Bills

Inquiry into Palliative Care Bill

Introduction and First Reading

The Hon. A. PICCOLO (Light) (11:28): Obtained leave and introduced a bill for an act to provide for an inquiry into palliative care in South Australia to be conducted by the Health Performance Council, and for other purposes. Read a first time.

Standing Orders Suspension

The Hon. A. PICCOLO (Light) (11:29): I move:

That standing orders be so far suspended as to enable the bill to be taken through all stages without delay.

The SPEAKER: An absolute majority not being present, please ring the bells.

An absolute majority of the whole number of members being present:

The SPEAKER: I accept the motion. Is it seconded?

An honourable member: Yes, sir.

The SPEAKER: Member for Light, do you wish to speak to the suspension?

The Hon. A. PICCOLO: I think the house should support the suspension of standing orders and consider all stages of the bill. I gave notice of this bill some time ago. I circulated the bill on 26 August to all members. I also provided a briefing on 6 September, including the Minister for Health and Wellbeing. It was deferred. It is basically a one clause bill.

Motion carried.

Second Reading

The Hon. A. PICCOLO (Light) (11:32): I move:

That this bill be now read a second time.

The Hon. A. PICCOLO: The aim of the bill is to ensure that South Australians have a world-class palliative care system so people have a real choice in how they wish to be cared for at the end of their life. The bill directs the South Australian Health Performance Council to undertake an inquiry into the South Australian palliative care system and make recommendations on how it can be made better to ensure that all South Australians have equitable access to it. By equitable access, I mean both geographically and financially.

Why the inquiry? The Joint Committee on End of Life Choices, of which I was a member, along with other members here, made the following findings in relation to palliative care. Based on submissions from professionals in the field, a number of consistent themes emerged including, and I quote from the report:

1. Palliative Care is a critical part of our health and wellbeing system although it requires a greater level of funding to ensure that it provides more consistent and equitable access.

2. Any improvements to the Palliative Care system should design services that are appropriate and accessible for people in regional areas, Aboriginal people and those for whom English is not a primary language.

3. A key focus of Palliative Care should be on the dignity of people who are approaching the end of life.

4. There is a general need to improve data collection and reporting on palliative care—including the experiences of patients, their families and loved ones, clinicians and carers.

I have chosen to have the Health Performance Council undertake the review and that is based on feedback given to me during the voluntary assisted dying debate. The Health Performance Council is best placed to undertake the inquiry. There is legislative intent that it undertake such inquiries. I have consulted with the Health Performance Council, and they have indicated to me that the inquiry could be undertaken and also in the time frames I suggested to them. I have been advised that the review will probably take about 12 months to be completed, and they advised that they have the capacity to do that. The functions of the Health Performance Council—to read out the relevant portion—include:

(1) such other functions—

(i) assigned to the HAC under this or any other Act;

This bill is consistent with the act itself. I seek the support of this bill at this time because I want to ensure that, when the voluntary assisted dying legislation comes into effect in about 12 to 18 months' time, our palliative care system is ready to make sure that people have a real choice.

One of the fundamental questions put by people who supported voluntary assisted dying was that people should have a choice at the end of life. Choices have to be real, not just theoretical. For people to have a real choice, we make sure we have a care system that actually provides that. The evidence is—certainly the evidence I have received in support from regional members—that it is patchy across our state, and that is why it is important that we do this now. In 12 months' time, the government of the day will have the recommendation to make sure that when VAD comes into effect we also have a palliative care system ready to respond to that challenge.

The Hon. J.A.W. GARDNER (Morialta—Minister for Education) (11:35): I believe this bill has merit and the government will be supporting it. However, we do anticipate proposing an amendment, and we hope that it will get the support of the proponent—but, if not the proponent, then perhaps the majority of the house—because it is being put forward in absolute good faith. I am sorry that it is only now being circulated.

Apparently, parliamentary counsel is not able to circulate an amendment to a bill that has not yet been introduced but, now that the member has introduced it, it will be doing so. This is one of the things that happens when we move at pace, but this bill certainly is ready to progress. It is a relatively simple bill. I bring to the house's attention the reason that the amendment has not been circulated is only for that reason.

The amendment I will be moving—and I will explain it now, rather than wait until we get to the committee stage, to give members a couple of minutes to reflect—is a very simple amendment in relation to the commencement. The amendment will read:

1A—Commencement:

(1) This Act comes into operation on 1 December 2023.

(2) Section 7(5) of the Acts Interpretation Act 1915 does not apply to this Act or a provision of this Act.

It supports the intent of the bill to have the review, as described and outlined by the member for Light in his second reading contribution, but to postpone that review for a period in the order of a year, or potentially a bit longer, depending on the passage of the legislation in due course. I will briefly set out the reasons why.

The first starting point is that the Health Performance Council (HPC), which the member has identified as being the body that will be suitable to conduct a review, conducted a review of this matter in September 2013 as a midpoint review of the then current 2009-16 Palliative Care Strategy. The Health Performance Council conducted a follow-up review in 2018. Five years later, our proposal would see a further review—five years after that last one. SA Health is currently finalising the new Palliative Care Strategic Framework 2021-26 to guide and prioritise improvements in the quality and availability of palliative care services for all South Australians.

We are very clearly minded to achieve the policy outcome the member for Light is seeking to achieve by means of a review just by actually doing that work. Therefore, the review would have a significant benefit. It would be extremely effective if it were mid-cycle—a midpoint review, therefore, of that new Palliative Care Strategic Framework 2021-26. It would indeed be taking place a year and a half into that work. The member highlighted the relevance of the voluntary assisted dying legislation for why he has moved this, and I certainly understand and appreciate that.

We all know that on 24 June this year the voluntary assisted dying legislation passed the parliament. At that time, it was identified that it would likely take 18 to 24 months to see the regulations drafted, the processes ready and the resources ready to enact it.

Up to 24 months puts us, of course, into 2023. Obviously, the government has identified that if it can be done earlier than that it would be great, but interstate experience certainly suggests that it is going to take a level of time. It should take a certain period of time, because you certainly do not want to cut corners in relation to preparing that body of work.

There will be by then the impacts of the Palliative Care Strategic Framework, which is going to be certainly taking effect before the end of this year, and improvements there, and there is some time before the voluntary assisted dying legislation comes in. We are committed to ensuring that there is a safe accessible scheme as outlined in legislation within the time period outlined. If it is 18 months, then great, but it could well be 24 months from the passage of the legislation.

Demand for palliative care services, I am advised, has been shown to increase in Victoria following the introduction of voluntary assisted dying. In part, this is believed to be due to the increased awareness and promotion of palliative care as a compassionate and meaningful option at the end of life. Therefore, the government's view is that deferring the commencement of the proposed inquiry, which we support, would allow the Health Performance Council to also assess the impact of the introduction of voluntary assisted dying on palliative care in South Australia.

It would not be a long wait between the resolution of the regulations and the beginning of the review, but I believe it would be enough of a period for the review to have extra meaning and value, as well as being mid point in the cycle of the new Palliative Care Strategic Framework.

With that, I indicate my support for the bill and the government's support for the bill. I foreshadow the amendment that I will put in committee stage. I hope the discussion will not detain the parliament for an unduly long time. Members can reflect on their support or otherwise for the amendment for the reasons I have outlined. In any case, the government will support the review with or without the amendment, but I think the amendment would add significant value to the very purpose of the review that the member seeks.

Mr PICTON (Kaurna) (11:41): I rise to speak in relation to the Inquiry into Palliative Care Bill 2021 that has been moved by my friend the member for Light. I note that this is something that he has raised previously in this parliament and it was something where, in different circumstances, we differed on this exact question.

However, to spell out the reasons why I am now very supportive, firstly the original proposition was that this was to be done by the Productivity Commission rather than the Health Performance Council, and the other element was that this was to be done before the voluntary assisted dying legislation would come into effect. Both of these elements have now changed and therefore I am fully in support of the legislation that has been proposed by the member for Light, and I appreciate the parliament working very well unanimously to allow this to be discussed in all stages this morning.

This is something that will have a benefit to looking at what the issues are in palliative care, because there are very real issues happening right now in terms of palliative care. In my role as shadow health minister, I regularly hear from people who cannot get access to the palliative care for their loved ones that they need.

This is particularly true in regional South Australia, and I know that members from the regions will know how difficult it can be for their constituents to get access to palliative care. I can speak, having recently gone to a forum on the Fleurieu at Victor Harbor about the services based in that region. Well over 100, maybe 150, people turned up at a forum about palliative care at Victor Harbor and spoke about some shocking stories in terms of their loved ones' care and not being able to access the care that they needed. Those people who can access that care by and large have a very positive experience. We have amazing palliative care doctors and nurses in this state, but the issue is for those people who cannot access that care.

That is particularly true in regional South Australia. Moving this review is very timely. I think that this is urgent. I completely disagree with the proposition that has been put forward by the government that we should delay this review even starting for over two years. That is completely at odds with the experiences that people are having, and I do not think I could look any of those family members in the eye and say, 'We agree that there's an issue, but we are only going to start looking at it in two years' time.'

This government made a lot of promises about palliative care and they have really failed to deliver significant improvements in palliative care. I believe that the issue has become a lot worse. so this review is very urgent. The Health Performance Council is the right vehicle to do it. I know that the member for Light has had discussions with the chair of the Health Performance Council, Professor Stephen Duckett, who has signalled his support for the inquiry to take place and the timing of the inquiry to take place as well.

I remind members that the government wanted to abolish the Health Performance Council and, through the upper house of parliament, we were able to stop that from happening. This really demonstrates how valuable a mechanism that is to provide independent oversight for our health services in South Australia. This will be important. This will shine a spotlight.

I do not believe that there is necessarily the connection that some would say between voluntary assisted dying and the need for this inquiry. I think that we made very clear in the debate on voluntary assisted dying how that is different from palliative care—and I maintain that position—but I think that there is still a very real need to look into palliative care services and how we can improve them and the accessibility of them for people right across South Australia. I wholeheartedly support this bill.

Mr HUGHES (Giles) (11:46): I think this is a very important bill and one that has my full support. Reference has been made to the very patchy nature of the quality of palliative care available in regional South Australia, and I would imagine that even in the metropolitan area some places are better than others as well. I have, unfortunately, had some insight into this area having had some of my family members pass away. I know that high-quality palliative care does make a real difference.

My brother passed away in Whyalla Hospital. That hospital had undergone a major upgrade courtesy of a federal Labor government and a state Labor government grant to the tune of $70 million. Part of that upgrade was to get greatly enhanced palliative care rooms at the hospital, and it was in that hospital, in one of those rooms, that my brother passed away. That was over a six-week period.

The quality of what was provided was exemplary both in terms of the physical setting, which can make a difference, and the care, compassion and the professionalism of the nursing staff and the doctors who attended my brother. So what was an incredibly difficult and trying period was made somewhat easier. I was interested in the reflections that my sister made. She has worked at big hospitals and some smaller hospitals and private hospitals in New South Wales. When she came over and saw the quality of what was provided in a public hospital, she said that this was better than the hospitals she had worked in in New South Wales.

But a lot of communities do not have the quality that exists in Whyalla. There might be a shortage or non-availability of specialist staff. The physical settings might fall well short of what you would need. It will always be burned into my mind that when my father passed away from cancer in New South Wales he was in virtually an open ward with six other people also passing away. It was in what was a big weatherboard, almost transportable-type building at the back of Concord Hospital. It was an incredibly trying and difficult period. If you were looking at the quality of care, that was incredibly poor for a whole range of reasons.

When we debated the assisted dying bill, my view was that it is about choice. I think it is important that we need to provide good palliative care because it does give people that choice. I had that conversation with my brother, whether he would avail himself of assisted dying, and he said he could not see himself doing that. But he did say it was important that people have a choice. When palliative care—in a lot of circumstances, not all—is high-quality palliative care, people will probably not avail themselves of the need for assisted dying.

This is about respect, this is about dignity, this is about doing the right thing towards the end of somebody's life. For that reason, this bill is important. I think the sooner we progress the actions needed to look at what we have, to look at the gaps, to look at what funding is necessary, the better. A report came out some time ago—and I am testing my memory here—that I think was saying there was a shortfall of about $30 million in the provision of palliative care in South Australia.

It is not just about the person at the end stage of their life but it is also about the family, the friends, the acquaintances and, in some cases, especially in regional communities, the wider community where someone might be known extensively. I commend this bill. I think it is an important bill and it is a bill that deserves our support to progress it as quickly as possible.

The SPEAKER: Member for Frome.

The Hon. G.G. BROCK (Frome) (11:51): Thank you, Mr Speaker, and congratulations on your appointment. I would like to briefly talk about this bill, the Inquiry into Palliative Care Bill 2021. As other members have mentioned here, this is something that is very important to everyone across all of South Australia, but in particular to regional South Australia. First up, let me say that I have the greatest admiration for the staff who look after people in the Port Pirie palliative care system and others I have visited and come across.

In regional South Australia in particular, most of the people who look after those who have to be admitted to palliative care know them and they know them very closely. They get very personal with them and it also becomes part of their lives and the way those staff and the nurses perform their duties there. Also, they take that memory home to their families and they have to put up with a lot of the emotional impact of that, and I can talk from previous experience.

My late father-in-law had a very aggressive form of cancer. He was admitted to the palliative care system in Port Pirie, where the staff themselves were absolutely fantastic. There was a separate room for these people, and there was a chapel, not that he was very religious, but he had the opportunity to go in there a couple of times with the minister of his choice at that particular point. My partner, Lyn, and I were in the room at the same time. We spent the last few nights there just before he passed away. He opened his eyes and said how he had enjoyed life and things like that.

I have had my mother-in-law do the same thing—she had to go into palliative care—and in the last five or six weeks I have had personal friends who have had some form of cancer and had to be put into palliative care. On three occasions, they were diagnosed with some form of cancer and admitted into palliative care, and one passed away within two weeks and another within six days.

People will look at this from outside an inquiry. Sometimes, people perceive an inquiry as not that particular avenue, or what you are inquiring into may not be working properly. I think that palliative care is doing a good job out there. I think we need to have inquiries into whatever we do.

We do that with our own lives: we inquire about how we perceive ourselves, how we manage ourselves every day, and try to improve. This bill will only do that, in my view. It will look at opportunities of how we can improve palliative care facilities, their operation and the attractiveness of how we can make it a lot easier for families and things like that.

The member for Giles mentioned the regional people. Some people out there cannot get to a location—and this is getting more prevalent—or maybe cannot get into a local palliative care facility and may have to go away from their own communities and therefore have the extra burden and the impost of not having the family come in to visit and so forth.

It is about how we can improve the services. As I said earlier, the staff are fantastic. I take my hat off to the people who do this. I personally would not emotionally be able to handle the job they do. We also need to look at the opportunity to train more of these specialised people to be able to come from the health system into palliative care because, if we do not have those people trained in the near future, some of them will get emotionally worn out.

A lot of them are under stress and some, unfortunately, go a bit further and have mental health issues. I know one person, in actual fact, went to the degree that they just about lost their life because of the pent-up emotion that built up over a period of time. Also, I think we need to understand what is the quality of the infrastructure out there and whether we have enough rooms, and the locations and things like that.

Another thing I would encourage if this bill gets through relates to the staff themselves. I would make certain that they have some form of counselling, as I said, especially in regional areas where they know personally those people; they take it home with them and it impacts their own families. They have to be able to have some counselling. I know there is some at the moment, but we need to make sure that there is plenty of counselling out there.

As the member for Giles has indicated, if this bill gets through, we need to have this commence sooner rather than later. We do see lots of things that take a long time to commence. The longer we leave this, the worse it is going to be. We should do this as soon as we can. We should have a complete inquiry and look at all the avenues—I talk about regional South Australia in particular—and then in actual fact we can bring that back to the parliament, bring that back to the ministers and to relevant government agencies to look at the infrastructure and move forward on this. I congratulate the member for Light on bringing this bill here and I will certainly be supporting it.

The Hon. A. PICCOLO (Light) (11:57): I would like to firstly thank all members for enabling this bill to go through all the stages this morning. I do appreciate that. I would also like to thank all members for their contributions. I understand that the government wish to go into committee to amend a part, so I close the debate. I will ask the parliament to support the original bill, though.

Bill read a second time.

The SPEAKER: There being an amendment on file, we must go into committee.

Committee Stage

In committee.

Clause 1 passed.

New clause 1A.

The Hon. J.A.W. GARDNER: I move:

Amendment No 1 [Education-1]

Page 2, after line 3—Insert:

1A—Commencement

(1) This Act comes into operation on 1 December 2023.

(2) Section 7(5) of the Acts Interpretation Act 1915 does not apply to this Act or a provision of this Act.

I outlined the reasons for this in the second reading debate. I believe that it will add value to what is a good bill, but I think that the review will have significantly more positive impact and benefit if it is able to take into account potentially at least six, maybe 12, months of the new act of the legislative regime for voluntary assisted dying, rather than potentially making predictions about the impact that might have.

We know that there will be some impact, based on interstate experience. We would like to have the full impact understood so that the review can add maximum value. There is no doubt, there is no question, that improved services are absolutely the government's intent and commitment. That is one of the reasons why we have a framework for 2021-2026 for palliative care, a strategic framework that will guide and prioritise improvements in the quality and availability—critically the availability—of these services because, as members have outlined, they are tremendously important services.

The timing of the amendment would also allow that to be reviewed mid-phase, when any improvements would get maximum benefit in terms of what the HPC might recommend to government and in particular to the SA Health service that is being delivered.

The Hon. G.G. BROCK: I have a question to the mover of the amendment. This is basically putting it back 12 months further.

The Hon. A. Piccolo: Two years.

The Hon. G.G. BROCK: Sorry, it is two years. Can you specifically elaborate to the committee your reason as to why it needs to go back two years, other than what you have just said?

The Hon. J.A.W. GARDNER: I do not think that it is necessarily two years. It may be, but the bill as it stands requires the Health Performance Council to complete the inquiry and prepare and deliver the report to the minister no later than 12 months after the commencement of this section. The member for Light might have some insight into when the cabinet and the Governor might commence the section, but he has not outlined a reason why it would be two years prior to 31 December 2023 at this stage. I would further outline that we would not be looking to have this delayed unnecessarily once a review had started.

Firstly, as I have outlined twice now, the point of 1 December 2023 is that the new Palliative Care Strategic Framework 2021-2026 will have then been in place for some two years and the improvements that it will be seen to have delivered can then be assessed by this review, rather than this review starting at the same time as the new framework starts. It will be reviewing a new framework which has not yet had a chance to deliver those improvements, which I think would diminish the capacity of the review.

Secondly, there is the voluntary assisted dying legislation, passed in June this year. We have committed that we will get the regulations done so that process can be underway and the intent of that legislation delivered as soon as possible, but it is complex work to deliver those regulations. At the time, it was estimated 18 to 24 months. We would very much prefer it to be 18, rather than 24 because that is what the people of South Australia want and that is what the parliament's will was, but we are not going to cut corners in delivering those regulations because it is tremendously important that we get them right.

That legislation, under a timetable that has it in place by the end of 2022, would then have had some 12 months in action and therefore you would be able to have some evidence of what further improvements were needed over and above those within which the framework of 2021-2026 has been designed. That is the purpose of the amendment.

I will make clear that the government will support the bill if this amendment does not pass. We are not trying to stymie the bill in any way, but this amendment would add tremendous value to the review that the HPC would be able to undertake and see much more impact in the way that all members are hoping as a result of the review in due course.

Mr PICTON: Firstly, I confirm for the house that my understanding from the member for Light is that the has spoken to the Health Performance Council chair, Stephen Duckett, who has confirmed that the Health Performance Council has the capacity and the willingness to undertake this work almost immediately. There has been no communication with the member for Light that this would need to be delayed until the end of 2023 to start.

Secondly, as we have noted, once the act commenced there would be 12 months to do the report. This would mean that, if this amendment were passed, the act would not deliver a report in terms of palliative care until the end of 2024 and probably considered by parliament in 2025. I think the question for the parliament is: is this an acceptable time period in which we should be considering this, or should we be considering it earlier?

The minister has raised as his rationale that, first, we need to see how South Australia's Palliative Care Strategic Framework goes. My understanding is that there is not actually a finalised strategic framework in operation. My understanding from even just checking the SA Health website today is that that strategic framework is still a draft document out for consultation, and that consultation closed back in July.

The question for the government is: you have had a document you put out there earlier this year, consultation closed in July, we are now halfway through October and we still do not have a finalised document. Rather than highlight the need to delay this, when you see that level of inaction in terms of putting this framework in place, I think it heightens the need to get started on this straightaway.

There are no apparent additional resources going into this strategic framework. There has been no announcement in terms of where additional funding is going, out of this strategic framework. My understanding is that the funding that has previously been allocated has largely been spent, and so I think that really highlights the need to get cracking with this as soon as possible.

The Hon. J.A.W. GARDNER: I think there were a couple of questions in what was otherwise a reasonable statement, one that I did not entirely agree with, but I understand some of the points the member makes. Certainly, for consultation on the framework to have closed in July and our being in October highlights that, when we go out to consultation on such matters, it is a genuine consultation and we want to integrate the feedback from that consultation into the final outcome of the framework, and my understanding is that that is absolutely not very far away.

I have no doubt that the issues raised by some of the regional members in this house, in particular in relation to access—I do not say this with certainty, as I am not involved in the review—have been taken into consideration as a result of the consultation. Part of the purpose of the framework is to deliver the best services that we can.

In relation to whether the member for Light was consulted about this amendment or this commencement date, I make the point that we were not able even to table the amendment until about half an hour ago because, again, the bill had not been introduced formally into the parliament and read a second time. What usually happens is you adjourn and then you table amendments and circulate and discuss. That has been abbreviated, that part of the process has been conducted in front of the cameras in this chamber and I do not think the member for Light has taken offence.

The Hon. A. PICCOLO: I will just perhaps respond in terms of the amendment. I would respectfully disagree with the minister's view on this matter, and I will outline why. I think this is very important, as my colleague has indicated. If this were to commence in 2023, as the amendment suggests, on 1 December 2023, I have been advised by the Health Performance Council it will probably take about 12 months, which means December 2024 and that parliament would not consider this until 2025. In the meantime, you would have the voluntary assisted dying legislation in place. The very purpose of this bill is to ensure we have a palliative care system in place which gives people real choice when voluntary assisted dying is the other choice—to make sure we have that system in place.

In terms of evidence, we had a committee that sat for I think 18 months and collected a whole range of evidence on this very matter of palliative care, and the findings of that are there for all to see. I think that evidence could be also put into this process for the Health Performance Council. If the department are already doing some work, there is no problem with the department handing over that information they already have to the Health Performance Council to assess. In fact, doing it now, while the department is undertaking its own strategy, probably makes for really good timing—to make sure that the final product the department comes up with is a strategy that actually has support.

I think this review would actually inform that strategy process. As I said, the previous committee, which I and I think the member for Davenport and a few others were on, already looked at this issue and has enough evidence. And if we need evidence as to what could happen, given this is based on the Victorian model, there is nothing stopping the Health Performance Council saying, 'What happened in Victoria in terms of voluntary assisted dying?'

Let's not forget that an overwhelming majority of people will not access voluntary assisted dying. The overwhelming majority of people will use palliative care as a way to end their life. While I did not agree with VAD, this bill does not impede the VAD legislation in any way, so if people want to exercise that choice, that is fine. But let's remember that the overwhelming majority of people will still use palliative care as a way to end their life, and I think it is important that they have that real choice when the time comes. As my colleague said, what do we say to people? 'We know this is an issue, but we're not going to do anything about it until 2025'?

The Hon. J.A.W. GARDNER: Apart from the last sentence, I think the member has just made a very good case for the amendment, because his suggestion that we have the review and then that feed into the work SA Health has already done I think gets it completely about the wrong way. The work SA Health has done, including community consultation, is with a purpose of improving services and then getting those improved services out as quickly as possible. I would submit that the member for Light has just argued to delay those improved services until after his review has happened. I may have misunderstood, and I apologise to the member if he did not argue that, but that was what I took out of his submission.

Further, in relation to the points he has made about voluntary assisted dying, I reiterate the point I made in my second reading speech and in response to I think the member for Frome: that in Victoria demand for palliative care services has been shown to increase following the introduction of voluntary assisted dying. In part, this is believed to be due to the increased awareness and promotion of palliative care as a compassionate and meaningful option at the end of life, and I think that all members of the house would support that approach being taken.

Ayes 24

Noes 20

Majority 4

The CHAIR: Are there any further questions on the bill at all? We have two more clauses. I am happy to take questions on clause 2 or clause 3 if I could get an indication from the floor. No further questions?

Remaining clauses (2 and 3) and title passed.

Bill reported with amendment.

Third Reading

The Hon. A. PICCOLO (Light) (12:22): I move:

That this bill be now read a third time.

I would like to thank people who spoke on this bill. I will not deny that I am disappointed and it is disappointing that members, particularly those from regional areas, have decided to defer the commencement of this inquiry which would benefit their constituents the most, and I am sure their communities will take notice.

The Hon. J.A.W. GARDNER (Morialta—Minister for Education) (12:22): I am pleased to speak on the third reading of this bill, which has been much enhanced by the amendment which means that, unlike what the member for Light suggested in his last question on the amendment itself, where I believe his suggestion was that the improvements for regional South Australia be delayed until after his review takes place, we now have a bill that will ensure we can improve services as much as possible, and then we will review them to make sure they are improved enough.

I think that all members are to be thanked for their contributions to this bill. This bill now has its best possible version. As I said, the government was happy to support the bill in its original form but we felt it could be improved and I am pleased that the house has seen fit to agree.

Mr PICTON (Kaurna) (12:23): I am drawn to provide a third reading contribution, in that I think the minister is misrepresenting the views of the member for Light. The member for Light has been staunchly advocating that this review should happen immediately because he is so concerned about the state of palliative care services. In fact, he wanted this review to happen originally before the voluntary assisted dying legislation would come into effect.

So I think, for the record, that has been the view of the member for Light. Obviously it is welcome that the bill is passing in some form, but we are now in a situation where unfortunately we will be considering the outcomes of this review in the last year of the next term of parliament, before not the next election but the election after that. I think that this is something that could be done sooner. I hope that we can find a way to commence this work sooner rather than wait as long as planned under the government's amendments.

Bill read a third time and passed.