Health Care (Private Day Procedure Centres) Amendment Bill

Introduction and First Reading

Received from the House of Assembly and read a first time.

Second Reading

The Hon. I.K. HUNTER (Minister for Sustainability, Environment and Conservation, Minister for Water and the River Murray, Minister for Climate Change) (16:56): I move:

That this bill be now read a second time.

I seek leave to have the second reading speech and explanation of clauses inserted in Hansard without my reading it.

Leave granted.

The Government is introducing the Health Care (Private Day Procedure Centres) Amendment Bill 2017 to Parliament to amend the Health Care Act 2008 ('the Act') to:

remove health services involving the administration of local anaesthetic from the definition of a 'prescribed health service' in relation to the licensing of premises as private day procedure centres; and

insert a power for the Minister to confer exemptions in relation to specified prescribed health services by notice in the Gazette.

The Health Care (Miscellaneous) Amendment Act 2016 amends the Act to enable the licensing of stand-alone private day procedure centres. This brings South Australia into alignment with other jurisdictions and provides a range of measures, including the ability to impose specific licence conditions, to ensure that potential safety and quality risks are addressed.

In accordance with the Health Care (Miscellaneous) Amendment Act 2016, a person must not provide a prescribed health service except at premises in respect of which a licence is in force as a private day procedure centre. Prescribed health services are defined as:

a health service that involves the administration of general, spinal, epidural or major regional block anaesthetic; or

a health service that involves intravenous sedation (other than conscious sedation); or

a health service that involves the administration of local anaesthetic; or

as prescribed by the regulations.

The administration of local anaesthetic was not included as a prescribed health service in the original Bill that was consulted on in March and April, 2015, and which then entered Parliament last year. The intention had been to capture procedures of sufficient complexity or invasiveness using only local anaesthetic in the Health Care Regulations 2008. This would have avoided the scope of the licensing system being applied too broadly and unnecessarily capturing within scope a range of minimally invasive or low-risk procedures using only local anaesthetic.

However, an amendment to the Bill was proposed in the Legislative Council to include the administration of local anaesthetic as a 'prescribed health service' for licensing purposes. A further amendment excluded services provided by a medical practitioner in the course of practice as a general practitioner; and by a dentist in the course of general dentistry practice, being the two largest groups of practitioners using local anaesthetic to undertake minor procedures in their private consulting rooms or office based surgeries. The ability to make further exclusions via the regulations was also added and the Bill was passed by Parliament in May, 2016.

During the recent stakeholder consultation on the subordinate legislation, the draft Health Care (Private Day Procedure Centres) Variation Regulations 2017, it became apparent that substantial concern exists regarding the inclusion of the administration of local anaesthetic as a 'prescribed health service' in the Act.

Stakeholders including the Australian Medical Association, Royal Australasian College of Surgeons and other colleges and associations representing a variety of medical and health practitioners, such as the Australian Society of Plastic Surgeons, Australasian College of Dermatologists, Australian Podiatry Association, Royal Australian and New Zealand College of Ophthalmologists and Royal Australian and New Zealand College of Obstetricians and Gynaecologists, expressed substantial concern that local anaesthetic was included in the licensing criteria and that only general practitioners and general dentistry were exempted from this criteria in the Act.

They are concerned that the legislation appears to prohibit specialists and other practitioners from performing routine surgical procedures using local anaesthetic in their private consulting rooms or office based surgeries. It is argued that restricting the performance of these procedures to licensed private day procedure centres will lead to a number of unintended negative consequences and adverse patient outcomes, including an increase to the cost of basic minor procedures imposed on patients and lengthy delays to a significant number of important diagnostic procedures and other treatments.

A broad range of minimally invasive, low-risk procedures are performed under local anaesthetic in practitioner's private rooms or office based surgeries. For example, by a dermatologist to diagnose skin biopsies and remove malignant or non-malignant skin cancers. A podiatrist uses local anaesthetic to undertake procedures on ingrown toe nails, warts and skin lesions. Ophthalmologists use local anaesthetic for eyelid skin biopsies and lesion excision, drainage of abscesses and intravitreal injection of medication for the treatment of macular degeneration. Obstetricians and gynaecologists use local anaesthetic for the insertion or removal of hormonal implants and intra-uterine devices and the investigation, biopsy and treatment of pre-malignant or potentially malignant conditions of the genital tract. Radiologists use local anaesthetic in their practices to facilitate ultrasound guided joint and tendon investigations or during aspiration biopsies of breast lumps. These are just some examples of the use of local anaesthetic for the performance of a substantial range of minor procedures by a large number of different medical and health practitioners.

The consistent message communicated by the majority of stakeholders with respect to the consultation on the draft regulations was that an amendment should be made to exempt all registered medical, dental and health practitioners in the course of their normal scope of practice from the local anaesthetic criteria. Exempting all registered practitioners clearly undermines the provisions of the Act pertaining to local anaesthetic and makes it redundant. It is therefore sensible to remove the sections of the Act referring to the administration of local anaesthetic.

The South Australian legislation would then be consistent with other jurisdictions that require facilities to be licensed based on the higher levels of anaesthetic (general, spinal, epidural, major regional block) and intravenous sedation (other than conscious sedation). No other jurisdiction includes the administration of local anaesthetic within their private day procedure centre licensing criteria.

Where more complex or invasive procedures are performed under local anaesthetic these will be prescribed by regulations, as was the original intention. A good example of this is the tumescent technique for liposuction, where a large volume of very dilute solution of local anaesthesia is injected into the fat beneath the skin, causing the targeted area to become tumescent. To this end it has been proposed with stakeholders that the cosmetic surgical procedures listed in the New South Wales' Private Health Facilities Amendment (Cosmetic Surgery) Regulations 2016 be replicated for inclusion in the South Australian regulations. It is understood that the majority of stakeholders, including the Australasian College of Cosmetic Surgery, support this approach. Prescribing these specific procedures by regulation, rather than in the Act, will provide the flexibility to add additional services as and when required in response to changes in technology and service delivery methods.

It should also be noted that the existing thirty-one private day procedure centres that have already been declared by the Australian Government and issued with a facility provider number under the Private Health Insurance Act 2007 (Cth), on the basis of a previous recommendation by SA Health, will be issued with a deemed licence under the Act's 'grandparenting' provision.

In addition, this Bill inserts a power to confer exemptions in relation to specified prescribed health services by notice in the Gazette. This power will be used to make exemptions for emergency services organisations including the South Australian Ambulance Service, MedSTAR and the Royal Flying Doctor Service, as well as providing the flexibility to make any further exemptions in the future. There are two further clauses in the Bill which are administrative in nature and simply redesignate sections.

The Government believes that the proposed amendments will bring South Australia into alignment with other state and territory jurisdictions, by setting an appropriate threshold for licensing based on patient safety, without unnecessarily restricting the provision of essential health services utilising local anaesthetic in private practitioner's consulting rooms or office based surgeries.

The Health Care (Private Day Procedure Centres) Amendment Bill 2017 will come into operation immediately after section 10A of the Health Care (Miscellaneous) Amendment Act 2016 comes into operation, which has been delayed until 1 May, 2018, to enable an appropriate lead-in time for premises meeting the requirement to be licensed to prepare for licensing, including the requirement to attain accreditation to the National Safety and Quality Health Service Standards.

I commend the Bill to Members.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

3—Amendment provisions

These clauses are formal.

Part 2—Amendment of Health Care Act 2008

4—Amendment of section 89—Preliminary

In Part 10A section 89, this clause proposes to delete paragraph (c) from the definition of prescribed health service thereby removing from that definition a health service that involves the administration of local anaesthetic. The clause also makes a consequential amendment to delete subsection (2).

5—Insertion of section 89L

This clause proposes to insert a power for the Minister to make general exemptions from the operation of Part 10A of the Act or specified provisions of that Part by notice in the Gazette. Such exemptions may be granted on conditions the Minister thinks fit and a failure to comply with a condition will be an offence with a maximum penalty of $20,000.

6—Redesignation of section 89—Other staffing arrangements

In Part 11 section 89, this clause resolves a conflict in the numbering of certain provisions.

7—Amendment of section 92—Conflict of interest

This clause is consequential on the redesignation in clause 6.

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