Bills

Health Care (Governance) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 16 May 2019.)

The Hon. C. BONAROS (16:54): I rise to speak on behalf of SA-Best in support of the second reading of the Health Care (Governance) Amendment Bill 2019. As we know, the bill provides for the second tranche of changes to the Health Care Act 2008, with the first set passing with the support of SA-Best in July of last year. The first set of amendments in the 2018 bill established governing boards for local health networks, which sees decentralisation of the health system in this state.

Chairpersons for the 10 governing boards were appointed last year and, as I understand it, the remaining board appointments have all been made, bar perhaps one or two appointments. They have already started meetings and no doubt the minister will update us as to the progress of those meetings when he sums up the debate.

The governing boards will, from 1 July this year, be responsible for the delivery of local health services within their geographic area, which is a departure, of course, from the centralised system of Transforming Health under the former Labor government. Transforming Health had poor health outcomes for patients and consumers of our health system. That has been well documented and continues to be clear through the evidence presented before select committees, and indeed before the select committee into public health services, which I am chairing.

It is also clear that to continue with Transforming Health was absolutely no longer a viable option. There has been evidence on the public record, which has made its way into the press, in relation to the damning nature of the assessments being made by stakeholder groups. Only a week ago, Phil Palmer, the secretary of the Ambulance Employees Association, painted a very bleak picture of the current state of affairs impacting our overworked and stressed ambos dealing with an equally stretched health service.

While we cannot quote, obviously, from the evidence that has been given to the inquiry, we can certainly refer to statements that he has made to the media. Mr Palmer has publicly stated that some patients are waiting more than 10 hours for an ambulance as paramedics battle to cope with a severe staff shortage. It is forcing staff to work unreasonable amounts of overtime, and that overtime is costing us somewhere in the order of $15½ million dollars, which would, of course, have paid for some 155 paramedic interns. I think those figures translate, in fact, to about $600,000 a fortnight in terms of what we are paying in overtime fees.

He has further been reported as saying that ambulances were only meeting key performance indicators for priority 1 cases. I am sure the minister will provide his own views in relation to the 10-hour waiting period, but again I think Mr Palmer has been very clear in terms of distinguishing between priority 1, 2 and 3 patients. He was quoted by The Advertiser as follows:

Priority three response times are not meeting response time criteria…cases that should be responded to in 30 minutes are actually taking 10 or more hours. These are patients who are very sick and/or in significant pain.

In addition to that, Mr Palmer has also been on the public record as saying that, with the very severe influenza season we are facing this winter, he anticipates that wait times will move from the accepted eight minutes up to 23-plus minutes. This is in the public domain in terms of statements Mr Palmer has given in the media. A 10-hour wait for priority 3 is nothing short of an outrage, and I am deeply concerned about key performance indicators not being met when dealing with the sick and vulnerable in our community.

He has said that ambulance services are underfunded, under-resourced and are suffering a crisis of morale. I would be interested to learn from the minister what we plan to do in terms of this crisis of morale and specifically what this government and what the minister plans to do in relation to this crisis of morale, as reported by the very person representing the ambos, those people on the front line, on the ground, who are having to respond to this very dire situation.

Also, I would like to hear what he plans to do to rectify the chronic underfunding and under-resourcing that Mr Palmer talks about and whether this government has an understanding of the sacrifices that are being made by our ambos in order to meet KPIs for priority 1 cases to their detriment—to their detriment in terms of their own health and in terms of their own wellbeing.

The research is clear about the effects of stress and post-traumatic stress disorder on our emergency services staff. Compounding the stress they face on the job by inadequate resourcing and not enough funding will only drive ambos to leave the service in droves as they seek to protect their mental health and wellbeing.

As I said again, just moments ago, we are in the midst of what has been labelled the worst flu season on record. We have known this for some time and yet our emergency services and indeed our health system as a whole are ill-equipped to deal with it, and that is simply unacceptable.

Of course, we have not just heard from Mr Palmer in public, we have also heard from senior industrial officer Bernadette Mulholland from SASMOA, the Salaried Medical Officers Association, who has also painted a very bleak picture in relation to an issue which we have raised time and again in this place; that is, in relation to our mental health patients. In fact, just last week Ms Mulholland was quoted in the paper as having referred our treatment of our mental health patients in this state to the Human Rights Commission. That is not a good state of affairs for any of us.

Returning to the bill before us, it revises the functions of the chief executive of the Department for Health and Wellbeing and includes provisions for service agreements between the chief executive of the Department for Health and Wellbeing and the local health networks and the SA Ambulance Service. It makes provision for the annual reporting and transfer of assets for the metropolitan governing councils that will be dissolved on 1 July this year. It reflects the new governance and accountability framework for the public health system.

It also intends to remove one aspect of the disclosure requirements that were introduced and amended in stage 1 of the bill from 2018 regarding conflicts of interest being noted in the minutes of board meetings. In relation to that, I note the Hon. Tammy Franks has an amendment opposing the particular changes being proposed in the bill, and I am certainly keen to hear from both the minister and the mover of the amendment before finalising our decision on whether we will support or oppose those amendments.

Of particular note, the bill also seeks to dissolve the Health Performance Council once the proposed commission on excellence and innovation in health is established. It is this aspect of the bill that has caused the most concern among stakeholders, including the AMA(SA) and SACOSS, among others. As we know, that council was established in 2008 when local hospital boards were abolished and authority and accountability for our public health system became the responsibility of the chief executive of the Department for Health.

The Health Performance Council has provided independent and objective oversight of the health system since its inception. It acts as an independent body that investigates, gathers data and provides recommendations for change. I note that Labor in government had previously sought to abolish the Health Performance Council on at least two occasions, I think it was, but failed to do so. From the briefings provided by the minister and his staff, I understand the Health Performance Council members have been advised that they will have their jobs until August 2020 if the changes that are being proposed are successful.

However, I note again that the Hon. Tammy Franks has amendments opposing the proposed dissolution of the Health Performance Council. Again, while we are yet to formalise our position in relation to those particular amendments, I will say that it is our view that it is imperative that in this state we have an independent body that can assess the performance of the state's health systems and do so without fear or favour.

I note also that a number of concerns were raised by stakeholders in relation to the data collecting capabilities or roles previously undertaken by the Health Performance Council, and that is something that I am hoping the minister will be able to expand upon either in his summing-up or once we move into debate so that we have a clear understanding going into this bill about what it is that we are seeking to abolish, what the minister says will be replacing the council in this particular respect and where the holes are in terms of data, data collection and so forth.

I am not just referring to the obvious data collection issues that we have with private hospitals but the issue that has been raised in terms of the Health Performance Council being unable to undertake that role effectively in its current form with the data that it has available to it. Concerns have been raised by the AMA, which I certainly share, regarding the independent assessment and the independent collection of that data, so we will be asking the minister to expand upon his understanding of that in due course.

We have consulted widely on the bill and we are grateful to have been invited to take part in a stakeholder briefing held, I think, a fortnight ago, organised by SACOSS and the Health Consumers Alliance. It was a big turnout. We were joined by other groups, including the AMA, the Australian Association of Social Workers, SANDAS, the Mental Health Coalition, the Public Health Association, the Lived Experience Network Leadership Group and Health Promotion. There were a lot of concerns raised by stakeholders at that meeting, many of which have now been included in a series of Labor amendments filed only today, including statutorily enshrining the role of the Mental Health Commissioner and amending the act to provide an independent consumer voice, as well as providing for a focus on community consultation.

I certainly have not had the opportunity to consider those amendments in any level of detail up until now. Again, I note that they have only just been filed today, so I would not support any move to deal with those amendments today or at least until we have had an opportunity to consider them appropriately. It would be of great benefit if the minister could address the amendments from the Greens and the opposition so that we are all able to come to some position in relation to them sooner rather than later. I note also that the government has filed amendments to the bill which deal with testamentary gifts and trusts. As I understand it, they are not controversial amendments but, again, I will let the minister confirm that for us.

Finally, I want to thank the minister for the briefings provided to us and for passing on the submissions made by stakeholders in relation to the bill. We have had a number of conversations now and this debate is one which inevitably is going to be divided, particularly in terms of whether you support a centralised or a decentralised model of health governance. Our position in relation to the first tranche is already on the record and so we will not be diverting from that; that is the position that we support, but there are a number of issues that I think we need to deal with in the context of this bill.

I appreciate that the minister may not necessarily agree that this is the appropriate forum for dealing with some of those issues, but the fact that so many stakeholder groups feel like this is the only forum available to them is certainly something that concerns us on this side of the chamber. I have spoken about the ad hoc nature of the consultation process with respect to government bills, and it is exceedingly frustrating and extremely inefficient that we continually have to chase up submissions on bills. However, I do thank the minister and his office for making that process slightly easier on this occasion and would hope that the government continues to follow in his footsteps in terms of making that a much more streamlined and efficient process.

At the end of the day, this means that we come to this place prepared for debates and we do not have to go begging stakeholders for copies of their submissions or looking for them here, there and everywhere to put them together. It would be extremely efficient if we were able to get them from the minister responsible for whichever portfolio we may be dealing with. Again, I acknowledge the minister's assistance in this. With those words, I indicate SA-Best's support for the second reading of the bill.

The Hon. J.A. DARLEY (17:10): I rise to speak on the Health Care (Governance) Amendment Bill. The bill makes a number of changes to the act, in line with the government's commitment to reform South Australia's health system. Among other things, the bill outlines the role of the chief executive. I understand the chief executive and local health network boards will enter into service agreements, and the chief executive will be responsible for ensuring that the obligations under the agreement are met.

I, like many others in this place, received a joint statement signed by a number of authorities, including SACOSS, SANDAS, the AMA, Health Consumers Alliance and the Aboriginal Health Council of SA. This joint statement outlined a number of shared concerns. One of the concerns that was outlined was the issue of a silo mentality that may arise if local health networks are operating completely independently of each other. What provisions are there to ensure that, if you attend The Queen Elizabeth Hospital's emergency department, the experience you have will be much the same as if you attended the Royal Adelaide Hospital?

I organised a briefing with the minister a few weeks ago to address these issues and was assured that it was the role of the chief executive to ensure that the health system as a whole worked cohesively, notwithstanding the autonomy of the local health networks. That is to say that, even though the local health networks are responsible for what happens in their areas, the chief executive will have oversight of the system as a whole and will address issues with local boards that are not meeting the performance standards as outlined in their service agreements.

There was also great concern that the Health Performance Council would be abolished and a commission on excellence and innovation in health would be established. Whilst the government has not said that the commission will directly replace the Health Performance Council, the commission will take on many roles that are currently undertaken by the council.

Part of this concern was that the bill lacks the provision of independent oversight of the health system. Understandably, many people are sceptical of a Caesar under Caesar approach, whereby an internal body is charged with oversight. Again, I have raised this with the minister and I understand that the commission will have statewide clinical networks that will help drive policy and direction for the health system.

For example, I understand there will be a cardiac clinical network that will comprise clinicians and practitioners, as well as consumers, who will be charged with looking at cardiac-related health services. If a particular problem is identified, the clinical network will be able to investigate further and provide recommendations. These investigations can be self-instigated or come by direction.

In essence, the minister advised that there will still be oversight available through these statewide clinical networks under a commission on excellence and innovation in health. I would be grateful if the minister could confirm my understanding of these networks and add any additional details on how they will operate in order to ensure that there is transparency and independent oversight on the health system.

Whilst I have been largely satisfied with the responses the minister has given to me regarding the concerns raised in the joint statement, I understand there are a number of amendments that have been filed that will address some of the matters. Given they were only filed today, I have not yet had time to consider them but, on looking at them briefly, I believe there may be some merit to them. Whether we need to legislate for everything that the amendments address is a matter that needs further consideration. I support the second reading of the bill.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (17:14): I would like to thank the honourable members who participated in the second reading of this bill: the Hon. Kyam Maher, the Hon. Tammy Franks, the Hon. Dennis Hood, the Hon. Connie Bonaros and the Hon. John Darley. The Marshall Liberal government went to the 2018 state election with the strong and clear commitment to establish governing boards for local health networks in South Australia. Boards will put responsibility and accountability for our networks at the local level and ensure that clinicians and communities are engaged in decisions about their local health services.

Last year, parliament passed the first tranche of amendments to the Health Care Act 2008 to establish the governing boards. Appointments have been made with a view to the boards coming into full operation on 1 July 2019. As the Hon. Connie Bonaros rightly said, the boards have been operating on a transitional basis for some time. My understanding is that the Central Adelaide Local Health Network started meeting in late 2018, if not early 2019, and other boards have started meeting progressively since then.

The second tranche of amendments to the act was foreshadowed at the time of the first bill. It was necessary to do more work on developing the new governance and accountability framework for the public health system. Since the passage of the first bill, work has continued on the governance and accountability framework for the public health system and the role of the department and the governing boards. Stakeholders have been engaged at differing times on specific matters. A key goal is to ensure that there are key roles for each entity and that functions are neither duplicated nor omitted. In particular, it is important to delineate the role of the minister, the role of the chief executive, the role of the governing boards and the role of the local health networks.

Let us look at each element in turn. Firstly, the minister, under the new governance accountability framework, will continue to be responsible for ensuring the public health system meets the requirements of the South Australian community. The act outlines three aspects of the role of the minister. The first is to support the provision of a system of health services that is comprehensive, coordinated and readily accessible to the public; the second is to ensure that health services that are established, maintained or operated by the government are operated in an efficient and economical manner; and the third is to ensure the proper allocation of resources across health services.

The second element of the governance structure is the chief executive of the department. From 1 July 2019, the role of the Chief Executive of the Department for Health and Wellbeing will change from having direct responsibility for the administration of the local health networks to being that of a system manager. The chief executive as a system manager will be responsible for the overall management of the public health system. The chief executive's role will be not to usurp local health network management but, rather, to maintain oversight of the whole system.

He or she will be responsible for setting system-wide strategies and policies and to ensure that system enablers are in place, such as workforce, capital infrastructure, funding and technology. The role of the system manager is not a new concept; it is outlined in the National Health Reform Agreement. It has been adopted in all other Australian states where boards oversee the roles of their hospitals, consistent with the National Health Reform Agreement.

The third element of the governance model is the governing boards of the local health networks. From 1 July 2019, the governing boards will be responsible for the government and management of the local health networks. The governing boards will be responsible to the minister for the oversight of the delivery of health services in accordance with the service agreement negotiated between the local health network and the Department for Health and Wellbeing.

A form of service agreements have been in place in South Australia for a number of years through administrative arrangements. As required under the National Health Reform Agreement, these service agreements have been published on the department's website. However, as the governing boards will be required to report annually against the performance measures outlined in the service agreement, the bill formalises these agreements and their content. This, again, brings South Australia in line with other jurisdictions that have health service governing boards.

The issue has been raised about what would happen if a local health network does not sign a service agreement. The service agreements will outline a dispute resolution process. It is anticipated that the service agreements will require negotiation firstly between the deputy chief executive of the department and the local health network chief executive officer; failing this, a determination will be made by the chief executive of the department. The bill also include provisions that in cases where the department and the local health network are unable to agree, the minister will make the final decision. Again, this provision is similar to legislation in other jurisdictions.

As system manager, the Department for Health and Wellbeing will monitor the performance of local health networks and take remedial action when performance does not meet the expected standard. This remedial action would involve an escalation process once an issue has been identified. The department will firstly work with the governing board and the local health network on measures to improve performance. Should the issue continue, the legislation gives the minister the opportunity to appoint an advisor to the board to assist the board in meeting its performance measures or, where there is sustained performance failure, the minister may remove the board and appoint an administrator.

One feature of the bill on which feedback was received during the consultation process was the government's decision to dissolve the Health Performance Council. In particular, feedback was focused on the need for data in the health system to monitor system performance and support clinical care. The Marshall Liberal government reforms significantly strengthen performance monitoring data and analysis. In this context, the government considers that the functions of the Health Performance Council will be better discharged by other entities in the future.

The history of the Health Performance Council demonstrates the consistency of the government's position. In 2008 Labor introduced the Health Care Act 2008, which abolished boards and centralised decision-making about health services within the department. The Health Performance Council was established under the Health Care Act 2008 at that time and in the context of the abolition of boards.

The role of the council, in the absence of boards, was to provide advice to the minister on the operation of the health system and health outcomes for South Australians. The council was to be an independent voice to the minister on the management of and decision-making about the health system, which was now the responsibility of the department. It was done to compensate for the loss of boards.

With this government introducing boards and decentralising governance arrangements there will be increased scrutiny and monitoring of health system performance, with the governing boards being accountable to the minister and subject to performance monitoring by the department through service agreements. Governing boards will also be required to develop and publish both clinician and consumer and community engagement strategies to ensure that clinicians and consumers are involved in the planning of health services.

In 2008, under Labor, the central department became responsible for the operation of the whole health system. In this government's reforms, the local boards will now be responsible for the provision of health services at arm's length from and accountable to the department and the minister. This removes the conflict that Labor set within the department and allows the department to give strategic advice and guidance without the conflict of simultaneously being responsible for service delivery.

The opposition's position on the abolition of the Health Performance Council is hypocritical. Labor twice tried to abolish the council with two bills, one in 2014 and one in 2015. At the same time Labor dismantled the Clinical Senate and the statewide clinical networks as part of its disastrous Transforming Health experiment. The loss of these two bodies undermines the ability of consumers and clinicians to provide input into decisions about the health system.

This government is not only establishing boards, we have also moved to re-establish statewide clinical networks. The networks will help ensure that clinicians, consumers and other stakeholders are able to provide input on the needs of the community, delivering the highest standards of safe and quality care and being economically viable for the future.

The statewide clinical networks, bringing together stakeholders from right across the health system, will provide independent insights into the delivery of health services. The first three statewide clinical networks are currently being established. They are focused on cardiology, palliative care and urgent care.

The government is also strengthening performance monitoring and accountability through the establishment of both wellbeing SA and the commission on excellence and innovation in health. These bodies will absorb many of the functions of the Health Performance Council and will provide broad alternative views within the health system.

The establishment of wellbeing SA will see the return of health promotion and prevention strategies designed to keep people out of hospital. Wellbeing SA provides the opportunity for chronic diseases, such as diabetes and asthma, to be managed through effective management practices and to tackle risk factors that are known to have an impact on health, such as tobacco, alcohol and drug abuse, obesity, physical inactivity and high blood pressure.

Wellbeing SA will be evidence driven and strategic. Performance monitoring and data will be key to its work. The department's planning sees the following elements as key to wellbeing SA: epidemiology, health economics, data collection and monitoring, analysis and evaluation, evidence translation and priority setting.

The commission on excellence and innovation in health will be based on similar entities in New South Wales and Victoria and will bring together expertise from clinicians (both from the public and private sectors), consumers, health partners and other relevant stakeholders to work together to maximise health outcomes for South Australians.

The Health Performance Council was also seen as a mechanism to independently report on the performance of the health system. Since 2008, there has been an increased focus on transparency and health system performance and monitoring. Under the National Health Reform Agreement, all states and territories are committed to the reporting of data to the Australian Commission on Safety and Quality in Health Care and the Australian Institute for Health and Welfare. These bodies report nationally comparable information about hospital performance and health services across individual hospitals and jurisdictions.

In addition, the Department for Health and Wellbeing has published patient safety reports and hospital dashboards to provide easy access to current data and information about how the state's public health system is performing in a range of areas. These performance and accountability measures, along with the focus on outcomes by wellbeing SA and the commission on excellence and innovation in health, duplicate the current role of the Health Performance Council.

There have also been comments about the lack of data available for the Health Performance Council to perform its role in providing advice on the health system. This has been a long-running issue and I understand that a particular issue has been the ability to obtain data from the private health sector.

Many of the barriers to accessing data are slowly being broken down. For example, Medicare and pharmaceutical benefits data from the commonwealth government have recently become available to jurisdictions for planning purposes. I hope that that the inclusion of clinicians from the private sector into the commission on excellence and innovation in health and into the statewide clinical networks will continue to break down barriers and result in better access to data from the private sector.

However, I would make the point that, in spite of 10 years of work by the Health Performance Council on these and other issues, the issues remain. I want to make clear that the government does not intend that the Health Performance Council will be abolished until both wellbeing SA and the commission have been established. The members of the Health Performance Council will serve their full terms through to August 2020.

I know there have been two other issues raised by stakeholders of the bill. The first is about the disclosure requirements for the boards. In the first tranche of amendments there was considerable debate about the disclosure requirements. The end result was that disclosure requirements were placed in the bill that were higher than those in any other Australian state with health boards and higher than those in any other state government board.

The government seeks to finetune these arrangements. We propose that the act continue to set the high-water mark for provisions for health boards nationally and for state government boards. The proposed change is supported by both the Australian Institute of Company Directors and the Commissioner for Public Sector Employment, both of which have indicated that the disclosure requirements as currently legislated go too far and could have the effect of deterring members from raising a conflict of interest.

While I will speak to this in more detail during the committee stage, the government is proposing that all disclosures will still be recorded in a register available to be inspected by the public but not to be recorded in the minutes of the meeting. Board members will still be required to disclose a conflict of interest at a board meeting and must not be present or vote on the matter at the meeting. Failure to disclose a conflict of interest will attract a maximum penalty of $25,000, a higher penalty than any other South Australian government board and the highest penalty of any other health board in other states.

I would also like to address the issue of the level of consultation on the bill. As outlined earlier, stakeholders were engaged at differing times on specific matters with the bill. For example, discussions on the employing authority commenced with employee representative organisations in late 2018. Discussions on the role of the chief executive and the service agreement requirements have been ongoing with board chairpersons since their appointments.

The bill was released for public consultation—I think it would be fairer to call that targeted consultation—on 8 April 2019 and briefings were held with stakeholders between 9 and 16 April 2019. Stakeholders were provided until 30 April 2019 to make comments on the bill. Two stakeholders were provided additional time beyond 30 April 2019 to submit their feedback. The bill was introduced to the parliament on 2 May to allow the parliamentary process to be accommodated, with a view to having the legislation passed by 1 July 2019.

I would put it to the council that the fact that the bill was made available in full almost a month before it was tabled in the parliament and the fact that it has been in the public domain for another month before we resumed consideration today demonstrates that there has been ample opportunity for consultation and engagement. It is not unusual for bills to be introduced to the parliament while consultation is still underway, or the bill itself can be the basis of consultation.

The outcomes of consultation can be dealt with through government amendments, and the government's openness to amendment was demonstrated in the first round of legislation. To say that there was little consultation on this bill is just not true. I would like to thank officers from the department and from parliamentary counsel who assisted me in bringing this legislation before the chamber.

In conclusion, I would like to remind the council of some history. In 2002, Labor claimed that they would reform the health system. The key reason they gave for the reform was to have stakeholders, consumers and the community involved in working collaboratively towards improved health status. In their Generational Health Review, it was reported that communities were disempowered in health matters and there was a need to substantially involve clinicians in the work of the department.

The review recommended the establishment of six country regions and three metropolitan regions. These regions would continue to have boards but with strengthened mechanisms for input from community members and consumers. That model seems remarkably similar to the model that is before the council tonight.

The Generational Health Review also recommended a clinical senate to provide direct advice to the department on a broad range of issues such as health workforce requirements, the research and training needs of the health system, professional development requirements, safety and quality issues and the appropriate use of technology. A number of networks are established under the senate to provide advice to the senate on particular matters such as older people, cancer and cardiology.

I put it to the council that a number of those elements are part of the government's proposed commission on excellence and innovation in health and the statewide clinical networks. The then minister for health at the time of the establishment of the Senate in 2004 stated in a media release, and I quote:

We believe the most effective way to bring about changes to improve the coordination and outcomes of our health system is to involve clinicians, and for those clinicians themselves to lead the process and be advocates for improvement.

That did not happen in the past, and it is an important step forward for improving the health system in South Australia.

Given the 14 years that followed that statement under Labor, it is galling. Labor backed away from reform and, at the same time that the rest of the country was establishing boards under a Labor federal government, here the state Labor government moved to monolithic centralised control. The health system was severely damaged by the centralisation of health under Labor and its arrogant disregard for clinicians and the community.

We saw this arrogance in the design of the new Royal Adelaide Hospital. We saw this arrogance in EPAS. We saw this arrogance in Transforming Health. This government has a mandate for a very different path. Labor should put its arrogance aside and let the government reconnect the health system with the community and the health systems that serve them.

I might pause and, at the risk of being deemed out of order, respond to some comments made by the Hon. Connie Bonaros in relation to the Ambulance Service. The Ambulance Employees Association has made comments about excessive overtime in the Ambulance Service. I am advised that the South Australian Ambulance Service has spent $14.6 million during the last calendar year on overtime for front-line staff working under the paramedic award.

While SAAS is exploring a range of options with the employee representative body to reduce its reliance on overtime, including reviewing roster patterns, this figure comprises a range of scenarios. Ten per cent of the overtime can be attributed to end-of-shift overtime, when a crew is being held on a complex job supporting patients. A significant portion of the overtime is attributable to resourcing our often vulnerable country areas, and strategies are underway to mitigate this. I make the point that our country services are volunteer services, so it is not a matter of employing people to avoid that overtime. I am advised that overtime is reducing month by month, as strategies to better configure rosters come into effect.

I can assure the honourable member, the Ambulance Employees Association and our hardworking paramedics that the government is committed to continuing to work with the Ambulance Service to make sure that overtime is managed at an appropriate level so that the occupational health and safety of our Ambulance Service is maintained.

Bill read a second time.

Committee Stage

In committee.

Clause 1.

The Hon. K.J. MAHER: I want to confirm something the minister made reference to in his second reading summary. In terms of the dates in relation to feedback, is it correct that the bill was introduced to parliament one day after the formal date for stakeholder feedback was closed?

The Hon. S.G. WADE: As I said in my second reading summing-up, I think a couple of stakeholders asked for additional time and that was provided. It was always the intention of the government that, as the need arose and as consultation feedback was analysed, amendments would be filed to address any issues that we saw had merit.

The Hon. K.J. MAHER: To confirm then: the minister finalised this bill, had it approved by cabinet and presumably his party room and put it into parliament for the parliament's consideration before he or his department had actually considered any of the stakeholder feedback?

The Hon. S.G. WADE: I do not know what the honourable member thinks cabinets do with draft bills for consultation—

The Hon. K.J. Maher: They consider what stakeholders say about things, in my experience. They do not just ignore it.

The CHAIR: Let the minister answer. We are in committee. It is free ranging. You can raise your points in a second. Minister.

The Hon. S.G. WADE: The date today is 4 June. The bills were distributed to stakeholders on 8 April, which is two months ago. There has been plenty of time for people to review the legislation and express their views. This is only one house in a two-house parliament. There is opportunity for amendments here. The government has put forward amendments. The opposition and crossbenchers have put forward amendments.

In the context of the imminence of the full introduction of the boards from 1 July, it was the government's judgement that it was appropriate—so that the parliament would have due time to consider this bill before it is enacted so that it can take effect before 1 July—that the bill be tabled and amendments be placed as the bill progressed.

The Hon. K.J. MAHER: Does the minister consider he breached any undertakings he gave when this council considered the first bill on this government's reform in terms of consultation and properly listening to consultation with this second reform?

The Hon. S.G. WADE: If the honourable member has a particular statement in mind then let him draw my attention to it.

The Hon. K.J. MAHER: A final question on this topic: does the minister envisage it will be his habit to introduce legislation before the government has even considered stakeholder feedback when he tries to make reforms?

The Hon. S.G. WADE: The two tranches of the bills, I believe, demonstrate a very respectful engagement with not only the community but also parliamentarians. I do not recall the number, but I suspect there were four progress updates where I made available to crossbenchers and members of the opposition updates on where we were on the consultation on the health governance.

The community, including the stakeholders who have engaged in this round of consultation, was made aware of the architecture of this governance framework since the bill passed last year. The key element of the second bill is the performance and accountability framework.

As I said in my second reading summing-up, there was consultation with external stakeholders last year and this year. There has been very extensive consultation with employees of the department, particularly in relation to employees in the country regions because these reforms will have the most significant impact on country staff.

The second tranche is, if you like, putting in some finer detail on a framework that was put in place and passed by this parliament last year. We believe that the development of the bill, which was based on significant input from a range of stakeholders, particularly employees and their representatives, was given adequate time and that, considering the time remaining, there was a balance to be struck.

In my view, the tabling of legislation after full consultation would have meant that we would basically miss the opportunity to have the framework in place by 1 July. The opposition would have criticised us for that. This is the nature of the opposition under the member for Croydon. It is basically negative. We saw that with the mining bill and we see that with this bill. This opposition—

The Hon. K.J. Maher: We are supporting you. We will pass this bill; the opposite of negative.

The Hon. S.G. WADE: —plays politics. It is completely politics.

The CHAIR: Leader of the Opposition, given the committee is free ranging, given that you can make any statements you want, let the minister answer the question and then you can get up and say exactly the same thing as you are saying seated.

The Hon. S.G. WADE: In terms of the consultation that we have undertaken on the first tranche, the second tranche and the policies and procedures that sit around them in terms of the department, I am more than satisfied that we have done a very good job at engaging the stakeholders in what has been a limited time frame. Certainly, some of the interstate experts who advised us saw it as a courageous time frame, but let us be clear: this state is in dire need of reform. Board governance is central to getting the state back on track in relation to health services following the disastrous Transforming Health experiment. We were not going to wait another year while Labor continued to play political games.

The Hon. K.J. MAHER: I thank the minister for his response and I think his probably ill-advised use of the word 'courageous', which we know from Yes Minister is another way to say 'foolish and outlandish' behaviour from executive government. But I thank the minister for confirming that he intends to treat external stakeholders with the disrespect that he has shown in this process. Can I ask him now: what will happen in the event of a dispute between the chief executive of SA Health and the boards over funding priorities?

The Hon. S.G. WADE: I addressed that issue in my second reading summing-up. I am happy to reiterate those remarks if the honourable member was not listening.

The Hon. K.J. MAHER: It is very specifically on financial funding priorities in particular.

The Hon. S.G. WADE: Service agreements include funding priorities.

The Hon. K.J. MAHER: I would appreciate it if the minister would place on record the dispute mechanism specifically for funding priorities?

The Hon. S.G. WADE: I thank the honourable member for confirming that he was not listening to the second reading summing-up, and I will give him the benefit of hearing it all again.

The Hon. T.A. FRANKS: Point of order: in terms of procedure, where people expect us to go from a second reading summary responding to our questions and then to know exactly what was said several minutes later without the benefit of a written copy, it would be good parliamentary process to give us written copies of what is going to be said if we are going to move straight into clause 1.

The CHAIR: Thank you, the Hon. Ms Franks. Minister, if you could take that on board, that we have gone into committee.

The Hon. T.A. Franks: We do not know everything you said. If we had a copy, which sometimes we do and sometimes we do not, we would not be quibbling over this.

The CHAIR: The minister is going to re-read or do whatever he is going to do.

Members interjecting:

The Hon. S.G. WADE: Going back to the comments by the Hon. Connie Bonaros, I am very interested in improving the way that we engage within the parliament, but how can I provide you with written comment? The Hon. Connie Bonaros raised issues in relation to the Ambulance Service which I had no notice of. All I ask is that if people want to be part of the debate they actually listen to it. From 1 July 2019, the governing boards took responsibility for governance and management of the local health networks.

The governing boards are responsible to the minister for the oversight of the delivery of health services in accordance with the service agreement negotiated between the local health network and the Department for Health and Wellbeing. As required under the Health Reform Agreement, these service agreements will be published.

In terms of what happens if a dispute arises in relation to a service agreement, it is anticipated that the service agreements will require negotiation firstly between the deputy chief executive of the department and the local health network chief executive officer and, failing this, a determination will be made by the chief executive of the department. The bill also includes provision that in cases where the department and the local health network are unable to agree the minister will make the final decision. Again, this provision is similar to legislation in other jurisdictions.

As system manager, the Department for Health and Wellbeing will monitor the performance of a local health network and take remedial action when performance does not meet the expected standard, and this remedial action will involve an escalation. Once an issue has been identified, the department will firstly work with the governing board and the local health network on measures to improve performance.

Should the issue continue, the legislation gives the minister the opportunity to appoint an advisor to the board to assist the board in meeting its performance measures or, where this is sustained performance failure, the minister may remove the board and appoint an administrator.

The Hon. K.J. MAHER: I thank the minister for his answer. What other powers does the minister or the chief executive have to override decisions of boards?

The Hon. S.G. WADE: I am not sure what the honourable member is implying there.

The Hon. K.J. MAHER: You just said—

The Hon. S.G. WADE: Sorry, if I was—

The Hon. K.J. MAHER: You just said—

The CHAIR: Leader of the Opposition, let the minister answer. You are pre-empting the answer. Let the minister answer.

The Hon. K.J. Maher: He seems to have difficulty understanding the basic things today.

The CHAIR: You can ask as many questions in committee as you like, Leader of the Opposition. Let the minister answer.

The Hon. S.G. WADE: The honourable member's question, as I understand it, was about disputes in relation to funding. His follow-up question asked me in what other context could the government or the minister override the decision of the board? With all due respect, it is not a decision of the board as to how much funding goes to the board. The board is charged under the act with the responsibility of appointing the CEO, managing their budget and delivering health services within their region.

The Hon. K.J. MAHER: Either the minister is deliberately choosing to misunderstand the question or he is seriously misguided about what he thinks has been asked. I said 'other areas', so not just funding but in what other areas would the minister have ultimate responsibility? When could the minister override a decision of the board? We have talked about a decision of the board and, if it was a dispute between SA Health and the board, eventually the minister could have the ability to override the board in funding areas. In what other decisions could the minister override the board?

The Hon. S.G. WADE: The provisions in the act are general in terms of directions and that is not dissimilar to other LHN board governance models around Australia. If you like, much of the reality of how the system works is the spirit that both the minister and the department bring to the model. In that context, I would like to read from a memorandum issued by the chief executive of the department, which says:

The Minister for Health and Wellbeing has considered the question of what level of autonomy should be afforded to the South Australian local health network boards. His advice is as follows:

The goal is to maximise board authority. This authority is to be exercised in the context of government policies and priorities. Government policies and priorities may be expressed in terms of service level agreements, as set out and amended from time to time. The minister expects a high level of engagement, both formal and informal, with board chairs, to be kept abreast of major decisions and emerging issues. It would be fair to say that the higher the level of engagement and cooperation, the more likely there will be high levels of autonomy, that is, earned autonomy.

The powers of the minister and the department, in terms of direction, are broad, but both the powers of the minister and the powers of the department will be exercised with the overarching principle that the goal is to maximise board authority. The former Labor government persistently centralised power; we are decentralising power, with a determination to maximise local control.

The Hon. K.J. MAHER: This might be more helpful for the minister: in what area of operation of the board or a local health network can the minister not intervene?

The Hon. S.G. WADE: I can only reiterate what I have already said, namely, that the powers of direction of both the minister and the department are written broadly, but just as they are in other jurisdictions, just as other jurisdictions have respected the autonomy of the board, there is no point decentralising if you are not going to let them exercise their power. It will be the determination of this government that we implement board governance in a way that maximises devolution.

The Hon. K.J. MAHER: I thank the minister for not even coming close to answering the actual question. So that the minister understands clearly: can the minister name one single area of operation of a board or a local health network in which the minister could not override a decision?

The Hon. S.G. WADE: I have already answered that question.

The Hon. K.J. MAHER: So the minister cannot point to a single area in which he could not override a decision? Will we see the minister take responsibility for decisions of the board, or will the minister say that they are autonomous board decisions and that he has no control over it, or does the minister now concede that he cannot identify a single area in which he can override so that he has the ultimate responsibility?

The Hon. R.P. Wortley interjecting:

The CHAIR: The Hon. Mr Wortley, please, you are not assisting me.

The Hon. S.G. WADE: A key principle of devolution is the devolution of accountability. Devolution of accountability by definition means that those who make the decisions own the decisions. I expect boards to consult with their community and their clinicians and to own the decisions they make.

The Hon. K.J. MAHER: Who has the ultimate responsibility for the provision of health services to South Australians?

The Hon. S.G. WADE: Again, it would have helped the progress of this committee stage consideration if the honourable member had listened to the second reading summing-up. In that, I highlighted the specific roles detailed in the legislation of the minister, the department and the local health networks. Each has their own area of responsibility. As I confirmed in my second reading summing-up, the minister, of course, has primary responsibility for the delivery of health services in South Australia.

Consistent with the policies of the Liberal Party of Australia (South Australian Division) taken to the March 2018 election and consistent with a clear mandate given to that party at that election, we are putting in place, with the support of this parliament, devolution of health board governance, which will fundamentally shift power back to clinicians and the community. The fact that the Labor Party, in the first tranche of the bill and here again tonight, is trenchantly wanting to oppose that mandate that this government has is to their shame.

The Hon. K.J. MAHER: Can I ask the minister what section of the bill allows the minister to intervene in disputes and what section of the bill allows the minister to override decisions of boards?

The Hon. R.P. Wortley interjecting:

The CHAIR: Order! It is not even humorous. That is not funny, the Hon. Mr Wortley; it is 6 o'clock.

The Hon. S.G. WADE: Given the hour of the day and the fact that the honourable member is asking a question, I propose to take that on notice and move that we report progress.

Progress reported; committee to sit again.