Controlled Substances (Confidentiality and Other Matters) Amendment Bill

Committee Stage

In committee.

Clause 1.

The Hon. K.J. MAHER: On whose advice or what was the advice that led to the decision to adopt an approach much closer to the Queensland model over the Victorian model of monitoring?

The Hon. S.G. WADE: I am advised that the decision to follow the Queensland model rather than the Victorian model was as a result of the South Australian officers who were involved in the national implementation steering committee for RTPM. One of the key issues was that Victoria was the pioneer jurisdiction in this space. After the Victorian scheme was established, the National Data Exchange (NDE) was established at the commonwealth level, so for us to follow the Victorian model rather than the Queensland model would actually mean that we duplicate the NDE work.

The Hon. K.J. MAHER: During the opposition briefing, we were told that SA has a more extensive list of monitored medicines than Victoria. If that is the case, as the minister has outlined, what medicines are we monitoring with this system that Victoria is not monitoring?

The Hon. S.G. WADE: For the benefit of Hansard, I will have a go at pronouncing them, and then I will have a go at spelling them. My understanding is that Victoria does not monitor the schedule for the medications gabapentin, pregabalin and tramadol. South Australia will monitor all of these.

The Hon. K.J. MAHER: The nodding that occurred indicates that the minister did not completely mess up the pronunciation, I think, so big ticks there. Is the minister able to outline whether physical records will be kept in addition to electronic records, at least for a transition period?

The Hon. S.G. WADE: I am advised that, no, we will not be maintaining a backup physical set of records. We already have an electronic system, and that will run side by side with RTPM and will provide the backup surety that we need.

The Hon. K.J. MAHER: Is Fred IT the provider of the IT system?

The Hon. S.G. WADE: I am advised that the preferred provider is Fred IT and that that provider is the preferred provider of most, if not all, other jurisdictions.

The Hon. K.J. MAHER: For what period of time is the contractual arrangement with Fred IT?

The Hon. S.G. WADE: I am advised that it is a tripartite agreement that also engages the commonwealth. The current contract, which has already started, is for three years plus two years—so an anticipated five years.

The Hon. K.J. MAHER: Can the minister inform the chamber what the value of that contract is, both for three years and the potential five years?

The Hon. S.G. WADE: I am happy to get that information for the honourable member. Could I suggest that we undertake to give it to the opposition before the house considers it? We think that we might have the total figure here; we do not think we have the breakdown. If the opposition is agreeable, we will get the breakdown and provide it to the honourable leader.

The Hon. K.J. MAHER: That would be appreciated. In the minutes remaining considering this legislation, even just the total as a start during the course of this bill would be appreciated. I am wondering, is the contract for the provision of these services by Fred IT—

The Hon. S.G. WADE: I am now able to advise the committee that the total value of the Fred contract, in other words not the two parts but the total, is $3,885,200 including GST.

The Hon. K.J. MAHER: Is that figure reported and publicly available, and is the contract itself publicly available?

The Hon. S.G. WADE: Funny you should ask: the contract and tenders website carries the contract, which is contract ID number SAH2019-1244.

The Hon. K.J. MAHER: Either at the end of the three years or if the option is exercised at the end of the five years, what provision is made for who owns the IT infrastructure and intellectual property?

The Hon. S.G. WADE: I am advised that the commonwealth contracted Fred IT to build the NDE, the National Data Exchange, and that in that contract Fred IT owns the IP. South Australia's procurement was for an add-on, a regulatory portal for the South Australian context, and Fred IT is our preferred partner and delivering that portal. Under that arrangement, they also own the IP.

The delivery of RTPM in South Australia involves a tripartite agreement with the commonwealth, Fred IT and South Australia. South Australia did look at the option of owning the IP. The advice was that, to achieve that outcome, we would need the agreement of the commonwealth, all other participating jurisdictions and Fred IT. That was not only seen as unlikely or impractical, but likely to be cost prohibitive. In that context we have gone ahead with this IP approach. I am advised that that being the case, no other jurisdiction owns the IP in relation to their portal.

The Hon. K.J. MAHER: A follow-on question: who has permanent access and ownership of the data that is generated?

The Hon. S.G. WADE: I am advised that each jurisdiction owns its own data, so South Australia owns South Australian data.

The Hon. K.J. MAHER: To clarify, if towards the end of the three years or the five years, depending on for how long the contract with Fred IT ends up going, in the negotiation for a new provider or renegotiation of the contract, is it absolutely crystal clear that South Australia has a right to all that data, that they retain the data, and how does that then work with the possible handover to a new provider?

The Hon. S.G. WADE: I reiterate the advice I am given, which is that South Australia owns the data. We have not given any thought to the mechanism which South Australia—and, for that matter, other jurisdictions—might take to manage the data in any transition to a future provider.

The Hon. K.J. MAHER: In relation to resourcing this scheme, what resources both in FTE and dollar funding will be dedicated to provide for this scheme to come into operation over and above the, I think, $3.8 million over the five-year life of the contract? And can that be broken down into what funds will be provided for education to clinicians and other users of the new system?

The Hon. S.G. WADE: I am advised that beyond the Fred IT contract costs the main two areas of funding are education, training and resource development and, secondly, the addiction and medication services. We are not able to break down that funding at this stage. I undertake to provide the leader with an answer before the matter is considered in the house.

The Hon. K.J. MAHER: What training is to be put in place to prepare the end users for this program and is the training program ready to roll out?

The Hon. S.G. WADE: I am advised that training and education will be available to all prescribers and pharmacists prior to statewide rollout. Due to the current COVID-19 pandemic, training will be delivered as online modules that can be completed at a time convenient for the health practitioner. The free training will include a series of short modules and will cover technical content such as how to register, log on and view notifications and alerts, and information to support practitioners to identify patients at risk of harm and treatment options available when a patient has been flagged by the system to be a person at risk of harm.

Training will be supported by standalone videos and demonstrations of how to complete key steps in the registration for and use of ScriptCheckSA. The South Australian training and other supporting resources will be similar in training delivered in other jurisdictions, with state-specific information for prescribers and pharmacists.

The Hon. K.J. MAHER: I thank the minister for his answer. I wonder if the minister can outline the rationale behind whether Medicare numbers are going to be used to identify patients, as per the College of Psychiatrists' suggestion?

The Hon. S.G. WADE: I am advised that as a state we are not able to use Medicare numbers. I think it is important to keep in mind that the National Data Exchange is a commonwealth asset and within the National Data Exchange the Medicare number, along with a range of other commonwealth data and general data of individuals, will be used to match individuals.

The Hon. K.J. MAHER: I am wondering if the minister can outline whether clinical guidelines will be developed to guide prescribers on how to handle notifications?

The Hon. S.G. WADE: I thank the honourable member for his question. I have already indicated that the training, not surprisingly, will deal with the administrative IT aspects of the program, but the training will also support prescribers and pharmacists in understanding their options when patients are flagged by the system. This will maximise opportunities for patients to be treated by their general practitioner or usual doctor and ensure resources are available for those patients that require specialist support and treatment

The training and education materials include support for health practitioners in having difficult conversations with patients. This will provide links to clinical resources and provide standard text which may help explain complex situations in plain and easy to understand language.

The Hon. K.J. MAHER: Can the minister outline whether there will be clear guidelines established for the referral of patients who are identified with a substance misuse issue, and how will they work?

The Hon. S.G. WADE: As part of the project, there is a clinical advice and pathways working group, which has identified the existing support services available and developed a triage framework for the efficient use of these. It has further refined a model of care to enable health practitioners to have the confidence to treat patients identified by the system as misusing or dependent on monitored medicines and to know when patients with complex issues should be referred to other services such as addiction medicine, pain management or similar.

The Hon. K.J. MAHER: Has any extra resourcing been allocated for alcohol and other drug services, given the potential increase in demand this monitoring system will create?

The Hon. S.G. WADE: It certainly has, and that was consistent with the government's policy that we put before the last election. As I indicated earlier, the government is undertaking to provide a breakdown to the opposition of the funding that will be provided for both education and training and also addiction and medication services.

The Hon. C. BONAROS: I just have one question in relation to the data that is managed both at a commonwealth level and a state level. We have the commonwealth managed National Data Exchange. It is my understanding that that data also feeds into the My Health Record. I just want to confirm for the record that the data that we are using here does not have any interplay with the My Health Record, especially given the number of individuals who have opted out of that system.

The Hon. S.G. WADE: I am advised that My Health Record is a patient-controlled summary of a patient's health record and patients can choose what is included and who can view their medication history. In other words, they can opt out. ScriptCheckSA, on the other hand, allows prescribers and pharmacists involved in a patient's care access to a complete record of the monitored drugs that have been prescribed and dispensed for that patient. In other words, it is not opt out.

In that context, too, My Health Record only engages PBS-dispensed drugs and there is a significant area of private prescribing that is also of concern. That is why ScriptCheckSA will not be opt out and will be inclusive.

The Hon. C. BONAROS: I understand that this will not be an opt out system and that that one is an opt in system. Perhaps if I can rephrase the question: given that we are relying on that National Data Exchange, I just want to know whether there is any possibility that there could be an overlap between the two systems in respect of the bill that we are passing now?

I acknowledge that one is opt in and one is opt out, but we are relying on a set of data that is being maintained by the commonwealth that is used as part of My Health Record. That is really what my query is.

The Hon. S.G. WADE: I am advised that the two data pools are separate.

Clause passed.

Clauses 2 and 3 passed.

Clause 4.

The Hon. C. BONAROS: During my second reading contribution, and I think that of other members, we touched on the issue of police accessing information that was not necessarily accessed appropriately but rather at the request of the police. I note that in this bill there are penalties both for disclosing confidential information but also for those who actually receive that information.

I want to confirm for the record two things. First, what discussions have taken place with SAPOL, if any, as a result of these measures, particularly in relation to previous requests for information from this? Second, noting that there is a maximum penalty of $10,000, are there any immunities from prosecution that would apply if that information that is confidential was inappropriately sought by public servants?

The Hon. S.G. WADE: In the context of the time that has elapsed since the honourable member asked the question, we have made inquiries of SAPOL. We were advised that SAPOL is not aware of any such incidents and, in the time available, has not been able to undertake a search of records. My advice, though, is that whilst my department is aware of requests from a range of entities, those requests are rare, and it is in the context of this legislation that the government wants to provide assurance to South Australians that their data will be protected, so the range of entities that may seek that information through this system will have more clarity on the confidentiality requirements that it is subject to.

The Hon. C. BONAROS: Despite how rare those occurrences may be, there were suggestions at the briefing we attended—not by us but by the information that was proffered—that SAPOL was identified as one of those parties that have often tried to access this information in the past. They may need to go away and look at any incidents that they have recorded or otherwise. I suspect it may be that some of those are not recorded.

My question is twofold: (a) has SAPOL been alerted to this legislation in terms of ensuring that their officers do not engage in this sort of behaviour; and (b) if an officer of SAPOL or any other agency or entity—that is, a public servant—did engage in this behaviour, would they be subjected to the maximum penalty that applies of $10,000 under 60A of the bill? Are there any immunities that apply to them in relation to those penalties?

The Hon. S.G. WADE: I would be starting to wander into areas of legal advice in answering the second question, but the advice I have from a nonlegal perspective is that there are not immunities. In terms of SAPOL's awareness of this legislation, there is a Real Time Prescription Monitoring External Advisory Group which has been established for input and feedback in relation to the design and development of the Real Time Prescription Monitoring system, and the SA police are part of that advisory group. So I am sure that if they had any suggestions to make in terms of the RTPM they would have made it through that advisory group, and they are aware of this legislation being progressed.

Clause passed.

Remaining clause (5) and title passed.

Bill reported without amendment.

Third Reading

The Hon. S.G. WADE (Minister for Health and Wellbeing) (12:35): I move:

That this bill be now read a third time.

Bill read a third time and passed.