Economic and Finance Committee: Yorke Peninsula Health Services

Mr HUGHES (Giles) (11:39): I move:

That the sixth report of the committee, entitled Inquiry into Delivery of Health Services on the Yorke Peninsula, be noted.

Beginning in November 2024, the Economic and Finance Committee, pursuant to section 16B of the Parliamentary Committees Act 1991, established an inquiry stemming from a petition presented to the South Australian House of Assembly in 2023 that requested the house to urge the government to take steps to ensure the equitable distribution of health expenditure, material and staffing resources to ensure appropriate access to quality health care for regional and rural South Australians and to reclassify Port Pirie and Wallaroo hospitals to improve resource allocations within the electorate of Narungga.

The Economic and Finance Committee resolved to specifically investigate (1) the classification of the Wallaroo Hospital, (2) the most appropriate local health network coverage of the Port Pirie hospital, (3) factors impacting the delivery of health services on Yorke Peninsula and especially in relation to access and equity and (4) any other matter relating to health services on Yorke Peninsula.

The inquiry received 86 submissions and heard from witnesses in Adelaide, Yorketown and Wallaroo. The committee thought it was especially important to visit Yorke Peninsula to hear from people directly and not expect them to come to Adelaide. The committee heard from nearly 30 individuals at the two public hearings on Yorke Peninsula as well as from several organisations and stakeholders.

One of the petition requests was an examination of the classification of Wallaroo Hospital within the Yorke and Northern Local Health Network, as it is the primary hospital on Yorke Peninsula. Classifications are determined for certain facilities and services at hospitals, with most services at Wallaroo Hospital being resourced at level 2 or 3. A number of submissions and witnesses stated that the services at Wallaroo Hospital needed to be upgraded, with a limited number of beds, particularly in the emergency department. It also highlighted that some specialist services, such as radiology, were not available at Wallaroo on a 24/7 basis.

Representatives from the local health network told the committee that the plan was to establish Wallaroo as part of a triangular hub alongside hospitals in Port Pirie and Clare with similar levels of service delivery.

The petition also requested for the Port Pirie hospital to be transferred from the Yorke and Northern Local Health Network to the Flinders and Upper North Local Health Network. There were submissions and testimony which suggested that the Port Pirie hospital drew resources away from hospitals on Yorke Peninsula and that people were unlikely to travel to Port Pirie for treatment when travelling to metropolitan Adelaide was preferable, with suggestions that removing Port Pirie hospital from the local Yorke and Northern Local Health Network may result in the redistribution of a similar level of resources within a smaller network. However, the committee also heard that Port Pirie hospital was critical for maintaining levels of resources, staff and institutional knowledge within the Yorke and Northern Local Health Network.

The committee received submissions and witness statements on several other issues concerning health services on the peninsula. A problem faced across the region is a lack of personnel, including doctors, nurses and allied health professionals. This has meant that hospitals are at risk of being understaffed, people cannot access GP appointments in a suitable timeframe and specialist services are not available. Furthermore, the committee was told that early intervention and health monitoring measures have become inaccessible to many.

A lack of health practitioners on Yorke Peninsula partially stems from difficulties in recruiting to and retaining staff on the peninsula, especially when other regions in South Australia and nationally also have staff shortages and compete for suitable personnel. The committee heard that incentives are needed to attract staff to Yorke Peninsula while also addressing workload and safety concerns amongst existing staff.

Distance on Yorke Peninsula was raised as a significant issue during the inquiry, with many people choosing or needing to travel to Adelaide for treatment. This may be due to a lack of suitable appointments on the peninsula or that the services, particularly specialist services, are not available in the region. Further to this, there were numerous reports of people needing to travel long distances to Wallaroo, Maitland and Kadina from the southern parts of the peninsula. These travel requirements put strains on patients as well as their loved ones and present further risks to the residents of Yorke Peninsula. A lack of travel options was highlighted, with many depending on the Patient Assistance Transport Scheme or volunteer-driven ambulances.

Many specialist services are limited on Yorke Peninsula, including mental health services, antenatal and postnatal care, and palliative care services. In many of those cases, the committee heard that people need to travel significant distances, such as to Wallaroo or Adelaide, to access them or face substantial waits in accessing necessary services. This has led to a call by residents on Yorke Peninsula for greater investment in staff and facilities to provide greater services that are more locally accessible.

The committee made 16 recommendations in its report. Some of the key recommendations include investment to be considered to upgrade services at Wallaroo Hospital, such as an increase in the number of beds and 24/7 onsite radiology services, and the exploration of options to develop emergency department facilities at Yorketown and Maitland hospitals. The committee also recommends an investigation of pathways to increase the number of staff in hospitals on Yorke Peninsula, including incentives for early career nurses and those based in metropolitan areas to relocate and work on the peninsula, and possible expansion of the Yorke and Northern Local Health Network's Rural Doctor Program.

There are also recommendations in the report that relate to consideration of expanding specialist services for the community on the peninsula, such as increased mental health support in hospitals, greater child and family health services in the region and the expansion of palliative care services. A full list of the recommendations, with explanations, can be found in the report.

On behalf of the Economic and Finance Committee, I would like to extend my gratitude to the individuals and organisations that submitted evidence to the inquiry. I particularly want to highlight the contribution made by residents on Yorke Peninsula who attended the town hall meetings in Yorketown and Wallaroo in April of this year. I would like to thank them for their generosity of time and the evidence provided.

I would also like to thank my colleagues on the Economic and Finance Committee for their work on the inquiry as well as the parliamentary staff: Jessica Watson, Shannon Riggs and Dr Evan Smith. I would also like to acknowledge the work of the member for Narungga in getting behind the petition and advocating so strongly for his community when it comes to the provision of health services.

All of those that live in the country, and especially the more distant parts of the country, know that there is a real challenge when it comes to delivery of services. There are issues around access and equity, and there is no magic wand here. There is no partisan political magic wand to some of these issues, but we have to keep plugging away. We have to sensibly allocate the resources necessary and we have to address some of the systemic issues—some of which are state based, but some are federal—and the interaction between the federal sphere and the state sphere. Once again, well done to the member for Narungga.

There are some changes currently going on. Country and Outback Health has been doing a lot of good work in the country; that is a federally funded agency that has a degree of flexibility. One of the issues that was raised on Yorke Peninsula, and especially in Yorketown, was the availability of GPs. There has been one very longstanding GP in Yorketown and there have been issues around accessibility and availability, so I am pleased that Country and Outback Health has now secured one additional GP for Yorketown and they are very confident about another GP also relocating to Yorketown. One of those GPs, the one who is currently there, has come all the way from Wales and apparently is settling in very well. So I think it is worthwhile calling out that organisation for the good work that it is doing.

I know in my electorate we were looking at losing Dr Tony, one of those old-school longstanding GPs, who has now retired, and Country and Outback Health were able to secure two GPs for Quorn who came from overseas. From what looked like a fairly dire situation when it came to securing GPs, the work done by the federal agency has certainly helped. With those few words, I commend the report.

Mr TELFER (Flinders) (11:52): I rise to speak on this important report from the Economic and Finance Committee as a member of the committee and obviously as a regional member of parliament. The work that was done to encourage these hearings to happen was really important. This was brought to the attention of this place through the petitioning and the signatures of thousands of members of regional communities, predominantly across Yorke Peninsula, highlighting the challenges, restrictions and risks that are faced every single day by regional people who are dealing with a health system that is very different from the one that their city cousins enjoy.

Some of the aspects that were brought to the attention of the committee through the hearings were really important, such as the challenges of distance, which the member for Giles has highlighted. When you are living hours and hours and hundreds of kilometres away from a major hospital, the level of care that is delivered is not adequate and is not sufficient. We heard about some of the challenges that are faced in some of the smaller hospitals in regional South Australia and Yorke Peninsula through the hearings, but I know that these are only replicated—if not amplified—for those who live even further away or in more isolated communities.

There are the challenges of recruiting and then retaining staff, whether it is GPs at the very top or the challenges that we have seen through the hearings and through our experiences of even some of the basics: the registered nurses or even just general nursing staff in regional communities. The load that is being carried by a smaller cohort of nurses in regional communities is significant. This is why it really is important that these sorts of reports are brought to this place and these petitions are brought to and understood by this place about the challenges that are being faced by regional communities when it comes to health delivery.

As the member for Flinders, I am fully aware of the 11 hospital and medical centres that are around my electorate, and the challenges that they are facing with health delivery. If you cannot get to a GP appointment on the corner of one of the main drags here in Adelaide, you have choices: you can go to any number of clinics and try to get in—you can go to 24-hour GP clinics, you can go to emergency departments—but when you are in regional South Australia, when you are a long way away, and you are in an emergency situation or you need urgent medical care, the choices are not there. This is why we are seeing some really negative health outcomes in some of our regional communities.

The petitioners who brought this to our attention, which led to this report, really were crying out for help, and they were crying out for help on Yorke Peninsula in particular. I congratulate the member for Narungga on his work in getting behind this petition and ensuring that his community's voice is heard. Those issues and challenges faced can be replicated right across regional South Australia. The member for Giles points out that the more isolated, the more regional and the more remote you are, the more challenging that health delivery is becoming. My colleagues on both sides—the member for Giles, the member for Chaffey, the member for Stuart, the member for Hammond, and yourself, sir—would well know that communities that are further away from Adelaide are finding it increasingly difficult to get that consistent level of health care.

We understand from regional communities that we are not going to get the exact level of health care that our city cousins get. It comes with the territory—no pun intended—it comes with the population size. I believe there is a standard of care that is expected to be delivered right across South Australia, but that we in regional and remote South Australia really should expect because of the contribution that we are making to the state's economy. The perverse outcomes that can result from that medical care not being delivered are significant, and they are costly.

We heard in the report about the reliance on the Patient Assisted Transport (PAT) Scheme. Those of us who live further away from Adelaide know the PAT Scheme well. There are those of us who have to advocate on behalf of our communities to speed up recompense and to get appropriate recognition. Just because nominally there is a specialist who might be closer, it is actually better for medical care, for logistics and for transport for us to go to Adelaide to get that care. So there needs to be an understanding within the health department and within the bureaucracy that there needs to be that flexibility within the Patient Assisted Transport Scheme.

I have been on my feet in this place many times advocating for there to be an expansion of that scheme in recognition that we are having less and less specialist care delivered in regional South Australia, and this is something which is not sustainable. So it is a nod to a bandaid covering up a situation rather than a healing of it, but at least that structure needs to be in place to recognise those challenges that are faced. The people of Yorke Peninsula really did call out to the Parliament of South Australia, through this petition and through their submissions to the committee, to have their voice heard and to have an understanding of those challenges that are being faced in regional communities.

As I said, in Flinders we have communities far and wide, hundreds of kilometres apart from each other, and we are in a sad situation where they are all competing for a very small amount of funding. You have towns a hundred kilometres away from each other that are basically fighting for the attention of the health department to just get a doctor in town. You have bureaucracy telling health professionals that, 'Well, you're alright to service this town, this town and this town,' even though they are 250 kilometres apart. They are asking doctors to be on call at a hospital even though they are over an hour's drive away. Some of the ridiculous outcomes that we are seeing, because of the lack of understanding by decision-makers, is really astounding—and I hear these stories, as I know my regional colleagues do as well.

There needs to be an understanding within the decision-making bureaucracy. We know the size of the SA Health budget. We know that last financial year it was $700 million over budget and we know that the year before that it was $900 million over budget.

There needs to be an understanding of what actually is being delivered on the ground in regional communities and the work that has been done by this committee is really important. Our regional communities deserve that level of care that should be expected in a community like ours in Australia. The outcomes for your health should not hinge on what your postcode is. It should not be variable depending on how far away from Adelaide you are. For the petitioners who helped form this committee it was a cry for help. It was a cry for help, not just from those who are receiving medical care but if you read the submissions, if you go through the long list of people who had their voice heard through this process, you will see.