Lymphoedema Services

Adjourned debate on motion of Hon. C. Bonaros:

That this council—

1. Acknowledges that this year's state budget failed to make provision for a garment subsidy scheme and dedicated treatment services for lymphoedema sufferers within SA Health;

2. Notes that South Australia continues to be the only jurisdiction without a garment subsidy scheme;

3. Recognises that lymphoedema sufferers in South Australia are disadvantaged compared with sufferers in other jurisdictions; and

4. Calls on the state government to implement a garment subsidy scheme and provide dedicated treatment services for all lymphoedema sufferers as a matter of urgency.

(Continued from 25 September 2019.)

The Hon. M.C. PARNELL (21:23): I rise today on behalf of the Greens to support this motion, and I thank the Hon. Connie Bonaros for bringing it to us. Lymphoedema is a chronic condition where excess fluid causes disfiguring swelling in one or more parts of the body. Lymphoedema is a progressive condition that is restrictive, painful and debilitating, and it requires ongoing treatment. It can also have severe impacts on a person's psychological, social and financial wellbeing. Lymphoedema can affect men, women and children and has a number of causes. What honourable members may not be aware of is that the onset of lymphoedema can occur within months of damage to the lymphatic system, but it can also occur years afterwards.

The Hon. Connie Bonaros has previously shared with us in this place the impact that lymphoedema has had on the lives of Monique, Lachlan and Alison. I want to share one more story today, and that is the story of a constituent of mine, June. June developed lymphoedema, following breast surgery in 2000. She recognised the symptoms and subsequently had laser treatment and lymphatic massage for five years. Because she had it in a mild form, her treatment eventually resulted in the loss of swelling.

June is one of the lucky ones; however, she is only too aware that her lymphoedema could return and as such she follows a regiment of care, including exercise, self-massage and she wears compression sleeves and gloves when travelling distances, particularly when flying. June takes other precautionary measures such as wearing protective gloves for activities such as gardening. She is careful not to scratch or cut herself or be bitten by insects. Any infection or injury to her hands or arms could cause the lymphoedema to return. As June's lymphoedema physiotherapist said to her, 'You will do this forever.'

According to the Australasian Lymphoma Association, and as the motion notes, 'South Australia continues to be the only jurisdiction without a garment subsidy scheme.' This must change. The garments, which help control swelling, are tailor made and may need to be replaced as often as every three months. This amounts to a significant financial outlay, which not everyone can afford. I was provided with a letter yesterday from the Minister for Health, which I understand will be tabled, read or referred to later, and in it the minister says that his department:

…through Wellbeing SA, is currently in the process of establishing a South Australian garment scheme for people who have lymphoedema.

This is very good news. The wheels are finally in motion to remove the disadvantages that South Australians living with lymphoedema are facing. The minister's letter goes on:

An advisory group has been convened involving health professionals from research and clinical practice, and individuals who can provide insight and lived experience from organisations such as the Lymphoedema Support Group of South Australia and the Australasian Lymphology Association.

But wait—there is more good news. A second letter has now been provided to me from the office of the federal Minister for Health, which says:

The Australian government will be providing $10 million over five years to assist with subsidies for the provision of compression garments to eligible Australians with lymphoedema.

The letter notes that this sum is intended to complement and extend the existing compression garment schemes in states and territories, rather than replace them. I commend the minister in this place for his actions, as well as the actions of his federal counterpart in Canberra and I look forward to the day when South Australians living with lymphoedema can access a compression garment scheme; however, a dedicated treatment program must follow.

Earlier this year, during Lymphoedema Awareness Month, many of us in this place wore blue ribbons to show our support for those living with this debilitating condition. I have dug mine out for the occasion and am wearing it proudly today. I think it is time in this motion to show our support once more. With these words, the Greens are very happy to support the motion.

The Hon. R.P. WORTLEY (21:27): The opposition is wholeheartedly in support of this motion. Lymphoedema is a condition involving swelling of parts of the body—

The Hon. S.G. Wade: Sixteen years. No scheme in 16 years.

The Hon. R.P. WORTLEY: Mr Acting President, I think it is very rude for a minister to be calling across the room while I am talking on such a very important motion. I need your protection.

The ACTING PRESIDENT (Hon. D.G.E. Hood): You have my protection, the Hon. Mr Wortley, but standing orders indicate that you should not respond to interjections, so please continue.

The Hon. R.P. WORTLEY: Lymphoedema is a condition involving swelling of parts of the body due to problems with the lymphatic system, often affecting cancer survivors. Compression garments enable sufferers to manage the swelling and to go about their day less impeded by their condition. Unfortunately, these compression garments require replacement every six months and represent a significant financial burden on lymphoedema sufferers.

South Australia is the only state yet to introduce subsidies or dedicated public treatment services for people living with lymphoedema. There are very limited public lymphoedema services available in South Australia and no services that are funded specifically for lymphoedema. Lymphoedema advocates have been calling on the establishment of a garment subsidy for years. That is why, back in August 2017, the then Labor government committed to commencing a business case for a lymphoedema garment subsidy.

Earlier this year, Labor joined with Lymphoedema Support Group of SA president and patient, Monique Bareham, to publicly raise concerns regarding the lack of a garment subsidy. Still the government failed to commit to funding to establish the subsidy. Last month, an SA Health lymphoedema compression garment subsidy scheme advisory group met for the first time, only going so far as to discuss the terms of reference for considering a subsidy. No funding.

It has now been almost 2½ years since Labor committed to the business case to establish a garment subsidy scheme and still there is no subsidy. Instead, all we are seeing from this government are delaying tactics to avoid facing up to providing proper funding for a subsidy.

This is a pattern with this Liberal government, where they lack any compassion; they have been cruel. This is only one instance where people are being denied the opportunity just to exist with a very basic life because of no funding or lack of funding in many cases. We call upon the government to start acting to immediately outline the proper commitments and to secure concrete funding to assist lymphoedema sufferers in this state.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (21:30): I thank the Hon. Connie Bonaros for moving this motion. It gives the government the opportunity to provide an update, which I propose to do, both through an amendment and through this speech. The Marshall Liberal government acknowledges the people who are living with lymphoedema and the challenges they face with this chronic condition.

We also recognise the clinicians and the wide variety of skilled health professionals who provide expert care and treatment across our health system. The Marshall Liberal government is committed to meeting its election commitments, and has met its commitment to develop a business case for a compression garment subsidy scheme and designated public lymphoedema services. The former Labor government failed to deliver a business case. It failed to deliver a scheme in spite of 16 years of management of the health system.

I appreciate the meeting I had with the Lymphoedema Support Group of South Australia, facilitated by the mover of this motion, on 10 May this year. It helped me to better understand the specific needs of South Australians living with lymphoedema and the deleterious impact the lack of a compression garment scheme in this state has had on their lives.

In particular, I acknowledge the ongoing advocacy of the Lymphoedema Support Group of South Australia, the Australasian Lymphology Association and the Lymphoedema Action Alliance, who have been asking the state to establish a subsidy scheme and increase treatment services to lymphoedema patients for a long time.

South Australia is the only state currently without a compression garment subsidy scheme, and the Marshall Liberal government is committed to rectifying this situation. Funding has been secured to provide for the establishment of the South Australian compression garment scheme this financial year. SA Health has commenced the implementation work to deliver the scheme and is meeting regularly with key stakeholders through an advisory group which has been established to support the implementation of the scheme.

The first meeting of the advisory group was held in October, and they continue to meet regularly. The advisory group includes individuals with lived experience from organisations such as the Lymphoedema Support Group of South Australia and the Australasian Lymphology Association, and others from research and clinical practice, as key partners in the establishment of the scheme, and are working with officers to inform the design and implementation of a scheme to benefit all eligible consumers.

Representatives from local health networks have also formed a working group, which is meeting fortnightly to inform the development of the scheme. To date, the working group has focused on mapping the potential patient pathway, reviewing other state and territory scheme details, informing eligibility criteria and examining training requirements and options.

The Morrison Liberal government has also announced that they will provide an estimated $8 million over four years for a subsidy scheme for specialised compression garments for people post breast cancer living with lymphoedema. The Marshall Liberal government, through SA Health, is working closely with the Morrison Liberal government to ensure we are able to maximise the benefit to people with lymphoedema. There are a number of points of interface with the commonwealth government, including the Department of Health, the National Disability Insurance Scheme and the Department of Veterans' Affairs.

The health system is complex, and ensuring we work together to deliver the best possible outcomes for our communities is critical. The treatment and care decisions are indeed matters for our clinical experts, and it is important to recognise the need for a holistic multidisciplinary approach to care and treatment. By establishing a compression garment subsidy scheme, we will be able to address a longstanding gap in the provision of this equipment for South Australians. This is one step along the way to improving the care and treatment of people with lymphoedema, but it is an important step and one the Marshall Liberal government is proud to be able to deliver. I have an amendment to the motion to update it for the progress made since the motion was moved, and accordingly I move to amend the motion as follows:

Paragraph 1—Leave out all words after 'that' and insert:

the Marshall Liberal Government has met its 2018 election commitment to progress development of a business case for a compression garment subsidy and designated public lymphoedema services;

Paragraph 2—Leave out paragraph 2 and insert new paragraph 2 as follows:

2. Acknowledges that the Marshall Liberal Government is implementing a South Australian Compression Garment Scheme;

Paragraph 3—Leave out paragraph 3 and insert new paragraph 3 as follows:

3. Notes that an advisory group has been convened involving health professionals from research and clinical practice, and individuals who can provide insight and lived experience from organisations such as the Lymphoedema Support Group of South Australia and the Australasian Lymphology Association; and

Paragraph 4—Leave out paragraph 4 and insert new paragraph 4 as follows:

4. Acknowledges the announcement made by the Morrison Liberal Government in May 2019, to provide an estimated $8 million over four years for a subsidy scheme for specialised compression garments for people post breast cancer living with lymphoedema.

I understand the mover of the motion will not accept the amendment. She prefers her out-of-date motion to stand. So be it. I note that SA-Best is showing yet again they are more interested in words than action. That is not the approach of this government.

The Hon. C. BONAROS (21:34): If I were more interested in words than action, then I would not bother to stand up here every time we sit and speak on these important issues. I have made it very clear that I will continue to stand up here and take the time of this chamber to speak about these issues until we get some change. On that front, I do acknowledge the work that the government has been doing on this front. I acknowledge that they are in the process of implementing a South Australian compression garment scheme. I acknowledge that stakeholders have been approached and that meetings are underway with those stakeholders. I understand there is a meeting planned for December in relation to that.

The Hon. S.G. Wade: Sounds like action to me.

The Hon. C. BONAROS: Absolutely it sounds like action, and it is about time. I also acknowledge that the former government did not take the actions that this government has taken in relation to this, so I am not dismissing the actions of the current government. But what I will say is that if the minister wanted to put up a motion which effectively replaces the motion that I did—

The Hon. S.G. Wade: Updates it.

The Hon. C. BONAROS: —I would say replaces—then he was well within his rights to do so. If I compare the amendments to my motion, my motion says that we acknowledge that the state's budget for this year has failed to make provision for a garment subsidy scheme and dedicated treatment services for lymphoedema sufferers within SA Health. That is still correct.

It notes that South Australia continues to be the only jurisdiction without a garment subsidy scheme. That is still correct. It recognises that lymphoedema sufferers in South Australia are disadvantaged compared with sufferers in other jurisdictions. That is still correct. And it calls on the state government to implement a garment subsidy scheme and provide dedicated treatment services for all lymphoedema sufferers as a matter of urgency. And that is still correct.

For those reasons, I will not be accepting the amendments that have been proposed, but I do absolutely look forward to the day when all those matters are addressed and South Australian lymphoedema sufferers are put on an equal playing field with lymphoedema sufferers across other jurisdictions. I certainly hope that that will occur as a matter of urgency.

Amendment negatived; motion carried.