Parliamentary Committees

Select Committee on Health Services in South Australia

The Hon. C. BONAROS (18:09): I move:

That the final report of the select committee be noted.

One of the first things I did when I came into this place was to propose a select committee of this place to be established to report on health services in SA. I reflect on that very fondly because there was my motion and there was a motion by the Hon. Emily Bourke. Mine had been proposed first and the Hon. Emily Bourke wanted a committee on Pathology SA. The Hon. Ian Hunter inserted himself into that discussion and debate at the time and we ended up having both committees as a compromise, or as the numbers fell at the time.

There was some to and fro between all three of us in terms of ensuring that the Hon. Ms Bourke got her committee and I got this committee. It was re-established in 2022 without the need for any of that, and I think that is a reflection of the work that committee has done. That committee has continued to meet on numerous occasions to hear evidence on ways to improve the quality, accessibility and affordability of health services through an increased focus on preventive health and primary health care.

It does play an important role in bringing the needs and shortfalls of the South Australian health system to both the public and government's attention, ensuring transparency and accountability at all levels. Historically speaking, members could see that the last election—it was obvious to me just from being on that committee—was going to be a health election. I think the beauty of that was that in a very impartial way, without any reference to any particular opposition, we literally had lots of experts, doctors, nurses and members of the public queueing up to give evidence to that committee.

Importantly, the committee would break stories that never would have seen the light of day otherwise. It became a very important instrument in terms of having newspapers or radio coverage or TV coverage and bringing to the fore for the public the sort of evidence and testimony that was being provided to that committee. It was pleasing to note that SA Health endorsed all of the recommendations of the interim report tabled in 2023, with the intention of implementing those recommendations that align with both state and federal priorities.

Last week, that committee heard—and I will give a summary of what we have done and what is in this interim report—from medical student Sam Diprose, an advocate for improved mental health policy and systems. Sam has lived experience with depression and mental health issues. He gave us an oversight of what that was like in a very eloquent way when it comes to transcranial magnetic stimulation, a non-invasive neurostimulation therapy which has proven effective for 60 per cent of patients with a history of resistance to other treatments but is not available in the public sector in South Australia. Sam said that suicide is the ultimate complication of depression and is what makes depression a lethal disease. This is why he is so passionate about seeing TMS introduced in the public system.

In October, we heard from Dr Monika Skubisz, a clinician, researcher, specialist, obstetrician and gynaecologist, and the South Australian Councillor for the National Association of Specialist Obstetricians and Gynaecologists (NASOG) who warned us of a maternity crisis in Australia. We heard that in Adelaide, since 2018, we have had 40 per cent of our private maternity units close. It is part of a national trend where we have seen 18 units close around the country since 2018. It leaves us with swathes of Australians who have no access to a private specialist in pregnancy.

Dr Skubisz said that if private obstetrics was to collapse this would force an additional 30 per cent of women who currently deliver in the private system to deliver in public instead, a system that we know is already working at or over capacity. Displacing 30 per cent of our private mothers into the public system would of course in turn displace other elective procedures, whether in gynaecology or in other specialties, and our elective surgical wait list will continue to blow out if that happens.

She pointed to findings that showed that public care costs just shy of $6,000 more per birth and yet delivers poorer outcomes, that the private maternity sector is allowed to collapse, and that if women currently in private obstetric care all moved to standard public care the net additional cost to government would be $1.77 billion per year. I will not run through all of the evidence. It is available for members to go through, but it is this sort of evidence that we only get to hear about through this committee.

Some of the most confronting evidence we heard during this session was in relation to laryngectomies. A very visual display was put on for the committee so that we could actually see what it was like living with one of these procedures. Associate Professor John-Charles Hodge, who is head of ENT at the RAH, told the committee that while often eight-hour cancer surgeries had a high survival rate many patients were not happy to survive, given the subsequent poor quality of life.

The reason I point to that one is because today's committee—and I will get to the committee members—use those sorts of cases to go directly to the minister and say, 'Minister for Health, this has been brought to the committee's attention. I think it's something that we could address quite reasonably without a huge cost blowout in South Australia. We are the only state who is not doing something. How about it?' That is currently one that we know is still sitting with the minister, and I have been assured that they are trying very hard to get that done.

I will point to another example, and I know the Hon. Tung Ngo is exceptionally pleased with this one. I visited Uniting Communities Streetlink Youth Health Service. They had only a couple of months left of funding. We talked about what we could do. I said, 'Why don't you come and tell the committee about what's going on down here and the vital and critical service that you play?' You did not really have to ask any questions because you could see how convinced all members were of the important work they had done.

The Hon. Tung Ngo and the Hon. Dennis Hood proposed and seconded a letter to Minister Picton in order to secure funding to keep that service going. Lo and behold, there was a positive outcome. That service was further funded. It is a service that plays such a critical role for transient and homeless people in the state, people who can walk in and have access to health services, who would otherwise end up at our hospital doors and further impact the health sector.

There are lots of these sorts of instances where the committee heard about the really critical services that exist out in the community. In the scheme of things, they needed very frugal funds or input from government to allow them to continue to play their part in terms of relieving the health system overall from further strains.

We heard from Dr Megan Brooks about the lack of resources in primary care and the calls for investment in nurse practitioner and advanced clinical practice roles and expanded scope of practice. Pharmacists appeared before the committee as well. We did the first inquiry into UTIs and then a number of subsequent inquiries into the need for full scope of practice. We know that those things are then used as levers to have those discussions with the health department.

I will not run through all of the sorts of examples as I am very mindful of the time. The Mental Health Coalition has provided evidence several times. It would be remiss of me not to mention SASMOA. Professor Svigos and Professor Warren Jones have done extraordinary work providing witnesses and experts who have appeared before that committee really successfully. There are campaigns that are, 'Let's just present before this committee and see if we can get an outcome,' and in so many cases it has resulted in really fruitful, useful and beneficial outcomes.

The Women's and Children's Hospital were very regular witnesses before this committee for the previous report. If you were to go down to the Women's and Children's Hospital you would find they attribute a lot of the success around getting 49 additional doctors to the work they were able to achieve through that committee. These are extraordinarily, I think, important things. The Michael Rice ward for paediatric cancer, the ICU paediatric unit at the Women's and Children's Hospital: all of these are the sorts of things that we have raised over the years at this committee.

I am extremely grateful to have had the privilege of chairing this committee. There are a host of others. I know that Minister Picton's team listen intently to see what is coming next at this committee. I would just like to say that at the end of this, the final report of this committee, there was only one recommendation made with unanimous support of all members who have served on the committee, and that is that the committee do indeed continue in the next term of parliament. I impress that upon members in this place.

I am extremely grateful to have served with amazing colleagues on this. I thank the Hon. Tung Ngo at the moment and the Hon. Dennis Hood in particular—it has been a privilege to serve with both of you—and the Hon. Russell Wortley and the Hon. Michelle Lensink. There have been previous members, including the Hons Ms Bourke, Ms Centofanti, Mr Dawkins, Ms Pnevmatikos, Mr Stephens, Mr Wade and Mrs Henderson, and of course the members I have just mentioned.

I love the way this current committee has gone about its work. We do not meet on a set day. It is not rigid, but we have made it issue based. When something comes up and people want somewhere to go, then the committee is there, much in Budget and Finance style. We have been very fortunate to have Dr Robinson sit through those with us. I thank our secretariat, Mr Beasley and Dr Robinson, for their work on the committee. I think we hit the jackpot when we got Dr Robinson as our research officer in this case, working through the sort of evidence that has been presented to this committee.

I am going to end by again thanking everyone for their service and maybe thanking the Hon. Ian Hunter for the deal we did way back when we got this committee off the ground. I impress upon this parliament how critical a role this committee has played, regardless of which side of politics you sit on. It has played a critical role in terms of transparency, accountability and our responsibility towards what is in the public interest in ensuring that things that are in the public interest indeed do make their way into the public domain.

The only other case that I will mention on that point is that, had it not been for this committee, that cluster of baby deaths during COVID is not something that would have made its way into the public domain. That is probably the best demonstration of the impartial way that we have gone about serving on that committee and the work that it has done. I thank honourable members and remind everybody what a wonderful committee this has been. I seek their commitment to ensuring that it continues in the future.

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