HEALTH CARE BILL

Committee Stage

In committee.

(Continued from 14 February 2008. Page 1733.)

Clause 1.

The Hon. J.M.A. LENSINK: The Liberal opposition received these amendments only this morning and whilst they do not look particularly complicated I am obliged to consult with my colleagues before we are able to make a contribution of substance and, indeed, form a position on any of these amendments.

The Hon. SANDRA KANCK: I met with the Minister for Health last week to discuss some aspects of this bill and received a letter from the minister yesterday that answered some of the queries I raised in my second reading contribution. However, I would like some answers put on the record so that they are not just answers given to me in writing; I think others in this chamber should also be aware of those answers.

In the first instance, I asked some questions about the application of the Generational Health Review and its recommendations, and how they matched up with this bill. I would appreciate it if the minister could respond to that concern.

The Hon. G.E. GAGO: The report's message about the need for, and direction of, governance reform, particularly in relation to hospital boards, is quite clear. It said that existing legislative protection of individual health unit boards has stood as a clear barrier to health system reform, and that problems associated with individual health unit boards had been identified by Labor and Liberal governments over the past 30 years.

Numerous attempts have been made to reform governance, encourage greater cooperation and coordination, and reduce duplication of services and infrastructure through regionalisation but with little success. The GHR concluded that legislative change was required to substantially reform governance arrangements in South Australia. It strongly supported community participation but did not make a necessary link between participation and ownership; instead, it said it was important not to confuse corporate governance and community participation.

The GHR also proposed that an explicit commitment to the principles of community and consumer participation be made within legislation. The bill does this, in its principles and functions of the minister, the CE and the advisory councils. The GHR recommended the establishment of regional boards to act as a voice for the country region and these were established; however, these boards soon recognised that they duplicated the functions in each region and created seven differing systems of management and administration, creating inefficiencies and extra costs. The boards elected to dissolve themselves and establish a single body, the Country Health SA board, to act as a board of governance for the country region and to advocate and advise on country health issues.

The Hon. SANDRA KANCK: In my second reading speech, I also raised concern about representation of consumers on the health advisory councils. I would appreciate it if the minister can advise us what consumer input there is likely to be.

The Hon. G.E. GAGO: The government is committed to increasing consumer and community input into the delivery of health services, through both legislative and non-legislative means. This bill allows health advisory councils to be established for specific purposes, potentially including consumer HACs at particular metropolitan hospitals and special interest consumer HACs, such as Aboriginal health, or guardian or lesbian health.

Each country area will be able to have a local HAC to provide advice on local needs and service delivery issues. In addition, it will be ensured that there is a consumer representative on the health performance council (HPC) and it will also be ensured that the HPC undertakes the role of monitoring how the health system as a whole engages in a meaningful way with the community and health consumers.

The Hon. SANDRA KANCK: I am not clear whether some other questions I raised in my second reading speech were answered in the last week of sitting when we were, at that stage, discussing clause 1. In particular, I had noted that there would be advisory committees to assist the HPC. What I want to know is whether those advisory committees are a direct replacement for what the Metropolitan Hospital Board's subcommittees are already doing and, if so, will these advisory committees be composed of departmental staff or volunteers, or a mix of the two?

The Hon. G.E. GAGO: My advice is that the old committees can become HAC committees if the hospital so chooses and that the membership will remain pretty much the same as it is currently the case.

The Hon. SANDRA KANCK: In my second reading speech, I also raised the issue of policy development. My understanding is that, particularly for the metropolitan hospitals, a number of the subcommittees of those boards are involved in policy development. I would like to know whether this will function in the same way as the minister advised in her previous answer, or will it be something that will be taken up within the department?

The Hon. G.E. GAGO: Where the policy relates to the region, the policy will continue to be developed locally (as it is at present); and where the policy relates to a statewide project, it will be developed by the department.

The Hon. SANDRA KANCK: If they are going to be developed in the regions, I assume, then, that that will become part of the role of the HAC, that is, policy development in a particular region.

The Hon. G.E. GAGO: The responsibility will lay with the chief executive officer of that region who would be highly likely to seek advice from HAC.

The Hon. SANDRA KANCK: In relation to an earlier answer about policy development in the metropolitan area, the policy development will be occurring in the department. As I said in my second reading contribution, I do not expect that people in the department currently are sitting around waiting for tasks to be given to them. Does this mean that extra staff will have to be employed in the metropolitan area for policy development work in health?

The Hon. G.E. GAGO: The short answer is no. Currently, there are three metropolitan regions and they will continue to develop their own policy. In relation to policy across the metropolitan area as a whole, that will continue to be done by the department.

The Hon. SANDRA KANCK: I seek a little clarification on that answer. The purpose of this bill, at least in part, was to dissolve the three hospital or health service boards that exist in the metropolitan area. How will they continue to do these tasks if they have been dissolved?

The Hon. G.E. GAGO: The boards as a governance body will be dissolved, but the resources they use for policy development will still be available.

Clause passed.

Clauses 2 to 10 passed.

Progress reported; committee to sit again.