No-confidence Motion

Minister for Health and Wellbeing

The Hon. D.J. SPEIRS (Black—Leader of the Opposition) (14:15): I move:

That this house has no confidence in the Minister for Health and Wellbeing and that this house calls on him to resign for his failures in the health portfolio, in particular his failure to deliver on Labor's key election commitment to fix the ramping crisis.

It is an extraordinary tool within the parliamentary toolkit to use a motion of no confidence in a minister, but from time to time a motion of no confidence is required. A motion of no confidence is required when a situation is so grave that it needs to be brought to the community's attention, that it needs to be brought to the parliament's attention, and that this house must decide on whether or not a minister has the confidence of this place to continue to fulfil his appointed duties.

The Labor Party went to the 2022 state election with a central election commitment. They positioned their election campaign around fixing the health system and, within that, they said that they would fix the ramping crisis. There was no doubt about how central that commitment was—and it was a commitment that cut through. South Australians voted for Labor Party candidates on the basis that they would fix the health system and that they would fix the ramping crisis. It worked; it changed votes.

South Australians put their faith in the Labor Party of South Australia, in our Premier, and in the health opposition shadow minister at the time. They put their faith in Labor to deliver. The statistics speak for themselves: they are not delivering on this central commitment. South Australians are cynical; South Australians are worried. Many South Australians are scared: they are scared to call an ambulance, they are scared to front up at an emergency department, they are scared for themselves and they are scared for vulnerable family members who might rely on our health system.

A total of 4,773 hours were lost on the ramp in the last month of May 2024. To put that into perspective, 1,522 hours were lost on the ramp during the last month that the Liberal Party was in office here in South Australia, February 2022. Now, 1,522 hours is perhaps not acceptable and we should strive to do better than that—but the Labor Party said they would. They said they would fix the ramping crisis, yet 4,773 hours is a far, far worse figure.

It is so important that we don't just get caught up in the statistics and the figures, because sitting behind those figures are real lives—people who are sitting in ambulances, paramedics who are working with patients in ambulances, ambulances sitting on ramps: ramps at Modbury Hospital, ramps at the Lyell McEwin Hospital, at the Royal Adelaide Hospital, at Noarlunga Hospital, at the Flinders Medical Centre.

But actually, ramping has now spread to regional South Australia. We know that ramping is now occurring at Mount Barker hospital. We know that there are cases of ramping occurring at Mount Gambier hospital in our state's South-East. The crisis has spread from the city into the regions and that is just unacceptable. These are real lives and real people in real places, struggling and fearful for their lives. Patients do not call ambulances unless there is a fear or a need to go to a hospital. When they get to a hospital they want intervention, they want care, they want support. The ramps are full, but our emergency departments are full, too, and our hospitals beyond the emergency departments are full.

We know that last week for five consecutive days our hospitals were on Code White, meaning that there was not a single available bed in metropolitan Adelaide's hospitals—not a single bed. What sort of message does that send to South Australians when it comes to calling an ambulance? What sort of message does that send to South Australians about the level of care and support for the most vulnerable in our society, because when you need to go to a hospital you are vulnerable. No matter what your status in life, you are at your most vulnerable when you front up at a hospital for care.

The Labor government made this commitment. They made a commitment that they would fix the ramping crisis, but every one of their interventions to date has failed. They talk about aged care being part of the problem, they talk about the NDIS being part of the problem, they talk about COVID and other respiratory conditions being part of the problem, but all these problems were in place. They were part of what the Labor Party factored in when making their commitment in the lead-up to the 2022 state election. If anything, the situation with COVID was far, far worse in 2022 than it is now, where it is much more normalised across our community and dealing with it through vaccinations is a much more structured process.

The Labor Party knew what they were committing to in 2022. The Labor Party knew that they were taking a significant election commitment to the South Australian people, and what they did not take, sitting behind that, was a range of solutions. They said they would throw money at the problem, but they have not targeted that money to where it needs to go. The opposition does get asked from time to time what would we do, and we have made it very clear what we would do. We have outlined very significant areas where we believe there should be more expenditure and where there should be more reform.

One idea that we put on the table four weeks ago was to have a broader community-based access program for our flu vaccinations, and the government rejected that. There is a group of people in our community who get free flu vaccinations, and that is a good thing because they have got particular vulnerabilities, but we believe that that needs to be broadened because, in terms of the more people who get a flu vaccine, there is a direct correlation as to the number of people who will get the flu.

We need a broader-based flu vaccination program and we need more community awareness of the availability of that program and we need more access initiatives to give people that vaccination. We know that if that decision had been taken four weeks ago there would be fewer people in our hospitals today suffering from influenza. That is just a fact and that could reduce some of that pressure on our hospitals. So that is one idea that we put on the table and that was rejected by the Labor government. They could still pick it up, though, and the Immunisation Coalition of Australia made it very clear yesterday, standing with me in a press conference, that this was still something that the Labor government could do.

We have talked about mental health. Our mental health system is in crisis. Mental health patients are going to our emergency departments too often and in too great a number. We need to reduce the number of mental health patients going to our emergency departments. We need to reduce the number of mental health patients being transported by ambulances. We need to find ways that they can be cared for in more sympathetic environments, gentler environments. Our mental health system is in absolute crisis. We have seen that result in some terrible actions of violence in our community where people have lost their lives in the most catastrophic of ways. Mental health is a crisis in this state. It is something that we should work towards solving.

We know that there is $125 million of unmet need in terms of mental health provision in South Australia. That means mental health infrastructure in terms of the built environments to support mental health patients, but it also means mental health support workers—psychiatrists, psychologists, nurses—and the further you get from metropolitan Adelaide the worse our mental health needs become. We have to have a sustained focus on mental health to take patients out of our hospitals and into better environments. That will help the ramping crisis, and I truly hope that the state government applies significant resources to mental health in the upcoming state budget next week.

Regional health care is an area that is in very, very significant crisis. If we think our metropolitan hospitals are in trouble, you only need to look at towns like Port Pirie, Port Augusta, Whyalla, Mount Gambier, down to Kingscote, to Victor Harbor, where regional hospitals, particularly infrastructure but also service personnel, are truly lacking what they should be.

I was up in Port Pirie just a few days ago and we were told about the crisis that that hospital is in. The government made a commitment to do a major infrastructure project at Mount Gambier hospital. That project has not even begun yet—a commitment made before the 2022 state election will probably not even be delivered before the 2026 state election—and that is not what the good people of Mount Gambier were led to believe. They believed, like many of Labor's health promises, that these commitments were silver bullets that would be delivered with incredible speed. That was the impression that we were given as South Australians in the lead-up to the 2022 state election.

We also believe that we need to have a sustained focus in building up the role of the general practitioner. The general practitioner is a key role within our hospital system. That old-fashioned idea—and it may be old fashioned, but it is so important—that you can rely on your GP to deal with most of your health needs. We need to get back to that in regional South Australia but also metropolitan Adelaide.

There are certain parts of the general practitioner role that are supported by the federal government—absolutely—but it has to be federal and state working together to build up these roles, to celebrate these roles, to make it a profession of choice for medical students and to provide a pathway to GPs practising right across our state. The decline of the general practitioner and the lack of people studying to be general practitioners, who are specialists in generalist medicine, is so important. We have to focus on that area. Without a functional community of GPs, our health system will continue to decline.

It appears to the opposition, and, more importantly, it appears to the South Australian community, that this government just does not have a handle on the health system. There are many challenges when managing a modern-day health system; there is absolutely no doubt about that. Those challenges are varied and many, but very few of them are surprising. The arrival of winter is not surprising. The number of hospital beds that are available, the size of the workforce—we know all of these things. By and large, the government knows what it is dealing with. You can do modelling around the number of patients likely to enter our hospital system, so why is the government not prepared for these things?

I am not going to focus in personally on the health minister. While this motion of no confidence is framed around an individual because that is the process of our parliament, it is broader than one person. It was the Labor Party, it was the Premier, it was the shadow cabinet who went to the 2022 state election with this lofty election commitment: 'We will fix the ramping crisis. Vote Labor like your life depends on it'. We heard Ash the ambo out there, the creation of a political caricature around one person, making this commitment, this call to action: 'Vote Labor like your life depends on it'. Well, South Australians' lives do depend on a functional health system, they depend on a government and a minister who have their act together and can deliver for South Australians.

I think of Eddie from Hectorville—his life depended on an ambulance turning up for him and he waited 10 hours and by the time it turned up Eddie was dead. There are many other stories similar to Eddie's out there in our community, people who have waited too long for ambulances, people who have sat on the ramp for too long. We have an ambulance service, a community of paramedics, whose morale is rock bottom, who believed that this would be fixed, who see new ambulance stations—and, again, we welcome those—but do not see better outcomes in terms of their ability to do their job that they signed up for.

Today, we stand with South Australians. We stand with the health workforce, our doctors, our nurses, the many personnel who work in hospitals. We stand with the paramedics who feel utterly let down by the government and their employee association today.

This is a government that is failing our health system, failing the South Australian people and the problem is bigger than just the Minister for Health. We highlight the minister's role today and we seek the parliament's position of no confidence in the minister, but it is broader than that. This is a government that has let South Australia down. It is a government that has delivered record ramping. It is a government that has seen our emergency departments clogged to capacity. It is a government that has seen elective surgery cancelled and chronic pain conditions pushed into the future as people have to wait on an unknown date to get that necessary operation that they had their heart set on achieving by this week.

Ramping is out of control: 4,773 hours in May 2024. That is the headline statistic, but let's remember there are real people sitting behind those 4,773 hours, people who live in communities around this state. It is people who live in Golden Grove, Banksia Park, St Marys, Happy Valley, and Brighton. It is people who live in Prospect, Port Pirie, Port Augusta, Mount Gambier, and Naracoorte. It is people who live in Sheidow Park and Hallett Cove. It is people who live all across this state and it is those people who are suffering at the hands of this government's failure.

The SPEAKER: Before I call the Premier, I ask: is the motion seconded?

An honourable member: Yes sir.

The SPEAKER: I also remind everyone on both sides that the Leader of the Opposition was heard in absolute silence. It is a big thing to suspend standing orders and to put this sort of motion, so I would expect that to continue through the course of this debate.

The Hon. P.B. MALINAUSKAS (Croydon—Premier) (14:31): I thank the house for the opportunity to be able to address this motion. It deserves a wholehearted and a fulsome response in both policy and deeper analysis in terms of its impact on people.

We have just heard from the alternate Premier of the state. I think it is telling that throughout the course of his 15-minute contribution he was unable to add one single health policy to his already health policy propositions that he has offered the people of South Australia, which equates to literally nothing—literally nothing.

We have just heard 15 minutes of problem identification. Some of the problems that the Leader of the Opposition refers to in his remarks are well known. Indeed, some of them we would freely acknowledge. There is no doubt that throughout our nation, including in the state of South Australia, and, in fact, it is largely true throughout any Western country around the world, OECD listed or otherwise, that health systems, particularly public health systems, are under unprecedented and enduring pressure.

That pressure manifests itself in a number of ways and the Leader of the Opposition has referred to transfer of care hours, otherwise known as ramping data, the pressure that that places on the men and women working so thoughtfully and hard within our health service looking after patients, and the impact it has on patients themselves. This is well documented and not in dispute.

What matters, though, to the people who are so affected by our health system, so reliant on the services that our health system provides, is that those who are in charge of it, ultimately each of us on the Treasury benches, is committed to addressing the challenge, who actually have a costed policy to make sure that we make a positive difference on the impact that the system is confronting.

To that end, this government, led by the efforts of the health minister, is determined to make sure we see to a lot more capacity, a lot more endeavour existing within the system. To that end, over the last two years, what this government deserves to be tested by is: what have we been able to put in place that the others never would? What have we been able to deliver that we know the opposition not only were not willing to commit to but were actively opposed to? To that end, we are very grateful for the fact that there are already a lot more beds in the system. The one thing more important than beds in the system are the people who work within it.

Let's go through some of the facts. Today, as we speak, there are already over 1,400 additional clinicians working on the ground over and above attrition: 691 extra nurses employed today and 329 doctors already employed above attrition today. There are 219 extra ambulance officers employed today over and above attrition, leading to better outcomes in ambulance response times, and we should not forget the 193 extra allied health workers that are looking after patients. That is 1,400 clinicians trained, skilled, to provide assistance to people in need that would not be employed had the last election result been different.

What would they have got instead? A basketball stadium. Had the government not changed hands two years ago, there would be a basketball stadium being erected—true, that, but there would also be 1,400 fewer clinicians looking after all the additional patients that are coming into the system. There would be fewer beds for those patients coming into the system, if those patients got into the system at all, because we know of course that one of the great successes that this health minister has been able to deliver is the dramatic improvement in performance we have seen in ambulance response times.

Two years ago, lights and sirens emergencies, people calling 000 in the most urgent and acute of circumstances, were being arrived at on time one-third of the time; that is to say, in two in three 000 calls that were emergencies, the ambo did not get there when they were supposed to get there. Now, in essence, the opposite is true. We have been able to achieve P1 and P2 results that see two-thirds of ambulances getting in on time rather than two-thirds of ambulances getting in late. Why? Because this minister, in the space of two years, has overseen the biggest recruitment and investment exercise that the South Australian Ambulance Service has ever seen in its history.

We know what the Leader of the Opposition oversaw during the course of his time in the cabinet. What did they decide? What did the Leader of the Opposition make himself a party to when it came to decisions around the Ambulance Service? First year: cut it. Second year: cut it. Third year: a little bit of extra money. Fourth year: cut it. Three out of four years, the Leader of the Opposition sat around the cabinet table and actively endorsed cutting the Ambulance Service in the middle of a global pandemic. If that was not enough, the Leader of the Opposition sat around the cabinet table and called in KordaMentha to start running the Royal Adelaide Hospital, and then, if that was not enough, sat around and said, 'You know what? During the course of a global pandemic, we are going to actively approve making health workers redundant.'

Those who had the responsibility of sitting in this place during the course of the pandemic, in those early days not that long ago, at the beginning of 2020, sat in here in a unified effort—Labor, Liberal, the Greens, the crossbench, everyone—utterly unified, so everybody that had the responsibility of sitting on the treasury benches could do everything possible to keep South Australians safe. It was very clear what the agreed policy position was amongst clinicians and health professionals around the world: when it came to COVID, it was all about flattening the curve and pushing out the peak. Remember that? Flattening the curve, pushing out the peak.

What were the reasons to flatten the curve and push out the peak? Because it would buy time for governments to invest in the health system, to go out and recruit all the extra clinicians that would be required to be able to account for COVID, to be able to invest in all the additional beds and infrastructure that was going to be required once COVID came in. The consensus was that COVID would come; we just wanted to suppress it to buy time, to flatten the curve, push out the peak and get us ready for the onslaught.

What did the government of the day do? Well, it suppressed COVID and did it quite well, to the former government's great credit. But what they did not do was get the health system ready. They did not recruit more clinicians: they made them redundant. They did not invest in the Ambulance Service: they cut it. They did not open more beds: they closed them.

Now we find ourselves, in a way that everybody knew was going to happen, in a way that was utterly predictable, in a situation where the COVID numbers are coming thick and fast. Last week alone there was something like three times the number of COVID cases in one week, when, let's face it, most people are not testing. In the space of one week we had more COVID cases than the former government endured throughout the course of the entirety of 2021.

What this government is dealing with is COVID that is real, combined with flu and RSV. That is not an excuse: that is a fact. We are dealing with it with a system that lacks the capacity that is required to be able to handle the challenge. Why do we lack the capacity that is required to handle the challenge? It is because when they had the opportunity to invest, they cut. What are we doing since we have come to government? Well, we are not cutting. It is telling that during the course of the Leader of the Opposition's critique, he did not refer to a single cut the government is making. Do you know why? Because we are not making any.

In fact, the Leader of the Opposition could not even bring himself to critique any particular program or policy that the government is introducing, because they are not making a commentary on policy, they are making a commentary on politics. We are focused on delivering. This minister has one almighty task on his hands because the work was not done by those opposite. So how is he going on that score? Apart from the 1,400 additional staff he has already been able to recruit over and above attrition in an environment when the rest of the world is trying to do the same, and we are outperforming most other jurisdictions around the country in this regard, he is also opening the beds, leading to one of the biggest infrastructure investments that SA Health has ever seen in its history.

Let's start to examine some of that. Work is already rapidly progressing to get the Mount Barker redevelopment underway—site selected, contractors being procured, designs being delivered. The QEH in the western suburbs of Adelaide—opening weeks away, 50-odd additional beds. Lyell Mac—over 40 beds coming throughout the course of the end of this year.

We have been able to secure under this minister's leadership a $200 million investment at the Flinders Medical Centre coming from the commonwealth, which never normally happens, on top of the hundreds of millions of dollars that we are investing, and there are beds that are already opening at Flinders Medical Centre as a result of those decisions. We know there are literally countless more to come at FMC alone. Modbury Hospital—big investment underway, beds already open at Modbury. We know that Modbury has more to come with the cancer centre and what we are doing around mental health in Modbury. I can speak to almost every hospital in the state and I could point to an investment program that this minister is delivering.

More than that, what I have seen enormous evidence of during the course of the last two years alone is not just the minister doing everything he possibly can to deliver on that massive building program, but also focusing on other things that make a difference to people's lives in respect of their health care.

Let's just look a few different examples. Just an hour ago, the Minister for Trade and Investment and I met with a representative—I think I can say this—of Samsung who is in South Australia who went out of his way to thank the government for the fact that we have 24/7 pharmacies because it resulted in him being able to get access to an urgent medicine at 5 o'clock this morning that otherwise was not able to be found; so, 24/7 pharmacies.

The delivery of drug and alcohol beds: trying to provide assistance to those families who are going through enormous difficulty as a result of their son or daughter suffering addiction through methamphetamine or other means. People suffering from epilepsy in this state have been constantly overlooked by state government after state government, resulting in epilepsy nurses delivering services for people in that community who have been in need forever.

If you get MND in Australia and you are over the age of 65, you are cut loose because you do not get access to the NDIS. MND in South Australia were desperate just to get a meeting with the former government, the former Premier, which they could not get; and now in South Australia as a result of the work the minister has done, we are providing funding to MND in South Australia so that if you are over 65, you get a bit of extra care—something I know the member for Davenport has been a passionate advocate for.

CAMHS, the Child and Adolescent Mental Health Service, is seeing more child psychiatrists, more child psychologists, and investment in funding than we have ever seen before. This minister has funded LELAN, an organisation charged with the responsibility of holding the government to account, a not-for-profit organisation that bangs against the door of the government of the day to advocate for more mental health services, particularly for young people. We are funding people to campaign against us, that is how much this minister cares about actually getting thoughtful policy delivery in place.

There is the Ambulance Wish SA program for people undergoing palliative care. As a result of the investments we've made in the Ambulance Service, they now have the capacity to look after people who are in palliative care, in their dying days, so that they might have a more compassionate conclusion to their precious life—and we saw the example of that at Adelaide Oval just the other day. That is a program that has been delivered under this minister's leadership. Tackling vapes, one of the biggest public health emergencies the country has faced in decades, or since the decline in cigarettes, this minister has been a leader on.

The Leader of the Opposition mentions GPs. Well, unlike the conservatives in parliament at a federal level, and acquiesced to by those at a state level, where they cut the Medicare rebate, this minister is addressing issues that concern GPs, particularly in regional South Australia, with the introduction of the single employer model, which we know has already delivered outcomes in the member for Chaffey's electorate in terms of more regional GPs. It is a model that is now being rolled out to other parts of the state.

We have a new headquarters for BreastScreen SA that has been long overdue, and we know that this minister has been a lead on that. We have re-established a full-time Mental Health Commissioner. Who would have thought there was a regime that oversaw not having a full-time Mental Health Commissioner? Now we have one.

Family Drug Support is a not-for-profit organisation that provides assistance to families whose child is suffering a form of addiction. They now have more resources as a result of Chris's stewardship. The minister has re-established Preventive Health SA, and palliative care nurse numbers have been increased by 50 per cent. There is the PATS scheme, which is so important to regional communities; #RegionsMatter—well, we are turning that into a reality by doubling the fuel subsidy for the PATS scheme, thanks to this minister.

In the APY lands there is better care being provided and support to our nurses on the front line as a result of changes that have been introduced by this minister. There is the re-establishment of birthing services on Kangaroo Island that we tragically lost during the course of the last term of parliament; they are back, they are coming back on Kangaroo Island, birthing services, as a result of the work the health minister has done. I could go on, but these little things add up, and they matter, and they don't happen without leadership.

We should also mention the big change in policy that this government, led by all the work that Chris and his team are delivering, has seen around the Women's and Children's Hospital. We had a choice on the Women's and Children's Hospital: a hospital that would have over $2.4 billion of expenditure under their plan to deliver us one extra overnight paediatric bed for children, or a hospital that sets us up for the long-term, a new Women's and Children's Hospital that is actually bigger for the women and children it will look after, and making the tough decisions about where we will build it. We are not just thinking about the short-term politics, which they have managed to find themselves aligned with; we are setting us up for the long term.

This is serious policy, this is making a difference on the ground, and none of it would be happening without the leadership of the health minister—or, heaven forbid, if those opposite were in charge. This is what serious government looks like, this is what care for people in need looks like, which has always been in the DNA of the Parliamentary Labor Party of South Australia—and we will continue that work. We acknowledge the challenges, and we will not take our foot off the pedal. That is why we very much anticipate this week's state budget—which we will all be present for and paying attention to.

I do not just endorse the Minister for Health, the Minister for Health does not just have my confidence and this government's confidence, I anticipate that this Minister for Health will have the entire parliament's confidence. We will send a message in this parliament that we want him to get on with the job, continue to do the real work and focus on the policy. You guys can faff around on politics and a policy vacuum, but we are going to make sure that the patients of South Australia who require genuine leadership in this health system get exactly that from this government.

Ms PRATT (Frome) (14:49): I rise to speak to this motion of no confidence in the Minister for Health and Wellbeing at a time when public confidence in the health system is at its lowest ebb. Back in March 2022, South Australians were told to vote for Labor like their life depended on it, and they did. The Labor promise to fix ramping was the greatest electoral fraud in South Australia's political history, and I think it is a case of the Premier doth protest too much.

The rhetoric flowing from those opposite is coming from the same party that downgraded the emergency departments of Noarlunga Hospital, The QEH, Modbury Hospital and disrespected and betrayed our veteran community by closing, shutting down the Repat—the same party which shut down in a different era the Glenside mental health hospital with no plan for a modern mental health replacement. Our health system has been beleaguered for many years by Labor ministers of varying incompetence, and I think the Premier's defence of the health system is very telling.

The current minister promises that more ambulances, more beds and more nurses will take pressure off the system, but the data says otherwise. The Premier has used numbers in his defence of the minister today, and the numbers do not lie, but this is a numbers game with a difference. So, Premier, I see your statistics and I raise you:

nearly 100,000 hours have been lost on the ramps in our city hospitals;

4,773 hours were lost just for the month of May, the worst on record;

over 20,000 signatures were collected through a petition calling for better access to regional-based radiotherapy services;

it has been 12 months since a baby has been born at Whyalla Hospital;

19,000 South Australians are living with an unmet need in mental health;

there was a 94-hour wait for one mental health patient at the RAH ED; and

we will be facing a shortage of 10,000 GPs nationally over the next six years, but there are no competitive incentives from our state.

Finally, to sum up this catalogue—this shopping list of complaints and poor statistics—we see at least an $8 billion budget for the state health department, but we are still getting the worst outcomes.

In every corner of the state from coast to coast, from the West Coast to the South-East, country patients are sick to death of the excuses and dismissive treatment that they are getting from the system. Port Lincoln patient Joe Morrison had his spinal surgery cancelled three times just last week. When they called him with the bad news, they did not even know that he had flown in from country SA and had spent hundreds of dollars to make that trip. The personal cost to our country patients adds up very quickly, but in Joe's own words, 'We don't want priority in the country, we just don't want to be stuffed around.'

For the thousands of patients impacted by this unprecedented Code Yellow, just imagine their week. They began fasting days in advance, which would have required some very unpleasant personal preparation; they booked leave from work; they cancelled their social plans; they made arrangements for child care; and country patients also had to make travel and accommodation plans at their additional cost.

So the minister in his wisdom has approved this open-ended pause for elective surgery, but at what cost to the public? Even Billy Elrick, the state secretary of the Health Services Union, is calling it out by stating:

It is disgraceful that SA Health is not acknowledging the root cause of this code yellow crisis for what it is; chronic allied health staff shortages that they've been aware of for years.

The minister's curious response has been to pat himself on the back about extra beds that are not coming online until next year, but he says it is going to be the equivalent of another QEH: that very same hospital that this Labor Party had downgraded as part of their Transforming Health legacy. Instead of parading around construction sites with a press pack, I would invite the minister to fly to Port Lincoln and sit down with Mr Morrison to apologise to him for his experience.

We remain the only state or territory still without a regional-based radiotherapy service. With one email this minister could change the health prospects for a catchment of 80,000 people from Kingston to Mount Gambier, people who live on the Limestone Coast. All the minister needs to do is write an email and declare it as a priority area for radiotherapy services and unlock that federal funding that is available, but the minister has refused to put any region forward as an area of need and has doubled down on this blinkered but perhaps impoverished approach to regional health. I am certain we are witnessing a financial and moral retreat from country health, which is evident by the lack of investment and a withdrawal of services by stealth.

These same country hospitals are in desperate need of diagnostics equipment. From KI to Clare, our country hospitals are limping along with substandard equipment at best. We know hospital upgrades have been promised, but completion dates are pushed out beyond what is acceptable. The residents of Mount Gambier have been sold a pup. They were promised they would get a multimillion dollar upgrade. Not only will it not be finished by the end of next year but it has not even started yet. It has just gone to tender.

The midwifery workforce is the canary in the mine. Yes, there is a national shortage. That is the worst-kept secret. My question to the minister is: what is he going to do about it? Once midwifery services are on bypass or withdrawn from our country hospitals, they are very hard to get back. It is a slippery slope. We look to Victor Harbor, Kangaroo Island, Waikerie, Gawler and Kapunda as a cautionary tale.

The tragedy is when we look at the Whyalla Hospital, where 250 babies have historically been born per annum. Not one baby has been born in the last 12 months. It has had a lick of paint, a new ward, a new name, a new director, but the mothers who live in that region have at cost had to travel somewhere else to deliver their children. In the absence of a plan, in the absence of midwives, like night follows day we can expect to lose the surgeons, the anaesthetists and the activity in our country hospitals. Very quickly when that activity slides, we know that is an opportunity for the minister and the department to close or downgrade these country hospitals. I worry every day that that is the path that we are on. Country patients are being squeezed out of their local towns and communities and forced to the city because that is the only workforce this government can salvage in the health system that is in crisis.

We are days away from the budget being handed down. What does the opposition want to see? We want to see investment in mental health. It is not an exaggeration to say that the system is broken and that people are lost in this system. Even the federal Minister for Health and Aged Care declared at a recent lunch for MATES in Construction that the mental health system is in crisis. It does not come much higher than that.

Yet we also know that the Office of the Chief Psychiatrist has released a number of concerning reports. Sadly, each of these reports points to a failure in the pipeline of services. We know that 19,000 South Australians are living within unmet need in mental health. We know that it will only take $125 million of co-funded payment from the commonwealth and the state to meet that need. We know one in four psychiatrists have declared they are preparing to leave their field of work in the next four years.

We know that you have a better chance of accessing a psychiatrist in Mongolia than if you live in regional South Australia. But what we do not know is how the minister is intending to address the fallout when people living with mental illness are discharged from short-term acute care in hospitals and then left to fend for themselves. People are losing their lives due to ramping, and the public has naturally lost faith in this minister and the government. South Australia is watching and expects more.

The Hon. S.E. CLOSE (Port Adelaide—Deputy Premier, Minister for Industry, Innovation and Science, Minister for Climate, Environment and Water, Minister for Workforce and Population Strategy) (14:58): I have been on the other side of the chamber, as have most of us, and understand what it is like to be in opposition. It is a difficult role to play because not only do you need to critique the government on the other side but you also need to come up with a proposition to offer to the public. The opposition, sadly, appears to have only heard the first part of that message and not yet turned its mind to the second.

What we have heard today, and in fact what we have heard for the last two years, is an admiration of the problem, although not always accurately described, and an admiration of all the things that we wish were different. But we are in politics not to describe problems but to seek to solve them. That is where it gets hard, because that is where you have to come up with ideas that are based on evidence, that are likely to gain traction and support, and that are better than alternatives that engage in a competition for ideas. None of that has occurred as yet on the other side of this chamber, none of that.

I cannot understand what the policy critique of this government is in health. What is it that this government has been doing that the opposition does not support? If you think of their record, you could suggest that maybe we have too many staff, because the opposition's approach when in government was to cut staff. If you listened to the proposition from the Leader of the Opposition recently on the radio, maybe it is that we have invested too much in beds, because he seems to think that perhaps new beds are a waste. But none of this is coherently expressed; it is just that we are trying to glean what it is that the opposition is trying to suggest to us.

The challenge is to come up with a proposition for dealing with the challenges that they have at times accurately and at times inaccurately described today. What is the proposition that you are putting to the people of South Australia in less than two years' time? I agree with the Premier that there is essentially no health policy that has been advanced at all. I have heard a suggestion that maybe they would like to see some free flu vaccinations, although I was not able to discern if that was actually a commitment that they would introduce it from the next election or not, but let's pretend that it is. I am all for vaccinations; I am always available to have as much vaccination as possible, and having just come off COVID again I wish that we could have vaccinations more frequently against that.

But free flu vaccinations has no support from the Chief Public Health Officer and South Australia has the highest rate of flu vaccinations, whereas the state that has free flu vaccinations—Western Australia—has the lowest. So where is the evidence for this possible suggestion of an idea of possibly having a policy? It is not actually dealing with the challenges of what is going on inside our hospitals, nor is it in fact dealing with the challenges of getting more people to be vaccinated. I would be horrified if people watched that kind of media and took from that, 'I shouldn't have a flu vaccination until it's free.' That would be a disastrous outcome. I am sure it is not one that was intended, but it did worry me when I was watching it.

I just want to do a quick dive into mental health response. Just to give an example—the Premier gave many, many excellent examples; it is always delightful to come second after the Premier in speaking. But there are examples of the ways in which we have responded to the mental health challenges that remain very present and significant. But in addition to boosting the number of mental health beds that have been provided so that people can come out of the emergency services care and go into mental health care beds, we have allocated $3 million for public community mental health teams.

Between 2018 and 2021 under the Liberal government, the funding for the NGO mental health services was cut by 19.2 per cent. So, again, is it that we are putting too much in, because what we have decided to do is increase funding by 11.8 per cent in the first year and $6 million over the four years, increasing to an extra $2 million per annum? Is that the problem? Do you think we are putting too much into that? In the absence of offering an alternative policy, what is one to think that you believe we are doing wrongly?

The funding boost will see more than 1,000 extra South Australians a year receive one-on-one NGO support. Is that not supported by the opposition? Do they not want to see us doing that? We are working with the federal government also to have the additional foundational supports jointly commissioned across the commonwealth and all of the states. We are recruiting an additional 10 child psychologists and five psychiatrists to work in the CAMHS service, as the Premier mentioned. We are establishing Regency Green, the non-government-run services for people with psychosocial conditions who would otherwise be in hospital. Do you not support that or do you support that? What are your policies? What is it that you are going to be doing?

Opening a kids' Head to Health hub in Bedford Park and an Aboriginal and Torres Strait Islander mental health and wellbeing centre in the CBD: is this a good idea or not a good idea? Talking about the challenges in our health system takes us nowhere if you are not prepared to step up and say what it is that you would do differently.

What is crucial is to think about the counterfactual had we not won the election. Had we not won the election, we would have left in charge of the health system a government that felt it was appropriate to cut staff and to bring in the liquidators to see where they could cut more deeply. That is not a government that deserved to win the last election, and as yet I am unclear whether the opposition thinks it is an opposition that deserves to win the next.

The Hon. J.A.W. GARDNER (Morialta—Deputy Leader of the Opposition) (15:04): The motion is that this house has no confidence in the health minister and it sets out why. The motion points out that the minister has failed the people of South Australia when it comes to health policy and in particular he has failed the people of South Australia in relation to Labor's signature health policy of fixing the ramping crisis.

There is not a South Australian who can forget during that 2022 election campaign every TV ad showing Ash the ambo calling on South Australians to vote Labor like their life depended on it, nor every poster on every Stobie pole from Mount Gambier to Port Lincoln and every street in South Australia it seemed, with the Premier's face and it saying, 'Labor will fix the ramping crisis'. This was the commitment from the Labor Party.

On half a dozen occasions throughout February and March of 2022, the Labor Minister for Health highlighted either 'Labor will fix the ramping crisis' or 'Labor has a comprehensive plan to fix the ramping crisis', or, indeed, one version was, 'Only Labor has a plan to fix the ramping crisis'. The Premier and the Deputy Premier, throughout the course of this debate, have framed the question that they say the opposition should be answering as: what policy critique, what policy analysis have we done of Labor's health minister that leads us to the conclusion that we should have no confidence in him?

I put to you, sir, and I put to the parliament that it is about outcomes not inputs. It is about Labor being held to account according to the criteria that they set for the former government and which they set for themselves. It is about the Labor health minister being held to account for the policy that he would have been directed in his letter of appointment by the Premier to deliver on. Labor's central tenet for existence in government was their promise to fix the ramping crisis. Labor's central tenet during the election campaign to the people of South Australia was that they would do better than the former government on health.

But we are interested in outcomes. So what have those outcomes been by the standards to which the former government was held to account by the health minister? In August 2021, when there were 2,727 hours ramped, compared to 3,763 hours lost in August 2022, and 3,721 hours lost to the ramp in August 2023, and 4,773 hours lost to the ramp last month, the Minister for Health said in relation to 2021:

Each of these months [thus far]…was worse than the previous highest record of April this year.

Each [and every one of those] hours represents a person stuck in pain, without dignity, not getting the treatment they deserve.

Ramping at that time was 2,000 hours or so less than it was last month. In August also, the Premier set some standards. He said:

Emergency departments are for emergencies and it is clearly unacceptable for anyone to have to wait nearly 15 hours to be seen in an emergency.

Behind all of these people are real people with real stories of suffering. I can't imagine what it's like to wait nearly 15 hours to be seen in an emergency department.

At 12.51pm today, the Adelaide ED Twitter account reported that there were 10 people in South Australia waiting not 15 hours but more than 24 hours, a whole day, for a bed in a hospital, and 32 had been waiting more than 12 hours. In November 2021, when there were 2,137 hours lost to the ramp compared to 3,516 lost in November 2022 and 4,285 lost in November 2023 and 4,773 hours lost last month, the health minister said the following: 'So far during 2021, ambulances have spent 21,043 hours on the ramp.' That was up until November. He thought that was very bad.

I note that so far this year, at the end of May, ambulances have spent 20,035 hours on the ramp. I suspect that by the end of this week we will have passed that figure that was described as so terrible at the time. In that period, the health minister said, 'Each of the past seven months has seen more than 2,000 hours lost to ramping.' Each of the past 12 months today has seen more than 3,000 lost to ramping, three of them more than 4,000 hours. The health minister at that time said:

Yet again, these statistics paint a picture of how bad the ramping crisis is under Steven Marshall.

He said:

Whichever way Steven Marshall slices and dices the numbers, this is an appalling record.

He said:

But behind these numbers are real stories of real people suffering medical emergencies and forced to wait outside a hospital or left waiting for an ambulance to arrive.

I put it to you that if the November 2021 ramping figures, disappointing and unacceptable as they may have been, were achieved in any of the last 24 months, the Premier and the Deputy Premier and the health minister would have been lining up to celebrate.

Despite the fact that the former government during a once-in-a-century pandemic had world-leading outcomes when it came to our health response, despite the fact that we reopened a hospital closed by the Premier when he was health minister, and despite the fact that through all of this the Minister for Health and the Premier said that people are dying and the former government should be culpable for their loss when it comes to the voting booth, they now want to relieve themselves of any responsibility for figures that are far, far worse.

By the standards to which they held the former government, by the standards they set through their central election promise and, indeed, by the standards of decency held by any South Australian, this health minister should resign as a sign of the failure of this government to deliver on their promise.

The Hon. A. KOUTSANTONIS (West Torrens—Minister for Infrastructure and Transport, Minister for Energy and Mining) (15:10): I have complete confidence in the Minister for Health. He is one of the most, in my opinion, talented members of parliament I have seen in my 27 years in this house. He is yet to make his full mark on this house, in my opinion.

Whenever an opposition says, 'This motion isn't personal,' it is like saying in a debate about money, 'It's not about money.' Absolutely it is personal because it is not a no confidence motion in the government, as the critique has been made by the opposition, it is in the minister. Read the press releases. It is absolutely personal.

This is the most anticipated and important week in a political calendar in South Australia, for the government and the opposition, but not for the Leader of the Opposition. The most anticipated event this week is a buck show in the United Kingdom—the most anticipated event. This is an opposition that claimed in a by-election, that fought a by-election and said, 'The key issue here will be ramping,' yet throughout their entire by-election offered no alternative, not one policy, to fix ramping and the results speak for themselves.

This is not about ramping, this is not about the Minister for Health, we are having this debate because the Leader of the Opposition has to catch a plane. That is why we are having this debate today because he is too busy attending a family wedding in Scotland rather than doing his job as Leader of the Opposition.

I heard the Leader of the Opposition in his contribution to the house today say that the budget is next week. So far out of sight and out of mind. It is on Thursday, when the state government outlines its commitment for the next four years and its spending over the next 12 months, something that has taken us nearly six months to put together. The Treasurer has a young family. The work he has put into this, the work that cabinet puts into this, and the Leader of the Opposition will be on a plane, drinking cocktails rather than doing his job.

The Hon. D.J. Speirs: I've got a family too.

The Hon. A. KOUTSANTONIS: Here we go. Here we go.

The Hon. D.J. Speirs interjecting:

The Hon. A. KOUTSANTONIS: Oh really. Is this the temper we see in the emails we receive?

The Hon. D.J. Speirs interjecting:

The SPEAKER: Minister, for 56 minutes this house has acted in a very, very good way and I applaud everyone and I commend everyone for the restraint and for the way they have gone about their business, both people making their contributions and those listening on. We have four minutes left on the clock; let's stick to the facts and bring this home in a way that the students watching on would be proud of their local MPs and all members of parliament in this place.

The Hon. A. KOUTSANTONIS: I think we just saw that temper that has been made pretty evident in his emails we have been receiving. I just want to point out to the opposition that if they have won the argument that the health minister deserves to be removed from office in a vote of no confidence, that would carry more than the 13 votes they have on the floor.

The example I give the opposition is when other no confidence motions were moved by an opposition in this parliament just over two years ago. We made the argument, we proved the case to the parliament and received a majority and a Deputy Premier was suspended from the parliament and the parliament found no confidence in her conduct. That is how oppositions make an argument. You cannot have the Leader of the Opposition go on radio and say to South Australia's leading political journalist: 'I don't feel confident today sitting here saying that I could eliminate ramping,' and yet come into the parliament and demand that another member of parliament resign their commission for not being able to fulfil what members opposite say they cannot do.

There is a context here and the context is the budget. The budgets are an extension of the government's will. The government has exposed the government to what it is our intentions are and what we want to achieve. Such is the lazy attitude the opposition have to this, which is that they are not even going to be here to critique it.

I heard the Leader of the Opposition say it is the quietest parliamentary day he has. I can tell you from my experience that for the former Leader of the Opposition, it was one of the busiest days he had. The Treasurer ripping up the budget papers that we had, giving them out to shadow ministers to read because the opposition gets an advance copy. We get an advance copy—that is how important it is—and we all pore through it. Why? To formulate policies, understand the government's priorities, do our job for the public and give an alternative opinion.

Notice the parliamentary U-shape of the adversarial system. It is designed for you to do your job. Look up your title, it says 'opposition leader' not 'travel agent'.

Members interjecting:

The Hon. A. KOUTSANTONIS: Well, I have emails that say the only bully in this parliament is the Leader of the Opposition. The way you behaved on election night in Dunstan—it was not me, I was not the one getting angry. You say it is not personal, yet you attack the health minister. You say it is not personal, yet you attack people. This is not about us. There is only one person in this room that we all know the parliament does not have confidence in and it is not the health minister, it is the Leader of the Opposition.

The house divided on the motion:

Ayes 10

Noes 28

Majority 18

AYES

NOES

PAIRS

Motion thus negatived.