Transforming Health

The Hon. K.L. VINCENT (17:05): I move:

That this council notes that the Delivering Transforming Health document—

1. Plans to shut down the Repatriation General Hospital and Hampstead Rehabilitation Service thus disenfranchising the clientele who are both familiar with and confident in the services these facilities provide;

2. Ignores the additional positive rehabilitation benefits of the community outreach programs offered by the Hampstead Centre which facilitates reintegration into family, community and work;

3. Fails to recognise the ongoing rehabilitation value of access to attractive outdoor environments in contrast to an acute clinical environment;

4. Fails to address the shortage of adequately equipped hydrotherapy pools in metropolitan Adelaide;

5. Ignores that mental health services in South Australia are already overstretched;

6. Fails to address the issue of people with mental illness presenting to emergency departments due to a lack of support services;

7. Completely ignores the June 2014 SA Health report on borderline personality disorder which recommends establishing a statewide borderline personality disorder service;

8. Fails to address the critical shortage of primary healthcare services available in the community following the minister’s cuts to these services in light of the McCann review; and

9. Remains silent on the poor communication between SA Health, Disability Services, Housing SA and other commonwealth social services and that this miscommunication prevents people returning home once they have been declared fit for discharge, and in doing so continues to waste taxpayers' money.

As members will be aware, the Minister for Health, the Hon. Jack Snelling MP, released the Delivering Transforming Health document. This document outlines a number of hospital closures that are of great concern to Dignity for Disability and members of the community who have been in contact with my office, in particular, rehabilitation services, the Repat, St Margaret's and Hampstead. I know that there are many veterans who have spoken of their concern about the Repat at Daw Park closing, but I would like to address the issue of Hampstead Rehabilitation Service in particular.

Before I go on, however, I want it understood that Dignity for Disability is not opposed to health system reform point blank. The system is already stretched to breaking point and this necessitates a serious change in thinking if the situation is to improve. However, I think it is important to note that the government's own website about Hampstead points out the difference between longer-term rehabilitation and rehab in an acute hospital setting. Dignity for Disability is very concerned that SA Health's Transforming Health paper is failing to heed its own words from the Royal Adelaide Hospital website, and here I quote:

Rehabilitation is very different from being 'treated' in an acute hospital care setting. In all areas trained allied health, medical and nursing staff work with clients, clients' families and friends, and others, to design and implement rehabilitation programs using an integrated team approach.

We are concerned that, in moving all rehabilitation services into an acute hospital setting, people who have a very successful rehab at places like Hampstead will lose the community outreach programs that they have been able to access thus far, such as the Mensheds program, which enables men to get together and talk about their experience with accident or injury that has led them to become part of Hampstead.

These are particularly important programs because I think any holistic rehabilitation program needs to take into account the psychological and emotional effects of injury as well as the purely medical repair of any injury or illness. People may also lose access to an appropriate hydrotherapy pool, of which we already have a marked shortage here in Adelaide, and they will no longer be able to enjoy the peaceful garden setting that Hampstead currently offers.

All these things provide for a much more holistic recovery, it is my understanding, than may be available in a strictly hospital setting. Yes, access to rehabilitation allied health staff seven days a week is very important, but that can occur, I believe, without needing to shut Hampstead down and move those services into an acute hospital setting.

When I announced via my Facebook page that I would be moving this particular motion today, a lot of positive comments about the services at places like the Repat and Hampstead quickly came to me. To illustrate my point, I want to share just a couple of those comments with members in the chamber. One lady said to me:

My partner has an ABD and without this world-class facility and later physio at the Repat he would not have challenged the belief that he would be a 'vegetable'. He now walks, talks, drives a car, etc.

Another person said to me:

If people saw the number of returned servicemen who are currently waiting for admission to Ward 17 at the Repat for treatment of PTSD, depression and other mental health issues, they would have a better understanding of the situation. Closing the Repat & Noarlunga ED will place even greater strain on our already over burdened and broken system! FMC [Flinders Medical Centre] is frequently over status and on bypass…So many issues and potential consequences have been ignored or not even considered. Unfortunately it will probably result in fatalities via lack of treatment and then will be looked at when it is too late!

I hasten to make it clear that these are not my words. These are comments I have received, but I think it is important to put them on the record to illustrate the depth of concern that is out there in the community about some of these proposals.

Dignity for Disability is also surprised, to say the least, to see that mental health featured in less than three pages of this 60-page document. Bizarrely, it did mention the government is recruiting a chief psychiatrist, as if advertising for a standard pre-existing position is somehow revolutionary or transforming. There was no mention of the mental health council which has been promised to members of the mental health community, and there was no mention of co-design of systems and programs alongside mental health consumers. So, again, this does not involve mental health consumers as the experts in their lives and as the experts in their own experience with their mental health conditions.

There was definitely no mention of the June 2014 SA Health report on borderline personality disorder, or BPD, called A Way Forward. On that basis, perhaps in the two years we have waited for SA Health to sanitise this document, SA Health should have renamed the document 'Doing things the same way and expecting a different result' or something similar. I believe it was Albert Einstein who said that the definition of insanity is doing the same over and over again and expecting a different result.

I simply do not understand why we would be looking at fundamental changes to our health system, and yet are ignoring the significant contributors to stresses on our emergency departments, for example, mental health being one of those. Why are we not opening a statewide specialist borderline personality disorder service, as one example, following report after report? If we do not, it is more of the same, and certainly not a way forward.

Speaking of ignoring features of our health system that bring pressures to bear on our hospitals brings me neatly to the issue of primary health care.

The Hon. S.G. Wade: It's not in the budget.

The Hon. K.L. VINCENT: I am getting to that. The Hon. Mr Wade rightly points out that primary health care is not even in the document, but I will ignore that interjection and get on with making that very point. I agree that our mental health system needs reform, but you simply cannot reform our hospitals in isolation. They interact with the rest of our health system, with the rest of the community, our housing department, disability services and many, many commonwealth and state departments.

Of great concern is the Transforming Health document's silence on the provision of primary health care. Fundamentally, primary health care is an umbrella term for the services and supports that help to prevent people from getting acutely ill in the first place. Under the recent review of non-hospital based services, colloquially known as the McCann review, this government has already significantly reduced access to a number of these supports.

I have been told that a community music program in the southern suburbs, for example, helped people with mental illness to feel connected to community, constructive, and gave them an arena in which to share their experiences with peers without the pressure that is often felt in the consumer/therapist relationship. Similarly, I understand that a successful partnership between state and local governments, which helped to promote positive physical and mental health in the Port Pirie community, was also defunded following the review.

Primary health care is essentially about recognising that health—physical, mental or otherwise—is something that we all have, and that it exists on a very wide spectrum. In other words, it is not the case that one is either perfectly well and in need of no help whatsoever or unwell and in need of immediate hospitalisation.

There are many shades in between, and proper primary health care helps us to recognise the signs of poor health and improve them before hospitalisation becomes necessary. To have a document which is essentially about overall improvement of health in this state silent on a matter of this vital importance is disturbing, to say the least. Surely, it would be beneficial for government to have its citizens well and participating to the fullest extent possible in work and community.

With those brief words, I commend the motion to the chamber. I encourage the government to pay heed to some of the comments not only that I have made but those I have put on the record from the community. There is very real concern in the community about a number of these suggested reforms, and we want to see genuine consultation and understanding about the true ramifications of those recommendations. I encourage other members to support this motion and to learn about the concerns that exist and support proper health care in this state.

Debate adjourned on motion of Hon. G.A. Kandelaars.