Parliamentary Committees

Social Development Committee: Inquiry Into Regional Health Services

Adjourned debate on motion of Hon. G.E. Gago:

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

(Continued from 27 September 2017.)

The Hon. J.S. LEE (22:29): As a longstanding Liberal member on the Social Development Committee, I rise to speak on the Inquiry into Regional Health Services. The committee received 71 written submissions from peak bodies, health advisory councils and Country Health SA Local Health Network, and we also heard from 58 individuals. I place on the record my sincere thanks to all those who generously gave their time in preparing comprehensive submissions and providing valuable evidence at both the hearings at Parliament House and on our regional visits.

It would be fair to say that the regional health services inquiry would probably not have taken place without the persistent efforts and subsequent motion moved by Mr Dan van Holst Pellekaan in the other place. I would like to take this opportunity to commend the hardworking member for Stuart who moved the important motion to investigate the impact of health services on regional communities. While the terms of reference were quite broad, the inquiry was guided by principles that all South Australians shall have equitable access to appropriate health care. We should have a health system that ensures that people are not left behind regardless of where they live, whether they reside in Adelaide or in a regional centre.

Eight years have passed since the commencement of the Health Care Act 2008, which sets out the new governance arrangements of South Australia's Country Health hospitals and health system. The subsequent dismantling of hospital boards and the set-up of health advisory councils (HACs) has created a number of challenges. Not all HACs have been able to implement the full scope of functions that the Health Care Act provides for. Not every member of the HACs was confident in their role.

Issues of concern raised by HACs included difficulty establishing a cohesive identity, confusion about their role, problems engaging with the local community, loss of influence and power, feeling disempowered by too many bureaucratic layers and no clear mechanism in place for coordinated reporting back by Country Health SA Local Network to health advisory councils.

One particular concern raised by many HACs was the lack of financial information being provided by Country Health SA Local Health Network. For instance, HACs were not able to contribute to service planning because they either do not have a say or have limited input into hospital budget planning. Evidence informed the committee that, in order to better meet the expectations of local communities, HACs should have greater input into the budget planning process because this would be beneficial to regional health service planning.

The committee heard about the unnecessary red tape and deferments in the management of procurement and building maintenance. This caused a great deal of grief and frustration for many HACs. Country folk are known for their resilience, generosity and community spirit. Fundraising is so important for country hospitals and I would like to thank those passionate individuals and businesses in the region who gave generously to support country health services. Unfortunately, they had little control over the use of the funds that they were able to raise.

In addition, HACs have indicated a general lack of confidence that the goods and services they intended to use the fundraising moneys for were in fact used for that purpose. This has to change. During our inquiry, the committee found that there were incorporated and unincorporated HACs. Incorporated HACs can access the gift fund account funds, but it is not as easy as it sounds. Why? It is because, in order to spend certain amounts of money, HACs must apply to the Country Health SA Local Health Network for approval. As a result, there are lengthy delays in the application process.

On top of the legislative requirements of the State Procurement Act, purchasing must be done according to SA Health procurement guidelines or through the cumbersome process at the Department of Planning, Transport and Infrastructure for building maintenance and minor works. An overwhelming majority of HACs indicated that they were burdened by the fees associated with using DPTI for building maintenance. There were claims by HACs that using the DPTI-mandated service caused disruption in service provision and also impacted on economic stability and the wellbeing of townships or regions because the contracts were taken away from local suppliers and tradespeople in the local community.

After hearing these concerns, the committee formed the view that HACs should be given greater autonomy over procurement decision-making, and the procurement should be streamlined. The committee identified more work to be done to facilitate engagement between Aboriginal communities and also culturally and linguistically diverse populations in country areas which may encounter difficulties in accessing health services available to them.

The regional health inquiry was complex and it took approximately 18 months to complete. The inquiry provided the insight for the committee to come up with 49 recommendations. I would like to thank the members of the Social Development Committee for working diligently throughout the inquiry: the Presiding Member, the Hon. Gail Gago; the Hon. Kelly Vincent MLC; Mr Adrian Pederick MP, member for Hammond; Ms Nat Cook MP, member for Fisher; and Ms Dana Wortley MP, member for Torrens. I would especially like to acknowledge the member for Hammond, who is the only country member on the committee, for his strong advocacy and interest in this inquiry. His personal experience and insight was most helpful in the regional health inquiry.

Special acknowledgment goes to the amazing and hardworking secretary, Robyn Schutte, who worked tirelessly to coordinate the tight schedules for all members. I would also like to thank the two dedicated research officers, Dr Helen Popple and Ms Mary-Ann Bloomfield, for pulling the mountain of complex issues together, and of course the ever so diligent Hansard staff members, who recorded evidence in a cool, calm and composed manner, particularly working under pressure during our country visits.

In conclusion, I express my gratitude to all the doctors, nurses, ambos, admin staff, volunteers and HAC members who make immense contributions to improve our health system in country South Australia. I commend the report to the council and look forward to seeing the outcomes of the recommendations.

Motion carried.