Legislative Council: Wednesday, September 13, 2023


Patient Assistance Transport Scheme

Adjourned debate on motion of Hon. S.L. Game:

That this council—

1. Acknowledges that the Patient Assistance Transport Scheme is vital to our rural regions;

2. Accepts that the government needs to review its current framework; and

3. Recognises that without the Patient Assisted Transport Scheme, patients in rural areas are more likely to die from a range of preventable illnesses.

(Continued from 14 June 2023.)

The Hon. N.J. CENTOFANTI (Leader of the Opposition) (17:05): Overly complex, bureaucratic, stressful, essential, lifesaving—these are just some of the terms I have heard to describe the state's Patient Assistance Transport Scheme. At a seniors' regional health forum held only last month, residents from Port Pirie and the surrounding districts told my Liberal colleagues and I that this scheme is vital and that current rebates are inadequate.

The Patient Assistance Transport Scheme (PATS) is supported by all parties in politics and is recognised as imperative to the health and wellbeing of people living in regional South Australia. It should be noted that we, as the opposition, support the amendments to this motion put forward by the Hon. Robert Simms. We appreciate every opportunity we have to work with our colleagues on such important matters as rural and remote health.

I note our colleagues in other jurisdictions, both interstate and federal, are also intent on ensuring their respective schemes are reviewed with a critical eye to improving outcomes and streamlining processes for patients and families already enduring enough stress in their lives.

PATS seems simple enough on paper. It is a financial rebate towards the cost of travel and accommodation for people who reside more than 100 kilometres from their medical appointments or medical treatments. They must be a permanent South Australian resident to claim the subsidy. They must not receive any reimbursement or financial assistance from a private health fund or other government scheme towards that travel or accommodation, and there must be proof of a medical specialist pathway to confirm that medical appointment or treatment, such as a referring doctor or specialist.

The finer details can get a little bit more complicated. My office has spoken with a family who live out past Blinman in the state's north. They attempted to utilise PATS for medical complications after the birth of their first child. The delays in collating the three-part form—one part from the local or referring doctor, one from the treating specialist, and one for themselves—as well as the lodgement process and the six-week lag between travel, treatment and reimbursement, meant they had to take out credit card debt to facilitate treatment in Port Augusta. Their home is a 440-kilometre round trip from treatment.

Allied health, general dentistry, nursing specialists and GPs are not covered in the scheme. Appointments and treatments for these services cannot be claimed. I note that my colleague the Hon. Ben Hood will give some further details of this in his speech today, particularly addressing concerns about the absence of dental in this scheme.

Lowering the threshold for distances travelled and restructuring the travel calculations is one recommendation from the recent 2022 Tasmanian Patient Travel Assistance Scheme review. The government there has implemented either a 50-kilometre or a 75-kilometre one-way trip measurement for different types of treatment. In Queensland, their scheme is valid for a transportation rebate at 50 kilometres for a one-way trip.

Other jurisdictions, such as New South Wales and Victoria, allow for so-called block treatments to bump up eligibility. For example, a New South Wales regional patient who must travel 80 kilometres one way for radiation therapy treatment cannot claim PATS. However, if they are scheduled for multiple treatment sessions in a week, totalling more than 200 kilometres, they are able to claim that travel rebate.

In South Australia, this is unavailable. Our rural and remote communities are missing out. There is plenty of advocacy for an improved Patient Assistance Transport Scheme. If ever brought to this chamber, we are open and enthusiastic to innovation and efficiencies for this scheme to improve outcomes for country patients.

The Liberal Party has a proud history of advocating for regional communities and, in particular, focusing on regional health. My colleague the member for Frome questioned the Minister for Health and Wellbeing in the other place on this matter in May of last year, and we had a 2022 election commitment to double the travel fuel rebate.

Whilst the increase to the travel rebate on 1 January 2023 by the Malinauskas government was absolutely welcomed, it does not go far enough given the current cost-of-living crisis. Fuel prices, especially in regional and remote areas, are consistently holding at over $2 per litre. Add to this the likelihood of at least an overnight stay, if not longer, and there is a definite out-of-pocket expense for someone who is very ill and away from home.

Ronald McDonald House South Australia is a non-profit organisation that does not charge a family anything to stay at their Melbourne Street accommodation whilst receiving treatment from the Women's and Children's Hospital. This is despite the calculated cost per family per night being over $160. Madam Acting President, do you know what the rebate is for PATS per night in South Australia? It is $40—only $40 per night for patients over 100 kilometres away from their home. That is the lowest rate in the nation.

Another not-for-profit organisation that deals daily with PATS is the Cancer Council of South Australia. Prior to the 2022 state election, Cancer Council SA developed a suite of election priorities. Their second key priority was regarding PATS, which states:

Reducing the financial burden for rural and remote people with cancer

The rebated rates for transport and accommodation have not kept pace with the rate of cost-of-living increases in the state. South Australian rebates also lag behind the rest of the states and territories.

They provide data to show that the minimum appropriate level of accommodation for regional and remote patients who are immunocompromised had a daily rate in South Australia of $114 during the 2020-21 reporting period. Accommodation prices have certainly not gone down.

There are several other South Australian-based not-for-profit organisations providing subsidised accommodation for health patients which confirm the Cancer Council's position statement. Without the support of subsidised or gratis places like these not-for-profits, the financial impact on South Australian families needing to stay in Adelaide for long periods would be crippling. I know it was crippling for the young family from out past Blinman.

The Queensland state government recently increased the amount they rebate for nightly accommodation, and the Western Australian government rebates $100 per PATS claim per night. Again, I remind the chamber that South Australia only rebates $40 a night, the lowest in the country. Our regional communities are missing out.

It is encouraging to acknowledge that so many in this chamber support PATS. I would like to acknowledge the mover of this motion, the Hon. Sarah Game. The Liberal Party truly understands the impact of living in regional and remote communities because that is where I and many of my colleagues live. We know the added burdens that come from making arrangements to travel long distances for health appointments.

Those of us living out in regional and remote South Australia, an area that contributes over $26 billion to the state's economy with just under 30 per cent of the state's population, should not be disadvantaged when it comes to health care. Our party supports this motion wholeheartedly.

The Hon. F. PANGALLO (17:13): The Patient Assistance Transport Scheme serves regional commuters who must travel long distances to the city or larger regional centres to access health treatment. Many individuals rely on the support of friends or volunteer drivers to get them to their destinations in their personal vehicles, often at greater cost than the modest rebate per kilometre travelled that is paid, and I know that this amount has only recently been increased. However, it is still an expensive trip for someone who also has the added pressure of having to find affordable accommodation during rental squeezes on their travels.

During the 2022 election campaign, I caught up with several people in Whyalla who are regular users of the PAT Scheme and they expressed to me the difficulties they faced on the scheme. Their vehicles also suffer from wear and tear for which they are not really compensated. The PAT Scheme also highlights other problems confronting regional communities, notably the lack of regular and reliable transport, particularly rail passenger services that were axed by penny-pinching state Labor and Liberal governments over the decades, and also the centralisation of crucial health services for patients facing life-threatening conditions like cancer, cardiac and kidney disease, neurological treatments or even the less serious issues, but certainly important to them, like dental or ophthalmological services.

We have to live with PATS because of the failures of government health and transport policies. Communities needing specialist health treatments in the cities deserve better from their government and not having to rely on drivers transporting them along dangerous rural roads. In closing, I would like to salute all those who keep this vital service going despite the obstacles that they face. I commend the motion to the chamber.

The Hon. R.A. SIMMS (17:16): I also rise in support of the motion. In doing so, I move an amendment:

After paragraph 3, a new paragraph be inserted as follows:

4. Recognises the advocacy of all members of parliament and political parties on this important issue.

The reason for the amendment is that I think this is a moment of unity for the chamber where every member of parliament and, indeed, every political party is supportive of this vital scheme and ensuring that it meets the needs of people in regional South Australia, so I wanted to make sure that that was encapsulated in the motion. It not often that I lavish praise on the government, but I will praise them for increasing the amount of money made available under this scheme. That has been a good thing to do and something that we certainly welcome in the Greens, so I do want to recognise the government's leadership on that.

The Hon. I.K. Hunter: It's not very lavish.

The Hon. R.A. SIMMS: I see the Hon. Mr Hunter is overwhelmed by the generous nature of my praise—effusive. I did want to put that on the record and, as I say, recognise that all members of parliament are concerned about this and want to see this scheme meet the needs of regional communities.

The Hon. C. BONAROS (17:18): I rise to speak on behalf of SA-Best as the health spokesperson on the motion by the Hon. Sarah Game on the Patient Assistance Transport Scheme. We have heard now that PATS provides financial assistance to people who are required to travel at least 100 kilometres from home to access vital medical services they cannot access locally. To be eligible, we know that the patient needs to be a permanent South Australian resident, they need to be enrolled in Medicare and have an appointment for a claimable Medicare treatment at the nearest appropriate medical service.

It cannot be otherwise claimable from a private health fund. In other words, there is no double dipping. It does not provide subsidies for appointments seeking a second opinion amongst other things. Many of us in this chamber, as has been pointed out, have tried in vain, I think, to advocate on behalf of this scheme for a number of years, and that is on behalf of those patients who have no other option for fair and just compensation, as is reflected in the amendment moved by the Hon. Rob Simms, but importantly also in the motion itself.

As at 1 January this year, the fuel subsidy doubled from 16¢ to 32¢ per kilometre travelled in a private vehicle, or most but not necessarily all of the cost of public transport or air travel. Recently, yes, changes were made to the scheme to provide up to $200 in subsidised ferry travel to Kangaroo Island residents, recognising the 100-kilometre proximity to Victor Harbor is not helpful if there is an ocean in the way.

My review, I do not think, is quite as lavish as the Greens'. We do acknowledge those improvements. We acknowledge that the scheme reimburses now up to $44 a night, including GST, for commercial accommodation. It is designed to contribute to the transport and accommodation costs, which come out of the patient's own pocket, but here in the real world we all know that it barely touches the sides. Good luck finding anywhere in Adelaide to stay for $44 a night.

So while there may have been improvements and they are very welcome, not just by us but particularly by the patients who are relying on them, they do absolutely the bare minimum in terms of assisting those patients despite the fact that I am sure each and every one of them is not only relying on that but extremely grateful for it.

We know there are countless patients who have no choice because treatment is not otherwise available in their regions, and if those treatments were available then we would not be looking at this sort of scheme being needed to provide additional assistance for those who have no choice but to visit the city for health treatment.

PATS does not claim to be a full reimbursement scheme, but absolutely, given that those treatment options are not available, and that they have no choice other than to come to the city, it should be a scheme that is covered in full. If not for the lack of services close to home, you would not be out of pocket—it is as simple as that. That in and of itself is just another issue we know is impacting the state of health in this state.

We can pretend our health system is not on its knees and all of these issues do not have a domino effect, but in reality the only ones we are fooling are ourselves because we absolutely know that is precisely what is happening, which is why we, together with our colleagues, will continue to advocate for a full and fair reimbursement scheme to make up for that shortfall.

It is important that there appears to be unanimous support in this chamber today for this motion, but support alone does not result in outcomes. If the government does not do what the motion calls for, if the government does not actually consider what we are going to do to address this issue—and it is my expectation and I am sure it is the mover's expectation, I am sure it is everyone who is supporting this motion's expectation, that the government will do what has been called for in this motion—then the will of this parliament for one will be ignored, but, more importantly, it will do nothing to address yet another issue that is having a crippling effect on our health system.

Make no mistake, despite the fact that we are not seeing the headlines every day in the newspapers, our health system continues to be in a state of crisis. These are issues that could assist. If patients were not coming into Adelaide and relying on services in Adelaide, if we were not ignoring the domino effect that all these issues have, then our health system would not be in the state that it is in. It is for that reason that we wholeheartedly support this motion. We thank the Hon. Sarah Game for bringing it once again to the attention of this parliament and look forward to not just further momentum but some real, tangible change that will make this a better scheme.

The Hon. R.B. MARTIN (17:24): I rise to speak on this motion and indicate that we will be supporting both the motion and the Simms amendment. The Patient Assistance Transport Scheme provides financial subsidies to patients who are required to travel more than 100 kilometres each way to access necessary and approved medical specialist appointments that are not available locally. These subsidies provide a vital financial offset when patients have no option but to travel for specialist services.

Recently, there have been significant improvements to the scheme. The fuel subsidy was increased from 16¢ to 32¢ per kilometre for patients travelling from 2023 onwards. The scheme is undergoing internal review, and this review has already resulted in two small but important reforms: firstly, expanding eligibility requirements to include prosthetics claims, and secondly acknowledging the disadvantage of the Kangaroo Island community, expanding ferry subsidies and PATS eligibility to the entire island. Previously, the eastern side of the island had been considered technically under the 100-kilometre requirement when referred to Victor Harbor hospital for treatment.

The Malinauskas government is investing in specialist services in regional areas, which will reduce the need for patients to travel out of the regions. This increase will provide regional areas with doctors who are able to treat a wide range of preventable illnesses. In the event that treatment is unable to be performed in the regional areas, PATS will be able to provide a travel and/or accommodation subsidy to the patient.

If a patient is diagnosed with a terminal illness, confirmation from the treating specialist can be provided to PATS and a choice specialist for the patient's treatment will be noted on the PATS database. Additionally, travel and accommodation for treatment deemed as urgent by either the referring doctor or a specialist is supported by PATS. I confirm that we will be supporting the motion and the amendment.

The Hon. B.R. HOOD (17:26): I rise to add my voice in support for this motion that acknowledges the vital importance of the Patient Assistance Transport Scheme for regional South Australia and calls for review into its current framework.

The Liberal Party proudly supported this scheme for many years, and we were glad to see our 2022 election commitment to double the fuel rebate allowance eventually taken up by this government in January. Under the former Liberal government, we updated PATS to enable more flexible travel and support under the scheme. This included:

reimbursing patients for their actual travel costs rather than reimbursing them for travel to the GPO;

enabling eligible family members and carers who travel separately to the patient in an emergency situation to be subsidised;

removing restrictive criteria, which previously meant when a patient required interstate travel for treatment their support person was unable to work near the new treatment location, for the patient to continue receiving the subsidy;

expanding the eligibility criteria to include Airbnbs and similar accommodation options or commercial subsidies; and

covering remote patients when land travel over 100 kilometres is required to travel to a regional airport, which was previously not covered under the subsidy.

While the doubling of the fuel rebate to 32¢ per kilometre is welcome, unfortunately with the current cost-of-living crisis it does not go far enough. Fuel prices have surged since March 2022 and have not fallen to the same levels we saw under the former Liberal government's time. From 2018 to early 2022, fuel prices hovered from a low of $1.02 per litre to highs that rarely ever reached beyond $1.60. FuelPrice Australia reports that current average prices have not fallen below $1.98 in the past month in South Australia. Subsequently, inflation is well and truly eating up the extra rebate allowance.

Shadow regional health minister, Penny Pratt MP, called for the recent state budget to increase the accommodation subsidy from $40 for singles and $80 per couple, which is the lowest rebate in any state. The fact that this rebate has remained unchanged is a kick in the guts, given the spiralling cost of living we are now witnessing.

As Cancer Council SA notes in their 2022 state election priorities document, South Australian rebates are lagging behind every other state and territory in the country. Western Australia's accommodation subsidy is now over $100 for singles, over 2½ times our own. New South Wales increased their accommodation subsidy from $43 to $75 per night and up to $120 per night for eight or more nights. Even Tasmania exceeds our subsidy amount by almost two times, at $76 per night. Many of our interstate counterparts offer more generous qualifying criteria as well, including a reduced minimum travel requirement and the ability to combine multiple trips in one week to reach the minimum kilometre threshold.

The 2013 review into PATS that the mover of this motion alluded to in her speech considered a range of expansion motions for the scheme. Of the 200 letters and submissions to that report, allied health services were the most called for addition, followed by dental services. Coincidentally, my office received a phone call from a resident in Tarpeena just last week who raised the issue of dental services not being included in PATS.

While the review from 10 years ago identified that an expansion to include dental services would require significant additional resources, it would be prudent to re-evaluate this in 2023. In reviewing this, it is important that the benefits for improving access to preventative health are included in a cost-benefit analysis to ensure that not only the up-front costs are considered but also what long-term savings could be achieved through improving the oral health of our regional communities.

As we debate this motion and consider regional health measures, we must keep in mind the fact that health outcomes are almost universally poorer for those who live outside of Adelaide. Figures from the Australian Institute of Health and Welfare report that death rates range from 10 per cent to 70 per cent higher for regional, rural and remote residents compared with those living in our major cities.

The Heart Foundation reports that death rates from heart disease are 60 per cent higher for regional and rural towns, while hospitalisations due to heart failure were as much as 90 per cent higher compared with those living in the city. The Australian Bureau of Statistics National Health Survey also consistently shows that regional, rural and remote Australians have higher rates of virtually all diseases and conditions, and I could go on and on.

This is why a scheme like PATS is so important, but it also must go further to ensure health outcomes for regional, rural and remote South Australians are not left in the dust compared with their city brethren. I would also point out that Mount Gambier is still calling for radiotherapy in the Limestone Coast. Just imagine the money that could be saved in terms of PATS if people from Mount Gambier did not have to do a 10-hour round trip for a 15-minute consult and treatment for cancer. Think about those families who would not have to go through that terrible situation while dealing with the fight of their lives. I look forward to seeing the government's response to this motion, and I commend it to the chamber.

The Hon. S.L. GAME (17:31): I thank all the honourable members for their contribution. I want to make clear that I absolutely support the amendment by the Hon. Robert Simms to recognise the advocacy of all members of parliament and political parties on this important issue. I want to echo the sentiments of the Hon. Connie Bonaros that the purpose of the motion is not really to congratulate the government, but it is to spur on, hopefully, real, tangible movement in that area.

I want to thank the Hon. Ben Hood and the Hon. Nicola Centofanti as well for their contributions in particular, and echo that we absolutely need change with regard to the range of medical provisions that people are eligible for under PATS, and also echo how unsatisfactory it is that we have the worst accommodation subsidy in the country.

It was positive to hear from the government that there is some movement underway, and they are open for more change. I did ask the government last year if they would review the PATS system, and I was told they would not. I did ask the government last year if they would increase the fuel subsidy, and I was told they would not; they subsequently did in January or February of this year. I would call on the government to take this motion seriously, with a view to real, tangible outcomes to rural communities and their ability to access good quality medical care.

Amendment carried; motion as amended carried.