REGIONAL HEALTH SERVICES

Adjourned debate on motion of the Hon. J.M.A. Lensink:

That the Social Development Committee inquire into and report on the current provision and plans for future delivery of Health Services in Regional South Australia, with particular reference to—

1. Health Advisory Councils replacing local Hospital Boards, significantly reducing their decision making power and effective contribution to local operations;

2. The consequent decline in local community fundraising due to local communities not having a voice in health spending in their area;

3. How funds previously raised by local communities are now spent;

4. The removal of funding to the Keith, Moonta and Ardrossan Hospitals;

5. Country hospitals failing to receive final 2010-2011 operational budgets so that they are forced to work on indicative budgets and the impact on their ability to make decisions;

6. Property titles of hospitals being transferred inconsistently or inappropriately;

7. The impacts of a State-wide freeze on the hiring of staff for any new positions;

8. Transfer of St. Johns Ambulance to South Australian Ambulance Service and consequent outcomes including—

(a) removal of the ability of local volunteers to decide which community events they attend;

(b) “fees” for attendance at local community events set by and paid to Country Health SA instead of the traditional system of donations being provided directly to local ambulance stations; and

(c) reduced incentive for new volunteers to participate;

9. The reduction of admission rights for country general practitioners and the consequences for the provision of accident and emergency services across CHSA and community hospitals;

10. The centralisation of purchasing by country hospitals and the consequent impact upon local communities’ businesses;

11. Bullying and understaffing at the Port Augusta Hospital;

12. The impact of deeming Country Health as “local network” for all of regional South Australia within the Federal health system so that different regions within the State have no different identity within the Federal programmes and funding; and

13. All other relevant matters.

(Continued from 23 February 2011.)

The Hon. T.A. FRANKS (21:13): I rise to indicate that the Greens are supportive of this motion put before us from the Hon. Michelle Lensink, and we believe that the Social Development Committee should, quite rightly, inquire into and report on the current provisions and plans for the future delivery of health services in regional South Australia.

I would note that the Greens support a strong health sector, no matter where you live in this state, and we would be concerned if the takeover by health advisory councils were, indeed, to have significant negative impacts on local country hospitals, so we welcome that investigation. We support local communities having a strong voice in their local affairs; in fact, a strong belief in participatory democracy is one of the Greens' four pillars.

In recognition of that, I was very happy to present a petition signed by 570 residents of South Australia on 11 November last year, requesting this council to urge the Minister for Health, the Hon. John Hill MP, to establish an independent inquiry to reassess health services in Burra and restore an attending doctor for accidents and emergencies at Burra Hospital as quickly as possible. I do understand that there are issues around that but, certainly, it should be seen as a matter of priority for this government that people have access to quality health care no matter where they live in this state.

With my colleague the Hon. Mark Parnell, I joined people from Moonta, Ardrossan, Keith and other areas of rural South Australia in rallying on the steps of this place, calling for a fair go for country hospitals. I am new to this place, so I am not sure whether there are always so many rallies. However, from the outside, I certainly did not see as many as I have seen in the past months since the state government's most recent budget.

Members interjecting:

The PRESIDENT: Order!

The Hon. T.A. FRANKS: The Greens have publicly called for more support for these facilities, both in this place and in the federal parliament, where the member for Melbourne quite stridently supported Liberal motions for better support for South Australian rural health. Any South Australian could need a country hospital. Lives can be lost for the sake of a budget saving that amounts to a little more than a few ministers' phone bills. I understand that this government plans to close ambulance and emergency facilities at Ardrossan and put South Australian lives at risk. Ardrossan Accident and Emergency receives a measly $140,000 a year, which is not even a significant sum to cut, although it is cutting a significant service.

In the past, the Greens have been called on by the Hon. Bernard Finnigan, along with the opposition, to provide some detailed costings of what we would have cut in the government's state budget. The government made the choice to cut rural health, and I would say that the Greens would not have chosen to cut rural health. In fact, we would have taken some of the Sustainable Budget Commission's other identified areas of government largesse. For example, we would have reduced the number of ministers by three, from 15 to 12, which is something unnecessary when you do not have a minority government anymore, and we would also get to the national average ratio of ministers to lower house seats had we done that, and that would bring $7.5 million of savings.

We would also reduce chauffeur-driven vehicles and use a centralised administration system, which also could have saved over $2 million per annum. By just implementing a log book for ministerial cars and reducing the associated fringe benefits tax payable was, in fact, estimated by the Sustainable Budget Commission to be worth about $1.2 million in savings. Improving fleet vehicle utilisation (primarily by reducing home to office use) could have resulted in about $7.4 million by 2013-14. In real terms, these are small figures but, in terms of country health, comparable figures will have a significant impact on rural and regional people in this state.

Adopting any or all of these measures would have freed up a substantial sum of money that could have been redirected into the health system and ensured that our country hospitals were not forced to close as a result of inadequate resourcing.

The Hon. B.V. Finnigan: You are talking here about subsiding private hospitals.

The Hon. T.A. FRANKS: You may double the amount elsewhere, but you would have cut it to those particular services I have named today. If you are denying that you have cut those services—

The PRESIDENT: Order!

The Hon. T.A. FRANKS: —that's a whole different matter. The government's own State Strategic Plan sets targets, which include growing prosperity, improving wellbeing, attaining sustainability, fostering creativity and innovation, and building communities and expanding opportunities—and that means for all of us, not just for some of us and certainly not just for those who live in marginal electorates the Labor government would like to retain. The Greens are concerned that the current plans for health services in regional South Australia may indeed undermine the state plan, and we urge the government to have a real good look at addressing the wellbeing of our communities right across this state.

We welcome this motion from the Hon. Michelle Lensink. We do not take lightly the decision to refer matters to a committee. This is obviously a committee that is undertaking business in this council; this is not an additional committee. While Labor members keep whinging about having to sit on committees, they should remember that they are privileged to be here in this place representing the people of South Australia. If they cannot turn up to a few more meetings, when they are doing such disgusting and destructive things to country health, maybe they should hand over the government to people who would willingly attend a few more committee meetings. With those words, I commend the motion to the council.

The Hon. A. BRESSINGTON (21:19): I rise to briefly indicate my support for the honourable member's motion to establish the Social Development Committee inquiry into the future delivery of country health services and the report of health performance councils on the operation of health advisory councils.

It seems like only yesterday that this place was debating the Health Care Bill 2008, which significantly reformed the structure and management of health services, including those in rural areas. At that time, we were promised by the minister that country health services would only prosper under the new arrangements; of course, it saddens me to learn that this has not been the case.

May I say that in hindsight this is one of the top 10 issues on my list that raises my level of cynicism toward promises that governments make to get their legislation or their policies through. Sadly, I have come to learn that the only motivation for any sort of reform in this state to do with health or any other social issue is a money-saving initiative and that, when we are making those decisions based on the bottom line only, there is going to be human carnage out of that. We are seeing that over and over.

I also reiterate the Hon. Tammy Franks' remarks about members from the government whingeing about the number of committees. The fact of the matter is that if this government was actually doing its job and delivering on social issues the way a government is supposed to, we would not need all these committees to be called. If we had more information freely available to us, we would not need to have these inquiries to try to drag the truth out of bureaucrats and everybody else who has been involved in the drastic policies that have been introduced since my time in here.

I might also say that I have put in a freedom of information on fluoride data. It has taken four months, but there is still no response and they keep asking for an extension. That is one health issue that is on my list of priorities, but there are laws around freedom of information. We have actually to put in freedom of information to get the most basic of information or to try to get some sort of idea of why this government is doing what it is doing, how much it is going to cost and all the rest of it.

We do not get that in our second reading speeches, we do not get it in this parliament in the debates. We have to go hunting for it, and that is not actually our job. I know the Hon. Bernie Finnigan does not like committees and thinks that all committees are politically motivated and whatever.

The Hon. B.V. Finnigan: Always.

The Hon. A. BRESSINGTON: Always—not that members in this place actually might want to have an opportunity to question people about what is really going on and get another perspective, other than the tripe we are fed in here in debates.

I have been informed that the honourable member and a colleague in the other place (the member for Stuart) have worked with the Minister for Health to draft an improved terms of reference for the inquiry, which I believe is accepted and supported by the government. If that is the case, the government should be commended for its cooperation, although the old maxim, 'Never hold an inquiry unless you know what the outcome will be,' comes to mind.

I am sure the minister believes that the Social Development Committee will deliver a glowing report. Time will tell if his belief is well founded. Given what we are now told about the viability of the Keith hospital and other complaints that have been raised in this place and elsewhere, I do not see how that could possibly be. I look forward to reading the report.

The Hon. R.L. BROKENSHIRE (21:23): I rise on behalf of Family First to support the motion. I refer honourable members and others to my second reading comments on 23 March (the last Wednesday of sitting), reintroducing Family First's Country Health Guarantee Bill and my question on 24 March concerning community hospital funding.

I will not speak to every aspect of the committee's terms of reference under this motion, but I do hope it is understood that issues such as bullying and understaffing are allegations that the committee ought to look at, rather than established fact. They may well be true, but I am cautious about such allegations.

My concerns are on the record about the funding situation at Keith, Moonta and Ardrossan hospitals and, in the case of Keith, the fact that they have had to secure pledges to keep that hospital's emergency and other doors open for the immediate future. From where we sit in the parliament we are seeing a concerning trend, with this government creating bureaucracies and taking away from communities and community organisations the initiatives that they have come up with and, in some cases, supported for years, if not decades.

One clear example of this is the community hospitals that the Health Care Act unfairly labels as private hospitals. Throughout country South Australia they include infrastructure that was put in there by fundraising and donations from their community. Country communities have great love for their community hospitals, and there is a frustration that they have lost control of those hospitals. The Hon. Michelle Lensink's motion picks up on that sentiment.

As an example, the community and I had to fight to ensure the ongoing operation of the McLaren Vale hospital, which a minister in a former Labor government decided was going to be cut. Today we have a vibrant and integral hospital that is so important in supporting the tertiary hospitals at the Flinders Medical Centre and Noarlunga. There are other issues more minor but still important. I recently raised with the Minister for Transport the issue of lighting of the landing strip at Renmark which, I understand, did not function correctly during a recent medical evacuation. The patient had to be taken to Loxton, which created an unsatisfactory delay in an emergency situation.

This is a timely motion. It will, through the Social Development Committee, give an independent assessment of the state of country health, and I look forward to that feeding back into my bill on Labor's country health guarantee—and indeed the guarantee has now been broken. I support the Hon. Michelle Lensink's motion.

The Hon. R.P. WORTLEY (21:26): I would like to indicate to the chamber that I will be moving an amendment to this motion, which will be coming shortly. It has been discussed with the opposition and it is in agreement with it. The amendment ensures that the proposed questions are framed in a more neutral and fair light.

The scope of the inquiry into country health is very broad and appears to be based on anecdotal claims. We do not oppose investigation into these 13 areas of inquiry; in fact, we think it is a very good story to tell about country health care and how the reforms will deliver new services to regional patients. However, the original terms of reference pre-empt the outcome of the inquiry. The amended terms do not prejudice the outcome of this inquiry. For example, the original point 11 regarding bullying and understaffing at the Port Augusta hospital failed to reflect that this is a claim only. This is against the principles of natural justice in relation to the management team and staff at the Port Augusta hospital.

I note that two formal claims of bullying were submitted to Port Augusta hospital in 2010. Both of these were investigated by an external consulting firm and the independent reports found them to be unsubstantiated. I understand that bullying and harassment claims are treated very seriously, and all claims are investigated at the hospital. I am concerned that the Liberal Party wants to pursue this case against the Port August hospital management team and staff. I think this pursuit will create a reluctance in staff to provide statements in the future and impact detrimentally on staff morale. These investigations are about protecting staff safety and welfare.

In another example, point 9, it is claimed that there is a reduction of admission rights for country general practitioners. Admitting rights have not been reduced. This is a misunderstanding. Instead, it is a fundamental principle by Country Health SA to ensure competency in the delivery of services to country hospitals by making country general practitioners subject to a credentialling process. The Liberal Party may think it is appropriate for those matters to be investigated by the Social Development Committee. I have not opposed its inquiry. All I have suggested is that these and all other proposed matters should start discovery in an objective way.

A number of items specifically relate to health advisory councils in country South Australia, which, members will be aware, will be reviewed by the Health Performance Council in accordance with the Health Care Act 2008. The Health Performance Council was set up to be a new consumer voice for South Australia's patients, volunteers and community members. Legislative Council members may recall the substantial work undertaken to ensure that the Health Performance Council conducts an independent overview of health services in this state.

It was all Independent, non-major party members of the council who supported this legislation, including the Hon. Ann Bressington. Dennis Hood, of Family First, moved an amendment requiring that the Health Performance Council review the governance arrangements after a period of three years, and this was supported by the government.

Members may recall that it is a requirement under section 101 of the Health Care Act 2008 that the Health Performance Council must, within a reasonable time after the third anniversary of the commencement of the act, furnish to the minister a report on the operations of the health advisory councils established in relation to any incorporated hospital or hospitals established to provide services in the country area.

This statutory report must review the effectiveness of the relevant health advisory councils in promoting the interests of local communities; review the level of satisfaction with the governance arrangements between the relevant health advisory council and any relevant hospital from the perspective of the members of the health advisory councils, the local community and the hospital; and identify any other significant issues relating to the operations of the health advisory councils considered relevant by the Health Performance Council.

The minister must, within 12 sitting days after receipt of this report, cause a copy of the report to be laid before both houses of parliament. The minister must, within six months after receiving the report, cause a formal response to the report to be laid before both houses of parliament. The Health Performance Council has formed a Health Advisory Councils Governance Review Advisory Committee to provide advice to the Health Performance Council on the development and implementation of the Health Performance Council's 2011 Health Advisory Council Governance Review Project.

I have asked for an addition to the inquiry; that is, it is proposed the Social Development Committee inquiry first consider the review of the Health Performance Council on the operations of the health advisory councils in accordance with the Health Care Act 2008. In doing so, the Social Development Committee respects the intent of council members only three years earlier. That is as far as my submission goes. Hopefully, the council will see fit to support the amendment. I move:

Leave out all words after 'That the Social Development Committee' and insert:

1. Examine the review by the Health Performance Council on the operations of the Health Advisory Councils in accordance with the Health Care Act 2008; and

2. Inquire into and report on the current provision and plans for future delivery of health services in regional South Australia, with particular reference—

(a) the role and responsibilities of Health Advisory Councils and the benefits, or otherwise, of the removal of local Hospital Boards;

(b) trends in local community fundraising for medical equipment services;

(c) how funds currently and previously raised by local communities are held and spent with particular regard to authorisation and decision making.

(d) the ability of Keith, Moonta and Ardrossan community-run non-public hospitals to operate sustainable budgets and retain services;

(e) timing of finalised operational budgets in country hospitals;

(f) ownership and transfer of property titles of country hospitals;

(g) the process and timing of the hiring of staff for new and existing positions;

(h) South Australian Ambulance Service arrangements, including the role of volunteers, fees and fundraising and the benefits, or otherwise, to local community events;

(i) admission rights of country general practitioners to country hospitals and the provision of accident and emergency care;

(j) procurement by Country Health SA and the benefits, or otherwise, to country communities;

(k) claims of bullying and understaffing at Port Augusta Hospital;

(l) the benefits, or otherwise, of all of rural and remote South Australia being classified as one Local Hospital Network within the Federal health system; and

(m) all other relevant matters.

The Hon. J.M.A. LENSINK (21:32): Honourable members will be pleased that I will be brief. I did circulate that we (that is, the member for Stuart, myself, the member for Morphett and the minister's office) had come up with an alternative form of words because the minister's office was concerned that the wording in the initial motion may skew the debate, if you like, because the language was not particularly neutral.

We have come up with a set of words which is acceptable and which I think will still cover the intent of what the member for Stuart in particular was seeking to inquire into. I thank honourable members for all of their contributions and look forward to the Social Development Committee reporting on this very important matter in due course.

Amendment carried; motion as amended carried.