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House of Assembly - Fifty-First Parliament, Second Session (51-2)
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HEALTH CARE BILL

Second Reading

Adjourned debate on second reading.

(Continued from 27 September 2007. Page 983.)

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (11:01): This bill was introduced by the Minister for Health on 27 September 2007. On behalf of the opposition, I thank ministerial staff and departmental officers for the two briefings (15 and 22 October) that were provided on this bill. It is fair to say that the bill has been under discussion in the broader community (although we will have some comment to make on the consultation process) over a sustained period—effectively, over the last two years. The government issued a draft bill on 1 August 2007 to a wide range of stakeholders, members of parliament and boards, seeking their comments by 10 August 2007.

There has been some variation from the draft bill, leading to the bill that has now been introduced for our consideration. Generally, this measure introduces reforms to the governance and administration of hospitals and health services and, in particular, provides for the abolition of hospital unit boards and the introduction of centralised decision-making. It also brings the ambulance services in South Australia under the direct responsibility of the Minister for Health. Ambulance services in South Australia have historically sat with health; they have operated under emergency services as well and have then been brought back under health, and are now being legislatively restructured, with certain new parameters, under this bill.

Specifically, the bill will provide for the administration of hospitals and health services under a new structure, which will be detailed. The bill will establish a health performance council as essentially the new consumer voice. The council will establish health advisory councils to replace, in certain circumstances, although not directly replicate the unit boards that operate across the state. It is to provide for the licensing of ambulance services and the licensing systems for our private hospitals. The bill proposes to effect this change and comprehensive review of governance, at least of the public health sector, by repealing the Ambulance Services Act 1992, the Hospital Act 1934 and the SA Health Commission Act 1976.

The opposition opposes this bill. That opposition is comprehensive and without dissent. I will present to the parliament a number of reasons why the opposition opposes this bill. It is fair to say that there are five important points. First, the governance reform in this bill has been highly selectively cherry picked from the Generational Health Review. Whilst aspects of it are consistent with Mr Menadue’s report, there are glaring omissions from the governance structure proposed in this bill. Secondly, the opposition utterly opposes the centralised employment of some 25,000 employees of the Department of Health and its regional offices and the services that it provides in the community.

Thirdly, the opposition says that the removal of hospital boards, particularly in the absence of a regional structure, fails to recognise the value of what these boards have done over the past 160 years of this state's history (during which time there has been significant public health administration) and the contribution they make; and the bill also introduces a regime under which the minister has the ultimate power to dispose of these boards by referring to them subsequently as health advisory councils (HACs) without their consent. Fourthly, health advisory councils will have no effective influence; they will be a voice only. These hospital boards, as a group, historically have been an important advocate for communities and consumers, but health advisory councils will be a voice with no influence.

Finally, the bill deals only partly with the governance of health. It proposes to change comprehensively the governance arrangements for the public hospital and health sector, but it simply translates the licensing provision for the private hospitals in South Australia from the previous legislation. The minister says, 'We will review that and fix it up later.' This is consistent with this government's piecemeal approach to a myriad of legislation; it is not acceptable in health as it has not been acceptable in education reform, planning reform and local government reform. It is not acceptable that the government says that it is necessary to do a review of health after 30 years of the current legislation (I refer, in particular, to the South Australian Health Commission Act) and only do half of it. That is not acceptable to the opposition. We need to see the full disclosure on the table about what is going to happen. Our private hospitals do not deserve to be tacked on with a proviso that says; 'We will review you'—which we need to do—'but we will do it later.'

Finally, I would say that I will have a significant amount to say about the Health Performance Council which has been proposed by the government and which has a structure within this proposed legislation. I think it is fair to say that the opposition would see it at first blush as being an important initiative if you are going to have any voice for consumers and any capacity for patients, consumers, their families and the local communities to have some genuine access to it and a reporting and accountability process to parliament.

At first blush, that looks pretty good. I propose to outline to the parliament my concerns, however, about what we are about to receive in this bill and what will be a welded-on attachment to the Education Department and about the minister, with the Independents, trying to suggest that someone can vote independently if they are a member of the ALP caucus and have a say, but they cannot ultimately go against caucus rules. That is how independent it is, and I will have a bit to say about the Health Performance Council in that regard.

I have indicated a summary of the effect of the bill in relation to governance reform, but I will briefly refer to the minister's contribution on the question of: where we are going in governance reform and why, what is the justification and rationale for this approach, and what is the single area of reform that is actually being proposed. The minister pointed out that, as a state, we have a very good public health system, staffed by very committed health professionals and administrative staff.

He says, however, that it is important, if we are to provide safe and effective health services for the future, that we review legislation that has now been over 30 years in operation. The minister says that it is legislation which was developed over 30 years ago and which is now in need of major reform that is necessary to respond to contemporary and future demands. I am not quite sure whether that means that if you have got legislation that is 30 years old or more that that is in itself a ground for reform, but I think he does qualify that down the track.

I would have to say that if the government is relying on legislative review and reform because legislation is 30 years old, then I cannot wait to receive the complete review of the Education Act which, of course, has been sitting there since 1972, which had been comprehensively investigated by a previous government and parliament prior to 2001 and the review of which still has not seen the light of day. Nevertheless, the minister goes on to tell us that there are significant challenges to the health system which, as he says, 'make it increasingly difficult for the public health system to meet the demands in a cost-effective and equitable way unless reforms to the health system are instituted'. He then goes on to say that some of these pressures and trends are recorded and reported upon in the Generational Health Review report, of which Mr John Menadue was the author and which I will refer to shortly.

The minister claims in his second reading speech that, 'It'—meaning the Generational Health Review report—'clearly identified fragmentation and duplication of planning, funding and governance arrangements as major inhibitors to the development of a coordinated health system, and a systematic approach to improvements in health outcomes for South Australia.' He then points out that this bill does represent the opportunity for the house to be able to make fundamental reforms on governance arrangements. He says:

Without these reforms South Australia risks having a public health system that is incapable of meeting the challenges identified in the GHR report and by other national and international bodies to provide a more sustainable public health system with better and more equitable outcomes for its population.

He goes on to say that, to effect greater coordination, less fragmentation and the reduction of unnecessary duplication, it has been clearly identified by the GHR that there are barriers to that. To address those he says:

The Health Care Bill will enable the Chief Executive of the Department of Health to have the overall responsibility and greater control over services provided by the public health system. This will enable the public health system to have a much better capacity to act as a coordinated, strategic and integrated system.

He then goes on to say that, with some qualification, the chief executive is responsible to the minister, with neither the minister nor the chief executive being able to give a direction in respect of clinical treatment of a particular person. With that qualification, he says to the parliament in his contribution that it is necessary to vest and centralise this power to the chief executive, overseen by him as the minister, to effect these changes. He also goes on to talk about the objectives (which I will refer to in some detail later) and dealing with a population focus and a primary health focus, which I do not have much issue with. However, I want to go back to the governance aspect and what the Generational Health Review really says.

The Generational Health Review, identified as Better Choices, Better Health; Final Report of the South Australian Generational Health Review, published in April 2003, was presented and announced by the Hon. Lea Stevens, the former minister for health, after the review committee had been appointed in May 2002, chaired by Mr John Menadue, as I have previously said. Intending no disrespect to him, I should recognise that it is Mr John Menadue AO. There were some additional documents and reports with important data and, I suppose, a statistical snapshot of South Australia's health, which was largely prepared from national ABS and state data and reports.

I think it is fair to say that it presented the need for a change in the way we delivered health services if we were going to address two important things: one being the increasing demand and diminishing workforce of the future—and I will not go into the arguments about how valid they are, but that is essentially one aspect; and, secondly, the need to appreciate that, with current social circumstances, it was important that we start to have very clear, statistically-based population data underpinning any decisions to be made about future health. I do not take much issue with that because it is important.

I will be referring to what is being done in other states shortly, but there is no question that we have social factors of inequity which need to be addressed, and we have circumstances dealing with chronic disease, an ageing population and the like, which continually need to be addressed. They are not new—and I will provide some historical context of this to the parliament; they are not an invention of John Menadue; they are not a new groundbreaking news basis for the Premier; and they are not the justification for this bill. They are not new factors, but they are ones which I agree with Mr Menadue need to be addressed.

Mr Menadue indicates further that we need to look at aspects, including primary health focus, in our priority objectives. He says that there is a pressing need to deal with a number of these issues because, essentially, if not for social equity then for pragmatic cost reasons it is an issue which is currently usurping a very large proportion of our state finances and budget. I do not actually agree with everything Mr Menadue said on this. I notice that the information in his report is largely provided by the state government and the department, and fails to address the question of how much state and federal governments are actually spending on health relative to their total expenditure—and that shows a very different picture.

It certainly is not consistent with Treasurer Foley's public announcements that health pressure is the reason that he has delayed the budget. The cumbersome burden of having to meet requests for extra funding has now fallen upon the Treasurer, who has made excuses for not being able to meet those requests, and this has been the major driver in his announcements on taxation measures, with references to the rejection of refund ideas and applications for further projects in other jurisdictions of responsibility. According to the Treasurer, health is all consuming, and it is an issue about which information has been transferred to Mr Menadue—it is in his report—and, having received it, he says it is a very important aspect that needs to be considered. In relation to a population-based health governance consistent with the direction we take, with the objectives and with how that is to be implemented, Mr Menadue says:

The power to direct and control resources and health services lies principally at the ministerial level. However, to balance central control and direction and responsiveness to local communities, there is a need for a principal governing body with adequate authority and responsibility for promoting and managing health services for a defined geographical population.

The report does not say that, to effect this objective, all power has to vest in the chief executive and the minister: it does not say that there and it does not say it anywhere in this report. It does say:

Local community participation in health-care agencies and issues needs to be maintained and strengthened. It is important to recognise the continuing interest of local communities in assets that they have funded, and to support and encourage ongoing fundraising and contribution in kind.

Further, the health services:

will require the dissolution of incorporation of all health units and the integration of their management into regional health services.

Mr Menadue has made a very clear statement in the paper today when weighing in on the discussions held at a federal level about introducing local boards for the administration of direct capital funding to public hospitals—a proposal announced by the federal health minister. He states (and this supports the minister's position):

The key to reform in SA was getting rid of—

'was'—it has not even happened yet—

—the hospital boards—they maintain little fiefdoms, silos, they look after their own patch and resist integration.

I will have a bit to say about these hospital and health service boards and what they have done, what contribution they have made to the state, and what they have done to rationalise and regionalise health services, particularly over the last 30 years. In the meantime, John Menadue makes it perfectly clear in his report and in the paper again today that local boards are not the way to go. That is an endorsement of what the minister says. But he also makes a number of recommendations—and this is where the selective cherry-picking comes in with this whole notion of abolishing metropolitan and country health unit or regional boards. He states:

Legislation needs to make the system more accountable to the community with health system performance and decision-making more transparent and inclusive. The Generational Health Review understands that legislative amendment is a likely prerequisite to the formation of the recommended new country regions and the dissolution of the health units.

What has happened here is that the government has said, 'Great! Here's the endorsement. Get rid of those pesky little health boards; they are just a nuisance. All they do is provide us with advice and they are able to criticise.' They have absolute protection under the current legislation from the minister interfering with their assets, with their staff selection, or with their delivery of service.

Of course, they are bound by a whole lot of quality standards and other things, but there is direct protection in the current legislation providing that the minister shall not interfere with those three areas. And what is really important is that, although the minister has seen fit to introduce this legislation to get rid of these boards—which has the endorsement of Mr Menadue in his report—the bill fails at every level to actually provide what he also recommends; that is, regional structure for a voice and a capacity to remain directly involved. By that, I do not mean some performance council that is a welded-on attachment to him or his department or health advisory councils that he can dispose of if he does not like them. The minister needs to re-read this report and understand that the opposition will not participate in the restructure of governance with the extermination of one group on a recommendation in a report and yet patently ignore another.

If you are to have any understanding of how damaging it is to say, 'We'll introduce a new structure without both sides of the picture,' then all we have to do is look at the announcement of the health care plan in June. This is a new plan to cover us in terms of health services to be delivered in South Australia over the next 10 years. It has been openly and repeatedly criticised not just by members of the medical profession, but by consumers, patients, current employees of hospitals and health services, and the clinical, medical and nursing fraternity. We have a situation where the government has announced the plan, put it on the table and said, 'This is what's going to happen, and now we'll consult with you.'

If there was ever an example that should make members of the house patently aware of how unreliable a commitment by the government is to ensure that we maintain an involvement and consultation with stakeholders—clinicians, patients, family members of patients, local communities, and particularly those who are at risk of social inequity (whether they be people from the western suburbs of Adelaide or from remote townships in country South Australia)—this ought to be a sobering reminder that unless a commitment is in the legislation we cannot trust the government to honour it. And I will have a bit more to say about that later.

In his report, Mr Menadue refers to integrated community care services as being the new name for the medical services that will be provided in rural and regional areas. That concerns me because he says that they will still be a key support to primary care services in the regions. He talks about the networking that will take place across a range of locations from a single centre and indicates that they will include minor and elective procedures, chemotherapy, outpatient medical, surgical, high dependency, uncomplicated obstetrics and mental health assessment and treatment in conjunction with general practice. He says:

Integrated community care centres will, in the main, evolve from existing rural regional and metropolitan hospitals and each proposed region would have at least one facility that could be an integrated community care centre. These centres will require inpatient, day patient and diagnostic facilities to be on site.

If you are one of the lucky ones in the country—one of four—you have a chance of getting a good swag of these. However, God help you if you live a long way from any of these major centres of Port Lincoln, Whyalla, Berri (from recollection) and Mount Gambier—and I will come to the importance of those centres not just for country people. I want to make this point: it is very important to provide medical and health services not just for the people who live in remote, regional and country areas of South Australia and who, I might add, comprise a third of the state's population. I think it is important for the parliament to appreciate that people who live in Unley, Burnside or Enfield travel to the country.

We have population on the move, especially grey nomads; people who have been inspired by the beautiful natural environment of the state are crisscrossing all over the state and country. We have highways and road access to every possible retreat, resort and place of respite you can think of. People are crisscrossing our state on our roads, and they need those health services. In fact, when we look at the network of health services across the state, we find that they are utilised not only by the people who live there but also by the people who travel back and forth as a tourist, a truck driver or as someone providing a service, such as the myriad of people in the Public Service who live in metropolitan Adelaide and who travel to and participate in the activities of regional areas as a result of their work obligations.

We have a mass of people out there who rely on and require these services. We already have some towns that are experiencing a summer invasion, whether they be small towns, such as Elliston on the West Coast, Streaky Bay, Venus Bay or Emu Bay on Kangaroo Island. They suddenly treble their population in the summer when people come to holiday, fish and so on. We also have areas such as Port Lincoln and Victor Harbor, which are attractive locations for spending weekends (and I do not mean any disrespect to those places I do not name) and which have a major transient population who utilise the services. Just ask any general practitioner in these towns how many fish hooks they have to take out of some child's finger during the summer period and you will have some idea of the increased level of service that is needed in coastal regional and rural towns.

Mr Menadue was quite clear in his recommendations that it was necessary also to make sure that services are provided at a local level. Thirdly, apart from making sure the services were available at that local level, he was very clear in his recommendations that it was important to include the people of South Australia who have an interest in or an alliance with this area. Obviously, he is talking about a cohort of patients, former patients, clinicians, hospital administrators, departmental advisers, universities and research teams—all the people who have an interest. Probably the biggest cohort, of course, are those people involved in the nursing and caring services.

I should mention so that it is clear that I am not attempting to exclude in any way those who provide allied health services. It was important that they be part of this, and I thought that was a very important statement in the Generational Health Review. The publication of the South Australian Health Plan and the cries of discontent and anger from people excluded from consultation beforehand ought, again, be a sobering reminder that the government has cherry-picked out of the Generational Health Review what suits it and simply ignored other important aspects.

Of course, the consequence of the South Australian Health Plan is that the government's announcement that it will transform a number of hospitals into general hospitals in the metropolitan area—and they are to be Noarlunga, the Repatriation General Hospital, the Queen Elizabeth Hospital and the Modbury Hospital—has produced an alarming level of concern at the community level. The minister will say, as his representatives have said at public meetings on this issue, 'Well, all change can sometimes be hard to swallow', and that is true. For some people, change that may be necessary or desirable will always be difficult.

However, when you have not been told about it, when you have not been invited to make a submission and you are told, for example, in the Modbury region, that you do not need to have obstetric and more than 24-hour care for paediatric services, these people feel very aggrieved. Publicly at their local government meetings they have expressed their disquiet and urged the government to review its position.

They say, 'That's not right. You might have grabbed some data which says that we are not producing as many children as Roxby Downs or somewhere else in the state, but our catchment area and farther afield is still producing 700 babies a year. We do want these services, we do use them, and we expect to continue to use them. Some children were born here, and we want to have more and we want to have them here. How dare you come and tell us what services we need because of some demographic which the government has plucked out'—and which they claim is not even accurate.

The government should have made a genuine attempt to say 'Well, look, we will look at the population aspect because John Menadue has told us that we should. We will assess that and we will go out to that community and say that we think they are all getting old, that they are shrivelling up and that they are starting to need chronic disease management. They will not have many more babies and those who do can slip across to a few other hospitals. We think that your demographics and your population leads to a trend for more services for an aged community. We are therefore thinking about increasing elective surgery, increasing palliative care services and providing support for the aged in terms of chronic disease management.' That is not always for the aged, I might mention, but it is commonly thrown in at the same level.

They could have said at that point, 'This is what we understand the position to be; what do you think?' But, no, they did not consult with the clinicians, the patients or the people who work in the Modbury Hospital. The best the Modbury Hospital got was an announcement that the government would de-privatise it, bring all the staff back onto its books, and, that after that had happened, that it would be centrally controlled and that it would then have services that would be determined by the chief executive.

That is not only a lack of consultation but also a deceptive act to this community. It is just one example of where there has been not only a failure by the government to come clean on this issue and take the people with them, as the Generational Health Review recommends (as do others that I will mention later) but also the complete evaporation of any chance of anyone trusting the government to consult with these local communities. It has totally evaporated. Those commitments have been demonstrably ignored and a totally different direction has been taken.

So much for the Generational Health Review; an important review—and we have had plenty of them. I will refer to a number we have had over the years. The review is an important document, and I commend it to members as a contemporary assessment of our situation overall. Because I do not agree with some of the things in it—or with some of the things the government has given to Mr Menadue—does not mean it is not an important document.

I refer to a second example of how the government has progressed the governance reform in a way which is not only inconsistent but also highly selective. The government will say it is consistent, as it is has plucked out that paragraph and supported that, having selectively cherry-picked, but it is important that we examine what has happened over the past few years since the committee reported in April 2003. As a first stage of hospital board reform, the government issued policies of statement and direction in June 2003 to establish a regional health structure. These largely related to metropolitan health services and were claimed to be part of the better accountability, improving services, building capacity and so on that have been covered, all of which sound good.

To have an integrated system of care, it announced that it would establish two regional health services for Adelaide: the central northern region, to include the Royal Adelaide, Queen Elizabeth and Lyell McEwin hospitals, St Margaret's Rehabilitation Centre, Modbury Hospital and a number of community health services; and, a second southern region, to include the Flinders Medical Centre, Noarlunga Health Service and a number of other community and mental health services. It announced at that time that the Repatriation General Hospital, which had been invited to be part of that, had declined (and I will refer to that in some detail later and probably in committee).

Importantly, the independence of the Repatriation General Hospital, consistent with the statements of the Premier, former minister and this minister (in his comments in the second reading speech of this bill) was to remain, with it having its own board and unit—it will be the only one left in the state—and it was able to have its wishes respected and not be brought into the southern regional board.

The third one was to create in many ways a statewide but still metropolitan-based regional board for all the women's, children's and youth services but, principally, it was the Women's and Children's Hospital (which was amalgamated in 1989) and Child and Youth Health in order to provide one regional board to deal with all those services; so a significant hospital and health services under that board. Furthermore, it would support the existing regional structures in country SA and work with those units to collaborate on reform. At this stage, there was no mention whatsoever about abolishing the regional boards which had been set up a number of years before. They had local hospital and health centre boards, as well as regional boards. They do not get a mention at this point.

What is important is that in the published material of the government it announced 'there will be no forced removal of local boards in country South Australia'. There it is in black and white in June 2003 after the Generational Health Review has come down. It was an indication that it wanted to move along with governance and not be just added on the end or tacked in the middle but, rather, it made a bold public commitment that there would be no forced removal of local boards in country South Australia.

It is hardly surprising that the former minister subsequently went to country communities prior to December 2005 and said, 'What do you say about disbanding the regional boards because we do not need them any more?' Do members think they would have taken some comfort from the published material of the government which stated that there would be no forced removal of the local boards? Of course they did. They are entitled reasonably to accept that, if the government has published it, it is a genuine commitment which would be honoured. Why wouldn't they?

The government had made the statement and made it abundantly clear that, in getting rid of all the unit boards from the Women's and Children's Hospital, the Queen Elizabeth Hospital and the Flinders Medical Centre in order to have regional boards, when it made a commitment to the country health units and said, 'We will get rid of regional boards,' of course they would line up and say, 'They have done their service.' In essence, the country community has said to me that they have done their service. We have used them as an important instrument in getting together within regions and working out how we rationalise and regionalise the services. It has been a good initiative to do that and they have been able to sit down and work out what limited resources they have. Governments do not have an endless purse, but they are able to say, 'How can we do that in our community? What is the best way we can manage that?' They have done their job.

When I have gone around South Australia and seen country health services from allied to acute services, including aged care, I have to say that they have done a fantastic job of doing the hard decision making in their own communities, rationalising those services and making sure they have best and maximum use of the funds and resources available. So their time was finished, their purpose had expired and the government got rid of them.

Not only were these people unable to rely on this statement as being a genuine, true and committed statement of the government, but also they were not told at the time of the abolition of the local hospital boards that there was any such move on the agenda. There was no mention of it. Instead of this government going to the people of South Australia and saying, 'We need to reform and here is the case for reform. We need some governance and structural reform to facilitate that, otherwise we will go broke, and these are the reasons,' the regional structure of boards was completely removed.

There was not only this statement circulating out there but also no disclosure whatsoever of their intent to abolish the local unit boards, which have in some cases for over 100 years provided the service, raised the money and ensured that the sick and disabled in our community were looked after. If the government was honest and prepared to do as Mr Menadue says, that is, take the community with you when you do the reform, at the very least it would have been honest. Decency would have demanded that the government be honest with this reform. It would have put its case—and it may have had to be a fairly persuasive argument—listened to the response and then made its decision. But, no, it had to go for this big concealment of disclosure approach, and I have rapidly learned that we cannot always trust and rely upon the government's commitments in this regard.

So, there are very specific precedents and examples of the government's form in this regard, and it gives no comfort when we look at what else we can rely on when the government makes a commitment. This is important because, like a lot of legislation that comes into this house (and it may not have always been this way but certainly has been in the five years I have been here while this government has been in power), we are constantly told, 'When the regulations come out we will have this detail covered and we will let you know,' etc. We have always had regulatory power.

I have seen legislation come out in the previous 25 years which we have had to interpret as lawyers, and I have to say that the regulatory and rules powers seem to take up an extraordinary amount of paper these days and there has been a reduction in detail in the legislation which would let the parliament and the people know what is happening as it goes through. You must be able to trust a government to give you the full picture and a commitment and not go back on it. We must have full disclosure, and we must have that before we are expected to sign up to something that is, on the face of it, an alarming reform without adequate nexus to the benefits that the government claims will follow.

I think it is important in this debate that we look at the history of the SA Health Commission Act. It is not the only act we are repealing and reproducing in the areas covered in this bill, and this is not to diminish the ambulance services and hospitals acts in the aspects that are important. The SA Health Commission Act of 1976 was somewhat of a watershed in what had happened in the previous 130 years or so of the colony and state in relation to health.

I will refer to the preceding couple of centuries later in my speech, but I now want to refer to the SA Health Commission Act 1976. As the minister pointed out, this legislation is 30 years old and it needs to be reviewed: it has to change if we are to implement what he says are the necessary outcomes to keep health on the rails as a contemporary service. It is fair to say that, prior to 1976, the South Australian health service was overseen by a number of bodies, including the hospitals department, the public health department, mental health services and various other organisations. Those bodies were all administered through various acts. There was concern that the services were fragmented and lacked an adequate degree of control (it has a familiar ring to it, does it not?). For example, there were a number of hospitals that were not even formerly part of the health system.

There was a general review of the matter under the Dunstan administration in the early 1970s. Justice Bright (as he then was) was commissioned, and a committee was formed, to conduct a very significant review. The Bright report (which was published, I think, in 1973-74) was the basis upon which there was a significant catalyst for the reorganisation of the state health services. It is also important to remember that at that stage there had been a change of government federally—fleetingly, thank goodness—and the then prime minister, Mr Whitlam, had introduced a new regime for the provision of medical services—the original Medibank—and we had a whole new structure that related to that. So, it was probably an important time to undertake the review, which became the catalyst for what became extensive and pretty fiery debates in 1976 in this house and in the other place.

Among the recommendations of the Bright report was the suggestion that there should be a single authority external to the Public Service to bring within a unified system of control all health services provided or subsidised by the government, to rationalise the activities of voluntary bodies in the health field and to regionalise and localise the administration of government health services. A portion of that is a direct quote from the report.

The government of the day accepted that, and it introduced the South Australian Health Commission Bill—it is a little bit of deja vu: not only have I read the same things in the Bright report as are in the Menadue report, even about ageing populations (and I will come to that again in a minute), but what is incredible is that the Australian Labor Party has form in government, with respect to health governance reform, of being quite deceptive in bringing legislation to this parliament that it claims reflects the recommendations of a review and a report, but which we find is quite glaringly different.

So, not only have I exposed this state government and its failure to follow the recommendations of all of what John Menadue said in relation to governance reform—that is, cherry-picked it out—but the same thing happened 30 years ago in this very parliament, when the Bright report said that we do need the reform (and I have read the statement), and the government went on to establish a health commission in the bill through the parliament. However, what it did not do was follow the Bright recommendation to give this health commission the independent status that had been recommended. In fact, it was critical, according to the Bright report, that if health services are centralised they must be independent of the health department and the bureaucrats, and there must be that arm's length.

The bill fortunately had a fairly rough passage through the parliament and, ultimately, underwent very significant amendment after a further parliamentary inquiry into this matter. The government of the day was caught out and the matter went off to an inquiry. It then attracted some amendment not only to deal with the rationalisation, coordination and centralisation—all that—but also to ensure that there was an arm's length commission. Members who made a contribution to the debate at the time included the Hon. Don Banfield, who was a minister for health from about 1973 to 1979, and the now infamous Peter Duncan, who was also a minister for health. Perhaps it is fortunate that he was only the minister for health for six months, but I will refer to him later in relation to what he oversaw in the sausagegate meat scandal of 1979.

In any event, Mr Banfield was perhaps one of the lesser known members of that government—he did not wear pink pants or safari suits like Hugh Hudson and others—but he was a longstanding and respected health minister. He introduced this bill which claimed to be consistent with the Bright report but which was far from it. David Tonkin, the leader of the opposition at that stage and subsequently premier of this state, had this to say:

I oppose this bill, which is connected with one of the most blatant pieces of misrepresentation that has ever emanated from the health department. I say that advisedly. It has possibly resulted from the instigation of the minister, who is showing an extreme amount of interest in its passage through the house. In the second reading explanation the following reference was made to the Bright committee report: 'Following a detailed study of the recommendations contained in that report, the government accepted the broad principles of the recommendations and has since that time attempted to implement some of the recommendations relating to community health and the expansion of mental health services.' That is the biggest piece of con work I have seen for a long time. The statement implies that this legislation now before the house is in some way implementing the recommendations of the Bright committee report. That is a sham and a fraud, because this bill does not in any way implement the main recommendations of that report, and the minister knows it.

They got form on what they say is legislation supported by a report. Dr Tonkin pointed out that this report contained a number of things. I want to summarise what they were, because I think they are as important today as they were then. Dr Tonkin further said:

Chapter 3 of that report states: 'The purposes we have in mind are...(a) to bring within a unified control all health services provided by the government...(b) to administer and control every service provided by government agency at a point as close as possible to the place where that service is provided...(c)to encourage existing and new voluntary health services...and to bring the activities of the voluntary bodies in the health field into a unified pattern of health care delivery.' In other words, function a coordinating body, a body which will not discourage voluntary enrolment but which will encourage it and direct it through coordination into areas where, if it so chooses, each body concerned can do the best it can for the community...What have we got? Instead of that situation, we have another government department. It can be called an authority, a commission, or any name one cares to choose. It can be described as a corporate body but it still exists within the Public Service. It is still nothing more than an enlarged government department.

There were many other contributors to this debate—on both sides of the house and in another place—and there were some important reforms to bring development back on track so that it had some consistency with what was in the Bright report. However, this ought to confirm to parliament just how far this government, and its predecessor Labor governments (and I have a few more to point out shortly), are prepared to go to achieve what they want—that is: central control; the silence of critics; getting rid of those in the way; and to have it all put under the umbrella of 'We fund it so we ought to be responsible and directly accountable; therefore we should make all the decisions.' They have been trying to do that for 30 years; they have tried to get away with it and deceive parliament in the past, and they are trying to get away with it this time.

When the Health Commission Act went through that process there were a number of aspects to it. One was that the legislation identified the constitution of the commission which, at that stage, had to be three full-time members and no more than five part-time members who were also to have the necessary expertise and experience needed to effectively deal with health services—that is it was, to a large degree, a skills-based commission. The powers and functions of the board were to extend to all areas of health services in South Australia, and organisations providing health services could be incorporated under the act, which formalised their relationship with the commission. It was a requirement that government hospitals and health care centres where incorporated; however, in those days other health providers could be incorporated under consent. It also had delegation powers and the power to appoint committees.

There was a staged approach to the implementation of this. By 1980 we saw some amendment to the composition of the commission, with the three full-time members being replaced by one full-time member (who was to be the chairman), and with the five part-time members being increased to seven. The chairman also became the CEO of the commission. The role of the commission was further defined in 1981 when the regional sectors were introduced—and it is interesting that this was during the regime of the Adamson ministry (Jennifer Cashmore, as she later became), when there had been recognition by the Liberal government of the importance of regional entities.

When the Bannon Labor government came into power we had a series of different ministers, and further changes were made in 1983 regarding the composition of the committee. The Labor administration came in and changed the number of full-time members from one back to two, and changed the number of part-time members from seven down to three. They abolished the Health Service Advisory Committee altogether. By 1987, 20 years ago (and true to form, as we have seen repeated in history), it got rid of the regional structure.

When one considers some of the information available at that time—including a subsequent book written by Dr John Cornwall, who was a minister for health during this period (indeed, for a significant time under the Bannon government)—it is interesting how deja vu this all is.

So, there was a major change in the 1970s; implementation, with amendments, during the early 1980s; and we had a regionalisation and recognition under the Adamson ministry and Tonkin government. Then, of course, the Bannon era began, and there was sweeping change, with the regional groups being abolished.

At that time, the act was amended to ensure that 'respective roles, functions and responsibilities of the commission and hospitals were defined clearly and unambiguously. These included amending a provision so that the commission was to be 'subject to the control and direction of the minister'. So, history is repeating itself, and you have to go back only 30 years. We have already gone from central, regional to central—and we are only up to 1987. In relation to the Health Commission's ability to function and the need for reform, in a book published in 1989, Dr Cornwall said:

What was far more important was the Health Commission's ability to manage the wider system in a rational and coordinated way. In any rural community, the local hospital provides the status, a symbol of social cohesion and sense of security in times of medical emergency. Locals can often boast that it was built, 'by my father and grandfather'. It ranks with the district councils as a significant employer. As several quality assurance studies have shown, the perception of security in times of medical emergency is occasionally misplaced. Although the standard of general practice in rural South Australia generally remains high, there are exceptions to the rule. On clinical and financial grounds, it is very difficult to justify the continuation of acute patient care and obstetric services in any small hospital which is less than 30 minutes road travel from a district or regional hospital.

If the smaller hospital combines this proximity with a low bed occupancy and a high day bed cost then its role and functions should be changed. Redistribution of budget resources in this way can provide a multimillion dollar expansion of community and mental health services, which are still urgently needed in many rural areas. Twenty-four hour casualty clearing services, backed up by some of the best road and aeromedical retrieval services in the world, can be maintained at their present level without staffing for surgical and obstetric services. There are major problems in rural medical practice; which include deficiencies in undergraduate and postgraduate training for a single or remote area practice; provision of locum services and locum allowances; a lack of adequate continuing education and refresher courses for rural practitioners; professional isolation; a lack of employment and career opportunity for spouses. Providing expensive acute inpatient services in small rural hospitals 20 minutes' drive from a larger district hospital,(where they can be admitted by their own GPs), solves none of these problems.

Well, deja vu—Dr Cornwall wrote that some 20 years ago, describing his time and the need for this reform, which occurred in 1987.

I suppose the Australian Labor Party never gives up. That is one thing about the Australian Labor Party: it tries and tries again, and it does the damage while it is in office, and here we are lined up again with the same problem. In 1994, under the Brown Liberal government, a new Department of Health was established, with the CEO reporting to the minister for health. It had a new departmental structure, with not much in relation to autonomy. In 2002, under the subsequent Olsen government, further SA health commission legislation was introduced, which the then government described as: 'to streamline administrative arrangements and to more appropriately reflect the legislation what was occurring in practice'.

The act also sought 'to clarify the functions which would reside with the Commission and those which would more appropriately be vested in the minister'. So, it is fair to say that, at this stage, there was a redefining legislatively of what the commission and the minister would do. It is fair to say that they were very distinct functions, and ministers Armitage and Brown were involved in those deliberations and the subsequent amendments.

Notwithstanding that Dr John Cornwall had centralised extensively in his reforms of the 1980s, and whilst there had been some identification of powers in the early periods of the Brown-Olsen government—who we might remember were somewhat pressed with attention at that time of the major collapse of the State Bank and the financial pressures that that brought on everyone in this state and the legacy it left—they undertook some reform of the legislation and they tidied that up. I will refer to that later when it comes to what we are moving into now.

I think it is important to note that a very significant piece of legislation that is independent of what we are discussing today has a significant effect, and I refer to the reforms that occurred as a result of the government's attempts to protect state employees from the potential negative effect of WorkChoices programs that had been introduced at a federal level in legislation. Of course, we, as the opposition, saw that as completely unnecessary because the state government was employing these people and, if they were at risk of anything, it was of the state government letting them down, not a federal policy which had absolutely no jurisdiction whatsoever over their employees.

Nevertheless, all around Australia, they presented this legislation in their state parliaments, puffed out their chests and pretended to be there to protect the workers of South Australia (their workers, their employees) against the evils of some federal government initiative which had no application to say that this is what they were going to do. But the truth of the matter is that, apart from a publicity stunt, this was a very important transfer and centralising of power to chief executive officers. So, the definition of 'employing authority' was changed from a designated person, as employing authorities to different classes of employees, to a transfer to the chief executive being the employing authority, and that was not just in the health department: it was in every other department in which there is public employment by the state government, in particular under the Statutes Amendment (Public Sector Employment) Act 2006, which is the legislation to which I refer.

That is something that I suppose has slipped in alongside all this in the development of governance reform on the provision of public health services in this state, and it is one which cannot be ignored or overlooked. My understanding of it at present is that it applies because it came into effect as of 1 July but there is some kind of directive (I am not sure of the nature of it) in which the chief executives of hospitals and health services—although, as a matter of law, they are directly accountable to the chief executive of the health department now—are required (so as not to offend the provisions of the current South Australian Health Commission Act) to be responsive to and respectful toward maintaining the relationship directly with their board, because they still exist.

The law still says that the minister is not to interfere, and so to ensure that there is no direct offending of that legislation they are acting under that direction. That is necessary, of course, until this parliament makes a decision in respect of the staff employed on those sites. Whilst there is a management role free of ministerial interference at certain levels then, of course, that should apply. I have no objection to the process, but it is that little piece of protection that is currently ensuring, as best it can, some continued relationship between the chief executives of hospitals, or health services, within the regions that they apply. Some of them are just single units and some of them have several services within them that apply.

I said in opening that the opposition absolutely opposed the centralising of this role to the chief executive of this department, or any department, and we remain utterly opposed to that. I will be referring to a number of philosophical differences between us and the Labor Party as to how this approach produces a fundamental difference in the way this area should be addressed. What I do want to say is this: the chief executive is a very important role, and if this legislation is passed it will give a power to whoever is sitting in the chief executive's office that we have never seen before in the history of governance in South Australia.

Dr Tony Sherbon is the current appointed chief executive. The comments that I am going to make about the history of this office are not to be directly reflected on his performance in the current role, because we are about to make legislation, if this legislation is passed, for all future chief executives: good, bad, useless, brilliant, whatever capacity, we are making legislation for the chief executive to have what I would see as, effectively, absolute control.

I think the minister, who in his speech presents as though he is going to have some capacity with the accountability chain coming up to him, thinks he is going to have quite a significant, I suppose, veto role and capacity where required. I am sure any minister, whether in the current government or whether they are ministers sitting on this side, will understand that, once you transfer that power to the chief executive, how the hell do you even know what he is doing half the time? So, it is important that, when we have areas of responsibility that are between ministers, chief executives, independent bodies, boards, unit representative committees or councils, we know exactly who is responsible for what.

One of the great protections is to ensure that we separate these and that there is a clear definition of who is responsible for what. As soon as you place it in the hands of one, trouble starts. I can tell you that there has been some trouble over the years, and I will be referring to a few of them, when you get dangerously close to absolving because it is too hard or transferring because you think you are doing the right thing, or referring because you think that it will be an effective mechanism, in this case, to provide for better health services in the future.

When I make this observation about the history of the chief executive role in this state, I do so for two reasons: one is because I think it is important that we understand what has happened in this role and what powers are being proposed to be transferred now. I suppose it is particularly important to Dr Sherbon, who is newly arrived in South Australia and is undertaking this role. He is from Canberra, and prior to that he was a resident of New South Wales, I understand, having held senior positions in health administration. I think it is important when he has a look at these debates—and I hope he has more than a glance because, after all, this could be called the Tony Sherbon bill, for all the power he is about to get—that he gain some understanding of what responsibility is going to be placed on his shoulders and where we see the potential deficiencies for both his office and others that may wish to challenge decisions he makes.

The minister himself is someone who has long been a resident of South Australia—and we welcome everyone to come and live in South Australia. We even welcomed the Premier, who turned up here from New Zealand in 1977. We welcome everybody. South Australia welcomes their ideas (especially if they have some good ideas on health reform) and invites them to participate, whether it is at government, parliamentary or private sector level. However, what we do not want is people (ignorant of what has gone before and saying, 'I know nothing') coming into this state and telling us what we should be doing, or trying to impose a regime which is copied from another state or jurisdiction without any rational assessment of the implementation of any similar approach.

I cite a classic example from New South Wales, where this matter was all dealt with back in 2004—same legislation, same powers, etc. However, without any rational assessment of what has been done, they come over here, pluck out bits of the managerial report that suits them and replicate this type of thing—which has been shown to state Labor governments all around this country—even though it has not brought about one scintilla of improvement in service delivery to citizen of those states. People are still lined up in emergency departments, there are still problems with readmission rates, as well as problems involving years of waiting on elective surgery and dental service lists. It is important that, if you are going to introduce an idea when you come into this state, you make it a good one, and then we will be happy to have a look at it.

I now want to refer to some historical context. I am pleased to have been provided with material by the Parliamentary Library relating to the administration of health services in this state. Members may be pleased to know that I am not about to read a 15-page chapter on this, but Dr Ian Forbes has produced a very concise historical account entitled 'From Colonial Surgeon to Health Commission', which is part of a history of the government's provision of health services in South Australia from 1836 to 1995. I think it is worth having a glance at this publication, which I will summarise from chapter 13. If I miss anyone out it is with no intention to overlook them because they are unimportant, but I just want to identify some aspects which I think are important here. This historical treatise states:

The administration of South Australia's health service was created with the appointment of a Colonial Surgeon. That was, in due course, euphemistically called the Medical Department and thus commenced as a one-man show. Initially, the duties of the Colonial Surgeon were to attend particularly to the indigent poor, and to others referred to him by resident commissioner of the immigration agent. By 1839 the Colonial Surgeon was also performing vaccinations.

We subsequently found the development of the role of inspector of hospitals, and at this point I want to recognise Dr James Geo. Nash. Many of these people, of course, are recognised in our health/hospital infrastructure history, and rightly so. The colonial surgeon and inspector of hospitals was a dual role. Initially, the colonial surgeon had a small department responsible to the Governor in Executive Council over 10 or 20 years, and it took a bit of time to increase that from one to two to three, and so on. Dr William Goss became acting colonial surgeon and superintendent of lunatics on 1 January 1856 and, by 1858, Robert Waters Moore had taken on that role.

This was a period in which we saw the development of the departmental role, or the support role, because the Adelaide Hospital was established, which later received royal consent to be named the Royal Adelaide Hospital by proclamation of the then Governor in 1936. We also had the Adelaide Children's Hospital by 1870 and the Queen Victoria Hospital by 1902, both of which were amalgamated many decades later in 1989. We have a history of mental health services—and I do not wish to overlook them. At the beginning of the colony, our poor mental health patients were in prison. The leaders of the day recognised the importance of those people having their own facility, and a dedicated mental health service and hospital were established where the Botanical Gardens now exist. By 1870, what became the very magnificent development of the Glenside Psychiatric Hospital on Fullarton Road, Glenside, had been built.

So, we had a significant number of public health facilities to deal with general medical health and vaccinations. If one remembers, this is a time—really up until the early 1900s—when we had the management of contagious diseases and the introduction of penicillin, by the 1930s, when we saw some radical reform. I briefly mention that, by 1889, the four government hospitals were wholly supported by the government and the department of the colonial surgeon; they were subsidised by the government, but managed their own affairs. Formerly, they were operating at Mount Gambier, Port Augusta, Wallaroo and Port Pirie and, latterly, also at Burra, Naracoorte, Kapunda and Jamestown.

So, within 20 or 30 years of settlement, we started a significant network and structure of hospitals. By 1885 we saw the development—and the funding to follow—of the St Margaret's Convalescent Hospital at Semaphore and the Belair Inebriate Retreat and Home for Incurables. By the early part of the 20th century, the government was starting to provide services for the young and also, particularly, for school medical services—again remembering that this was a period when contagious disease was a major health issue and a significant reason for a number of fatal contaminations.

After 1933, at a time when the mortality rate of infants comprised half the number of deaths in the colony, there was a period of significant transformation with the introduction of antibiotics. It was an entirely different profile of hospital and health services with very different diseases and demands. Whilst we had hospital facilities, it is fair to say that there were lots of isolation wards to contain the contagious conditions which, without antibiotics, were likely to cause the tragic death of many children.

The state's financial position has ebbed and flowed. Arguably, one could say that we should have plenty of money at the moment, but South Australia has been through some pretty tough periods, and by the late 1890s—about the time when women got the vote and won the right to stand for parliament—we started to have some pretty serious financial problems in this state. The mining and agrarian economies that were supposed to help our state to flourish had some setbacks, and we were in difficulty as a state, so it is important to remember this in that context.

Interestingly—I do not know whether Dr Sherbon would want to hear this—at the time there was such concern about the state of our finances that it was necessary for the colonial surgeon to take a cut in his salary of ₤600 per annum, and the salaries of the medical officers in Mount Gambier, Port Augusta and Port Pirie were reduced to ₤250, ₤200, and ₤150, respectively, in light of those circumstances. That does not apply any more, but a few times during our history there have been periods where we have had some trouble, and in those circumstances people have been asked to take a cut. That was not the weekly salary; it was the annual salary.

We have the long era from January 1919 of Mr Charles Spiller who was appointed as secretary to the inspector general of hospitals for the next 27 years. In the early part of the last century, in addition to the small staff for whom the early chief executive had responsibility, there were also seven country hospitals, including Port Adelaide (I do not think that it would want to be called a country hospital these days, it clearly is not, but it was then) and the Parkside mental hospital. The seven hospitals were Mount Gambier, Port Augusta, Port Lincoln, Wallaroo, Port Adelaide, Clare and Port Pirie.

There was a bit of growth in the department in the early part of last century. We also had the great development—again, I think because of the infant mortality issues—of mothers and babies health associations (formed in 1989) and the babies hospital, which also played a very important role. We had the advance of the Red Cross and a convalescent hospital at Woodville for soldiers which was built in 1912. Again, due to the circumstances of World War I, we saw a major commitment to health and hospital services not just in metropolitan Adelaide but across South Australia.

You can drive to town after town in this state and see the war memorial hospitals (general and country hospitals) that have been funded sometimes by huge bequests to recognise the importance of securing adequate rehabilitation services for returned servicemen. That commitment is obvious, and many of those services and facilities are still there today. I am proud to say that, just in the metropolitan area, we have the magnificent bequest by a former German soldier to establish the Burnside Memorial Hospital.

How is that for generosity? He came to Australia, recognised the importance of a facility for returned servicemen and was prepared to give it to a country and a people whose predecessors he had fought against. We had a generosity in our community that I do not think we have seen since. It was close after World War II, and there were certainly significant signs of it once we had healed all wounds post Vietnam. However, the capacity, the commitment, the industry and the preparedness to put the money and work into building hospital and health services across the state post World War I were magnificent, and I am sure that any other states would claim the same.

Because of the importance of contagious diseases, we saw the Mareeba Babies Hospital, which also provided magnificent training facilities. In 1954, we saw the development of the Queen Elizabeth Hospital, to which I think, Mareeba became attached at that stage, and the development of a number of other services and facilities. I recognise these in the hope that anyone reading this debate does not criticise what we achieved in general hospitals. There was a major expansion in the early part of the last century, particularly post World War I, when there were additional country hospitals, a number of which were subsidised. There were 28 by 1923; 30 the following year; 34 by 1925; 38 by the end of 1929; and 39 the following year. So, that just shows the industry and commitment these local communities had in the development of those hospitals.

As I have said, the Adelaide Hospital was given the royal charter to adopt the name of the Royal Adelaide Hospital in 1939. It was proudly received by the state and proclaimed by the then governor, and it is effective today. It will be interesting to see what happens when the government wants to bulldoze it—who will write to the Queen and tell her, 'Sorry; we don't need it any more. We have decided that we are not going to keep this name'? I would be concerned if one of the duties of our new Governor, Mr Kevin Scarce, were to fly to London with that task so early in his appointment. How disappointing that whole exercise is!

At this point I mention that, when we are talking about the government's cherry picking of the Menadue report as to what is needed in reform, not once in that report was there any mention whatsoever of the need for or desirability of building a $1.7 billion central hospital on North Terrace—not one mention. He talks about the importance of the capital development of existing structures, that sometimes we could not even keep up all those that were there and that there may need to be some rationalisation. However, he does not mention closing down the Royal Adelaide Hospital on North Terrace, moving it 200 yards down the street and paying $1.7 billion to build another hospital, not to mention what we now see is an additional $157 million in the budget under the transport portfolio to clean up the mess, and even that is under a cloud.

We had an assurance by the minister the other day, namely, 'No, that is all in order. That is fine. Some experts out there might be running around saying that it could cost as much as $700 million to $1.1 billion to clean up that site, but they have got it wrong. We have done the research. It will cost only $157 million.' Let me just make one point here, because the government (which has rushed through this idea of building a brand new hospital on the railway site) should ring up the Premier in Tasmania who announced his new hospital (before this lot) on a railway site in Hobart and see how he is getting on and whether there has been any blow-out in budget down there in respect of the clean-up of that site. Not only is the Premier's big announcement to build some fantastic new hospital and not rebuild the current one (which has had hundreds of millions of dollars spent on it in the past 10 years) original but he has copied it from his colleague in Tasmania who announced last year that he was going to build a new hospital (months before these guys even announced their idea) and that the preferred site was the railway yard in Hobart.

We will see about that. We will see what happens about the cost of the clean-up of that site to facilitate the government's new idea there. The important point is that there is no mention of it in the Generational Health Review, and there has been no mention of it by John Menadue since. He could have said, 'Oh, look, I did not put it in there but I should have'; or 'I omitted to mention it but it is a good idea.' I have not heard that, yet he is out there today making anti-federal government statements about the policy it is instituting. I will refer to him later in relation to a paper he has written on adverse events and root-cause analysis. He is out there, he is active and he is in the team. Whilst he may have been the head of the Department of the Prime Minister and Cabinet under Gough Whitlam, nonetheless, as I have said, he is recognised in this field as having significant experience in dealing with health administration.

Now, back to the historical development. We saw the colonial surgeons (that is, the predecessors to chief executives) with a small staff, small salaries (sometimes hacked about) and increased responsibility with respect to the development of health institutions in addition to very significant public health responsibilities. They had to inspect hospitals, they had to ensure that people were vaccinated, and they had to ensure that people were contained if they had a contagious disease (especially before antibiotics), which was a major problem. I would like to recognise Dr Cleland because he was very significant in his term of office as Colonial Surgeon. His service has been recognised in terms of Cleland House at the Glenside campus of the Royal Adelaide Hospital.

I do hope that, when the government develops that plan (that is, what will be left of it because it is selling off half of it, of course), people such as Dr Cleland continue to be recognised in the event that any facility which might be at the hospital and which may be destroyed or bulldozed is kept in some way as some recognition. I make that plea because it is important that we recognise that in our history. We had the Second World War and we had the development of the Queen Elizabeth Hospital in 1954, the Lyell McEwin Hospital in 1959, the Modbury Hospital in 1973, the Flinders Medical Centre in 1976 and the Noarlunga Hospital in 1991—all major acute care facilities which developed progressively when the populations expanded. I will not go into the detail of them all, suffice to say that they have all maintained very important roles in providing a variety of services—medical and health services—to those communities.

In relation to hospitals and health services, when we talk about hospitals in today's language, we understand that the hospital sites at the time of their inception provided acute services, but they are far from that in today's modern health services. Whilst we had a small explosion in the 1970s of separate community and allied health services developing in metropolitan and country areas independently of local hospitals, in the past 35 years we have seen a very different multidisciplinary service being developed from what we knew as the old acute hospitals.

A health service in, for example, a small rural town usually has the following profile: it may have 35 beds, 15 may be for aged care and 15 may be for acute care; it may have special services attached to one or two of those beds for mental health or regional services and the like; it may have some day surgery facilities; it may have some consulting rooms which are empty most of the time but which accommodate specialists and practitioners who visit the hospital; and, it may have nurses quarters, which used to be where nurses resided in the old days when they lived on site which are full of a myriad of allied health service providers—people who provide important counselling, speech pathology, and child advice in relation to health, immunisation and the like. If they are lucky, in some country areas they may have podiatry and other such services that are very important to support the more traditional medical, nursing and specialist services. In reality, they are truly multifunctional health premises.

Major hospitals in metropolitan Adelaide, whether they be general hospitals or one of the spinal group (under the government's new language this is what we call some of these hospitals), are now very much involved in the provision of a multitude of services, plus allied services such as counselling, referral coordinators (people who assist to link with home services and the like), advisory bodies throughout the facility, research and training services, and other significant health areas that make our hospitals very much multifunctional. Much less in the metropolitan area do we see a combination of aged care services in residential facilities, but we see other services that are important for our ageing community, namely, chronic disease management, medical ward facilities for older people, and palliative care. They are not all directly related to aged people, but a significant cohort of our ageing community heavily relies on these services.

Our modern health services are part of a network of many other community services. Whether they be general practitioners providing medical services, specialists, people providing mental health advice, or people giving advice on housing availability or follow-up services, there is a myriad of allied health and other services in the community, which provide an important nexus. Gone are the days when we simply had hospitals as such. So, when I refer to new hospitals I mean these multifunctional facilities. It is fair to say that in the training area major hospitals have always had a role over the past 100 years.

Also, over the past 20 years or so we have developed a much closer network between universities and major country hospitals in order to ensure training opportunities for our medical and nursing graduates, and the like. That is a good thing and, if the government continues to support that, I will continue to support it to do that. It is critical, especially if we wind back the variety and diversity of services available in major tertiary hospitals and the number of tertiary hospitals able to provide training and attract enough specialists to receive and/or keep accreditation in order to provide for the next generation of the workforce.

We desperately need to have on board the support of our major hospitals in country regions; so I applaud that as being an important aspect of it. I understand that there needs to be some other important business dealt with before the luncheon adjournment so I seek leave to continue my remarks.

Leave granted.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (12:56): I lay on the table a draft template constitution for incorporated health advisory councils, draft template set of rules for the unincorporated health advisory councils, the draft constitution for the Country Health SA Board Incorporated and the draft principles relating to aged-care services and explanatory comments.

Debate adjourned.

[Sitting suspended from 12:57 to 14:00]

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