Health Review

Adjourned debate on motion of Hon. K.L. Vincent:

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.

(Continued from 11 February 2015.)

The Hon. S.G. WADE (17:44): I rise to indicate that the Liberal team will be supporting the motion put forward by d4d in the name of the Hon. Kelly Vincent. In speaking to the motion the Hon. Ms Vincent reiterated that d4d has concerns in relation to rehabilitation but is not opposed to health reform per se. That is also the position of the Liberal Party.

In my consultation on the Transforming Health discussion paper and proposals paper, in particular, a range of issues have been raised with me in relation to rehabilitation. For example, there is concern about the number of rehabilitation beds and whether they will be dedicated or protected for rehabilitation, ensuring that the best of current programs are retained and that there is an assurance of no loss of outpatient and ambulatory services. There is certainly an eagerness to retain the excellent facilities at the Repat and Hampstead and an awareness that services, whilst they are more than just the building, have developed and evolved within their sites, and that the clustering of related services is a real boon and contributes strongly to centres of excellence.

There is certainly concern that rehabilitation, as the Hon. Kelly Vincent highlighted, is not just a matter of access to services, and that an appropriate and nonclinical environment which is conducive to holistic rehabilitation is important. The site needs to be disability friendly, it needs to have outside areas, it needs to have training areas.

In that regard, I make two particular points in terms of concern about the Transforming Health process. First, there is the lack of consultation. The disability sector highly values consultation. There is a saying in the disability sector, 'Nothing about us without us', and, in relation to a sector which particularly values consultation, this process is particularly poor in consultation.

I think the Hon. Tammy Franks was highlighting some of the weaknesses of this government's approach to information, and I think Transforming Health is a good case study in that regard. We were given 3½ weeks to discuss a radical health cuts plan when apparently we needed eight weeks to talk about how we want to structure our time zone, and we were given 3½ weeks to discuss a radical health cuts plan when we have been given five weeks to discuss rerouting a bus. This process is not only lacking in terms of time for consideration and dialogue on the issues, it is also lacking in terms of information. You cannot properly have a consultation, you cannot properly have community understanding and acceptance of proposals, unless the community is properly informed.

Considering that this is a health-related process, perhaps I can make the point that if the government were a health professional and the community were a patient, I think it would be reportable to disciplinary agencies, the fact that it cannot get informed consent to the radical health cuts plan with the current consultation because it is so poor.

Even within the process it deserves criticism. For example, at the discussion paper stage the government arranged 39 community information events. That was when, if you like, they were discussing the standards, the high-level principles. Then in the second stage, the proposals, when particular options were on the table, they had three community events. The 39 events for the discussion paper were all around the state but particularly in the metropolitan area; the three community events, obviously, did not even touch the areas of concern, and the particular area of concern raised by the Hon. Kelly in this motion is that of rehabilitation. There was not even a community event addressing the issue of rehabilitation. The Liberal Party shares the concerns of the Hon. Kelly Vincent and D4D reflected in the motion, and I urge the council to join the Liberal team in supporting it.

The Hon. T.A. FRANKS (17:49): I rise on behalf of the Greens to put on the record some of our concerns about Transforming Health. In doing so I echo the Hon. Stephen Wade's words. I have grave reservations about the time frame that has been given for people to make submissions with regard to the Transforming Health document, the end of this week being the deadline. I called for that time frame to be extended. I have heard many in the sector express concern that they do not have the detail they need to make an appropriate response. Certainly with a conversation this important, I really think we need to take the time to get it right.

However, I do in many ways commend the government for taking on health reform, because it is essential. On a Channel 2 program (I am not sure what the program was) that covers state politics there was a joke where one of the characters, who was a member of parliament, was threatened with punishment by his colleagues by being given the health portfolio if he did not pull his head in. I think it is a bit of a poisoned chalice to be given the health portfolio, but it is also a privilege. It is also vital, which is why it is important that we get it right.

I have been disappointed with the lack of attention to the Hon. Kelly Vincent's and my previous work on raising awareness about a specialised service for borderline personality disorders. I urge the government to keep that on the agenda. It is a great way forward and it ensures that people are not needlessly in an emergency department, which is the worst possible environment for them.

It is an area of mental health that is quite rightly defined as the Cinderella of mental health, although in this case I think 'Cinderella' is possibly too kind a description for the way borderline personality disorder and people with borderline personality disorder and their carers are treated. Some people find themselves leading quite desperate lives in those situations. There is a great deal more that we could do in this area. There is more we could do that would actually save the health budget. It would be good health economics and it would be a better, kinder, more compassionate way of handling the situation for those people.

I have been contacted by a registered nurse who has worked at the Repat for a significant amount of time. His name is Daryl Bullen. He has been campaigning online, raising awareness about the role of the Repat. I note that many members are aware that the Repat is more than just a building, and I think that is one of the things that has been borne out by the ongoing rallies and protests that we have seen and the real passion that the proposals in Transforming Health have held for the Repat. Mr Bullen writes:

So here we are Adelaide. We're going to close the Repat. I have worked at the Repat for 19 years. In that time I have worked on all of the wards and services that will be closed. What I think is special about the Repat is that all of the areas are linked to each other and nurses go relieving to each of them, so the culture becomes blended, creating a post-World War Two country/state hospital. It's a Repat thing.

So what does this mean? Hospice. Many South Australians have had their loved ones die at Daws Road. Everyone would agree that the compassion they received was excellent, and the care and ease of suffering their loved ones received was of the highest standard. Many people have been so moved by the care that their loved ones received that they came back to volunteer, staying on long after their family member's death. The nurses that I have worked with are both skilful and compassionate and have taught me a lot about pain relief and caring for the dying. I have taken these learnings into other aspects of my role in the hospital and into my home and community.

Many Vietnam vets have made the Repat their second home. I even heard the words 'sacred site' used to describe it. Many of these men suffer PTSD (post traumatic stress disorder) from their time served in Vietnam. When I have listened to their stories I have learnt what horrific experiences they've had and understand the importance of a place to feel safe and to share with a 'family' that understands them. This family is made up of the Vietnam vets, volunteers, nurses, doctors, physios and occupational therapists, ward clerks, social workers, the ward 17 support community, church groups, and many more. This is the Repat family that has taken years to develop. It is not just a specialised unit that can be uprooted and placed anywhere.

The surgical and medical wards at the Repat have evolved out of the original nightingale wards, which were established in 1950 when Repatriation hospitals were modelled and built in cities around Australia. The post WWII years were the busiest and most exciting for the Repat, and helped establish the relaxed but compassionate approach employed to care for the Aussie Larrikins, who were the WWI and WWII vets.

Most of the acute wards at the Repat now are only equipped to look after the post-operative, semi-acute patients, or medical step down acute patients. The wards take a large stress off the Flinders Medical Centre, and in the winter they help to reduce ambulance ramping. Wards such as 1 and 2 deal a lot with newly diagnosed dementia patients, who are predominantly elderly patients. When I go relieving there I am in awe of the skill and compassion the nursing, medical and multi-disciplinary teams (all of the rest) show the confused patients. These patients require a special unit and cannot be mixed in with the general population. The Repat suffers the same budget restraints as other hospitals, but those teams keep delivering the goods, and I believe maintain that relaxed compassionate feel that has been passed down since WWII.

The Intensive Care Unit is the ward which has been increasingly under-resourced each year, the unit proves specialised nursing care to our more critically ill patients and is also the medical emergency team for the rest of the hospital.

I work in the rehabilitation section. Around the year 2001 an $18 million rehabilitation health unit was built to cater for 40 patients. This is a fully functioning State of the Art rehab service. It has an Olympic size pool, a massive gym, a large physiotherapy area, great facilities for amputees and, of course, an excellent rehabilitation ward. Last year a new Vita ward was built to cater for 20 extra CVA patients who require rehab. I work in this facility. Southern Health only funds 55 beds, so the rehabilitation service at the Repat is a 55 bed service. The Vita ward is a beautiful unit; the prettiest health facility I have ever worked in. It has a patient lifting gantry system and a beautiful physio gym. The patients have private rooms with ensuites. It would have cost SA Health a lot of money to build it. Many patients come back and visit the rehabilitation service and give back in some way, either through motivating other patients or volunteering in some way.

I believe that closing the Repat is a ridiculous money wasting venture, when a simple retrofit upgrade would be more effective. A lot of unfunded resources will be lost if the Repat is closed due to the amount of volunteer work given to the hospital because of the special connection people have with it.

I understand that the Repat is not going in its entirety, and that is some of the detail we have in this document, but there is great uncertainty, and certainly when you have a Minister for Veterans' Affairs and the Minister for Health on the radio with two different answers about what will happen with Ward 17, those who work in this sector, those who have a connection to the Repat, have every right to be reassured and to have real answers and meaningful dialogue.

The business case must be released. Those documents must be provided to ensure we get this right. Dignity for Disability is quite a right to raise concern. While I acknowledge that much work and a lot of consultation has gone into preparing the documents that we have to inform the present debate, a three and a half week time frame for public submissions to be made is inadequate, and is a sign that I think shows a disdain for people's concerns, along with the lack of detail that the sector is complaining about, not having the Salaried Medical Officers Association, and so on.

These are not people who engage in this without great expertise themselves, but we need to get the health sector right. If Transforming Health is truly to work, I think the government should be taking heed of the words in this motion, ensuring that we have an informed debate and not just talking about getting the right medical treatment right the first time but getting the debate right the first time.

The Hon. T.T. NGO (18:00): I rise on behalf of the government to oppose this motion. The case for transformation of our health system in South Australia is driven by a quality imperative—to deliver a high-quality sustainable hospital system to all South Australians. The Transforming Health Proposals Paper was released on 3 February 2015 and is open to feedback until 27 February 2015, which is this month. The proposals in this paper were developed with groups of clinicians and a focus of achieving the quality principles that they consider essential for an effective health system. These are patient centred, safe, effective, accessible, efficient and equitable.

I will address the specific concerns raised in the motion of the Hon. Kelly Vincent MLC. In response to her statement about plans to shut down the Repatriation General Hospital, it is proposed that medical and surgical services currently provided at the RGH be integrated into the Flinders Medical Centre, Noarlunga Hospital and The Queen Elizabeth Hospital for local residents. Palliative care provided at Daw Park Hospice is proposed to move to Noarlunga Hospital by early 2017. Geriatric evaluation management services will be relocated to the Flinders Medical Centre.

Rehabilitation services will also transfer to the Flinders Medical Centre which will include 55 beds, a new pool and a gym. Whilst a range of services are being relocated to other hospitals, the existing orthotics and prosthetics service will continue on the site. The chapel and the Remembrance Garden at the RGH will be retained for their considerable significance, particularly to Second World War veterans and their families. The government will also explore opportunities for future use of the pool by community groups.

A new centre for excellence in the treatment of post-traumatic stress disorder will be built through a $15 million investment. It is envisaged that services provided will include assessment, counselling and, where appropriate, drug therapy by dedicated, highly-skilled mental health clinicians. A committee of veterans and clinicians will advise on appropriate models of care and the most suitable locations. Feedback will be sought from the veterans' community, consumers and clinicians before any final decisions are made.

With regard to Hampstead Rehabilitation Centre, the proposed integration of current Hampstead Rehabilitation Services into metropolitan hospitals will provide better patient care by ensuring that consistent rehabilitation begins as soon as the patient is deemed clinically capable. Current outpatient clinics and outreach services provided at Hampstead will continue to be available at sites where patients receive their inpatient care.

The proposed Transforming Health initiatives recognise the benefits of physiotherapy in a hydrotherapy environment and will increase the access of patients to hydrotherapy pools, with new rehabilitation pools to be constructed at The Queen Elizabeth Hospital, Modbury Hospital and the Flinders Medical Centre.

Improving access to mental health services and reducing long waits in emergency departments for people with a mental illness remains a priority for this government. Transforming Health provides us with an opportunity to refocus and redesign services. To assist in achieving improved services, the minister has established a mental health advisory group, comprising clinicians, consumers and carers, to provide guidance and monitor progress on our improved performance.

Further, the minister has set new performance targets for the state's mental health services. These targets include that by January 2016 no mental health consumer should wait more than 24 hours for admission to an acute hospital bed and that by July 2018, 75 per cent of mental health patients should be admitted within four hours and 90 per cent within eight hours. These targets will be achieved through new or expanded existing initiatives, such as the establishment of short-stay units in all three of our major metropolitan hospitals. This will allow for greater ability to directly admit to a mental health bed, avoiding emergency department attendance.

Additionally, through improved streaming of services and improved information to people who are already clients of the community mental health services, some emergency departments attendances will be avoided because consumers will know how to contact the community mental health team in the first instance. Mental health service provision will be aligned to the same geographical boundaries as general health services, supporting the integration of mental health services and general health. Alignment of mental health with the local health network boundaries will improve coordination of care between mental health and general health, which will improve overall services for mental health consumers and their families.

In 2014, the Statewide Mental Health Clinical Network released the borderline personality disorder (BPD) report. The report made a number of recommendations, including options for a separate specialist BPD service or a stepped approach across the local health networks incorporating existing BPD programs. SA Health has committed to a coordinated stepped system to care for people with BPD. The BPD service improvements project has commenced and input from the expert clinical reference group comprising consumers, carers and clinicians will inform this work. Statewide implementation under the auspices of the BPD steering committee will begin from April this year.

To respond to the Hon. Kelly Vincent's motion that the proposed paper fails to address the shortage of services in the primary care space, I wish to emphasise that the overarching aim of Transforming Health is a more streamlined hospital healthcare system that provides better service for patients. Whilst the government has started with a focus on the metropolitan hospital system, this is not the end of the process. The government wants to improve the links between our hospitals, GPs and community-based care, as well as look at the quality of care provided in our regional areas in the future. As part of this, I would expect the minister will look to continually improve communications with other agencies so that the patients can be discharged at the appropriate time.

In conclusion, I would love to hear from the Hon. Ms Vincent or other honourable members what are their solutions in terms of dealing with the healthcare reform. I know that the Hon. Ms Franks has mentioned that we need to deal with this issue. Data has shown that we are not delivering the quality of health care as we should be compared with other states or compared nationally, so what are our solutions in terms of dealing with quality of health care? Also, how do we respond to the federal government no longer funding or reducing funding for the National Partnership Agreement on Hospital and Health Workforce Reform.

The federal government has indicated that they no longer want to fund health growth, they only want to fund it by inflation or by population growth, as many of you would know. Inflation currently is running around 3 per cent, our state population has not grown very much at all in the last 30 years, and health care is growing at 8 per cent plus each year. How do we fill the gaps, the difference, that the federal government has given the state since they indicated that they no longer want to fund that difference?

In the last federal budget, the federal government already acted on that, and they have reduced funding by $300 million to the state government in terms of no longer wanting to fund the growth in health. At the end of the day, the federal government has the purse strings in terms of funding the state government's health system, so how do we as a state deal with this issue? It is important, I think, that we as members of parliament are able to come up with solutions to deal with the two issues that I just raised and provide the government with those solutions. I would like to finish off by saying I am really looking forward to members contributing and providing solutions and telling us what is wrong with our health system.

The Hon. K.L. VINCENT (18:11): In summing up, I would like to thank my parliamentary colleagues for their contributions to this debate: the Hon. Mr Stephen Wade, the Hon. Ms Tammy Franks and the Hon. Tung Ngo, and those other members who have indicated their support without necessarily going on the record as such. I would take some issue (I am sure it is no surprise) with some of the comments from the Hon. Mr Ngo in which he seems to insinuate that I, as Dignity for Disability's representative, have been nothing but critical of these reforms. If my memory serves me—thankfully I do not have to rely on my memory; I also have media transcripts—I have actually been, I think, rather positive about these reforms. We in Dignity for Disability have merely been critical of the lack of clarity around the proposed reforms and the concern that that is creating in the community.

The Hon. S.G. Wade: You said that in moving, too.

The Hon. K.L. VINCENT: The Hon. Mr Wade interjects (out of order, I know) that I also said that in moving the motion. I would like to give a few quotes from correspondence I have received from various professionals and members of the community about these reforms to again illustrate the lack of clarity and the concern around that in the community. This one I think is particularly relevant on the subject of emergency department closures:

There is widespread agreement for the need for greater efficiency in healthcare and there is a great merit in some of the 'Transforming Health' proposals such as 24/7 cover for emergency cardiac [and] stroke treatment, improved discharge pathways on weekends and the creation of a 40 bed 'waiting for placement' unit to improve patient flow through the system. However, the doctors and nurses working on the 'frontline' at Modbury Hospital [in this particular example] are gravely concerned about this proposed downgrade and the consequent loss of Acute Care and Critical Care services at Modbury Hospital.

Or this one on the subject of the Hampstead Centre:

The setup and layout of the Hampstead Centre is flat and very accessible for me and others with mobility issues because there is sufficient disability car parking near entrances, hand rails to lean on and I am generally able to walk the distance between the buildings I use.

Or this one on the Repat:

Over the decades, the RGH [Repatriation General Hospital] has developed teams of medical specialists who have built up an understanding of the veterans' needs and expertise in dealing with and resolving these problems. It is like a house of cards—pull out one, and the whole will likely collapse.

This does not sound to me like anyone is being overly critical or denying the need for healthcare reform point blank. It sounds very much to me like members of the community who are just concerned about the way these reforms might look and, if they do not have that information, it is very difficult for them to make informed decisions about whether or not they agree with those reforms. I think that we can all agree that there is need for healthcare reform. We simply cannot have a healthcare budget that continues to grow exponentially, particularly when we are not getting a return for investment with improvement in the health of our community.

I am sure that we all want affordable, modern health care which delivers a timely service which the community can rely upon. Technology, surgeries and drug therapies available for the chronically or critically ill or injured are better than they have ever been, but they do not come cheap; I am sure that there is no denying that. What is and always has been timeless and will not change is that prevention is better and often much cheaper than a cure. Prevent someone from suffering heart disease and expensive bowel surgery at 50 years of age through a healthy diet and regular exercise and that person will probably not only have better health outcomes and lifestyle for themselves and their family but you will save the health system plenty of money. Prevent cancer through a healthy diet, exercise and support and again you save money and improve people's quality of life and health outcomes.

No, we can never prevent all injury; I am not stupid enough to believe that. We cannot prevent all injury, illness or chronic disease, and it would be naive to think that we could, but with quality primary health care we can certainly lessen the burden on the healthcare system which currently exists. So, we all agree that there is a need for healthcare reform, but on how we do this we have widely varying views.

The Transforming Health document, while I am sure was well consulted with a select group of people, is light on detail. This lack of clarity on the peculiarities of the reforms is a serious cause of concern that is causing much unrest amongst patients, the community and most health professionals to whom I have spoken on the subject.

There are many of the reforms that have been welcomed by the sector, and again I make that point. In particular, bodies such as the Australian Nursing and Midwifery Federation have been widely positive and welcoming of these reforms, but even those mainly in support of these reforms admit that there is far too much to be nutted out before any of this can be properly implemented.

Dignity for Disability's motion focuses on a few areas within our healthcare system, mainly rehabilitation, mental health and the need for collaboration between government departments. Firstly, we have two high-functioning rehab facilities in the Rehab and Hampstead. The Repat, I believe, has six gyms and what I am told by one particular health professional is Australia's best hydrotherapy pool. How is that going to be replicated with the space constraints at Flinders? Do those running Transforming Health know that there are six rehab gyms at the Repat and, if yes, why have they not detailed in the document how this will be replicated at Flinders hospital?

It is all very well and good for people like those of us in this chamber, who are able to attend special parliamentary briefings, to get information through the media, to liaise directly with ministers and so on, but what about the people out there who are directly affected and directly using these services day in and day out who are not in the privileged position in which we find ourselves, who do not have those avenues to go to and who rely on a document such as the Transforming Health document to provide them with enough detail to make an informed decision?

I know that the government is capable of pretty effective and positive consultation like that we have seen under the rollout of the Disability Justice Plan. This arguably did not happen to begin with, but once some pressure was put on the government it did become very consultative and collaborative with stakeholders in that particular project. I am incredulous and simply do not understand why this kind of mentality only seems to have spread throughout that project. Surely it would not be hard for the government to follow its own example. Perhaps I digress.

The Hon. S.G. Wade: You have.

The Hon. K.L. VINCENT: I have digressed, I am told, but with good reason. What about hydrotherapy? As one example, I was on air with ABC radio 891 last week where—

The Hon. S.G. Wade: Name dropper.

The Hon. K.L. VINCENT: Name dropping again, I know—Professor Dorothy Keefe assured me that the closed down hydrotherapy pools would be replaced, but there is already a shortage of adequate hydrotherapy pools, as I have mentioned before. So how are you going to increase the number of hydrotherapy pools in South Australia, which is essential in any state with an ageing population. Again, I make the point that it is all very well and good for someone like me, who is able to call up the radio and get on air quite easily and talk to the good professor, but again I ask: why was that information about the new hydrotherapy pools proposed under the project not detailed in the document?

What about things like meal times? Are there going to be separate dining rooms for those in longer-term rehabilitation? Rehab requires discrete programs, particularly if they are in a mainstream hospital setting. On the subject of beds, if there are fewer rehabilitation beds, is there going to be a step-down facility for those in long-term rehab? None of these questions appear to have been adequately answered to allay some of the community concerns.

Hampstead provides world-class rehabilitation from brain injury, spinal injury, stroke and other traumatic injuries and health occurrences. It has outpatient services and a peaceful garden setting. My question is, again: has anyone measured the value of that to patient rehabilitation and wellbeing in the long term? The measures used to collect statistics do not seem to take completely into account everything provided in a health service, like what you might call the non-medical things such as the provision of a nice peaceful garden setting. We in Dignity for Disability certainly believe that you do need to take holistic stock of these measures and a true account of the effect that they have on people's recovery and wellbeing. So many people who have contacted my office report how essential to their recovery these kinds of facilities at the Hampstead centre have been.

On the subject of mental health, as I have previously elucidated, I find it deplorable that only three pages of Delivering Transforming Health is devoted to our all too often crisis driven mental health system. As the Hon. Tung Ngo mentioned, the document aims to reduce waiting times in emergency departments. This is certainly something I am sure we can all get behind, but when we consider the fact that the document proposes reducing waiting times in emergency departments to four hours, I believe, for people with physical complaints compared to 24 hours for people with a mental health issue we have to ask: is this really the best that we can do?

Just because 24 hours is better than a worse option does not make it particularly good. The glaring gap of 20 hours in waiting time if you have a mental health issue again demonstrates that perhaps this government does not understand the true effect that mental health has on people's lives and perhaps does not understand that a mental health issue can be just as debilitating and urgent, if not more so, than a physical complaint. That is of great concern.

I also would like to touch on the fact that the Hon. Mr Ngo, when talking about the area of primary health care, has touched on the fact that Transforming Health is meant to be—I think he used the word 'overarching project'. Again, I labour the point that we do not deny the need for hospital reform, but what about keeping people out of hospital and the health outcomes that that can achieve and the money that that can save in the longer term?

I do not understand, and I am very interested to know when, in the minister's mind, hospitals became the Mecca for all health and wellbeing, particularly for people with mental health issues. We know that keeping them in the community and connected to the things that make their lives routine, stable, connected and meaningful is vital. The lack of clarity around the importance of community support is very concerning.

In the absence of any detail, health professionals, patients and the broader community have jumped to the worst possible conclusion, because the Minister for Health and the government have failed to provide details. I am not saying that anyone in the community who has contacted me has been particularly misleading or alarmist. I believe it is simply human nature, when you hear that a service that you rely on or have relied on in the past is going to change and you do not understand that change, to be worried about that. It is very normal and understandable.

The government has once again, as it did on emergency service reform, said, 'Trust us, everything will be fine.' They are saying that it will all be for the better, not worse, and yet we have no real concrete evidence to work out how that will be so. How do we know that this will provide better services than those we already have? Some of that we do and I again add that some of the proposals have been very welcome. However, the less consultative governments are the easier it is for people to jump to conclusions.

Again I labour the point that the best way to get good outcomes is to involve the people who will be directly affected by those outcomes, particularly in terms of promoting primary health care for all South Australians. Dignity for Disability is saying that we want our taxpayer dollars to build a fence at the top of the cliff and not fund an ambulance to pick up the pieces at the bottom, as the old saying goes—and perhaps is has never been more fitting.

It is clear to me that the public does not feel adequately consulted or confident in what the government is currently offering. Therefore, I am not saying, 'Blow up the entire project. Let's not reform the healthcare system; it's too hard.' We all know that needs to happen, but do it in a way that respects and listens to the concerns of real people who are directly affected by these services. The government must take action to restore confidence in this process, both for the sake of people using the healthcare system and for its own sake, for its own reputation and to do its job properly. Again, if we do not involve the people who are directly affected it is not going to help anyone.

If people in the community and SA Health employees thought that they were listened to and that their suggestions would be implemented, then I am sure that they would not be calling my office (and I am sure other members' offices) in the numbers that they have. I welcome a day when we do not have to put this sort of motion to parliament. I welcome the day that we do not have to remind the government to do its job. With those few words, I thank members for their support. Once again, I implore the government to extend its consultation on this to be more consultative, to be open, to actually explain what is going on and they might be surprised at the positive results. I commend the motion to the chamber.

Motion carried.