Health Services

Adjourned debate on motion of Hon. C. Bonaros:

1. That a select committee of the Legislative Council be established to inquire into and report on health services in South Australia, with particular reference to—

(a) the opportunities to improve the quality, accessibility and affordability of health services including through an increased focus on preventative health and primary health care;

(b) the South Australian experience around health reform in the state, specifically Transforming Health, EPAS, the reactivation of the Daw Park Repatriation Hospital and other related projects and/or programs;

(c) the federal government’s funding of state government services and the linking of other federally funded services in South Australia, such as Medicare funded GP services, Adelaide Primary Health Network and Country Primary Health Network; and

(d) any related matters.

2. 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.

(Continued from 7 November 2018.)

The Hon. F. PANGALLO (16:02): I rise to speak in support of the motion put forward by the Hon. Connie Bonaros for a select committee on health services in South Australia. Where do you begin with this mess of a health system that became a huge, rudderless bureaucracy under the previous Labor government, where mismanagement and spending were totally out of control, as we are now being told by the Royal Adelaide Hospital's auditors, KordaMentha?

At the last state election, SA-Best was howled down for calling for a royal commission. Clearly, from what we are now learning, a major inquiry was warranted. This committee will be able to examine and report on the delivery of health care, health services and failed health reforms, and then make recommendations that will complement the bean counters brought in at great expense.

It is evident that there remains a toxic culture operating within SA Health that has spread like a pandemic, engulfing pen-pushing bureaucrats to clinicians, doctors and nurses in the various local health networks, making many fearful for their jobs and leading to a failure of services. Eleven CEOs in 11 years at the Central Adelaide Local Health Network indicates a lack of leadership, and morale must be low. South Australian Country Health is a disgrace, too. The needs of our regions have been forgotten. A system in overload and bursting at the seams must eventually impact on the level of quality health care South Australians of all ages expect.

It has cost lives and will continue to do so. I have already spoken in this chamber of the needless death earlier this year of a bright and bubbly teenager with a full life ahead of her. Kiera Maraldo was diagnosed in our brand-new hospital with a potentially fatal but treatable heart condition, yet was sent home because they did not think she was a priority. She died in her sleep not long after discharge. Who should take responsibility for that?

Kiera is just the tip of an iceberg of public patients going through our health system as if it were a lottery. My fear is South Australia—and Australia—is going the way of medical care in the United States where only the rich can afford to get sick or have surgery and ordinary people are made to feel they are mere numbers.

The news remains bleak even if the Marshall government can stop the flood of red ink. There is no quick fix, and governments know it. Canberra will spend $100 billion plus on machines that are designed to kill people yet baulk at spending one extra dollar than they must on saving the health of the nation to give us more hospital beds and facilities to cope with what is about to come. Here, the state Liberals can raise loans to build a boutique hotel at the Adelaide Oval, appeasing their politically aligned footy, cricket and pokie baron chums that sit on the Stadium Management Authority while closing down facilities or cutting funding to organisations and clinics that assist the less well off in our community.

In the meantime, our already fatigued health systems are about to be hit with a tsunami they should have seen coming a decade ago. Thirty per cent of the population are boomers entering their retirement years, which means they will be needing more health and aged care. If they can still pay for private health cover, they are now thinking twice about keeping it, because the rising cost of premiums is making it unaffordable, driving more to the public system. Even young people are ditching it because the cost of living is too high.

Health and education must be a nation's top priorities for its citizens. The $2.4 billion on the new Royal Adelaide Hospital is an outrageous waste, a folly by a polly, Mike Rann. It will eventually cost taxpayers $11.8 billion but most likely more. What kind of a legacy has been left for future generations? They could not even get the move done right. Why did Labor not maintain some presence at the old site to allow a transitional period? But no, they shut it down and gave away all that was there for a place that is not fit for purpose because the bureaucrats and politicians running health did not plan or consult properly.

No thought, for example, was given about relocating the much-needed respiratory clinic from its current site across the road from the old hospital. Now they are needing to make space for it at the new place. There was not enough room for an outpatient clinic, so an entire ward, that could hold up to 16 beds on the fifth floor, has had to be set aside as a short-term fix until a solution was found. But outpatient care is such a busy area, and the waiting lists are very long; a year later it does not look like being moved.

Labor wanted to shut down other hospitals. What were they thinking—that people do not get sick as the population grows and gets older? Cutting back when demand is only going to increase makes no sense.

Cuba is one of the poorest countries on earth and one of the last bastions of communism. It also has one of the best universal health systems in the world. Right now, it is far better than ours. Cuba provides more medical personnel to the developing world than all the G8 countries combined. Its healthcare system continues, in part, due to its unique medical education system, which turns out thousands of doctors, nurses, specialists and other clinicians. There might be lessons there for us, because here it is still a closed shop.

The only ramping in Havana is done in 1950s vintage Chevy or Dodge cabs loaded with tourists waiting to buy a box of Montecristos from La Casa del Habano. Patients are treated as equals. And it's all free. Medical tourism is a booming industry there, with specialist hospitals designed for foreigners and diplomats offering low-cost surgical procedures.

Unless you have personally experienced our health system, you would not realise the extent of the problems we have here. The best illustration I can give of this are recent instances that are close to home for me. I will start with my own ailing father-in-law, a pensioner in his mid-80s who worked extremely hard all his working life, contributing much to the community in taxes so that he could enjoy retirement and a healthcare system he once helped subsidise.

Earlier this week, he was ferried by ambulance to the Flinders Medical Centre with dangerously high blood pressure and blurred vision after collapsing at home. He then had to wait in an ambulance, ramped with several others outside emergency, for more than three hours with his blood pressure above 200 before anybody could see him. The frustrated ambulance medics, who cannot be faulted for their care and concern, handed him a pamphlet calling for action on ramping, an issue that nobody can make disappear despite years of rhetoric and politicking.

It took another two hours before a doctor suspected that he may have suffered a stroke, and it was only confirmed after further tests. Why must it take six or seven hours for an aged person presenting with serious neurological symptoms to be assessed when there is a real risk they could have another stroke? Staff talked about sending him home when it was obvious that he was in no condition to leave the ward and before they completed all the necessary tests—because they needed the bed.

He went home on Monday and was booked in for an MRI yesterday. He duly rolled up only for the MRI to be cancelled because he has a pacemaker fitted. Flinders staff knew this from his records yet still made the booking and did not communicate it to the MRI staff. An appointment cancelled, time and money wasted, and the hospital's already groaning waiting list extended because of poor communication skills. A bad decision has a domino effect. My anxious father-in-law has been told to wait while they find a solution.

I would also ask if staff at our hospitals are thinly directed to give less priority to aged patients. On my way out from visiting my father-in-law I bumped into the Varbaro family who were visiting their 90-year-old mother, and another horror story of communication breakdown unfolded. She had gone to Flinders Private in mid-October for a heart ailment. Family members advised staff not to give her the drug Endone because it had an adverse effect—but they still gave it to her. Then she had a serious fall with nobody watching her and broke her neck. In pain, Mrs Varbaro was then left in a bed wearing a hard neck brace. When no visitors came to check on her she became upset, thinking that her family did not care about her; however, it was because no staff member cared to call her next of kin to inform them of the incident and the subsequent injury.

The family only discovered what had happened when one of them happened to call her some eight hours later. From that day she has been complaining of head pain. She was recently moved to Flinders public where she was to have an MRI. Five weeks later no MRI has been done and she is still complaining about the head pain. Her son Tony tells me that staff only seem to react when he contacts them to complain about the level of care—not good enough, Mr Acting President.

Ron McIntyre, a friend I have known since childhood, has the unenviable reputation of being in the new RAH longer than any other patient, thanks to complications from surgery which may or may not require further investigation. He can no longer eat or drink himself; it must be done intravenously. He has cancer but now is not fit enough for surgery. He has been punted from the hospital to the Hampstead Rehabilitation Centre and back into ICU so many times that the system does not know what to do with him anymore.

He cannot go home or into a nursing home as he would be back in hospital within days because of pulmonary aspiration. At Hampstead they wanted him to sign a form as to whether he wanted to be revived if he had another incident. Has it got to that point where they want someone to sign away their life, Mr Acting President? Today, he is in the new RAH as a private patient. They were supposed to give him an MRI but that has not occurred. They want him out.

Hampstead does not want him either. He cannot get a straight answer. Does anyone care anymore? As a doctor warned me only last week, you do not want to get old in this state and get sick. However, it happens to the young as well. A distressed young father, who I have come to know quite well, Mahir Parikh, called me last week complaining about the substandard care initially given to his three-year-old son Rushi at the Women's and Children's Hospital last month. Rushi was rushed to the emergency department at the hospital with a very high temperature, and was constantly vomiting.

Without his condition being properly assessed by a doctor, a nurse at reception decided Rushi was not a priority case, so Mahir waited and waited in the packed emergency department as his son's condition worsened. He inquired twice about the length of time to see a doctor, but was told he had to wait. Five hours later the boy was treated for dehydration, but no tests were taken. Only by chance a visiting doctor noticed the boy was not doing so well, recognised the seriousness and ordered blood tests and an ultrasound, which revealed renal failure. One of his kidneys had already shut down.

After seven hours, Rushi was put on a ventilator and given dialysis, but even then, Mahir claims, the nurse had difficulty operating the machine. There were more dramas for the family the following day, when a scheduled operation was delayed by four hours because no other emergency operating theatre was available at the hospital. The boy was required to fast for that surgery, but was so hungry and distressed that his distraught father and mother had to stop him from biting his fingers.

The treating doctor said that Rushi faced the risk of dying had he not gone into ICU when he did. He was in hospital for 22 days, including 13 in intensive care. Rushi was found to have a rare case of HUS syndrome. Some of you may remember the terrible toll a type of HUS had on children during the Garibaldi contaminated meat poisoning scandal. The kidney took 11 days to start working again, but is operating at 70 per cent.

Rushi is taking an expensive subsidised drug on a trial that ends in March. It will then cost $6,000 per 300 milligram dose. Doctors cannot tell Mahir if there is long-term damage to Rushi's kidney, but he wants to know why it took so long to be seen, and then for the life-threatening problem to be diagnosed. Now he has the added burden of the high cost of ongoing treatment. He was told there was not enough staff to cope with the demand. Had Rushi been treated differently when he presented, the costs could have been significantly less for the hospital, the family and taxpayers.

How often does this happen? It would not be a rare occurrence. Waiting lists and staffing issues in our hospitals must also be addressed. I have outlined four cases I have personally encountered. How many others are occurring every day that we do not know about?

I note that today the new CEO of CALHN has announced a whistleblower hotline. It all sounds good, but what will it achieve when little is being done about the mountain of actual documented complaints? It is not acceptable. We live in one of the world's top 10 liveable cities, not a Third World country, unless of course you get sick.

I am that sure many of those working in our hospitals are doing their very best under difficult and demanding circumstances beyond their control. I will heap enormous praise on SA Ambulance for their dedication to the patients they serve. Their job is to collect and care for patients for the journey to our hospitals. They should not be a back-up ward in a car park, in the process holding up others requiring their assistance in emergencies. People have died as a result of ramping.

Something must be done; things must be fixed; we must get answers. There is an urgency that can no longer be swept aside. We are in the midst of an unprecedented crisis. Hopefully, we can get clarity from this committee's inquiry. I commend this motion to the chamber.

The Hon. E.S. BOURKE (16:19): I rise to briefly speak on the motion and indicate the opposition will be supporting the establishment of this select committee. The select committee will give this council the ability to gain a deeper insight into the government's policies and decisions in the health and wellbeing portfolio. The committee will be able to act as both the reviewer and accountability mechanism over the government's decisions in health moving forward. Given the importance of this portfolio and its impact on the lives of every South Australian, we believe it is a positive step for the Legislative Council to be considering the health portfolio at a more detailed level.

The first reference point of the select committee is centred on investigating opportunities to improve the quality, accessibility and affordability of health care, particularly looking at preventative and primary health care. The future of preventative and primary health care is particularly front of mind with the government's budget cuts in these areas. As we have heard in this chamber just today and yesterday, the cuts to SHINE SA, to sexual health funding and to Centacare's Cheltenham Place services demonstrates a shortsightedness of this government.

Cutting these services might represent a small budget saving in the immediate sense, but the rise in unplanned pregnancies, increased STIs and untreated HIV patients will have a huge impact on our health system and our health budget in the years to come. The opposition will be seeking to focus on those poor decisions of this government in considering how we move forward on preventative and primary health in this select committee.

The second reference point references a number of matters for the committee to consider. The opposition believes that a number of these matters have already been canvassed in great detail, some in previous committees. However, we are willing to support the motion and in particular seek to focus our efforts in this committee on current and future matters. In summary, the opposition will be supporting the establishment of this select committee. We look forward to having a level of oversight of the government's decisions in health moving forward.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (16:21): The opposition will be supporting this motion and the government will, too. I must admit I will be highlighting different things than the Hon. Emily Bourke. The first reference deals with, as the honourable member said, quality, accessibility and affordability. In the context of accessibility, I am sure the committee, as the Hon. Frank Pangallo highlighted, will want to be looking at waiting lists because access is a huge issue in relation to elective surgery. In the last year of the Labor government the elective surgery waiting list increased tenfold.

In terms of affordability, clearly it is important that we budget appropriately for the increasing cost of health care and the ageing of our community. Once you have set your budget, you have to stick to it. What we saw under the former Labor government was that, having set a budget and factoring in relevant growth, they blew it year after year. My understanding is that two financial years ago it was about $150 million; in the last financial year in CALHN it was $260 million; and this financial year the projection is $300 million.

These are not issues of cutting money; it is a matter of living by your budget. It is one thing to say, 'We will budget for growth', and then just ignore the budget. What KordaMentha found was that SA Health, in CALHN in particular, just had gross disrespect for the budget. That is not the way to make sure that our health services are affordable and accessible.

The second dot point of the terms of reference talks about the South Australian experience around health reform in the state. The Hon. Emily Bourke was religious in looking forward. She kept talking about looking at issues going forward. I would like to make it clear that the government expects this committee to honour its terms of reference; that is, to see the whole health reform experience.

I notice that the Hon. Connie Bonaros in her motion refers to Transforming Health, and I think that is very appropriate. The only way to see where we are, going forward on health services, is to know where we are now, and that is significantly affected by the experience of the last four years. For those of us who celebrate anniversaries, yesterday was actually four years exactly since the Transforming Health summit. A bit like an Amway convention, it was held at the Convention Centre and was all about launching a PR campaign that turned toxic against Labor.

The Hon. I.K. Hunter: Guess what this week is? It's AIDS Awareness Week, when you cut funding to sexual health services. You are useless. Stop trying to apportion the blame to someone else. Accept your own responsibilities.

The ACTING PRESIDENT (Hon. D.G.E. Hood): The Hon. Mr Hunter, please!

The Hon. S.G. WADE: The problem with Transforming Health is that it significantly failed to engage the community and failed to engage clinicians. In that respect, it was not alone in terms of projects of the former Labor government. I met a nurse this week who is a senior nurse manager at the Royal Adelaide Hospital and has been so for some time. She said that, in spite of her seniority, not once in the new Royal Adelaide Hospital project was she consulted on the hospital's design and the configuration of its services. It is hard to imagine that the former Labor government would think that you could have a fit-for-purpose facility and not engage the people who are going to use it, but that is exactly what they did.

Something I want to stress to the Hon. Connie Bonaros is that it is the government's view that it would be helpful not to stop at Transforming Health but also to look back over two other health reform initiatives, which I would like to highlight for the honourable member. The John Menadue report, called the Generational Health Review, in 2003, which recommended a very significant shift towards primary and preventative health. This was a report commissioned by Labor and the Labor government endorsed it. Yet, within three or four years, suddenly, instead of investing in primary and preventative health as the Menadue report suggested, we were building a large centralised Royal Adelaide Hospital. A lot of people in the health sector are saying that there is a disconnect here.

Secondly, I would also encourage the honourable member to be aware of mental health reform. Let's remember that this is not just about physical health; we are also concerned about mental health. I think it would be helpful for the committee to do a stocktake on mental health reform after Cappo. There is a lot of work to be done. A lot of issues have been raised over the last 10 to 15 years. You would expect, after all of the reports and all of the discussions on health reform, that we would be going forward. I think a lot of South Australians have lost confidence in health reform, and a committee to look at our experience and a more constructive way going forward would be helpful.

I certainly support the third recommendation in relation to the interaction between federal and state services, particularly with the emergence of the PHNs. I think there are a lot of issues in terms of federal and state interaction—a classic example is the NDIS. The interaction between different sectors and different levels of government, including local government, certainly warrants attention. If the committee were able to provide suggestions on how we could better cooperate with other levels of government, I think that would add real value. I offer those few remarks in joining other members in supporting this motion.

The Hon. T.A. FRANKS (16:28): Because of my own ill health, I am finding it a little hard to make vocal contributions at the moment. However, at this point I certainly want to make a contribution, some of which is similar to what the minister has just reflected on. I simply want to indicate that the Greens support the establishment of this select committee. In doing so, I note that, while it is unparliamentary to mention other select committee or standing committee inquiries currently underway, there is a standing committee about to look into workplace fatigue, bullying and stress within the health workforce itself. I flag that that work is underway and will soon commence.

Of course, I was a member of the previous Transforming Health select committee, which provided many reports to this place, and there will be much food for thought there. Two other things I wish to reflect on are that, within these terms of reference—and the minister has hit the nail on the head—there is little reference to mental health, and that is such an essential part of our health. Transforming Health, the most major transformation in a generation of our health system, did not even touch on mental health, and that is an error of the previous government itself. You would have thought that Transforming Health would have addressed that situation and had that particular cohort at its very core.

In fact, when the focus was on clearing out EDs and not having people seeking care on multiple occasions, and the idea that you would get the best care, first time, every time—well, when you do not look at mental health care, you are never going to get the best care, first time, every time. Finally, in terms of preventative health, I would hope the committee would undertake to look at the McCann review. From my own perspective, I get a lot of constituents come to me who do not fit into the mainstream health system. We have had the debates about SHINE and the services there, but trans people also find that they cop a pretty raw deal from the health sector.

We do not have a gender clinic in this state like Victoria does and, when we have South Australians having to go to Victoria for that sort of health care, I think we need to assess whether our health system is even coming close to giving those particular citizens of our state best care, first time, every time, but go to Victoria to get it. I hear a lot of heated words in this place and, while it would be unparliamentary of me to reflect that there is another motion coming up, which I am certainly also interested in, I ask in this case that we start to put some of these health challenges first. We are here we are politicians, and there is no getting away from that, but there are also quite pressing issues that face us, which I think we are here to make a difference to and make better. With those few words, I commend the motion.

The Hon. T.J. STEPHENS (16:32): I hope the chamber will indulge me. It has been brought to our attention that it would be the government's preference to have two members participate on this select committee. Whilst I know that those of us who are participating in committees are rather stretched at the moment, the Hon. John Dawkins has been kind enough to put his hand up to participate on the committee on our behalf. The minister, the Hon. Stephen Wade, thinks it is quite desirable that we have a second person, particularly on the off-chance that if the Hon. John Dawkins cannot make it we would like to be represented on this committee. So I am going to move to amend the Hon. Emily Bourke's motion—

Members interjecting:

The Hon. T.J. STEPHENS: Sorry, the Hon. Connie Bonaros's motion to make sure—

The Hon. C. Bonaros: I have already put two in.

The Hon. T.J. STEPHENS: —that we have two. I have flagged that, when we move onto the next one, we will certainly be doing this as well to make sure that we have two members on these particular select committees.

The Hon. C. BONAROS (16:33): At the outset, can I thank all honourable members for their contributions: the Hon. Frank Pangallo, the Hon. Emily Bourke, the Minister for Health and Wellbeing and, lastly, the Hon. Tammy Franks. I would like to make a few comments before finalising this issue in relation to the ills of our public health system, which I think are now well known and well documented, and the crisis impacting our public health system, which simply cannot be underestimated.

So bad is the long-term diagnosis that the state government recently gave the keys of the SA Health agency that runs the new Royal Adelaide Hospital to the bean counters who resuscitated the Whyalla steelworks. KordaMentha has been put in charge of turning around the massive $300 million budget blowout in the Central Adelaide Local Health Network—at a cost, of course, to taxpayers. In return, KordaMentha aims to return CALHN's budget blowouts by 2021. It is expected that savings of $41 million will be seen by the middle of 2019, $101 million by 2020 and $134 million by 2021. I expect that these are matters that the committee will certainly be looking into in the months to come.

According to media reports, KordaMentha's plans to save $276 million in three years include dramatically cutting patients' length of stay by an average of 1.5 days, saving $130 million over three years and freeing up 65,000 occupied beds per annum, overhauling rosters and cutting overtime, gaining greater revenue from privately insured patients, improving efficiency in both health services and financial services, and stricter controls on purchasing practices.

Whichever way you look at it, it is severe and it is drastic, and there will no doubt be a lot of heated discussion to come on this very issue. We acknowledge, very rightly, the basket case I think the Marshall government inherited from the Labor government and the difficult task that lies ahead of the government as it attempts to stop the bleeding.

The people of South Australia are absolutely depending on this. SA-Best has said from the outset that it is willing to work with the government in any way it can to ensure that a practical solution is found to ensure the hospital's doors remain open, and that commitment remains. For the record, I have made it clear to the minister and to stakeholder groups that we have been working with that that commitment remains. To that end, the terms of reference for this inquiry have been drafted intentionally broad enough to cover all manner of health issues, and I envisage that the committee will be able to undertake this task on an ongoing basis, but only with the referral and agreement on instruction of the council, should of course the council agree.

As I have said, I think the terms of reference are ample in terms of covering the issues that SA-Best and other members of this place and stakeholder groups have highlighted as being critically important. Importantly, they recognise that, in order to look into the future, it is absolutely imperative that we also look back to identify the errors that were made previously and ensure that they do not happen again. If we are truly genuine in our attempt to fix all those problems plaguing our health system, of course we must know the depth of what we are dealing with.

As much as the opposition may not like it, that certainly involves looking back to see how it is that we got to this point now. To that end, we have to remove the political motives and agendas, because, as we know, ultimately what this is about is people's lives, people's health and people's wellbeing. That should be what guides us, and that should be front and centre of all our deliberations on this issue. That is why we pushed so heavily for a royal commission into health, because we thought it was only appropriate that people's lives, people's health and people's wellbeing be the front and centre consideration on the issue of health.

This matter demands the support of everyone in this chamber, whatever their political allegiance, and I am extremely grateful to everyone who has supported the inquiry, but especially to the two major parties for their support, because I know it has been contentious. I am grateful for the cooperation of the Hon. Emily Bourke, and also particularly to the Minister for Health and Wellbeing, who I think has been very genuine in his commitment to working with me in relation to the terms of reference that have been drafted and ensuring that they provide a balanced position in relation to both the past and the future.

I am also pleased that the minister and the Hon. Tammy Franks have raised issues of mental health, which I see as central to this inquiry. It is definitely an issue that I have canvassed extensively with stakeholder groups, in particular SASMOA, because it is one of the issues that is front and centre of that organisation's agenda.

I can highlight for the record that it has always been SA-Best's intention that mental health will form a significant part of this inquiry and I believe that the terms of reference do cover that and allow for that and I certainly see that being an integral part of this inquiry. With those words, I thank members again for their support and I look forward to a fruitful and productive and beneficial committee process.

Motion carried.

The Hon. C. BONAROS (16:40): I move:

That the select committee consist of the Hon. D.G.E. Hood, the Hon. E.S. Bourke, the Hon. J.S.L. Dawkins, the Hon. I. Pnevmatikos and the mover.

Motion carried.

The Hon. C. BONAROS: I move:

That the select committee have power to send for persons, papers and records and to adjourn from place to place and to report on 3 July 2019.

Motion carried.