Public Works Committee: The Queen Elizabeth Hospital 24-Bed Mental Health Rehabilitation Unit

Mr BROWN (Florey) (11:27): I move:

That the 74^th report of the committee, entitled The Queen Elizabeth Hospital 24-Bed Mental Health Rehabilitation Unit, be noted.

The Department for Health and Wellbeing (SA Health) proposes to construct a new 24-bed mental health rehabilitation unit at The Queen Elizabeth Hospital in Woodville South. This is part of a $124 million capital works program to deliver an additional 72 mental health beds across the Adelaide metro area at The Queen Elizabeth, Modbury and Noarlunga hospitals to provide a significant expansion of service and capabilities within the health system.

The Queen Elizabeth Hospital is part of the Central Adelaide Local Health Network, which manages the delivery of public health services to approximately 470,000 people living across the eastern, central and western metropolitan areas. This is approximately 27 per cent of South Australia's population, and it is expected that the number of residents in this catchment will grow by 16 per cent by 2038. As the largest local health network by catchment population, number of employees and budget, the Central Adelaide Local Health Network employs over 15,000 staff.

Within this network, The Queen Elizabeth Hospital is a 303-bed acute-care teaching hospital that provides inpatient, outpatient, emergency and mental health services to approximately 250,000 people living primarily in the western suburbs. The Queen Elizabeth Hospital is currently undergoing a major redevelopment through the construction of the new clinical services building. This will enhance the capability and capacity of the services available at the hospital, including surgical, procedural, cardiac, emergency, intensive care and diagnostic imaging services.

The new infrastructure investment will also accommodate the relocation of general rehabilitation services at the hospital. This redevelopment will deliver a 24-bed mental health rehabilitation service in a new purpose-designed facility that will enable therapeutic, rehab-focused, adult mental health services to be established in Adelaide's western suburbs. The rehabilitation unit will be an integral part of a continuous and supportive pathway across the consumer journey.

The capital cost of the project is $44 million. Construction has commenced with expected completion by late 2025. The new mental health rehabilitation unit will be adjacent to The Queen Elizabeth Hospital on Woodville Road. This facility will be organised into four main zones over two storeys: entry, staff and support, consumer, and staff administration.

While the preferred configuration of the 24 beds will be two wings of 12 beds, the space will be flexible and could be operated as one 24-bed unit or two 12-bed units, with one wing able to be further divided into sub-pods of eight or four beds. This configuration supports the preferred staffing ratios of the unit, and allows an additional level of management of vulnerable or infectious consumers.

The design of the mental health rehabilitation unit is open plan and, with the safety of staff, consumers and visitors in mind, it maximises sightlines through the space. Observation of the entirety of consumer and entry zones will be largely facilitated by rotating the central staff support zone to consumer accessible entry zones. This rotation provides two staff stations, one for each wing, that have fields of view to the consumer space, as well as to the entry, foyer and main circulation corridors.

In lieu of seclusion zones, the preferred operational model will be to provide spaces for self or staff-managed withdrawal, with these spaces offering varying levels of enclosure, lights, views, size and acoustics to cater for a variety of requirements. The aims of this project are:

to assist with the decrease in long length of stay for consumers in acute wards due to lack of discharge options;

to deliver services that function as an integral part of the mental health system;

to utilise peer workers as integral staff members; and

to offer a best practice mental health rehabilitation model for consumers and carers that is trauma-informed from both a service delivery and infrastructure perspective, which works with the consumer to provide positive outcomes.

In broad terms, it is anticipated that the completion of the mental health rehabilitation unit will generate an increased focus on recovery and assist in reducing the length of stay for more complex consumers in acute mental health beds. It will also provide outcomes that go beyond the occasions of care and length of stay, plus increase the focus on outcomes from the consumer's perspective.

Project management will follow the best practice principles as advocated by the state government and construction industry authorities. Risk management will form an integral part of this process, identifying and assessing risk and ensuring that appropriate management or mitigation measures are incorporated into the delivery of the project.

A key risk is ongoing cost pressures across all capital projects from inflation and supply shortages, which will be addressed through a focus on value management. Given this project forms part of a 72-bed mental health initiative across local health networks, workforce is a significant risk to commencing operations, especially as particular experience and qualifications are required for staff. High-level workforce principles are being developed by the department's Mental Health Strategy and Planning Unit to address this.

With regard to potential risks presented by the site location, the project teams have reviewed site geotechnical information and will verify the existing conditions and how these can be mitigated or removed. For further oversight, a specific risk framework, managed by a risk work group, has been established. This will be chaired by the Department for Infrastructure and Transport and include membership from key stakeholders.

SA Health recognises that the provision of a health facility with good environmental qualities is essential to achieving a good value for money solution, and one that will assist in improving user comfort and wellbeing, and reducing patient recovery time. To achieve this, SA Health has incorporated ecologically sustainable development principles into the scope of the project. The design of the building spaces and support systems have been planned to be highly flexible to increase the adaptability and futureproofing of the building.

This includes a bed layout that can be configured in numerous ways, backbone systems, and engineering spaces that can support changes in technology, and provision in mechanical system design for potential increases in adverse weather conditions. Other measures include provision for the installation of solar panels on the roof, the increase of outdoor air delivery into the air-conditioning system to improve air quality, internal planning and window shade controls to allow for a high level of daylight while mitigating solar glare, and full electrification of the building.

The Department of the Premier and Cabinet Aboriginal Affairs and Reconciliation Unit has no record of Aboriginal sites within the proposed works location. The site has no registered or identified non-Aboriginal heritage value. SA Health states that significant trees within the development zone will be addressed in accordance with the significant trees legislation.

Engagement and consultation have been key themes throughout the various stages of the project. Consultation has occurred with clinical and non-clinical staff, consumer reference groups and industrial bodies. The project teams have undertaken specialist subject matter expert reviews within the department, the Central Adelaide Local Health Network and the Office of the Chief Psychiatrist. These include work health and safety, infection prevention and control advisers, the network's consumer and carer advisory group, as well as security and medical emergency response advisers. The local community has been consulted through an ongoing two-way process of engagement, supplemented by targeted letter drops, regular online and social media updates, in-hospital displays, fact sheets and information sessions.

The committee examined written and oral evidence in relation to The Queen Elizabeth Hospital 24-bed mental health rehabilitation unit. Witnesses who appeared before the committee were: Tim Packer, the Executive Director, Infrastructure, Department for Health and Wellbeing; John Harrison, the Director of Building Projects, Department for Infrastructure and Transport; Dr Paul Furst, the Executive Director of Mental Health and SA Prison Health Service, Central Adelaide Local Health Network; and James Sage, the Joint Managing Director of Cheesman Architects. I thank the witnesses for their time.

Based upon the evidence considered and pursuant to section 12C of the Parliamentary Committees Act 1991, the Public Works Committee reports to parliament that it recommends the proposed public work.

Ms PRATT (Frome) (11:36): I also rise to make comments on the Public Works Committee introducing or moving that the 74^th report of said committee, entitled Queen Elizabeth Hospital Mental Health Rehabilitation Unit, was noted by the member. I take this one final opportunity on budget day to reflect on the government's priorities—or lack thereof—of investing in mental health and, indeed, to pass judgement on them through this report.

While the opposition welcomes every single dollar that is invested into mental health services in South Australia, there is clearly more work to be done. I note that the budget lock-up is underway and I imagine there are a number of key stakeholders in the mental health space who are pouring through the tomes of budget papers, searching perhaps in vain for any significant amount of investment going into not mental health beds, which the government is quick to promote, but in fact psychosocial services, investment in regional mental health services and any number of services that provide low-fee, no-fee, no-referral, walk-in, peer-led clinical support that extends beyond what is a short-term acute stay in a hospital.

This report for The Queen Elizabeth Hospital mental health rehabilitation unit is welcome. It is not all doom and gloom. I note that this report and this investment is part of a $124 million program of capital works to build 72 mental health beds at The Queen Elizabeth Hospital, but also the Modbury Hospital and Noarlunga Hospital across the metro area. People living in regional South Australia can only dream about that level of resourcing.

The report goes on to state that that investment of $124 million 'will provide a significant expansion of service capabilities and capacity at TQEH', and we welcome that. I know that residents in the western suburbs would welcome, after years of neglect under Labor, a return of significant investment in The QEH, remembering this was one of the three hospitals downgraded by the Labor government when it was last in government through its disastrous Transforming Health escapades. We know how that worked out: they closed a hospital; it was called the Repat.

The report that I am reflecting on continues to state that this redevelopment at The Queen Elizabeth Hospital will deliver a 24-bed mental health rehabilitation service in a new purpose-designed facility that will enable therapeutic, rehab-focused, adult mental health services to be established in western Adelaide, and we welcome that.

The capital cost for the project is $44 million, and construction, this report states, was expected to begin in April just past—April 2024—and it is set to be completed by late 2025, so some way off. The aims of this project are worthy, and I note them in full:

to assist with the decrease in long length of stay for consumers in acute wards due to lack of discharge options;

to deliver services that function as an integral part of the mental health system;

to utilise peer workers as integral staff members; and

to offer a best practice mental health rehabilitation model for consumers and carers that is trauma-informed from both a service delivery and infrastructure perspective, and works with the consumer to provide positive outcomes.

It is a bit jargonistic, but the aims of this project are worthy and, I repeat, we welcome this investment, and we welcome this project. I return to the first dot point in this report which states that the aim of this project is to assist with the decrease in long length of stay for consumers (let's call them patients) in acute wards (let's call them hospital beds) due to a lack of discharge options. That is code for bed block, and what this dot point really is saying is the aim of this project is to reduce ramping, and so it should.

It should be aim for this government, 2½ years after it was elected, 2½ years after it promised to fix ramping. We have seen 24 months of the worst ramping records in history and, in fact, when we reflect on the ramping hours lost for the month of May, it is a tragedy to report that the month of May is now the worst month on record, and the opposition predicts we will see worse months to come, heaven forbid. We have seen 4,773 hours lost by patients, consumers, being ramped in an ambulance at our metro hospitals, and here is a long overdue report showing some level of investment in a rehabilitation unit, which we welcome.

In trying to address and take pressure off the health system, and trying to reduce the ramping that in some way I am sure has been inflated by the number of ambulances that are now on the road making their way to a ramp near you, this project will not be delivered until the end of next year, if we are lucky. There are many more months of ramping to come before we see this aim met, which is to assist with the decrease in the long length of stay for our patients in acute wards due to a lack of discharge options. It just means that they have nowhere else to go.

On budget day, when I am anticipating millions of dollars appearing in the budget to be invested significantly in mental health and psychosocial services, I am getting a bit wary. Those of us who have read the front page of the local paper today have seen the government's proud announcement—and rightly so—of $5 million invested in teen mental health. It is a very significant contribution thanks to the brave advocacy of a young teenager.

If the front page of the paper is signalling a $5 million investment as the government's best effort for mental health, then I fear for those who are waiting to discover if there is a $125 million investment in psychosocial services. We are going to have to wait for a Liberal government to be returned, because $125 million a year is required for 19,000 South Australians who are currently living with an unmet need in mental health.

How do we know that? We know because the Office of the Chief Psychiatrist tasked with the job of investigating that very community has reported, through its own mechanism, that very fact—19,000 South Australians, that we know of, are living in South Australia with unmet need in psychosocial services. They are in our community, they have an assessed diagnosis, they are looking for access to services and, if they live in regional South Australia, there are fewer options.

I take as many opportunities as I can in this house to speak to the options that are available, but this minister is obviously intimidated by, or put off by, or unable to really pursue a relationship with the federal Minister for Health and Aged Care to negotiate what is required—that is, $125 million co-funded, commonwealth and state, in psychosocial services to support 19,000 South Australians who are living with a vulnerability with their own health.

While we welcome this report and investment in mental health in the western suburbs, it does not go nearly far enough to meet the growing need in the mental health sector in South Australia. I know that stakeholders are very concerned that this government has not made investment in mental health a priority. I conclude my remarks.

Mr BROWN (Florey) (11:46): I would like to thank the member for Frome for her contribution to this debate. Also, it would be remiss of me not to point out the support of the local member, the minister and member for Cheltenham, for this particular project as well as draw attention to the fact that not only was he born at The Queen Elizabeth Hospital but also he was pleased to attend the ground breaking of this project yesterday.

Motion carried.