Legislative Council Fifty-Third Parliament, Second Session (53-2) 53 2 Parliament of South Australia Legislative Council published Bills Health Care (Administration) Amendment Bill Health Care (Administration) Amendment Bill Health Care (Administration) Amendment Bill Second Reading Second Reading Adjourned debate on second reading. (Continued from 4 June 2015.) The Hon. S.G. WADE Legislative Council The Hon. S.G. WADE (16:03): On 11 February 2015, the Minister for Health tabled the Health Care (Administration) Amendment Bill. The bill is basically the same as 2013 and 2014 bills with the same name; both bills lapsed at prorogation. The 2013 bill was supported by the Liberal Party in the House of Assembly. The bill deals with a number of issues, but I would like to focus on two aspects in particular: one is the changes in relation to the Ambulance Service and the other is the employment of clinicians in the Department for Health and Ageing. Under the bill, the government proposes to transfer the legislative basis for the imposition of fees for services provided by the SA Ambulance Service which do not involve ambulance transport. Currently, since July 2010 fees for ambulance services not involving transportation have been levied under the Fees Regulation (Incidental SAAS Services) Regulations 2009 and the Fees Regulation Act 1927. Section 59 of the Health Care Act allows the minister to set fees, by notice in the Gazette, to be charged for ambulance services, which is defined in a way which is limited to transportation in an ambulance. What the bill does is allow fees to be set under the Health Care Act in relation to non-transportation services. The words used are almost identical to the words in the current regulation but, as so often happens, it is the 'almost identical' that is the matter that raises concern. The first difference is in relation to the definition of an incidental service. The fees regulations in this area have evolved. In 2010 regulations commenced which said (and I will paraphrase; I will not belabour the council with the subheadings but read it as a narrative) that for the purposes of the regulation, incidental SAAS services are provided if a member of the staff of SAAS attends at a place in response to requests for medical service, and so on. In 2013 those words were changed to simply 'responds'. In other words, the phrase 'attends at a place' were removed: for the purposes of the regulation, incidental SAAS services are provided if a member of the staff of SAAS responds to a request for medical assistance. From 2010 until 2013 one might have praised parliamentary counsel for being economical with words and omitting that phrase, but it is then baffling to see this bill presented to us which reinserts the words. We now have in the bill, under clause 7, a proposed section 59(6) that would read 'incidental services are provided if a member of the staff of SAAS attends at a place in response'. So I ask the minister: what is the significance of that change? Why did we have one form of words in the regulation, then the regulation drop that form of words, and it is now proposed to reintroduce them by this bill? Another key difference is in clause 7, proposed section 59(1)(c), which adds the phrase 'any other matter prescribed by regulations'. In other words the minister may, by notice in the Gazette, fix fees in relation to the provision of ambulance services, the provision of incidental services and any other matter prescribed by the regulations. In the government briefing the officers were not able to explain why the provision was needed, and I ask the minister to explain—either in his second reading summing up or at clause 1—why, in fact, that provision is included. Members might say they are subtle points, but I think it would be fair to say that many in the South Australian community are very concerned about what the government's plans are for ambulance services, particularly in the context of the Transforming Health health cuts plan. The government is talking about reducing emergency department services in the regions and expecting people to travel further at a time when they most urgently need assistance. Another element of the changes in emergency services that has been foreshadowed in the Transforming Health initiative is that more services would be provided by ambulance officers, shall we say outside of the hospital context. For example, there is talk of increased services being provided in nursing homes by ambulance officers. The Liberal Party remains very concerned, as the community is very concerned, about the downgrading of emergency departments and hospitals. We are certainly open to the continued evolution of the ambulance and paramedics profession, but all we ask is for the government to be transparent. What is the government planning in relation to ambulance services and the fees therefore? Some might say that this is not new, that this is a continuation of a trend under this government. In that regard I would bring to your attention data that I received through the briefing process. I asked how many incidental services have been provided and how much has been raised for each year of service since the introduction of the Fees Regulation (Incidental SAAS Services) Regulations 2009. What it showed is that from the first full calendar year (which was 2009) there were 1,394 incidental services provided and, in a span of six years for the calendar year 2014, the volume had increased to 21,489. So, there has been a 20-fold increase in incidental services. Incidental services is what the act calls it. The briefing also called it 'treated, not transport'. That is when an ambulance service is being provided at a place rather than the patient being transferred for services at another place. There was a 20-fold increase in the number of services provided, and it was a more significant increase in terms of the billing value. The billing value in the first available calendar year was $221,430, but by 2014 the billing value had increased to $4,285,802 million. The opposition will certainly be alert to how this legislation is used, how the fees for ambulance services (particularly 'treat, not transport') change over the years and also how the delivery of ambulance services change in the years ahead. The second aspect I was hoping to highlight was in relation to the employment of clinicians in the Department for Health and Ageing. In this regard, I thought I would put on the record a substantive response that I received from the minister following a briefing. The aim of the amendment in the bill is to allow health professionals employed under the act to be employed under their relevant professional award if their position requires them to engage their professional skills, qualifications and clinical knowledge. The briefing response re-states some of what was provided in the second reading, but for the sake of coherence I will read it as provided to me: Clause 89 is a technical amendment required to ensure there is an appropriate employment mechanism available for medical practitioners, nurses and midwives to be employed to work in the Department for Health and Ageing (central office) under their professional awards. A number of these staff members are employed in clinical advisory or clinical administrative positions or in the direct provision of statewide public health services such as immunisation services, communicable disease control and public health emergency management. The department was advised that there was no mechanism available to properly employ clinicians to work in the department under their professional awards. Clinicians can be employed to work in incorporated hospitals, that is, local health networks, under section 34 of the Health Care Act 2008, pursuant to their professional awards, or in the department under the Public Sector Act 2009, pursuant to the South Australian Public Sector Wages Parity Enterprise Agreement: Salaried 2014. However, the South Australian Public Sector Wages Parity Enterprise Agreement: Salaried 2014 does not recognise the qualifications, entitlements and continuing professional development required for medical practitioners and nurses and midwives. Under part 5, hospitals, the Health Care Act 2008 allows for the establishment of incorporated hospitals. Section 34, employed staff, allows the employing authority to employ persons to perform functions in connection with the operation or activities of incorporated hospitals or in local health networks only. Under the Health Care Act the department is defined as an administrative unit of the Public Service and both the staff and the chief executive are appointed under this act. While it is possible to include medical practitioners, nurses and midwives within the Public Sector Act 2009 through the South Australian Public Sector Wages Parity Agreement, this is not likely to be considered an appropriate mechanism, given that separate awards already exist for these professionals. All other employees, apart from ambulance officers who also have their own award and are specified with the definition of health services separately, are covered by the South Australian Public Sector Wages Parity Agreement. This agreement recognises both the administrative staff as well as other allied health professional staff, such as physiotherapists, occupational therapists, pharmacists, as well as medical scientists and dental officers, who may be employed in direct clinical service provision and clinical advisory and professional management advisory roles under section 34 of the act, as well as in clinical advisory and public sector management roles under the Public Sector Act through the public sector wages parity agreement. The professional development of registration requirements of allied and other health professionals staff are recognised under this award. The proposed section 89 will be placed within part 11, that is, miscellaneous, and therefore has specific application to those persons employed in the department. Section 1, transitional provisions, clause 1(2) further makes it clear that clause 89 can only apply to particular classes of employees. There is no capacity to have a wider capture of other health professionals. Clause 89 can only apply to those working in the department in employment categories not otherwise covered under the public sector wages parity agreement. One of my concerns with the wording is how broad it is. I appreciate that the government is focusing on the employment of health professionals who come under specific awards, but to me the wording seems incredibly broad: 89(1) says 'the employing authority may appoint such officers or employees who have skills or experience in connection with the provision of health services'. That is not a reference to professional classes and not a reference to upper registered health professions or anything. To me, having skills or experience and a connection with the provision of health services could apply to a whole range of volunteers—it could apply to people who developed health skills on the job, so to speak, in roles. I expressed my concern as to why the words are so broad and why not reference to health profession categories generally or specifically, and I reiterate that query. In relation to the employment of clinicians in the Department for Health and Ageing, it may interest the council to receive some information that was provided to me in a briefing. In fact, I would ask the Acting President whether I could have two tables inserted into Hansard in relation to two matters: first, the matter I referred to earlier in terms of the volume and billing value of SAAS incidental services and also the information provided to me as to the medical professionals and nurses and midwives— The ACTING PRESIDENT Legislative Council Hon. J.S.L. Dawkins The ACTING PRESIDENT (Hon. J.S.L. Dawkins): The Hon. Mr Wade, are the tables purely statistical? The Hon. S.G. WADE Legislative Council The Hon. S.G. WADE: They are purely statistical and they are part of a briefing, and I would like to have the two tables from the briefing inserted into Hansard. The ACTING PRESIDENT Legislative Council Hon. J.S.L. Dawkins The ACTING PRESIDENT (Hon. J.S.L. Dawkins): You are seeking leave for them to be inserted in Hansard? The Hon. S.G. WADE Legislative Council The Hon. S.G. WADE: That is right, yes. Leave granted. Incidental Services Calendar Year Volume $ Billing Value (NB Not Actual Revenue received) 2009 1,392 $221,430 2010 6,300 $1,085,495 2011 15,657 $2,698,798 2012 17,372 $2,994,233 2013 17,709 $3,275,866 2014 21,489 $4,285,802 2015 (1 Jan–3 March 2015) 3,142 $635,913 Where medical practitioners, nurses and midwives are employed in the Department for Health and Ageing Division/Area Medical Professionals Nurses/Midwives eHealth Systems EPAS EPAS Adoption 1 HS EPAS Capital HS EPAS Capital 1 Public Health & Clinical Systems Communicable Diseases CDCB General 6 3 Immunisation Unit 12 Infection Control Unit 3 Medicines and Technology Policy and Programs PSS Dept 1 Public Health Office Of Public Health 5 Safety & Quality Safety & Quality 3 System Performance Data & Reporting Services Epidemiology 2 4 Mental Health & Substance Abuse Mental Health 2 Office of Professional Leadership ClinEDSA 1 Professional Leadership Office 8 Operational Strategy Operations Administration 1 Workforce Workforce Division 1 22 Grand Total 14 62 The Hon. S.G. WADE Legislative Council The Hon. S.G. WADE: I have already given some commentary on the SAAS table but if I could just, for the benefit of members, summarise the health professionals table. It talks about the different divisions where health professionals are employed, particularly medical professionals, nurses and midwives. The total for medical professionals in the department is 14, and the total for midwives is 62. In the context of the government's comments about people being engaged with their professional skills, in some of the divisions under which staff are employed it is not immediately apparent as to how their nursing, midwifery or medical professional skills might be engaged, but I trust that table might be of interest to members. In that context, too, I would ask a question of the minister either at the second reading or at clause 1 as to whether the government anticipates that all of the people in the situation such as those identified in the table, that being 76 officers, would be impacted by these changes. I will return to the other matters handled by the bill. The bill deals also with proclamations to dissolve three now nonoperational incorporated associations and transfer their assets to the appropriate incorporated health advisory council. One of them relates to the Peterborough Aged and Disabled Accommodation Incorporated. I note that one in particular because I understand the Peterborough community is working with both the commonwealth and state governments to try to improve the aged-care facilities associated with the Peterborough Hospital. Other minor amendments provided by the bill relate to the transfer of functions, assets, rights and liabilities from one incorporated hospital to another without the incorporated hospital to which they first belonged being dissolved. There are also matters such as a body does not need to be, under the act, providing a service and facilities specifically to an incorporated hospital for the undertaking of that body to be transferred to the incorporated hospital and the like. These amendments are supported by the opposition but it does highlight our concerns about the way the government has run health care administration under its 13 years. This is an incredibly centralising government. We saw the abolition of local boards in enactment of the Health Care Act 2008. We have seen the bureaucratisation of health with central office staff numbers increasing by 116 per cent over the last 10 years and now we have Transforming Health which is a centrally conceived, centrally driven, radical health cuts plan and a process which is riding roughshod over particularly outer suburban areas—people at Modbury, people at Noarlunga, the people in The Queen Elizabeth area in particular—but also, shall we say, non-geographic communities like the veteran community. The Repatriation Hospital has been providing services to the people of South Australia since 1941. It has evolved dramatically over those years and was continuing to do so. This government had invested $40 million only in the last few years in the enhancement of the capital assets there yet, all of a sudden, in direct contravention of a commitment by premier Rann to never ever close the Repat, the government has decided to do exactly that. Instead of investing $166 million in continuing to evolve the Repat, they have decided to spend $166 million in replicating the Repat at the Flinders Medical Centre site, let alone the costs at other sites. The opposition is very concerned about the way the government is managing our health services. We support this bill but we will continue to vigilantly keep the government to account in terms of how health administration and health management are accountable, transparent and responsive to the people of South Australia. The Hon. D.G.E. HOOD Legislative Council The Hon. D.G.E. HOOD (16:25): I rise to speak on the Health Care (Administration) Amendment Bill. This bill is a reinstatement, of course, of the 2013 bill which had its second reading in the Legislative Council but fell off, for want of a better term, the Notice Paper due to prorogation. The bill was subsequently reintroduced in the other place in 2014 but succumbed to the same fate—an argument, sir, I think, against such frequent prorogations. This bill makes several changes to the Health Care Act. The general consensus on the bill, as far as I can hear and see, is that most people are supportive of the intention but have some concerns about the effect it may have on the regions in particular, especially where the power has been given to transfer functions, assets, rights and liabilities from one incorporated hospital to another without dissolution of the first hospital. This bill allows the minister to set fees for ambulance transportation by notice in the Gazette whether the transport is to a hospital or another location. The bill further allows for the South Australian Ambulance Service to set fees for patient treatments in instances where the patient is not actually transported anywhere. Most fees within the health system are determined by the Health Care Act 2008. It is therefore not surprising that this power would be moved from the Fees Regulation Act and the corresponding regulations to the Health Care Act. This provision furthers the current situation by allowing fees to be set for treatment obtained in instances where a patient is not transported and, of course, the catch-all phrase that fees can be fixed for 'any other matter prescribed by regulation'. I note that numerous members in the other place raise issues about the potential cost for rural patients using the ambulance services under this bill. This is a legitimate concern. Whilst these provisions seem budget sensible, we certainly want to ensure that people are not disadvantaged due to these changes, especially as outlined by people in the other place with respect to people in rural areas in particular. The bill continues to make technical amendments to ensure that the act clearly reflects that doctors nurses and midwives are able to work within the central office of the Department for Health and Ageing and that they be employed under the relevant professional awards. All this is common sense and will be supported. The bill also incorporates proclamations to legally effect the transfer of assets, liabilities and undertakings of the Lumeah Homes Inc., Miroma Place Hostel and Peterborough Aged and Disabled Accommodation to the corresponding incorporated health advisory councils. As I understand it, this was meant to occur after the enactment of the Health Care Act in 2008, but it simply never eventuated; it is certainly time to rectify that. Family First is happy to support the second reading of this bill and will show some interest in the particular details that have been raised in the other place of matters of contention during the committee stage of the debate. The Hon. T.A. FRANKS Legislative Council The Hon. T.A. FRANKS (16:28): I rise briefly on behalf of the Greens to make a contribution to the Health Care (Administration) Amendment Bill before us today. I note, as previous speakers have, that this is indeed the third time we have had this bill before this parliament. Previously, it has been debated but fallen foul of prorogation in 2013 and again in 2014. I am reminded somewhat of the Oscar Wilde quote, that perhaps to lose it once was a misfortune but perhaps to have lost twice this bill due to prorogation might be seen as carelessness. The third time is charmed, however, and I hope that we will see this bill come to fruition and become law. The bill deals with the fees for services provided by South Australian ambulance services, and I want to dwell on one part in my contribution which is those that do not involve ambulance transport. Section 59 of the Health Care Act 2008 allows the minister to set fees by notice in the Gazette to be charged for ambulance services. An ambulance service is defined in the act as: …the service of transporting by the use of ambulance a person to a hospital or other place to receive medical treatment or from a hospital or other place at which the person has received medical treatment. The fees for ambulance services are currently set and charged under the Fees Regulation (Incidental SAAS Services) Regulations 2009 under the Fees Regulation Act 1927. The bill provides authority to the minister to set fees for ambulance services, in particular Treat no Transport services, under the Health Care Act 2008, rather than the current arrangements. It does not in itself, establish or alter the policy and practice of charging fees for ambulance services in our state. I understand that this bill does not introduce fees for Treat no Transport ambulance services for the first time; fees are already in place, enabled through the Fees Regulation Act 1927. My understanding is that this bill simply enables them to be set under the Health Care Act 2008 in line with similar health-care fees. While the Greens' preference is that access to ambulance services be part of the public health system—whether the services relate to transport or other services delivered by the ambulance—we note that fees are already in effect for these services and that this bill here today does not set policy in this respect. We sought clarification from the minister's office in regard to some concerns raised with us by stakeholders during our consultations on this bill. I want to thank the minister's adviser, Corey Harriss, for providing departmental advice in regard to the questions we raised and to our satisfaction. It is important to note that the proposed amendment will have no impact on the services being provided to senior citizens or someone, for example, experiencing a heart attack, nor will it impact people's behaviour or affect the services provided by the South Australian Ambulance Service to the public. The current regulations make it a requirement that the South Australian Ambulance Service will provide a service consequent to a 000 emergency telephone call, or other means, for a person who may have an injury or illness requiring immediate medical attention in order to maintain life or to alleviate suffering. This requirement is continued in this bill. A decision to treat at the patient's residence and not transport, or to treat and transport to a hospital emergency department, will be based on a patient's medical needs as determined by the attending clinicians. The proposed amendment bill is administrative only and does not affect the services currently provided by the South Australian Ambulance Service, nor will it affect or influence public behaviour in accessing those ambulance services. As of 1 July this year, the incidental SAAS services (the Treat no Transport) fee is a flat rate of $200, while for holders of a valid prescribed concession card that fee is $101. The Greens have consulted with stakeholders and taken those questions to the minister and had, as I say, an adequate response, and so we will say that we have no further questions to raise during the debate and look forward to the swift passage of this legislation. Debate adjourned on motion of Hon. J.M. Gazzola.