Health Care (Governance) Amendment Bill

Introduction and First Reading

The Hon. S.G. WADE (Minister for Health and Wellbeing) (18:36): Obtained leave and introduced a bill for an act to amend the Health Care Act 2008 and to make related amendments to the Mental Health Act 2009. Read a first time.

Second Reading

The Hon. S.G. WADE (Minister for Health and Wellbeing) (18:37): I move:

That this bill be now read a second time.

I seek leave to insert the second reading explanation and the explanation of clauses in Hansard without my reading them.

Leave granted.

Today I rise to introduce the Health Care (Governance) Amendment Bill 2020 into Parliament. A similar Bill was introduced in the Legislative Council last year proposing amendments to support the newly decentralised public health system.

Unfortunately, while the amendment bill did pass this place with amendments it did not pass the other place before Parliament was prorogued.

I would like to thank Honourable Members for their contribution to the debate in the previous session of Parliament.

Some of the amendments that were passed in this place have been included in this new Bill, in particular:

a principle for the operation of the Act to ensure it is inclusive of primary health care networks, Aboriginal and Torres Strait Islander health services and public health services provided in local government, aged care and disability.

an additional function of the Chief Executive of the Department for Health and Wellbeing to engage with consumer representatives and other interested parties in the development of health care policy, planning and service delivery.

that service agreements specify that each health service provider must operate programs that promote the provision of health care for Aboriginal and Torres Strait Islander people.

that the functions of a Local Health Network governing board include ensuring that their Local Health Network operates programs that promote preventative and primary health care, including the preventative and primary health care of Aboriginal and Torres Strait Islander people, within local communities.

The Marshall Liberal Government took to the election a commitment to decentralise the public health system by establishing governing boards to put responsibility and accountability for our local health networks at the local level, and to ensure that clinicians and communities are engaged in making decisions about their local health services.

Parliament passed the first tranche of amendments to the Health Care Act 2008 in July 2018 delivering on our commitment to decentralise the public health system and enabling the establishment of the Local Health Network governing boards.

The governing boards have been operating since 1 July 2019 providing governance and oversight for health service delivery within their local area. At the same time the Government also established six new Local Health Networks in country South Australia to replace the Country Health SA Local Heath Network on 1 July 2019.

The Bill I introduce today supports the decentralised system and the governing boards by establishing the new governance and accountability framework for the public health system. It largely proposes the same amendments as the previous Bill to:

revise the functions of the Chief Executive of the Department for Health and Wellbeing;

include 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;

dissolve the Health Performance Council; and

make minor amendments to sections of the Act to reflect the new governance and accountability framework for the public health system or clarify their intent.

Under the new governance arrangements decision making and accountability for local health service delivery is as close to local communities and clinicians as possible, to improve patient safety and provide a greater focus on accountability and transparency across the public health system.

Since 1 July 2019, the Governing Boards have been responsible for the governance and oversight of the local health networks, with their responsibilities including:

appointing their Local Health Network's Chief Executive Officer;

ensuring the LHN delivers safe, high quality services;

establishing strong relationships with local communities and frontline health professionals, particularly through the development of clinical and community engagement strategies; and

overseeing the efficient, effective and sustainable operation of the LHN.

The Governing Boards have been getting on with the business of governing our Local Health Networks and have achieved a lot in the short time they have been operating.

Governing boards have continued with the day–to-day business of establishing their governance committees including Audit and Risk, and Clinical Governance Committees, conducting their first Annual Public Meetings, and establishing the clinical and corporate governance frameworks to support the provision of safe, quality, and continuously improving patient care in their local areas.

I wish to take this opportunity to commend our health services and the governing boards on their response to the COVID-19 pandemic. The hard work, collaborative spirit and innovation that has been evident across our health system and the support our hospitals have offered to their local communities has been the foundation of our State's success so far.

Despite the effect of the COVID-19 pandemic the governing boards are well underway in progressing strategic planning and setting the vision and direction for the delivery of health services in their local areas.

The Central Adelaide Local Health Network Governing Board has overseen the establishment of a new leadership structure, with a new Executive team in place, and an organisation-wide restructure, with delivery of care now provided through clinical programmes which have medical, nursing, allied healthcare and business leads working as an accountable leadership team. The Board is overseeing the ongoing recovery programme and leading the Central Adelaide Local Health Network through a time of significant change.

LHN Governing Boards have also done significant work to develop their Clinician Engagement and Consumer and Community Engagement Strategies despite delays due to the COVID-19 pandemic. The Women's and Children's Health Network and the Northern Adelaide Local Health Network have published their strategies and all other governing boards are anticipating finalising their strategies in the near future. The engagement strategies will provide for strengthened and extensive clinician and community involvement in health service delivery and planning.

Local Health Networks continue to build connections within their communities. The governing boards of the Regional LHNs have been engaging with their Health Advisory Councils and wider community groups, Aboriginal organisations, General Practitioners, local government councils and specialists.

Our Governing Boards are improving the efficiency with which our LHNs deliver high quality care to our community, establishing improved governance, leadership and management protocols.

We now have a system where each Governing Board is accountable for the delivery of local health services within its geographic area that are safe, high quality and accessible, reflective of local values, needs and priorities, and sustainable within the resources available. Each Governing Board is responsible for the control of the budget assigned to their local health network, and will be actively engaged with its local communities and health professionals.

The Bill reflects the significant shift in the way that the Department and the Local Health Networks are operating to deliver our health services.

The Bill reflects the changed role of the Chief Executive of the Department for Health and Wellbeing from having direct responsibility for the administration of the local health networks to a 'system leadership' role. Notwithstanding this, SA Ambulance Service is still accountable to the Chief Executive.

As the last State to return to board governance for local health services, South Australia has been fortunate to be able to learn from other jurisdictions in the establishment of our new performance and accountability framework, including gaining an understanding how devolved health systems best operate.

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.

The Bill formalises these Agreements and their content and the Governing Boards will be required to report annually against the performance measures outlined in the Service Agreement. This again brings South Australia in line with other jurisdictions that have health service boards.

Governing Boards are instrumental in driving the Service Agreement process for their Local Health Network.

Concurrent with the work that has been occurring with the governance and accountability framework for the public health system, two other Marshall Government commitments have been achieved, with the establishment of Wellbeing SA and the Commission on Excellence and Innovation in Health as attached offices to the Department for Health and Wellbeing on 6 January 2020.

As attached offices to the Department rather than being part of the Department, Wellbeing SA and the Commission have a level of independence to set their own strategic direction, while ensuring they meet the strategic objectives of the South Australian health system.

The establishment of Wellbeing SA demonstrates the Government's commitment to health promotion and prevention strategies designed to keep people out of hospital.

The creation of Wellbeing SA provides an opportunity to tackle the major contributors to the burden of disease in a coordinated and integrated way through:

promoting wellbeing and preventing or managing risk factors in well people;

early identification of people who have an illness so that it can be treated or managed better; and

ensuring people who have chronic diseases have the best care, closest to their home and community.

It is well documented that early intervention is likely to be more cost-effective and lead to better health outcomes. Wellbeing SA will assist in alleviating the pressure points in the health system through the implementation of the My Home Hospital Program. This program will provide care for public hospital patients in their own homes who would otherwise have required admission to hospital.

The State Government has also established the Commission on Excellence and Innovation in Health. The Commission is based on similar entities in New South Wales and Victoria, and is established to:

provide leadership and advice within SA Health and to the Government on clinical excellence and innovation;

to bring together expertise from public and private sector clinicians, as well as consumers, health partners and other relevant stakeholders to maximise health outcomes for patients;

to be recognised as a centre for excellence and a strong partner for clinical improvement and innovation; and

to support the provision of safer, more innovative and efficient health care through empowering clinicians and consumers.

Importantly, the Commission now administers and supports the Statewide Clinical Networks, which have been re-established, after being abolished by the previous Government. The first four Statewide Clinical Networks are focusing on cardiology, palliative care, cancer, and urgent care.

The Commission will empower clinicians and consumers to work together to help build a continuously evolving, improving and learning health system. The Commission has committed to establish a consumer partnerships program including the creation of a Consumer Advisory Committee that engages consumers, carers and the community by involving them in the planning, design, implementation and evaluation.

I would like to briefly address issues that were raised when this Bill was debated last year including the proposal to amend the Health Care Act 2008 to include the Mental Health Commission.

In September 2018, the State Government engaged an independent consultant to review the governance of mental health services across the state.

The purpose of the review was to ensure the most effective governance and safeguards are in place to deliver high quality mental health services for all South Australians.

The Government broadly accepted the recommendations from the review but in relation to the Mental Health Commission took a different approach, strengthening the Commission Three part-time Mental Health Commissioners were appointed on 19 December 2019 for terms expiring on 7 January 2023.

The Mental Health Commissioners have increased focus on engagement with consumers and carers. The previous health promotion, preventative and administrative resources of the Commission have been transferred into Wellbeing SA, which now provides secretariat support to the new Mental Health Commissioners.

There is no need to enshrine the role of the Mental Health Commissioner within the Health Care Act 2008. It is important to allow the South Australian model to continue to evolve.

The six regional Local Health Networks are supported by the newly established Rural Support Service under arrangements agreed by all of their Governing Boards. The establishment of the Rural Support Service enables highly specialised, system-wide capacities, clinical governance and access to expertise to be made available to the regional LHNs. It supports the development of country and state-wide models of care to ensure equitable access to health services across country SA.

It also delivers specialised corporate functions that ensure all regional LHNs have equitable access to skills and expertise which may not be viable if carried out by individual entities. This critical mass ensures that Regional LHNs are able to focus resources on supporting access to care for consumers.

The Rural Support Service is hosted within the Barossa Hills Fleurieu Local Health Network; but through agreed arrangements, is accountable to a Chairs Committee, comprising all six regional Governing Board Chairs, and a Management Oversight Committee, comprising all six regional Local Health Network Chief Executive Officers.

Services and customer service expectations of the six regional Local Health Networks, with respect to the Rural Support Service, are set through formalised agreements between the six Regional LHNs.

I can also confirm that over half of the Rural Support Service's approximately 220 staff are located in different rural and remote locations across regional South Australia.

Service agreements are technical funding, performance and accountability agreements negotiated between the Department and LHN. Legislating for direct consumer and community involvement in their development, as was proposed when the Bill was last debated is not appropriate.

The Government remains of the view that the establishment of LHN governing boards has diminished the need for the role of the Health Performance Council. The Council was established in 2008 when the previous government abolished local hospital boards and centralised authority and accountability for the State's public health system in the CE of the Department.

The key rationale for its establishment was to provide a level of accountability and transparency, given the centralised governance, through provision of independent advice to the Minister and Parliament on the effectiveness of the health system.

The devolved structure of the health system provides for alternative checks and balances. This includes the remit of Boards in monitoring the performance of their LHN and their accountability to the Minister for the effective performance of their duties. The Department's role of system leader through Service Agreements with the LHNs provides additional scrutiny on system performance.

This is bolstered by the significant increase in national and State reporting in hospital performance since 2008, and the adoption of National Safety and Quality Health Service Standards, including the Open Disclosure Framework. These initiatives have strengthened transparency within the health system by monitoring health system governance, and mandating open communication and support for patients who have experienced adverse events during health care.

The Department has a refined focus on the strategic direction and performance of the public health system, increasing its role in analytics, evaluation and monitoring of the effectiveness of strategies, service plans and system performance, to determine investment priorities and guide commissioning.

There is strong alignment between areas of Wellbeing SA, prevention and population health outcomes research and analytics and functions of Health Performance Council, and the Commission's remit includes providing leadership and advice on clinical best practice and innovation, with a focus on maximising health outcomes for patients and supporting clinical collaboration.

The issues raised by this Bill have been the subject of significant consultation, including through the previous Bill.

The previous Bill was released for consultation on 8 April 2019 and briefings were held with stakeholders between 9 and 16 April 2019. All stakeholders consulted were offered a face-to-face briefing prior to introduction of the Bill. Stakeholders were given until 30 April 2019 to make comments on the Bill. Two stakeholders were provided additional time beyond 30 April 2019 to submit their feedback.

Since that time, the Government, our Local Health Networks and their governing boards, SA Ambulance Service, as well as the Department and new attached offices have continued to have ongoing discussions with our many stakeholders, as part of our commitment to strengthened community, consumer and clinical engagement in the way we do business.

In closing I would like to thank officers from the Department and Parliamentary Counsel who have assisted with bringing this legislation before the chamber.

I commend the Bill to the Council.

EXPLANATION OF CLAUSES

Part 1—Preliminary

1—Short title

2—Commencement

3—Amendment provisions

These clauses are formal.

Part 2—Amendment of Health Care Act 2008

4—Amendment of Long title

This clause amends the long title to remove the reference to the Health Performance Council.

5—Amendment of section 3—Interpretation

This clause deletes the definition of HPC from the provision.

6—Amendment of section 5—Principles

This clause amends section 5 of the principal Act to make provision for health services to be provided as part of an integrated system that is inclusive of primary health care networks, Aboriginal and Torres Strait Islander health services and public health services provided in local government, aged care and disability sectors.

7—Amendment of section 7—Chief Executive

This clause amends section 7 of the principal Act to substitute a number of the Chief Executive's functions.

8—Repeal of Part 3

This clause repeals Part 3 of the Act.

9—Insertion of Part 4A

This clause inserts Part 4A, which establishes a requirement for each incorporated hospital and SAAS to enter into a service agreement with the Chief Executive in relation to the provision of health services.

Part 4A—Service agreements

28A—Preliminary

28B—Service agreement with Chief Executive

28C—General provisions about service agreements

10—Amendment of section 33—Governance and management arrangements

This clause amends section 33 of the principal Act to broaden the functions of a governing board of an incorporated hospital.

11—Amendment of section 33A—Engagement strategies

This clause amends section 33A of the principal Act to provide for 3 yearly reviews of a strategy that the governing board of an incorporated hospital must develop.

12—Amendment of section 33B—Composition of governing boards for incorporated hospitals

This clause amends section 33B of the principal Act to alter the cases in which a person is not eligible for appointment to the governing board for an incorporated hospital.

13—Amendment of section 33E—Chief executive officer for incorporated hospital

This clause amends section 33E to provide that the governing board of an incorporated hospital cannot give a direction concerning the clinical treatment of a particular person.

14—Amendment of section 34—Employed staff

This clause inserts subsection (8a) to provide that no direction may be given by the governing board of the incorporated hospital to the chief executive officer relating to the appointment, transfer, remuneration, discipline or termination of a particular person if the CEO of an incorporated hospital is designated as an employing authority or a power or function of an employing authority is delegated to the CEO of an incorporated hospital.

15—Amendment of section 50—Management arrangements

This clause amends section 50(4) to provide that the CE cannot give a direction concerning the clinical treatment of a particular person.

16—Amendment of section 78—Testamentary gifts and trusts

This clause amends section 78 in relation to preserving the intention of testators in respect of the distribution of testamentary gifts to prescribed entities that have been dissolved.

17—Amendment of section 93—Confidentiality

This clause amends section 93 to make it clear that any obligation about confidentiality does not prevent a person from disclosing information in connection with the management or administration of the Department, or an attached office attached to the Department, as well as a hospital or SAAS.

18—Repeal of section 101

This clause deletes section 101.

19—Repeal of Schedule 1

This clause deletes Schedule 1.

20—Amendment of Schedule 2

This clause removes the reference to HPC from Schedule 2.

21—Amendment of Schedule 3—Governing boards for incorporated hospitals

This clause amends Schedule 3 of the principal Act to make changes to provisions concerning the governing boards for incorporated hospitals.

22—Insertion of Schedule 3A

This clause inserts Schedule 3A, which provides for the dissolution of the Health Advisory Councils listed in Schedule 3A, clause 2.

Schedule 3A—Dissolution of Health Advisory Councils

23—Amendment of Schedule 4—Transitional provisions

This clause amends Schedule 4 for transitional purposes so that HPC members are removed from office on the commencement of this clause.

41A—Cessation of office of Health Performance Council members

Schedule 1—Related amendments to Mental Health Act 2009

1—Amendment of section 106—Confidentiality and disclosure of information

This clause makes related amendments to the confidentiality provision of the Mental Health Act 2009.

Debate adjourned on motion of Hon. I.K. Hunter.