Parliamentary Committees

Select Committee on Matters Relating to SA Pathology and SA Medical Imaging

The Hon. E.S. BOURKE (21:27): On behalf of the Hon. J.E. Hanson, I move:

That the report be noted.

I rise today to bring up the report of the Select Committee on Matters Relating to SA Pathology and SA Medical Imaging. Two years ago, if you were to ask the everyday busy South Australian what SA Pathology was, few would have anything to say other than, 'I think they take blood samples.' SA Pathology was not a household name. SA Pathology was not known for being the state's frontline public health service, the service that literally unlocks the code to enable health professionals to treat their patients.

If you have a heart attack, experience a serious car accident, deliver a baby, have an allergic reaction or experience food poisoning, it is more than likely that it will be SA Pathology who will be running the test that provides the medical answer to how to best treat you. It was also this lack of awareness that perhaps was SA Pathology's weakness. We saw this when those opposite used their very first state budget in 16 years to lay down the threat of privatising SA Pathology.

Few everyday South Australians were jumping up and down about it. Yes, medical professionals were, because they knew that this would mean the safety of patients would be put at risk. Yes, Labor and the crossbenchers were jumping up and down and saying it was not a good idea to privatise an organisation that puts the health and wellbeing of people before profits. Yes, interstate government bodies jumped up and warned the state government not to follow their steps and privatise pathology, steps they are now trying to wind back so that they can take control of this public service.

But the general public did not perhaps realise the true significance of the role SA Pathology and SA Medical Imaging played in protecting the community until March last year when COVID hit. Perhaps the government also did not realise the true significance of SA Pathology until COVID hit. Imagine just for a second if SA Pathology had been privatised and we did not have a public pathology service to undertake the thousands, if not millions—I am sure the minister will be able to confirm how many—of COVID tests this state has undertaken. Imagine any private company taking the risk that SA Pathology undertook to establish mass testing processes during a time of statewide lockdowns and widespread uncertainty, not for profit but for the health and safety of South Australians.

I would like to thank the many members who jumped up and down and made noise to help shine a light on this essential public service, members who wholeheartedly supported the establishment of the joint Select Committee on Matters Relating to SA Pathology and SA Medical Imaging: the Hon. Justin Hanson, the Hon. Connie Bonaros and the Hon. Tammy Franks. I would also like to thank the government members of this committee, of which there were many: the Hon. Dr Nicholas Centofanti and the Hon. Dennis Hood, who saw through the finalisation of this report. I would also like thank you, Mr President (the Hon. John Dawkins), the Hon. David Ridgway (who is no longer here) and the Hon. Terry Stephens.

I would also like to thank the many witnesses who gave us their time and expertise, of whom there were more than 50, over 17 committee hearings. When asking the chamber to support the creation of this committee back in 2018, I said these words:

I feel this is a timely matter as it has the potential to impact the health and wellbeing of South Australians, and that is why I seek the chamber's support to vote on this motion to establish a select committee.

Back in 2018, none of us could have predicted that less than 18 months later the world would be relying on services like SA Pathology to help us track and trace transmission of a virus at the centre of the most deadly global pandemic in 100 years. However, it did not take a pandemic for our side of the chamber or my colleagues on the crossbench to see the value of both SA Pathology and SA Medical Imaging and the importance of retaining these services in public hands.

The Marshall Liberal government's first state budget cut $105 million from SA Pathology with plans to privatise their vital health services and SA Medical Imaging. There was little to no consultation with SA Pathology staff about any changes, and the Premier himself had promised before the last state election that the Liberal Party did not have a privatisation agenda.

This committee was established back then to thoroughly scrutinise the government's decisions to potentially privatise these vital public services and ensure that government would not put profits before patients. We were already concerned, way back then, that destroying the connection between SA Pathology, public hospitals and GPs through the privatisation of SA Pathology could result in tests being centralised or, worse, sent interstate. We knew back then that SA Pathology undertakes the most complex pathology work in South Australia and we were unsure if private labs would be able to compete with or meet the same standards. We were concerned because we knew that even then private labs would, and continue to, send their samples to SA Pathology.

Over the last nearly three years, this committee has heard evidence from numerous stakeholders about the vital role that SA Pathology and SA Medical Imaging play in our health system, not just the phenomenal work that they have done and continue to do during the pandemic but also before. The committee heard that accurate and reliable pathology and medical imaging services are essential to the provisions of appropriate medical care. We heard from Associate Professor Hartley-Jones that seven out of 10 decisions made by clinicians are made after they review diagnostic test results or see advice from radiologists, pathologists or medical scientists.

Sarah Andrews, the director of Professionals Australia, informed the committee that pathology is used in 70 per cent of medical treatment plans and nearly 50 per cent of GP visits in a pathology test. The committee heard that SA Pathology's role is not limited to diagnosis. SA Pathology not only provides information for vital management of public health, such as for the transmission of mapping diseases and illnesses, but commercial food, drink and pharmaceutical manufacturers also use SA Pathology to test the safety of their products. Regarding SA Medical Imaging's role, the committee heard that:

…medical imaging services are integral to the care of patients by providing accurate diagnoses and monitoring treatments in addition to performing imaging treatments and advising on the use of radiology for patients.

The South Australian Salaried Medical Officers Association (SASMOA) submitted to the committee that SA Medical Imaging was integral to the South Australian healthcare system, and I quote:

…the service provides 24/7 response which is critical for referring practitioners…to maintain the flow and pathways for patient care…

Further, Dr Christopher McGowan, the Chief Executive of the Department for Health and Wellbeing, informed the committee that minimal training is provided in the private sector in South Australia in relation to medical imaging and stated:

The medical imaging private sector in South Australia is essentially completely reliant on SA Medical Imaging for the provision of its medical specialists workforce.

Further, the Executive Director of SA Medical Imaging shared with the committee that:

SAMI trains nearly all of the medical imaging specialists working in both the public and private sectors in South Australia.

Similarly, SA Pathology provides not just the training for the majority of the state's pathologists but also conducts all pathology research in South Australia. No research is conducted by a private pathology lab. This is significant. Not only that but the committee also heard from Dr Thomas Dodd, acting clinical services director at the time, that SA Pathology is the sole training institute for pathology trainees in South Australia and said 'without that we would potentially face a significant workforce crisis in the future'.

Additionally, the committee heard evidence that SA Pathology has a strong research link to universities that cannot be replicated by the private sector. It was stated:

Those ties to education and training of our next generation of doctors and scientists do not exist in the private sector.

In terms of staff and workforce training, research and clinical development that SA Pathology and SA Medical Imaging provide is vital at every tier of the healthcare system in South Australia. This was true before the COVID-19 pandemic, this was true before the establishment of this committee, this was true before the $105 million was cut from SA Pathology by the Marshall Liberal government, and this was true before threats of privatisation were made without consultation with SA Pathology and SA Medical Imaging in the 2018 state budget.

These cuts and threats of privatisation by the Marshall Liberal government never made sense, not just because of the evidence I have just outlined, but even before the COVID-19 pandemic SA Pathology and SA Medical Imaging were under immense pressure to deliver more with less. The committee heard how stress, overwork and fatigue were commonplace in SA Pathology. We heard how morale was low and that staff had concerns for their future and the future of their colleagues.

Evidence was heard that staff within both organisations were working under stress due to a lack of resources and extreme workloads and that the threat of privatisation made them feel undervalued by the state government. It is remarkable that this government thought the best way to get more out of these vital public services was to cut funding and assume that privatisation would yield better results.

It is remarkable not just because of the evidence we heard regarding research partnerships and training but also because we know that when services are privatised a major consideration of those commercial providers is profit. The committee heard evidence that underlines why privatisation cannot improve pathology or imaging services outcomes and is more likely in fact to weaken outcomes for South Australian doctors, patients and researchers who rely on these services.

The report is thorough in its description of the evidence heard and I will share one particular quote that I believe clearly outlines the risks, especially to patients, as a result of privatisation:

…when private providers take over they often close hospital-based services and set up in areas that are more profitable. This means that regional areas no longer have the same access. It leads to long delays—for example if you are sending a sample from a regional hospital or from a regional health service, long roads of transport to a central testing laboratory degrades the sample and often they get poorer test results.

I have chosen this quote because it echoes the feedback from many of the witnesses over the three years of this committee. Privatisation could risk patient outcomes for profits. Let me repeat the last line of this evidence: 'and often they get poorer test results'. That should be enough of an argument against privatisation of these services. No government should make a decision that results in the risk to patients due to poorer test results.

But it is not just the patient outcomes. Future workforce concerns, research partnerships and development of new diagnostic tests should be reason enough to keep these services in public hands. We should also hear the evidence that not only is SA Pathology a bulk-billing service but SA Pathology is the only service which is 100 per cent South Australian owned, with all profits staying here in this state. If all, or part, of SA Pathology is privatised there will no longer be an incentive for private providers to bulk bill and South Australians will start having to pay out-of-pocket expenses for pathology tests.

Witnesses were clear that pathology and medical imaging are essential medical services for all South Australians, irrespective of where they live, or their income. Public pathology and imaging services play a vital role in ensuring everyone has equal access. Evidence to the committee highlighted the importance of having high-quality testing and services that are bulk billed.

At this point, I would like to thank the incredible staff at SA Pathology and all pathology clinics and labs in our great state for the superhuman effort that they have made in keeping us all safe by managing the tests required for the tracing and containment of this formidable virus. You have all contributed to an incredible undertaking and we owe you a great debt of gratitude.

It is unfortunate that it took the state government a one-in-100-year pandemic to realise the full value of publicly owned pathology and medical imaging. In his media release back in April 2020 announcing the decision to keep SA Pathology in public hands, the Premier and the Minister for Health and Wellbeing stated:

SA Pathology has developed a world-leading response to the COVID-19 pandemic.

I quote further:

SA Pathology has embraced innovation, introducing rapid COVID-19 testing which provides a diagnosis in less than 60 minutes.

Of course they did. Of course they could, because the committee heard—as the Marshall Liberal government would have known if they had consulted with SA Pathology—research and innovation are at the heart of SA Pathology. The Premier and the Minister for Health also said, 'SA Pathology has a central role in public health care.' Of course they do. They always have.

This report should be an important report that all ministers and governments reflect upon. We should always put people before profits. I would like to thank the secretary, Emma Johnston, for her incredible work and a special thank you to Leslie Guy, who had to step in and be the research officer for this committee. She did a fantastic job pulling the report together. So thank you, Leslie, and all members involved.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (21:44): On behalf of the government, I rise to provide a response to the select committee report. Before I do so, I pause in awe to acknowledge the extraordinary hard work and professional skill of the staff and management of SA Pathology in their response to the COVID-19 pandemic. From the very beginning, SA Pathology has demonstrated its innovative spirit and clinical excellence.

SA Pathology added tests for COVID-19 to the set of tests performed on respiratory samples beginning in February 2020—the very month that we had the first cases here in South Australia. SA Pathology introduced only the second drive-through COVID testing clinic in the world in early 2020.

The Hon. Emily Bourke asked me some pop quiz questions about how many tests SA Pathology has done. I am pleased to advise that, as of yesterday, since the start of this pandemic SA Pathology has delivered 2,790,994 samples. Amazingly, what the data shows is that 50.37 per cent of the South Australian population has been tested for COVID-19 by SA Pathology.

Key to the strength of the SA Pathology response to the pandemic has been the outstanding work of leaders like Associate Professor Dr Tom Dodd and Mr Mark McNamara. Under their leadership, SA Pathology was being stabilised and renewed even before the pandemic started.

Labor left SA Pathology a demoralised organisation. They had put it under the shadow of hundreds of job cuts since late 2014. They further harmed the organisation with the botched rollout of EPLIS, which saw millions of dollars wasted, staff working significant overtime and patient risk. Labor's report into SA Pathology in 2014 put forward the proposal that the regional pathology services should be closed, and this lay on the table for months before they were finally pressured into ruling out such closures.

Labor's record on SA Pathology shows their hypocrisy, as does their record on SA Medical Imaging. They were happy to outsource imaging services at locations across the state for 16 years under their rule. So, to use the words of the Hon. Emily Bourke: why did Labor risk poorer quality results by outsourcing imaging services in their term?

Let's be clear: the 2018-19 budget did not announce that SA Pathology or SA Medical Imaging would be privatised. It called for efficiencies and improved services to South Australians and that resources be used efficiently—and improved services is exactly what this government has delivered. Before the pandemic, on-time delivery for time-critical diagnostics rose from 66 per cent to 90 per cent, while turnaround times for non-critical diagnostics improved by 18 per cent. At the same time, SA Pathology delivered efficiencies of around $15 million—money which was then available for the COVID response.

While the government broadly agrees with most of the recommendations of the committee, some are not supported and others have been made redundant by the reforms we have already undertaken in partnership with the expert staff and clinicians of the organisations.

The PRESIDENT: Order! The Hon. Mr Pangallo, I wonder whether you might like to take that conversation outside. Particularly, it is against standing orders to turn your back on the President and the speaker.

The Hon. S.G. WADE: In closing, I thank members of the committee for their work and all the individuals and organisations that gave submissions or presented evidence to the committee. Thanks to the reforms implemented by the Marshall Liberal government in the 2018-19 budget and since, SA Pathology and SA Medical Imaging are stronger organisations that provide safe, quality services to South Australia in a sustainable and contemporary fashion. I thank them and congratulate them on their work and again commend all the hardworking staff of both SA Pathology and SA Medical Imaging.

The Hon. E.S. BOURKE (21:48): I would like to thank the Hon. Stephen Wade for his comments, and again I would like to thank the members who helped on this committee. The evidence was provided in a short time frame, but we did think it was important to bring back witnesses to ask questions, particularly in relation to how the COVID pandemic was being handled by SA Pathology, who have played an incredible role in keeping our community safe.

Motion carried.