Health Care (Miscellaneous) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 22 March 2016.)

The Hon. R.L. BROKENSHIRE (17:34): I rise to advise the council that Family First will support the government's Health Care (Miscellaneous) Amendment Bill. We did have some concerns over this bill earlier on, mainly because we were worried about retrospectivity and what that retrospectivity might not only do to existing day surgery facilities but also what it might do to negatively impact on an already crowded public and general private health system, particularly with respect to the public health system. We do understand that it is very important to accredit and inspect facilities. Sadly, at times we have seen mistakes occur, even in the public sector; checks and balances are not there and you are dealing with the life, health and wellbeing of the patient.

I met with a surgeon whom I highly respect and have known for a great period of time, an outstanding surgeon, namely, Dr Richard Hamilton, to talk about this. Dr Richard Hamilton probably led the way, with some of his other colleagues, in day surgery in their own private facilities, and I felt he was a person I should be talking to. He had also written to me and expressed some concerns about the legislation—and rightly so. If any of my colleagues wanted to visit a best-practice day surgery facility I would recommend that they look at a facility such as Dr Richard Hamilton's. To put them into a retrospective situation—when they have invested a lot of money, when they know how it all works, and they work as incredibly dedicated professionals with outstanding skills and the best possible facilities—would have been very detrimental.

The minister has not received a lot of credit in the last few months—he has received mainly brickbats, and you cop brickbats and you cop the odd credit as a minister, not too many credits but now and again you do—but I do give minister Snelling credit for this. I wrote to him and he did actually consider the letter, and he considered other lobbyists and other colleagues as well, I understand, and their concerns. To cut to the chase, the bill was changed and I am now advised that surgeons who would have been adversely affected, who would have had negative impacts on them and their patients, are now satisfied. That is the advice I have, and Family First therefore supports this government bill.

The Hon. G.E. GAGO (17:38): The key proposal contained within the Health Care (Miscellaneous) Amendment Bill 2015 is to amend the Health Care Act to enable the licensing of stand-alone, private day procedure centres in South Australia. Currently, in accordance with part 10 of the Health Care Act, only private hospitals are licensed and regulated in this state. The act gives the Minister for Health the power to grant, transfer, suspend or cancel licences, impose specific licence conditions, appoint inspectors, fix licence fees, and apply penalties.

The legislative framework governing the licensing of private health facilities has essentially remained unchanged since the early 1990s. During this time there has been a substantial growth in the private healthcare sector; this is particularly evident in the case of day-care procedures, as many surgeries and procedures which previously required overnight stays can now be performed on a same day basis.

Following the passing of the bill in the House of Assembly on 1 December, the Hon. Stephen Wade, shadow minister for health, submitted two amendments. The first of these proposed to expand the definition of a prescribed health service for the purposes of requiring a private day procedure centre to be licensed to also include a health service that involves administration of local anaesthetic.

The government supports the inclusion of local anaesthetic within the definition. It is recognised that some surgeries and procedures, although only involving the use of local anaesthetic, are of sufficient complexity, invasiveness and/or patient risk to warrant that they be subjected to licensing. Cosmetic surgery procedures, such as liposuction and breast augmentation, are increasingly being done under high volumes of local anaesthetic only. As we have seen from recent high profile adverse events in New South Wales, as well as a case here in South Australia just a few years ago that was the subject of a coronial investigation, these procedures can involve quite significant risk in some cases.

The amendment proposed by the shadow minister as currently drafted would, however, be unworkable in practice if the government were to licence all day facilities that provide health services involving the administration of local anaesthetic. A large number of general dental surgeries and office-based general practitioners' rooms performing simple, minimally invasive and low-risk procedures would be captured by this regulation. This would clearly broaden the scope of the type of facilities to be licensed significantly, and would be beyond the current SA Health resources to effectively regulate, not to mention the considerable layer of additional unnecessary red tape.

Consequently, the government consulted further on this issue at a meeting held in February 2016 with the Australian Day Hospital Association, which was attended by the deputy chief executive of SA Health, and it was suggested by the ADHA that the amendment proposed by the opposition be reworded to exclude its broader application to general dental surgeries and office-based general practitioners' rooms.

The government has therefore proposed a further amendment to section 89 so that the definition of a 'prescribed health service' does not apply in relation to the following health services involving the administration of local anaesthetic:

(a) a health service provided by a medical practitioner in the course of a practice as a general practitioner;

(b) a health service provided by a dentist in the course of general dentistry practice; and

(c) a health service or health service of a kind prescribed by regulation.

This amendment more effectively targets the scope of the licensing regime, excluding for example dentists performing restorations or removing wisdom teeth, and general practitioners undertaking minor dermatological procedures. At the same time, however, it will ask for more complex, invasive and high-risk procedures being done under only local anaesthetic, such as cosmetic surgery procedures, to be captured.

In addition, three minor related amendments have been filed by the government to make a change to the terminology used in section 89 in relation to intravenous sedation from simple conscious sedation to conscious sedation. This is a result of discussions held by the Australian Dental Association of South Australia.

The fifth government proposed amendment relates to section 89A and the standards of construction, facilities, equipment and the like. This is the result of discussions held with the ADHA, which was concerned that the minister was not required to liaise with the relevant industry bodies or consider relevant codes, standards or guidelines before gazetting any standards of construction, facilities and equipment. The proposed amendment is to this effect.

It should be noted that the standards to be gazetted will not be applied retrospectively to private day procedure centres that have already been declared by the Australian government and issued with a provider number for private health insurance purposes, except in relation to assessing applications for any alteration or extension of licensed premises, or where there is a proposed change in the nature or scope of the health services to be provided.

Importantly, private day procedure centres that have already been declared and issued with a provider number by the Australian government on the basis of a previous recommendation by SA Health will be deemed to be licensed under the amended act. There are currently 31 of these declared private day procedure centres operating in South Australia. The second amendment proposed by the shadow minister is to provide for the conditions of licence for private day procedure centres to be prescribed in regulation. The government will support this amendment to section 89D.

Whilst the licensing of stand-alone private day procedure centres is clearly the key objective of the bill, there is a small number of other proposed changes designed to improve the functioning of the act as it relates to private hospitals. First and foremost, removing the cap on hospital bed numbers will allow the private hospital sector to further expand and complement the public health system in meeting the demands of an increasingly ageing population. The cap on bed numbers is clearly redundant, having not been updated for some 20 years, and it is not the role of this government to interfere in the market by setting such limits.

Providing for the standards of construction, facilities and equipment to be set by notice in the South Australian Government Gazette will allow them to be set with reference to other already existing standards and codes, such as the Building Code of Australia and the Australasian Health Facility Guidelines, replacing the out-of-date standards currently prescribed in the regulations and avoiding duplication.

Enabling a private hospital to provide services at both their licensed premises and approved offsite locations recognises the changes in service delivery models which have seen hospitals provide offsite services in the area of low acuity postnatal nursing care, sleep laboratories, chemotherapy treatment and rehab services. Providing for the inclusion of an administrative fee for the variation of a licence or conditions of a licence will more accurately reflect the cost of administrating the licensing regime.

During the course of the development of the bill, the government consulted with key stakeholders, including licensed private hospitals, private day procedure centres, peak industry bodies and surgical and medical colleges and associations in general. The draft bill has received the overwhelming support of private hospitals, and the majority of private day procedure centres also recognise the benefits of the sector being subject to regulation.

The new section to be inserted into the act, part 10A—Private day procedure centres, is very similar to part 10 of the act—Private hospitals, and the licensing of private day procedure centres will function in essentially the same manner as private hospitals are currently licensed. The amendments to the Health Care Act 2008 will modernise private health facility licensing arrangements and bring South Australia into alignment with other state and territory jurisdictions. In addition, it will create a more level playing field between private hospitals and private day procedure centres, subjecting the private sector to the same regulatory compliance requirements.

Debate adjourned on motion of Hon. D.W. Ridgway.