Motions

Transforming Health

The Hon. S.G. WADE (16:33): By leave, I move my motion in a slightly amended form:

1. That a select committee of the Legislative Council be established to inquire into and report on the health, social and financial impact of Transforming Health.

2. That the committee consist of three members and that the quorum of members necessary to be present at all meetings of the committee be fixed at two members and that standing order 389 be so far suspended as to enable the chairperson of the committee to have a deliberative vote only.

3. That this council permits the select committee to authorise the disclosure or publication, as it sees fit, of any evidence or documents presented to the committee prior to such evidence being presented to the council.

4. That standing order 396 be suspended to enable strangers to be admitted when the select committee is examining witnesses unless the committee otherwise resolves, but they shall be excluded when the committee is deliberating.

On Friday 11 September, I publicly announced that I would be moving this motion. That announcement was supported by all non-Labor parties in this council, for which I thank them. On Saturday 12 September, I sent an email to all members of the Legislative Council in the following terms:

Dear colleagues,

I advise that I will move for a Select Committee of the Legislative Council on Transforming Health with the following term of reference:

'To inquire into and report on the health, social and financial impact of Transforming Health'.

I propose to seek a vote on the motion on 23 September 2015.

I would appreciate it if any member who would be willing to serve on the Committee could advise me at their earliest convenience.

Warm regards,

Stephen Wade.

I gave notice that I would be both moving the motion and seeking a vote on it today. I sent a reminder to members on 21 September. I acknowledge that it is not normal practice for a motion to be taken to a vote on the day it is moved, and I indicate that I would not want this to become common practice. I also indicate that I would support the adjournment of the motion if any member sought more time to consider it. No member has raised a concern with me.

The motion is simple and clear. It is a one-line reference: 'To inquire into and report on the health, social and financial impact of Transforming Health.' In terms of the case for the committee, I think it is well founded in the widespread concern in the community over Transforming Health. Labor's Transforming Health plan includes: cuts to hospitals; the downgrading of the emergency departments at Noarlunga, TQEH and Modbury hospitals; closing the Daw Park Repatriation General Hospital; closing the Hampstead Rehabilitation Centre; and closing the St Margaret's Rehabilitation Hospital at Semaphore.

South Australian Liberals oppose the closure of any hospital in Adelaide. We do not believe that any South Australian community should have to pay for Labor's waste and budget mismanagement with the closure of its hospital. We have real concerns that the government has not genuinely consulted with the South Australian community about its health cuts plan. The lack of time given for the key consultation period in February/March was 3½ weeks, and the government gave more time to consult on time zones than health. There was a lack of information, there was scant data and no options.

In terms of the government's engagement with the community, it was more in the nature of a public relations campaign that genuine engagement. The government has not released the 2,300 submissions it received on the proposals, even though earlier submissions on the discussion paper were published online. After waiting for almost eight months for transparency and accountability by this government, this parliament needs to step in and shine a light on the Transforming Health plan.

The Hon. R.L. BROKENSHIRE (16:37): I advise the house that Family First supports the Hon. Stephen Wade's proposal in its entirety. We have been very concerned about the Transforming Health structures for some time. The closure of the Repatriation General Hospital at Daws Road, Daw Park, is a disgrace. Putting the equivalent of Ward 17 out to Glenside is a disgrace. The reduction in emergency department facilities at the Noarlunga Hospital and TQEH is a disgrace, and people are not happy.

People have been wanting to see an inquiry that is open and transparent. The reality was, if we just quickly think back, that we had a situation where even I put in a submission on behalf of Family First and our constituents. There were, I believe, hundreds, if not thousands, of submissions that were put forward. Just after the closing date, whilst people thought there would be proper deliberation on this proposed model of Transforming Health, the reality was that the books were already printed. Just as one example, it would be interesting to see, through a select committee, whether or not the ink had dried on those books before the submission dates even closed.

I place on the public record that I have concerns about some of the peak organisations that represent returned servicemen and service women. I have tried to approach them and get answers where they stand on all this but have not had satisfactory answers or responses. I wonder whether they felt that they were perhaps intimidated and could not stand up to fight the way that a lot of veterans asked. Veterans told me that they expected a fight against the closure of the Repat. These are all the sorts of things that can be assessed by this select committee. I do know that we have a lot of work on at the moment, but I think that if members support this they will be doing a great service to the South Australian community.

Finally, I would like to see some in-depth assessment of what are the true cuts this state government is targeting with respect to Transforming Health. They talk about how much better it is all going to be, yet, when you talk to individual senior members of the government, they come up with discussions that involve the real facts behind this—that is, a reduction in services, acute beds and, ultimately, budget.

If this model is based on the British model, and from a briefing I went to with the minister and Professor Keefe it seems to me to be a model picked up pretty much from England, if you talk to anybody in England they will tell you that their transforming health model equivalent has actually taken health backwards, not forwards. I commend the Hon. Stephen Wade for moving this select committee and will be supporting it as it stands without any additional alterations to the reference terms.

The Hon. J.A. DARLEY (16:41): For the record, I would like to indicate my strong support for this most important motion and also would be more than pleased to serve on the committee.

The Hon. T.T. NGO (16:41): I want to put on the record that I am not against the setting up of this select committee to look into Transforming Health, but I am against how the process is being done by the Hon. Mr Wade. I have been told by the Hon. Mr Dawkins that the normal process is that it is put on the Notice Paper and you give the party the opportunity to decide what to do with it, whether it is in favour of it or against it.

In this case, it is being been moved today and we are being asked to vote on it. I know the Hon. Mr Wade said that he put out an email; you can put out an email, but you are not sure whether or not this will come up, so it was very difficult for me to talk about it in caucus this week because we were not very sure what the Hon. Mr Wade would do. Another point I would like to make is that Transforming Health was announced 18 months ago and the Hon. Mr Wade has had all this time to decide whether—

The Hon. S.G. Wade: It was 3 February

The Hon. T.T. NGO: I thought it was longer—at least a year ago. He has had at least 12 months—

An honourable member: Eight months.

The Hon. T.T. NGO: I assumed it was longer. I do not know what the urgency is. Now he comes in and asks us to vote on this motion which, as I said, I do not have a problem with; I just have a problem with how the process has been done. I would like to put on the record that I do not think it is the right way of doing it; however, the Hon. Mr Wade has the numbers, so we just have to cop it.

The Hon. G.E. Gago: He is setting a precedent.

The Hon. T.T. NGO: Yes, he is setting a precedent. I move to amend the motion as follows:

At the end of paragraph 1, add the following:

'and federal government funding cuts to the South Australian health system'.

Setting up a select committee to look at the impact of Transforming Health on matters such as the health, social and financial matters without looking at the impact of the federal government's funding cuts to the health budget in South Australia is like taking one side of the story between two fighting children. As you would be aware, the federal government funds many of our health services, but since the Coalition Abbott government came into power a couple of years ago, it has cut health spending to our state and many of our federal funded programs have also been cut or downgraded.

The opposition and the mover may argue that the state government has received more money now than ever before. This may be true, but it is very misleading. Everybody knows health inflation growth has been growing at 8 per cent plus every year for the past decade compared to the consumer price index (CPI) of about 3 or so per cent. Let me give you some figures. In 2014, Australia's inflation was 2.5 per cent; in 2013, it was 2½ per cent; and in 2012 it was 1.7 per cent. As you can see, Australia's inflation is very low.

Previous federal governments have committed to funding the states and territories using a funding formula of the growth in health inflation; however, this has changed since the Abbott Liberal government got into power. The federal government have now only funded health services using the new formula, that is, using the CPI and population growth and not the actual health inflation growth to fund health services, which means a shortfall to South Australia's health budget of hundreds of millions of dollars per year.

The 2014-15 commonwealth budget shows a reduction of $655 million in funding to South Australia's health budget over the forward estimates. This year alone, the 2015-16 state budget shows the total federal health budget cuts to this state were $938 million over the forward estimates. This $938 million total is made up of $700 million from the National Health Reform Agreement and $238 million from various other national partnership agreements.

Even worse, over the next 10-year period from 2014-15, applying the new Liberal government's formula this figure would balloon out to $4.6 billion in health funding cuts to the National Health Reform Agreement to South Australia. In the 2024-25 financial year alone, this represents a nearly $1 billion shortfall to the health budget. In that one year, it is nearly $1 billion. That is like building two new Adelaide Ovals—

The Hon. T.J. Stephens: Or selling two forests.

The Hon. T.T. NGO: —selling two new forests—or removing 600 hospital beds or closing an entire hospital. The cost of employing 3,000 nurses roughly costs about $300 million, so $1 billion, if some honourable members do not have a calculator, would be about 9,000 nurses. It is quite simply not possible to cut over $900 million from the state's health budget without severely impacting on the social health and wellbeing of all South Australians.

I have an article from the ABC News online, dated Friday 16 May 2014 at 9.02am, titled 'Budget 2014: doctors, nurses and SA government united against health funding cuts'. I will read out some of it:

Doctors and other health professionals agree with the South Australian government's assessment federal budget cuts will hurt the state's health services. They met SA Health Minister Jack Snelling on Thursday about the Coalition's move to take the scalpel to healthcare funding. 'There is not a single South Australian who is not going to be touched by cuts on this scale,' Mr Snelling said. Doctors, nurses and other health professionals all agree with Mr Snelling's diagnosis. 'An absolute disaster. This is bad, bad, bad for health,' Dr Patricia Montanaro of the Australian Medical Association said.

In the same ABC article, Mark Azgarian of the Salaried Medical Officers' Association said:

South Australians have access to a world-class health system. These cuts are going to rip the heart out of that system.

Everybody knows South Australia has an ageing population. People now live longer and the cost of health care is rising way more than CPI due to various reasons such as new medicines and equipment. On average, a 50 year old is now seeing doctors more often, having more tests and operations and taking more prescription drugs than a 50 year old did 10 years ago. The quality of the treatment they are getting has improved in many cases and there are treatments that did not exist in 2005.

If the Liberal federal government does not reverse the funding cuts to the states and keeps applying the new funding formula, then states like South Australia will be billions and billions of dollars out of pocket. It would be very difficult for any South Australian government, whether it is a Liberal, Greens or even a Mr X Team government, to continue to deliver high quality health services to our community.

We want to ensure that the select committee is provided with the full picture on factors that are impacting on the future of our health system and the health and wellbeing of all South Australians. As I said earlier, there are nearly $1 billion cuts to the health budget in the next four years. We need to investigate whether the health system set up using Transforming Health, as proposed by minister Snelling, can deal with all those cuts. The committee needs to understand and be informed about it.

In the last couple of years, we have seen hundreds of millions of dollars cut from our health budget by the federal government. There are also federally funded programs in our health system that now have ceased or have been heavily downgraded. Let me just name a few, as follows:

The discontinuation of funding to improve our public hospital service which helps to improve South Australians' access to elective surgery; improve waiting times in emergency departments; deliver more subacute care services, including rehabilitation, geriatric care, palliative care and psychogeriatric services; deliver a number of mental health projects to help people with mental illness both in our hospitals and in our community. That program has been chopped.

The discontinuation of funding of national partnership agreements (NPA) funding for financial assistance for long-stay older patients in our hospital. That program has got the chop.

The early termination of the NPA on preventative health which includes commonwealth funding towards Obesity Prevention and Lifestyle (which most people know as the OPAL program, and which state and local governments will continue to fund).

The Healthy Workers, Healthy Futures program has also got the chop.

The ceasing of funding to very important Indigenous teenage sexual and reproductive health and young parents supporting programs which include Yarning On, delivered by SHine SA; sexual health services for Aboriginal young women and their partners, delivered by the Aboriginal Health Council of South Australia and the Aboriginal family birthing program.

These Indigenous programs provided vital support and education for pregnant Aboriginal women and vulnerable young people which led to significant improvements in health outcomes for Aboriginal people. There is also:

The discontinuation of the funding for the national perinatal depression initiative.

It is very disappointing to see the end of an important program for prevention and early detection of antenatal and postnatal depression. I know about this, Mr Acting President, because my wife has just delivered a baby. And further:

Funding has also ceased for the NPA on treating more public dental patients.

I have more but, I will not read on. The commonwealth funding cuts to those programs and other important health initiatives do not hurt just the state's bottom line; they have social and health impacts for all South Australians, including our most vulnerable people. For the mover to believe that there will not be an impact on those vulnerable people in our society shows that he is way out of touch.

I know he has the numbers, he has become very arrogant so he can do what he likes. I can understand that when Mr Abbott was in charge members opposite were too afraid to speak out against their mates in Canberra. Mr Abbott's hairy chest and those bathers can be very confrontational and intimidating to some honourable members and therefore they may be too scared to speak up about funding cuts to our health system.

However, honourable members from the opposition do have form when it comes to keeping silent. When Mr Abbott was backtracking on his promise to build 12 new submarines here, not one member opposite was brave enough to criticise or put pressure on Mr Abbott to keep his promise. However, now that Mr Abbott is no longer in charge and quickly vanishing from the political scene, opposition members can now surely find the courage to speak up against funding cuts to South Australia's health system.

Could I refresh the memory of honourable members in this house about a rally on the steps of this parliament to oppose federal government health cuts to South Australia on Wednesday 4 July 2014. The rally was organised by SA Health Alliance, an alliance of South Australia's leading health union, health consumers, community groups and service providers. I have a flyer here promoting the rally. Let me refresh the memory of some honourable members about the rally. It states:

Rally to oppose health cuts, Wednesday 4 July 2014.

You will have seen reports regarding the impact that the recent federal government's budget will have on health services in South Australia.

The budget measures will, unless reversed, have devastating effects on the health system.

SA Health has advised that the cuts to services over the next 4 years will amount to approximately $650 million, with some programs and services affected from 1 July this year.

Which is last year. The flyer goes on to state:

Make sure that you, your friends and your families participate in the program. It's our health care system. We all need to act in order to prevent this.

I have some of the forecasts from the local TV news that night. ABC News stated:

More than 1,000 people have rallied on the steps of Parliament House protesting against the Federal Government's proposed cuts to health funding. They came from far and wide and their message was clear. [Chanting] Doctors, nurses, paramedics and other health professionals descended on Parliament to voice their concerns about the proposed measures in the Federal Budget.

I have another one: the rally was organised by SA Health Alliance and various people. Elizabeth Dabars, the head of the Nursing Federation here said:

It would result in bed hospital closures and people not getting the service when they need it.

I have one more from Channel 7:

Thousands of healthcare workers have rallied outside State Parliament in their fight against brutal Federal Budget cuts. They say hundreds of hospital beds will go putting our health system on life support. Protestors were out to give the Feds a taste of their own medicine. Almost 3,000 rallied at Parliament before taking their message to the streets. They say $600 million to be ripped from South Australia's health funding will cripple the system.

I will not read out any more. I also noticed that several members were at the rally; none came from the Liberal opposition, of course. There was a good turnout from non-government members: the Hon. Kelly Vincent, the Hon. Tammy Franks, and, I think the Hon. John Darley was there. I apologise if I have missed anyone else.

We were in solidarity supporting those health workers at the rally and promised to do whatever we could to expose the federal government's savage cuts to health. We need to give those health workers a voice. As the Hon. Kelly Vincent said on TV recently, those health workers impacted by the federal budget cuts also need to have the opportunity to tell the committee their story and how the cuts have impacted them and their families.

The federal government is the money man: it provides large chunks of funding not only to our health system but also to other services due to its ability to collect revenue—that is the fact. It is important that the committee looks at the health system holistically and not pick bits and pieces. We need to know whether what minister Snelling is proposing with Transforming Health will work for our health system, considering the billions of dollars being cut from the budget.

We could also call on witnesses from the health sector and their unions and put these questions to them. The health unions may say, 'Well, with the budget cuts from the federal government, there is no way what minister Snelling is trying to do with Transforming Health will work for our health system.' If that was the case, the committee can point this out to minister Snelling. How can the committee understand the impacts of Transforming Health when it does not want to engage with some of our doctors, nurses, paramedics and other health professionals who have helped create one of the best health systems in the world?

Unless we also look at the federal government's cuts to our health budget, there is no way anybody can take this committee seriously. The committee members will be condemned for using job losses in health and for patients suffering just for their political gain.

Members interjecting:

The Hon. T.T. NGO: No, true—that is why I am moving this amendment. The Hon. Mr Wade potentially in 2½ years' time will be in charge of this portfolio. It would give the health sector a lot of confidence and trust in him now if he were able to demonstrate that he is not all about smoke and mirrors and that he will consult widely if major decisions are made when he is the health minister. This is his very first real test.

I ask honourable members to support my amendments to give health professionals a voice. We have the responsibility as elected officials to represent everyone. The committee needs to give everyone who has been impacted by the changes either through Transforming Health or federal budget cuts an opportunity to tell us what is going on. Staff and patients from the health sector are calling out for an opportunity to be heard. They also want to be given a forum to explain what sort of impact funding cuts from the federal government will have on them and their sector.

It is not always easy to organise rally after rally or issue press releases about funding cuts to get attention from the media. With my amendments, these health workers will have a voice and that opportunity. I have a media release from the Australian Nursing and Midwifery Federation (SA Branch), dated Wednesday 13 May 2015, which states:

Federal budget does little to save SA from health cuts.

The Australian Nursing and Midwifery Federation (SA Branch) says this year's federal budget will do little to save South Australian hospitals, and nurses and midwives from savage budget cuts over the next decade.

'Last night's budget still leaves a gaping hole in previously-agreed hospital funding to the states,' ANMF(SA Branch) CEO/Secretary Adj Assoc Professor Elizabeth Debars AM said.

'South Australia's health system is still staring down the barrel of close to a billion dollars in cuts from our health budget in 2024. Nationally, the $50 billion torn from our healthcare system in last year's budget still stands, which is the equivalent of sacking one in five nurses and shutting one in 13 hospital beds.

The Federal Government will also save $962.8 million over five years in new measures that axe dental and preventative health programs and halt the construction of any new GP Super Clinics which have not yet commenced.'

I urge honourable members, especially those members at the front of parliament rallying against the federal government cuts to our health system, to support my amendment to give nurses, doctors and other health professionals the opportunity to tell this parliament of the impacts of the federal government's cuts to our health system on families and, most importantly, on patients.

The Hon. K.L. VINCENT (17:06): I will very briefly reiterate Dignity for Disability's support for this committee. I would also like to thank the Hon. Mr Ngo for legitimising this committee by giving it so much of his attention. That performance will be on your greatest hits for sure, I am certain. I would also like to thank the Hon. Mr Ngo and the government for further legitimising this committee by bringing their amendment to the terms of reference, because I was led to believe that the government thought this committee was such a waste of time that they would not give it any attention. However, they have gone as far as to—

The Hon. T.T. Ngo: So you will support the amendment.

The Hon. K.L. VINCENT: Yes, I will support the amendment because it legitimises this committee. I thank the government for doing that. I am happy to discuss the potential impact of the federal government cuts as well. I am happy to look at this holistically, so we will support the amendment and thank the government for legitimising this committee.

I also thank the Hon. Mr Ngo—I think he quoted me in part of that performance, which is a great honour. He was talking about how I had been quoted in the media as saying that the South Australian community needs a voice on this, and most certainly they do. As I have said before—and I will say it again—every South Australian will at some point interact with the healthcare system in some way, probably more than once in their lifetime, so why should they not have a voice?

I am not here to be negative for the sake of being negative. I think some of the aims under Transforming Health are laudable, but the fact is, as the Hon. Mr Ngo would have noticed from watching the news reports so closely, as it turns out, that there are significant concerns in the community about this proposal. It may well turn out that the government has everything correct.

If that is the case, they have nothing to hide but, whether or not they do, I consider it our job to give South Australians a voice on changes to a system that affects us all, either as consumers of that system or as taxpayers. With those words, I again thank the Hon. Mr Ngo for paying such close attention to my work and for his corporation on this important committee. We certainly commend the motion.

The Hon. T.A. FRANKS (17:08): I rise on behalf of the Greens to support the motion moved by the Hon. Stephen Wade of the Liberal opposition for a select committee to inquire into Transforming Health. I also note that the Greens will be supporting the government amendment to insert a reference to include 'and federal government funding cuts to the South Australian health system' but indicate that I move from the floor to amend the motion to include the words 'and state' after the word 'federal', as follows:

and federal and state government funding cuts to the South Australian health system.

We have been told that Transforming Health is not about funding cuts, so it will be very interesting, as somebody who is prepared to be a member of this committee, to hear what impacts federal or state (should we accept that part of the reference) cuts have and what relation that has to Transforming Health.

I thank the Hon. Tung Ngo for his speech, because it also reminded me of the words of this government, under the Weatherill era, which said that the days of declare and defend were over, yet we have seen this process—which I think is one of the most important processes in our state—of Transforming Health done in an untimely way. There was not enough information given to many stakeholders to enable them to have meaningful input.

Those voices, from the community and from the stakeholders, will be heard through this process. If what they have to say does not show that there are real concerns that need to be addressed by the government then it will have been a worthwhile process to simply give assurance in the community and within the sector that the government's plan is going the right way the first time.

Indeed, that is the basic premise of Transforming Health, that we get it right, first time every time. I believe that is a laudable intent. Of course, no-one gets it right first time every time, and it would be a folly to think that any government plan will get it right first time and every time, so the government should certainly not be afraid of this committee. In fact, it should welcome it, and I look forward to the government being very active on this committee.

I note that we have been told that if we stood in solidarity with the health workers earlier this year we should be ensuring that federal government cuts are addressed. I say, yes, absolutely. I stood in solidarity not only this year but also in 2010, when the health workers were protesting against the savage state government cuts, particularly on their wages and conditions. So the Greens stand in solidarity now, we stood in solidarity on the steps earlier this year, we stood in solidarity in 2010, and we continue to transform democracy. With that, I commend the motion.

The Hon. B.V. FINNIGAN (17:11): There are a couple of different types of select committee established by this place, and some of them do play a valuable role and come up with some useful recommendations. It is very hard to see how this committee could fall into that category.

It is quite often a tactic used by honourable members opposite, and some others, to establish a committee of the parliament so that a few issues can be litigated, two or three well-publicised hearings can be held, and then the whole thing just slowly dies a death until a rather brief report is produced and tabled two or three years later. I am reasonably confident that that would be the outcome of establishing this committee, although I accept that it appears to be the will of the council that that is what will happen.

I find it extraordinary that honourable members opposite would want to have the time of health officials and clinicians and other interested parties taken up attending what is essentially a political exercise, rather than getting on with the job of trying to improve the health system. The reason I say that is quite simple: does any honourable member seriously think that this committee is going to come out with a report that says, 'Transforming Health, what a great idea. We should press right ahead with that. Here are a few minor, tinkering-at-the-edges recommendations that we have but, on balance, we think this is a good scheme, a good plan to go forward with into the future'?

In my respectful submission, there is no way that this committee is going to conclude that, because it is a committee established with the end in mind before it has even been established or even meets. While I understand exactly why the committee will be established, I cannot see that health policy is going to be advanced in this state by its establishment. I think this again highlights the weakness of our standing committee system, which a few people have been talking about, in that we have a rather eclectic and scattergun collection of committees that do not necessarily address the key issues of government policy.

The vast majority of state funds are spent on health and education, the law and justice system, social services and transport and infrastructure, so I really think that committees ought to be based around those sorts of priorities so that there would be a standing committee which could have an inquiry, which is resourced and which would include, I would suggest, members of the other place as well. However, the problem with the current system of standing committees is that all but the Statutory Authorities Review Committee are controlled by the government of the day, whether that be Labor or Liberal, and that is a key weakness in allowing for independent oversight by a committee system.

In that vein, I am particularly concerned by what the honourable member proposes here, that there should be a quorum of two members for a valid meeting of the committee. I cannot recall any occasion on which this has been the case, where two members of parliament can constitute a select committee with all the powers and privileges—

The Hon. D.W. Ridgway: Not constitute. It's a quorum.

The Hon. B.V. FINNIGAN: Two members can constitute a quorum of a select committee, with all the privileges and powers that go with that, which are considerable. We are talking about two honourable members of this house being able to get together and decide to summon people and do the other things that a committee is authorised to do. I think that is a very concerning point. I am not quite sure why, in this particular committee, the honourable member is suggesting only four members but, certainly—

The PRESIDENT: It has been changed to three now.

The Hon. B.V. FINNIGAN: Four to three?

Members interjecting:

The PRESIDENT: The members are three. The quorum is two.

The Hon. B.V. FINNIGAN: I apologise to the house that I did not pick up that development. Even then, I think having a committee of three sounds a rather extraordinary proposition as well. I cannot see why you would deviate from the usual of there being five select committee members. I briefly want to put that contribution on the record. I oppose the establishment of the select committee.

The Hon. S.G. WADE (17:17): In closing the debate, I would like to particularly address the contributions of the Hon. Tung Ngo and the Hon. Bernard Finnigan, but I in no way want to reflect on the other members who contributed. I thank the Hon. John Darley, the Hon. Kelly Vincent and the Hon. Tammy Franks for contributing and I appreciate the contributions made.

In closing the debate, I want to indicate that the Liberal Party does not support the government amendment, and let me be clear as to why. The Liberal opposition has consistently stated our position, that we do not support federal cuts to health or, for that matter, state cuts to health. The Hon. Tung Ngo railed against the federal cuts and almost completely failed to mention the state cuts.

Documents provided to this parliament indicate that by 2017-18 Labor would be budgeting for $491 million in health cuts. These cuts, on the same report, are almost twice the level of the federal cuts at $275 million. So, whilst it was entertaining, and perhaps informative even, to have the Hon. Tung Ngo rail against the federal cuts, I look forward to him coming back and justifying the state cuts.

In terms of the current terms of reference, I indicate to the house that, in my view, to the extent to which they relate to Transforming Health, the current terms of reference already allow the committee to consider funding issues, both state and federal. I remind members that these terms of reference talk about financial impact. 'Financial impact', surely, includes cost savings that could be delivered through Transforming Health if those savings meet cost savings requirements related to federal and state cuts to health. In fact, that is my strong conviction. I have not believed from day one that Transforming Health is about improving health outcomes.

Let's remember it all started with Treasurer Koutsantonis on budget day last year—actually, it might have been the day before budget day—talking about the plagues that would fall on the South Australian community as federal cuts to health were imposed. He made a comment—I will not be able to quote it; I might quote scripture from time to time, but I am not in the habit of memorising speeches by Tom Koutsantonis—and said words to the effect that the community would need to decide whether they wanted to close beds, or close hospitals, or sack doctors and sack nurses. He said the government would engage the community in its response.

The parliament will remember that the government had decided that $322 million of what it says was the budget impact would be dealt with through a change to the ESL remissions, and in relation to that the other $322 million the Treasurer said, 'We shall look to the health system.' What did we have? I think it was in October 2014, and not the 18 months ago that the Hon. Tung Ngo refers to; the plan itself was not released until 3 February. But this Transforming Health has, if you like, the seed of the Koutsantonis budget of 2014.

I do believe that funding issues are relevant to the consideration of the committee. In that regard, I believe the terms of reference already allow for financial impact, funding issues, both state and federal. The Hon. Tung Ngo stressed the importance of engaging health organisations in relation to the impact of federal cuts in particular. I would like to remind him about the concern of health professionals over Labor's health cuts plan, which the PR company wants to call Transforming Health. The Royal Australian and New Zealand College of Psychiatrists says that:

…the Delivery Transforming Health document is grossly lacking in evidence base for many of the proposals that it puts forward.

The Australasian Faculty of Rehabilitation Medicine (SA Branch) says:

Sweeping and dramatic closures [of rehabilitation facilities] are forecast in the document, but no details have been provided on the replacement arrangements. [Such changes] are potentially catastrophic for those with disabilities and more detail is urgently needed.

I did not hear the Hon. Tung Ngo, in response to that, suggest that the government should start providing information to health organisations. The South Australian Salaried Medical Officers Association said:

SASMOA…was treated to a slide show presentation which provided no concrete detail regarding the proposals in the Paper…the presentation provided insufficient detail and the presentation content had all the hallmarks of 'fluff' and 'spin'.

This is what the government calls consultation. The Public Service Association said:

…the PSA continues to be concerned about the short period of consultation stated in the paper for proposals which appear to have such great impact on the South Australian Public Health System.

Dr Patricia Montanaro, the State President of the Australian Medical Association, says:

…this plan has no detail…this is a real estate deal around closing off the Repat and closing off Hampstead Hospital.

If the Hon. Tung Ngo says the government wants to hear health organisations, why are they not listening to the statements that have already been made? One of the major factors driving this committee is the government's disrespect not only to the South Australian community, who may well one day be users of the health system, but also to the health professional organisations.

The health bureaucrats and the expensive overseas consultants have shown such disrespect to clinicians on the ground. There are even indications in the Transforming Health material that they are realising the error of their ways. There was a Transforming Health bulletin recently which indicated that they were developing new ways of engaging clinicians because the project appreciated they had not been effective in their communication. When you have a few dozen handpicked clinicians on advisory committees, that is not system-wide consultation that you need for system-wide reform.

Let's not be flippant about the risks here. I think the Hon. Tammy Franks indicated how important this reform is because it is so substantial. For those members who are thinking about whether or not there is merit in this committee, I ask you to ask yourselves: considering the range of select committees we have in this place from time to time—some with a relatively, shall we say, narrow focus—would it actually be credible in 20 or 30 years' time for people to look back and say the government in 2014, 2015, 2016, 2017 (whatever period it takes), embarked on the most dramatic health cuts or health reform plan, whatever you want to call it, and the parliament did not even see fit to have one of its committees consider the matters?

I do not think it is at all surprising that the parliament would want to look at this. I would stress that I do not believe that a select committee of the Legislative Council has the resources or the expertise to recast a health reform plan. We are not going to produce the mountain of material that has been produced by the government; for that matter, we do not have the expertise either. What this parliament is duty bound to do is to provide to the community of South Australia transparency and accountability. When after eight months, since the details of the plan were announced on 3 February 2015, we still do not have fundamental details about how the government intends to recast health services, I believe it is incumbent on this house to step in and provide an opportunity for transparency and accountability.

The Hon. Jack Snelling on radio last week was defending the lack of detail by saying, 'You have to develop these plans as you go along. We decided we were going to close the Repat, but don't expect us to know where all the outpatients are going; don't expect us to know where Ward 17 is going,' etc., etc. Well, actually, we do. Fundamental issues like how you are going to deal with the more than 100,000 outpatient presentations to the Repat Hospital are not trivial details, not the dotting the i's and crossing the t's that, of course, one can develop as one goes along.

The lack of information, the lack of openness by this government as to how services are going to be delivered in the future, I think makes it incumbent on this parliament to inform the people of South Australia, both the health organisations that the Hon. Tung Ngo was so concerned about and the health consumers, the people who are using health services day by day. On this issue of the risk that the Transforming Health plan represents, I would like again to quote the South Australian Salaried Medical Officers Association. I think the minister aggressively referred to it as the 'doctors' union' last week, so I am sure the Hon. Tung Ngo will be very keen to hear what the minister regards as the union voice. SASMOA concluded:

The Transforming Health proposals will result in poorer provision and undermining of health services in communities, a loss of specialised health staff from South Australia, a significant impact on the training opportunities for medical students/junior medical officers and the issues of overcrowded emergency departments will only be exacerbated long term.

My third point is that if the government amendment is relevant to a select committee looking at Transforming Health, it highlights the hypocrisy of the government's engagement on Transforming Health to this point. Repeatedly, almost ad nauseam, the government has claimed that Transforming Health is not about cuts, it is about health outcomes. If this amendment is relevant to a select committee on Transforming Health, then the government has to explain if it is suggesting that its plan is driven by cuts. If the government amendment is not relevant to Transforming Health, then the government should raise the issue by a separate motion. As I said earlier, I am convinced that this government is driven by cuts not health outcomes, therefore I do not think it is unhelpful for the committee to consider financial impacts, which I have already said is in the motion.

One of the concerns I have about adding this particular tail—the tail amendment, if you like—is that it changes the nature of the terms of reference. At the moment, we have terms of reference which refer to the health, social and financial impact of Transforming Health. With all due respect to members, I would put the emphasis on health. It is about transforming the health system.

We do want to be mindful of the social impacts. We do need to be mindful of the financial impacts. We do want a health system that is socially enabling. We know that there are social determinants of ill health that need to be addressed. We certainly need to make sure our health system is sustainable. But if you had to choose one to emphasise, I would emphasise health. The Hon. Tung Ngo instead says, 'No, we want to emphasise financial. We are going to look at a health plan and focus on the finances.' We do not agree with that. The Liberal opposition does not agree that it is appropriate to shift the focus from people's health to the government's finances.

In terms of the comments by the Hon. Bernard Finnigan, I have already addressed the issue about re-engineering health policy. That is not what the committee could deliver. It is not what I see the committee will deliver. In terms of his comments about quorums, I appreciate he may well have missed the point that, following consultation with members in terms of their interest in being on the committee, I have moved an amendment to reduce the membership from four to three. In terms of the quorum, my view is that a quorum of two is appropriate for a committee of four and it is certainly appropriate for a committee of three.

In terms of his comments about parliamentary committee reform, I wholeheartedly agree. I think that standing committees with a broader remit would be very helpful in holding the government to account on both policy and legislation. For example, there could be a health and social services committee which would take not only broad references on issues such as Transforming Health, but it might also be referred legislation. For example, the tobacco products bill that was tabled in the House of Assembly today could be considered by a broader committee, not unlike the Senate committees on references and legislation.

I had heard it suggested too that if these committees were to be committees of the Legislative Council then perhaps it even might be possible to start considering government bills when they are tabled in the house so that the process of the parliament is not slowed down unduly. On the matters of process, I indicated in my statement in moving this motion that I appreciate that taking the motion to a vote on the same day that it is moved would be unorthodox, and I indicated that if any member objected I would not proceed. The Hon. Tung Ngo—I do not know whether he was speaking personally or on behalf of the government—did raise objections so I do intend to honour my word and I seek leave to conclude my remarks.

Leave granted; debate adjourned.