Parliamentary Committees

Social Development Committee: Regional Health Services

The Hon. G.E. GAGO (15:59): I move:

That the report of the committee, on an Inquiry into Regional Health Services, be noted.

I take this opportunity to acknowledge and thank the many people who have contributed to this inquiry. First, on behalf of the committee, I thank Mr Dan van Holst Pellekaan, member for Stuart in the other place, for following up the 2011 reference and bringing it to the parliament's attention in 2014. I also thank Ms Leesa Vlahos for moving that the inquiry be undertaken by the Social Development Committee.

To the many individuals and organisations who provided evidence during the inquiry, thank you for your contribution: your frank and honest accounts have assisted the committee to reach the best possible recommendations towards improving the country health system.

I also take the opportunity to thank the committee members for their efforts throughout the inquiry. In the other place I thank Ms Nat Cook, Mr Adrian Pederick, member for Hammond, and Ms Dana Wortley, member for Torrens. In this place I thank the Hon. Jing Lee and the Hon. Kelly Vincent, the committee secretary Ms Robyn Schutte and our research officer Ms Mary Bloomfield. Finally, on behalf of the committee, thank you to the parliamentary staff for assisting the committee.

It was very important to the committee that those who have had direct experience with the country health system, and who have experienced the changes brought about by the Health Care Act 2008, were provided with an opportunity to have direct input into the inquiry, and ultimately the recommendations.

The committee travelled to the South-East, the Riverland and the Flinders and Upper North regions to meet with communities and hear evidence from many stakeholders. The committee also received 71 written submissions. Members agreed that it has been a long and protracted inquiry. The reasons for this, however, in part have been the broad ranging terms of reference, as well as the complexity of the matters arising from the reference, as they came to light.

The committee has taken a very considered approach in its inquiry, but clearly there is no silver bullet to solve all the issues involved in the delivery of country health services. The first part of the reference addresses the Health Performance Council 2011 review, which found that health advisory councils were generally ineffective and the health system was not supportive enough to assist them in their role. We know that because of that review Country Health SA undertook to raise the profile of health advisory councils and encourage country communities to engage with their local health networks. While there is still more work to do, some of those goals have been met. For example, the Country Health SA strategic plan and consumer engagement strategies have been completed and implemented.

The second part of the reference refers to the delivery of health services in regional SA and the role and responsibility of health advisory councils. Twenty-two HACs responded to this inquiry, which is just over half the total number of 39 (or 56 per cent). Evidence from the health advisory councils indicates that a number are coping and doing very well with their responsibilities and the role that they have in their communities. Despite this, however, the majority have experienced continued frustration with the governance arrangements and are either unaware of the full scope of functions provided to them by the act or have been unable to utilise these functions.

The committee noted that some HACs are functioning well as healthcare advocates and raising funds, and some have excellent relationships with their individual regional directors. Yet, others told the committee they struggled with their role and did not feel that there were clear lines of access to Country Health executive staff. These problems appear to have developed out of the deficiencies in communication and lack of collaborative approaches between Country Health SA and HACs over a long period of time.

In relation to terms of reference 2(b) through to 2(m), the committee found that there are a range of issues that run contrary to the intentions of the Health Care Act 2008. These include hospital budget decision-making. The committee heard that most HACs do not want to manage their annual hospital budgets. However, they do want to have input into them. The committee recommends that Country Health SA develop guidelines to support this to occur.

Consultation with health advisory councils in hiring of senior hospital staff: a number of HACs have advised that they were not consulted, which the act provides for, in the process of hiring senior hospital staff, and they expressed a desire to do so. The committee has recommended that Country Health SA develop clear guidelines for consultation to occur.

Service planning: the committee notes that HACs are given cursory mention in the Country Health strategic plan 2015-20. This needs to be rectified to acknowledge HACs and their capacities for input into healthcare planning services. The committee has recommended that Country Health SA have greater recognition of HACs in core policy documents and continues to collaborate with them in their local 10-year health plans.

In relation to the expenditure of donated money, procurement practices and building maintenance, the committee has made recommendations to increase transparency and accountability and give some control back to the community over how these funds are spent. These measures, if taken up, should include an increase in the maximum threshold amount HACs can spend before approval from the Minister for Health is required. Of course, there will still be the necessary checks and balances in place.

In relation to the dedicated work of the South Australian Ambulance Service, the committee found there were inefficiencies and pressures brought about from increases in low-acuity patient transfers, the length of time to train volunteers, and the need to increase volunteer recognition. The committee has made a number of recommendations to address these and other issues discussed in the report. For example, it is recommended that Country Health continue working with SAAS in developing a memorandum of understanding for low-acuity patient transfers and other processes to assist volunteers.

In relation to SA Health procurement practices, evidence suggests that a review be made of the one-size-fits-all approach for country hospitals, particularly those that are very small or that are a great distance from a regional centre. Evidence suggests that procurement processes, whilst they aim to improve practices, can be restrictive to HACs and health services and the communities to which they are attached.

The issue of the mandated use of DPTI as the across-government building management service provider is, indeed, a problem for some HACs. The committee found that for some types of building work it is expedient, practical and financially beneficial for DPTI services to be engaged but this is not so in all cases and, at times, it has had quite a detrimental effect on some local communities and has created some ill feeling with local businesses, particularly tradies. The committee has recommended that the across-government facilities management arrangements be reviewed and that HACs be given greater discretion to use a service provider of their choice.

In relation to medical workforce planning, this obviously affects the whole of Australia's regional areas. We know that South Australia has higher than average GPs and yet these numbers are not distributed evenly across the metropolitan and regional areas. This is not a new phenomenon and, as such, the committee recommends that Country Health revisit its 2010 report of the Rural Doctors Workforce Agency, 'Road to rural general practice', and consider implementing the suggested model pathway to increase rural GP numbers.

The committee also recommends that Country Health SA undertake to do further work with the Australian Nursing and Midwifery Federation in furthering the development and implementation of the Country Health SA nursing and midwifery workforce attraction, recruitment and retention policy for the whole of South Australia. The committee has made a number of other recommendations aimed at achieving equitable distribution of medical staff in country areas.

In relation to the Enterprise Patient Administration System (EPAS), there were many problems, challenges and technical concerns when it was first introduced. The evidence shows that many of the initial issues have been resolved. Further improvements can still be made, however, in areas such as data capture. It is also worth noting that the majority of concerns raised in relation to EPAS came from less experienced users such as those GPs who consulted at a hospital on an irregular or infrequent basis. The committee has made a number of recommendations towards addressing this.

One of the highlights of this inquiry has been to see how the integrated mental health inpatient units have benefited regional communities. There are now integrated mental health units in Berri, Whyalla and Mount Gambier, with occupancy levels at approximately 85 per cent, which shows there is clearly a need. The committee travelled to Whyalla and received a tour of the unit. The committee commends the implementation of the integrated mental health units and the work of the dedicated staff in those units. The committee has made a recommendation for the Minister for Health to review the need to implement more units in country areas.

The committee considered a number of other matters during the inquiry such as the efficacy of the Patient Assistance Transport Scheme, the administration of aged-care services, and the linkages between primary, acute and tertiary care services. The report contains several recommendations for Country Health to review and continue to make improvements to those services.

To conclude the noting of this report, I want to highlight again the immense contribution regional and rural communities make to our state's country healthcare system. In the end, for this system to be fair and equitable, the bureaucracy needs to continue to improve the way it includes these communities in important discussions about the healthcare system and how it is planned and governed.

The report provides recommendations to garner potential for more extensive collaboration between Country Health SA and HACs and their local communities. It recommends a partnering approach and provides suggestions for HACs to continue expanding the functions and capabilities of their role in accordance with the act. I commend the committee's report and its recommendations to you.

Debate adjourned on motion of Hon. J.E. Hanson.