is to stand up for them, to support an independent consumers body that should be provided funding by the government, as it was previously, as it is in every other state and territory. There is absolutely no excuse for why there should not be such a statewide body.

The Hon. J.A.W. GARDNER: I thank the member for putting forward this contribution and this suggestion. The government, however, does not support it. I note that it is a similar suggestion to one we debated in a previous sitting week, and I warn members that my response may therefore have some similarities also to my response on that occasion.

The state government has a strong commitment to consumer and clinician engagement in guiding decisions about the public health system. We recognise that partnering with consumers in the community plays an important role in improving healthcare services. Funding a separate centralised body is not supported by the government. We believe it would result in unnecessary duplication and confusion, given existing statutory mechanisms to ensure consumer engagement within the Health Care Act 2008.

A fundamental principle of devolution to the public health system is to bring clinicians and consumers closer to the decision-making in their local health services to create a truly integrated approach to community engagement for patients, carers, families, consumers and clinicians at the local level to inform service delivery. We do not believe it is appropriate under a devolved governance structure for the department to lead consumer engagement processes relating to local health service delivery, as the department is no longer directly accountable for these services or for determining how they will be delivered.

As I believe I probably pointed out previously, through their existing statutory functions, which commenced on 1 July 2019, those LHN governing boards are responsible for establishing strong relationships with consumers, communities and frontline health professionals, particularly through the development of their clinical engagement strategies and consumer and community engagement strategies.

The newly established Commission on Excellence and Innovation in Health in SA and the Mental Health Commission also play important roles in the engagement of consumers and clinicians. We believe engagement with consumers and clinicians is tremendously important. I encourage the committee to provide the same opposition to this amendment as the earlier very similar one.

New clause negatived.

Clause 16 passed.

Clause 17.

Mr PICTON: In relation to governing boards for the hospitals, how many governing board members have either left or been removed since the enactment of the original legislation two years ago? Perhaps on notice, can the minister provide a list of all those members who have either left or been removed and the dates upon which that occurred?

The Hon. J.A.W. GARDNER: I will take that on notice, to the extent that I will bring back an answer that provides anything that is not already on the public record.

Mr PICTON: In that respect, and I do not believe this should necessarily be taken on notice, have any governing board members been removed, as opposed to having voluntarily left, since the enactment of the legislation? If so, what were the circumstances in which those members were removed by the minister under the act?

The Hon. J.A.W. GARDNER: Not that I am aware of as the Minister for Education representing the Minister for Health in this space. If the Minister for Health has anything to add, then I might suggest that the easiest way to deal with that is to include it in my response to the earlier question I took on notice just before.

Mr PICTON: One further question.

The ACTING CHAIR (Mr Cowdrey): One final question.

Mr PICTON: At any time since the passage of the previous legislation have there been governing boards that have not had the requisite number of members appointed to them; if so, which boards and for which periods of time were there not the requisite number of members according to the legislation?

The Hon. J.A.W. GARDNER: In relation to a health governing board, for example, I am advised that the Yorke and Northern LHN governing board does not currently meet the minimum of six members; however, an appointment to this board is imminent. I am advised that there is one other instance in which a local health network governing board has not met the minimum six members; namely, the CALHN governing board had less—'fewer', as Mr Atkinson would be most insistent—fewer than six members for the two-month period from 3 April 2020 to 29 May 2020, which was the period in between a resignation and a new appointment.

Clause passed.

Remaining clause (18), schedule and title passed.

Bill reported with amendment.

Third Reading

The Hon. J.A.W. GARDNER (Morialta—Minister for Education) (17:07): I move:

That this bill be now read a third time.

Bill read a third time and passed.

Mr PICTON: Mr Acting Speaker, I draw your attention to the state of the house.

A quorum having been formed: