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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 (resumed on motion).

(Continued from page 1221.)

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (15:48): At the close of my previous contribution on this matter, I had highlighted the development of other major hospitals, principally in metropolitan Adelaide, since World War II, and the expansion of hospital services. In particular, I identified the diversity of services currently provided in many of our hospitals across South Australia. Hospitals provide a broad spectrum of services far beyond perhaps their original charter to provide medical, emergency and surgical services, or quarantine services, which was a large area of responsibility in the early part of the 20th century.

After World War II—indeed, four months after the cessation of hostilities—the then state government appointed a committee to inquire into and report on the advisability of consolidating the state's health services into a single department under the minister for health. So, this proposal by the government, I suggest, has its genesis back in 1945. There have been rigorous attempts, particularly by Labor governments, to try to bring this about with the slow death by a thousand cuts of local voice and community board management through extinguishing the role of direct management. Whilst they might have some advisory role as an advocate for their community with no power of enforcement or management, that was the development.

In April 1946 the committee was appointed and the terms of reference identified. The committee found that the government-controlled health services in the state had developed in two directions. First, there was the field of preventative measures embraced by public health provisions, and so on. Secondly, there were curative measures comprising the provision of hospitals. The principal services were under the control of the minister for health, but, in addition to the 14 hospitals wholly financed by the state and directly controlled by the hospitals' department, 39 hospitals were subsidised by the state.

The responsibility of the director-general of medical services, in respect of these hospitals, was limited to advising the minister about grants to them. The end result was a patchwork production lacking in planned development and coordination. It was really a far cry from what exists today and what we are asking to move on from. Quite clearly, under the Playford administration in this state, consideration was given to how there could be a more coordinated role given the fact that there were only 14 hospitals—a minority—wholly financed by the state. With the introduction of a subsidy, there was a partial funding of the other 39 hospitals, so there needed to be some management of that. Centralising the regulation of hospitals that received state money did certainly have some merit, but that contrasted with the principle of decentralisation and divergence of authority, which services in South Australia had developed.

In the decade 1937 to 1946 gross state expenditure on hospitals and health increased by over 120 per cent. The committee believed that, since the public purse was involved to such an extent, and since in any case it seemed to be a more efficient method of administration, it was time to change direction. It accordingly recommended the establishment of the Department of Health, with medical services controlled by a commission of health, and chaired by a full-time director-general. The commission and its department were to be given wider powers of control and administration to integrate the range of services offered, and, indeed, some of the existing statutory bodies were consequently to be delivered in their powers. It was 30 years before the South Australian Health Commission, which in some respects was foreshadowed by the Shannon report of 1946, came into existence.

A federal referendum at the time of the national elections in September 1946 approved the transfer to the commonwealth of the power to provide pharmaceutical, sickness and hospital benefits and medical and dental services, although not so as to authorise any form of civil conscription. The involvement of the commonwealth government in medical and health services had far-reaching results, but, until the details of that involvement were revealed, there was a degree of uncertainty amongst state planners about the appropriate course to take.

Indeed, at the opening of state parliament in June 1947, the year in which the Shannon report was received, the Lieutenant-Governor said that the commonwealth proposals to control hospitals and medical services had left the states uncertain as to what policy they should pursue in such matters. I note that Dr Brian Shea was appointed as director-general of medical services in 1967. We saw further development as we moved into the Dunstan administration and the Bright report, to which I referred at some length. Dr William Andrew Dibden, I just recognise his position as director-general from July 1977.

The matter which I think is important to appreciate is the extent of the government health department as it was in 1971. This was at the time preceding the debate for the current bill that we are being asked to repeal. At that time, in August 1971, the state government ran two teaching general hospitals in the metropolitan area, seven general hospitals in the country and six psychiatric hospitals in the metropolitan area. In addition, the state subsidised two teaching special hospitals and two long stay hospitals in the metropolitan area and 54 general hospitals in the country. Together these facilities and those run by the commonwealth government provided a total of 8,336 beds.

I know that Dr Sherbon and others in today's world say that bed counts are no longer relevant for the purposes of assessing the delivery of services as a key performance indicator but, nevertheless, it is not difficult to appreciate that we have in the last 30 years, since the SA Health Commission Act was passed, had a very substantial reduction in the number of total beds. I think it is fair to say that that is most particularly pronounced in the area of mental health.

So, we had the Bright report, the proceedings on the legislation. That had recommended the unified control of all health services by an independent health commission, and it was also clear that there was the notion that hospitals and health centres should be administered by autonomous governing bodies. That was of central importance in the planning of the commission. That was, I think, attempted to be hijacked by the then Labor government but, nevertheless, rescued by the opposition and its submission at that time. I mentioned the establishment of the commission. I will not further detail that. It was progressive over a period of time.

But what I do wish to mention is that there are dangers in centralising control and not having people on the ground at the local level who have a legislative responsibility to manage what is going on. The direct consequence of that is that all the way up the chain, to the person who has the legal responsibility, we have a flow of people saying, 'Well, it is not my responsibility, it is his,' with the next person saying, 'It is not my responsibility, it is hers,' and with the next level saying, 'It is not my responsibility,' and it goes to some panel or advisory group and then it goes on to someone else. This is the danger when you centralise all the power in one reservoir of power.

I can give you the classic example of what happened in the late 1970s, when the meat scandal broke. It is argued, I think, that this is one of the most significant political issues which was made public and which caused very significant embarrassment to the Dunstan government, which then had to be carried by the Hon. Des Corcoran who had became premier upon Don Dunstan's retirement in 1979. So, for the last few months leading up to the 1979 election, at which Dr David Tonkin was successful, we had the breaking of the scandal, which was essentially that there had been a discovery of grave irregularities within the health commission (the former hospitals department). It was alleged that staff members at the Northfield wards of the Royal Adelaide Hospital were pilfering the meat supply and selling it for their own gain.

There had been allegations of mismanagement as early as 1975. The Auditor-General's annual report strongly criticised what it called a lack of elective internal audit and controls over many of the hospitals department's activities in response to the massive thefts of meat from South Australian hospitals. There was a request for the Auditor-General to investigate the matter, and the examination disclosed that the internal control was weak or non-existent, budgeting was poor and ineffective, and records inadequate. It was an all-round bad show.

Even I would come to the defence of poor Peter Duncan, who was the minister for health for six months leading up to the 1979 election—hapless, as he has been post-politics, and certainly more infamous. He was only there for six months, poor fellow. And, not only was there an election, but his premier resigned because he was too sick and there was a new premier. Poor old Des Corcoran gets trotted in, there is a huge auditor-general's report, a huge meat scandal, and outrage by the public. Poor old Des and poor old Peter Duncan had to take it on the chin.

Mrs GERAGHTY: I have a point of order, sir. While, clearly, the member is enjoying herself, I am not sure that what she is sharing with the house actually relates to the bill.

The ACTING SPEAKER (Mr Koutsantonis): I deeply apologise to the member for Torrens but, alas, I was not listening to the member for Bragg. I apologise to the house for my inattentiveness, but the continuation of the monotone voice turned me off. I will attempt to strain through it but, as far as I can hear, she has not breached standing orders. The member for Bragg.

Ms CHAPMAN: Thank you, Mr Acting Speaker. I am shattered if you have lost interest in listening to my speech and are concerned about the monotone contribution by the objector. However, I was coming to the defence of the former minister for health, Peter Duncan, who had had a career as attorney-general in the 1970s and the pleasure (although I am not sure about the benefit to South Australia) of being the minister for health in the dying days of the Dunstan-Corcoran administration. So, this has direct relevance.

I reaffirm to the house, for those who are listening attentively and perhaps to make sure that we capture those who are not, that, when it comes to control and consolidating and centralising that level of responsibility, everyone down the chain will blame everyone else, and it gets back to the chief executive officer and he or she has to take the call. The danger is that you have all these people underneath you who are making decisions or failing to investigate or, as the Auditor-General found in this instance on the meat scandal, have a lack of effective internal audit and controls and are generally not keeping alert on their watch—so much so, that we had trucks lining up at the hospital and people were piling the meat into the back of the trucks and taking it out of the hospital and selling it to their mates.

That is what was going on. It was a wicked scandal at the time, and it demonstrates, when you centralise control and you do not have people out there sharing that responsibility and keeping an eye on what is going on, how dangerous this situation can get. So, I urge the minister to reconsider again making the chief executive under this bill directly responsible for everything, making him the employing authority—

An honourable member interjecting:

Ms CHAPMAN: Well, you can ask some questions about it, but it says that the minister becomes responsible. However, as I pointed out, ministers are busy people. They do not do two things: first, they do not know what is happening in their department every day, and they cannot; and, secondly, if something goes a little bit wrong, I can tell you the department does not rush up to tell the minister. When it becomes a serious situation or there is a risk of exposure, then of course they rush into the minister's office as quickly as possible to explain why they were not responsible.

It is not adequate security for the $3 billion a year that is now being spent on health and/or administered by the state Department of Health. It is either their money, the commonwealth's money, earned money, interest earned from services or returned revenue from services. $3 billion a year is administered by the Department of Health. Dr Tony Sherbon, or his successor at any time, will be responsible under this bill for that, and there is no way that any minister in a government is able to keep a very close eye on all the mishaps. We have some protective mechanisms such as the Auditor-General's report and so on, but, frankly, they come a year late. A lot can go on in the time that passes in that situation. So I think this is a very major warning to the government about what can go wrong.

I have detailed the period post-1976 as to what happened with the SA Health Commission Act which we are now repealing, and the amendments that have been made. I think I have referred to the Jennifer Adamson (now Jennifer Cashmore) period. We have had the introduction of amendments which were very significant by Dr John Cornwall. From memory, Frank Blevins was also assisting the government for a short time as minister for health during the 1980s, and Martyn Evans (although I do not recall his period of time exactly).

Dr Don Hopgood, who as members will recall was the deputy premier, was also minister for health during the period preceding Martyn Evans. We had a number of different ministers, but we also had a number of reviews. I referred to John Cornwall, but I also mention, for those who are following the history of the continuing review of governance in health, that we also had the review, after the Bannon period, of Mr John Uhrig. He produced his great report—

The Hon. J.D. Hill interjecting:

Ms CHAPMAN: John Uhrig. He presented his magnificent report—

The Hon. S.W. Key: He was a great environment minister, too.

Ms CHAPMAN: Mr Acting Speaker, I am not receiving the attention of the members, because the interjection suggests that Mr John Uhrig was a minister. He was not, of course: he is an eminent—

The Hon. J.D. Hill interjecting:

Ms CHAPMAN: John Uhrig.

The Hon. J.D. Hill interjecting:

Ms CHAPMAN: The minister further interjects that he thought I was speaking about Dr John Cornwall, I am back on the myriad reports we have had on this legislation that we are about to repeal, and Mr John Uhrig, an eminent figure of management in the private sector, was called upon to conduct a review. However, history shows us that much of his review's major recommendations were not supported.

In October 1986, Professor Andrews was appointed as the chairman. This is very important, because from time to time his office and that of the minister disagreed in their interpretation of the Health Commission Act, which stated that the exercise of the functions of the commission were subject to the general control and direction of the minister. That is very important, because that is exactly what is happening in this bill again—all the day-to-day management and control to the CEO (or chief executive, as the position is now called). The minister has overriding power, but the precedents show that they have already had a fight about who should have what delegation of power in this regard and, again, we had reform to try to manage that.

I think I also mentioned that, after Dr McCoy's period as chairman of the SA Health Commission, we again saw some legislative change coming in under the Brown-Olsen periods for streamlining and securing some clarity with respect to the powers of the minister and the chief executive, bearing in mind that, throughout this period, although it had been changed from time to time, boards still continued to exist, operate, manage and maintain—as they do right to this day—the power and authority to determine what services they deliver, who they employ and the management of their assets, specifically protected in the legislation against ministerial interference or any direction by the minister on those topics. Moreover, I mention that, during the Armitage-Brown period of time—

The Hon. J.D. Hill: Recent years; living memory!

Ms CHAPMAN: I have to mention minister Armitage. He introduced a bill for an act to provide for the administration of health services in the state and to repeal the act that we are also attempting to repeal today by the governance bill. He explained (and I am sure the minister will be interested in this) that 'the Commonwealth Grants Commission had estimated that South Australia spent 6 per cent more than the national average on health services, largely because of the above average levels of service delivery'. He said that the health policy of the new government aimed to position the state's health services to meet the requirements of the future, and included the abolition of the South Australian Health Commission.

There were other proposed initiatives, such as the introduction of regionalisation, the integration of health services and the devolution of decision making into areas where services were provided. This was the era of taking it back to the people—doing it in a regional manner and asking them to do all the cuts (which, frankly, I thought was fairly politically smart); getting the regional boards, as subsequently developed, to make the hard decisions, to rationalise and regionalise the delivery of services across a significant area.

So, the Mid West Coast, the Riverland, the South-East, the Upper South-East and other regions around South Australia looked very carefully at what services they provided at each of their facilities; they made their own local decisions about what those priorities were and took the hard decisions. It was publicly described by one newspaper columnist at the time as the biggest shake-up that the state's health services had faced since the creation of the Health Commission 20 years earlier, and that the proposed legislation (as it was at the time) highlighted the distance that had been travelled on the road from colonial surgeon to Health Commission.

We now have the current situation. We have a chief executive who is about to have enormous responsibility transferred under this bill. He already has 25,100 employees, many of whom are people who work in our hospitals and health services—doctors, nurses and the like, nurses being the overwhelming majority at nearly half that number. A very significant proportion—on the figures provided by the Auditor-General just a couple of weeks ago, nearly a quarter of the workforce—under the responsibility of the chief executive are administrative, headquarters, clerks and advisers operating in the general management of the public service of health, as distinct from those who we would say are at the coalface of health, delivering the services in the local community—in hospitals, and so on.

It is a major staff. Perhaps I am one of the few people who is not critical of the chief executive's salary—a salary of over $300,000 a year—because I think, if you get a good one, they are worth every penny in any department. I am happy to be on the record of saying that, if they do a good job, pay them well, but if they do not do a good job, get rid of them. With this extra responsibility, I raise the caution of how dangerous that can be in the hands of one person who is not sitting next to but provides information to the minister of the day on a regular basis and who has to be answerable to and responsible to the minister. They have to present the minister with an annual report at the end of each financial year and within certain time frames and, of course, the minister has an obligation to provide that to the parliament.

I do not doubt that, if the minister rings up the chief executive of the health department and says, 'I need to see you about this issue or that issue' there would be a response and, no doubt, an appropriate response from his department, as there should be. But how does the minister know what is happening on every day in this department? How can he possibly know that?

The Health Care Bill, as I say, is stated to have this rationale of the need to reduce the existing fragmentation and unnecessary duplication of planning, funding and governance arrangements so that South Australia has a streamlined health system providing for the needs of the community. I must have referred to half a dozen quotes covering the last 35 years, in fact since 1945's 46th report of how that has been a desirable option. The creation of the unified single public health system is the objective. For the life of me, I cannot see how getting rid of these boards will produce that to the extent that the outcome is that we get better health services for patients and people in South Australia.

The centralising of strategic action and the control and employment of all the staff in the hands of the CEO and, ultimately, the minister, really leaves a situation where the minister is the determinant of all strategic development, and his chief executive is the person with the absolute authority to be able to execute that. I will now refer to the interstate experience. In 2004, New South Wales commenced changes to its governance structure with the passing of the Health Services Amendment Act—and I will refer to that shortly. In Victoria—at least as of a few months ago—a governance reform panel reported in May 2003.

In Queensland, there were two reviews of governance in 2005, as a result of which the government released a new health action plan. In Western Australia, the health reform committee reported in 2004. In Tasmania, the Minister for Health instituted an inquiry in about May this year. I do not know the recent status of those inquiries in the other states and/or legislative reform to their governance model. New South Wales has already done it and so members would think that, before this bill coming into this parliament, there would be some review and assessment of what has happened in New South Wales to see whether a change in the governance structure has resulted in an improvement in health outcomes, a cost saving or some other benefit that would warrant our following that course.

The reason why it is such a critical precedence to what we are discussing is that, when one reads the Health Service Act 1997 operating in New South Wales and its Health Services Amendment Bill (which they debated in 2004), it is pretty much word for word what is being presented in this bill by this government. It is the same bill as the then minister for health Morris Iemma presented to his parliament in New South Wales. Members would think that it would be something at which the government would look and clearly analyse its benefits before presenting the bill.

When outlining the bill, Morris Iemma said that the objects of the bill were: first, provide the area health services to be governed by their chief executives and consequently abolish the existing area health boards—sounds familiar. Secondly, provide the establishment of area health advisory councils to give advice in respect of certain matters affecting the operation of the area health services—sounds familiar. Thirdly, provide that statutory health corporations may be governed by their chief executives as an alternative to being governed by health corporation boards—sounds very familiar so far.

Four, to provide the establishment of an advisory council to give advice in respect of matters relating to the operation and provide for the establishment of a health executive service. Senior health executives were employed under the Public Sector Employment and Management Act 2002 of New South Wales. They did their little stunt in relation to anti-WorkChoices a little earlier. We lagged a little behind in that our state government did not jump in and legislate to make it operational until 2006. They had done it a few years before—in fact, they had done everything a few years before.

We have the control and management of area health services and statutory corporations under legislative review and a new model of governance as set out by the New South Wales then minister for health, Morris Iemma. It is all the same. It is incredible—there is nothing new. They repeat the same thing. Members will be pleased that I will not go through every health care plan in operation under each state Labor government around this country that has rewritten their plans. They all say the same.

I can pick up the Western Australia one or the Tasmanian one and I get the same stuff. It is a bit like plagiarising the health care plan of other states. I wonder who wrote this one for South Australia because, if we paid a lot of money, I would have to ask some questions about why. There are whole phrases that are just lifted from other state's health plans so I hope we did not pay too much money for this, because I believe it would be unreal to expect payment for something that was just lifted from another state.

Morris Iemma's announcement of his government's reform is almost word for word what we are doing here: amalgamation of the seven health area services; encouragement to build better clinical networks and enhance academic and teaching links; assisting in improving the distribution of the health workforce; all the new factors that are affecting health—population distribution, make-up and growth, health workforce distribution, patterns of clinical referrals, patient flows—and the need to be able to cut out all these people out who have had a say for the last 100 years (or, in the case of New South Wales, 200 years) and give it all to the CEO.

Mr Iemma also claimed there would be a $100 million saving in health arising out of his government's reform. I note that there has been an omission of any similar promise by this government in this bill—for good reason, I think. Quite frankly, I have not seen in any report that I have read in relation to the subsequent three years in New South Wales that its health service delivery suddenly saved $100 million as a result of its new governance procedure.

If it is there it is not very transparent, and you would think that, if it actually saved money, they would have rushed out and said, 'We have achieved this incredible saving as a result of getting rid of local boards restructuring and letting the decision-making rest with the central control of head office.' Oh no; we have not had them waxing lyrical from the mountains of success as a result of governance reform giving the benefits they claimed. It is the same old stuff: simpler, more direct, accountable governance arrangements. It is all an excuse for getting rid of the local people, not letting them have their say, having direct management involvement in service delivery to their communities, and taking on the central control.

The opposition in New South Wales made the point during debate (and I think this is important to note) that the bureaucracy had not only expanded in the years of the Carr government, but that there had also been a burgeoning—even a bursting—of extra public servants. Well, what about South Australia? We have a situation where 25,100 people are employed in the minister's department. He is happy to rush in here and tell us when he has increased the number of nurses, even if they only work one day a week. He tells us over and over again how many extra nurses and doctors he has, but what about the 80 extra executive positions he created when the minister introduced the metropolitan regional boards?

I have been out to a number of the regional boards—for example, the administration headquarters for Central Region, at that stage headed by Dr David Panter at the Hampstead Rehabilitation Centre. It had its offices in one of those heritage buildings, corridor after corridor of people, some of whom had been transferred from headquarters and some of whom had been advertised for and taken on. So, far from actually making the savings they expected from getting rid of the Women's and Children's Hospital and the Royal Adelaide Hospital board, and each of the unit boards, whose meetings were held mostly for a nominal income, we actually got a whole mass of new public servants.

The Hon. L. Stevens interjecting:

Ms CHAPMAN: The former minister shouts that that's not true.

The Hon. L. Stevens interjecting:

Ms CHAPMAN: I apologise; she did not shout, she interjected quite politely to the effect that that was not true. However, I urge the former minister to look at what actually happened. She may have aspired to contain the expansion, the breeding program they must have had in there to support the expansion of bureaucracy, but it got away from her.

The former minister needs to look at the Auditor-General's Report and the continued increase in numbers. She will be pleased to know that in the last few years they have given us a breakdown of how many doctors and how many nurses (and the full-time equivalents), how many clerks and how many administrators—not to mention the 65 who get paid more than $100,000 a year. We have paid out close to $2.5 million in the last financial year to get rid of three of them.

I encourage the former minister, who interjects about the workforce, to have a good look at the Auditor-General's Report and see the costs incurred even under the interim arrangements introduced by this government—which they are now scrapping, because even those regional boards are about to get the chop. My concern is that if you pick up The Sydney Morning Herald or The Australian you will still see, on a regular basis, the same sad story that we see in South Australia—that is, people telling tales about the horrific experiences they have had (usually as a result of attending the emergency department of a major public hospital); the distress, pain, suffering and sometimes fatal consequences of failing to receive attention.

Just recently there was a woman who complained of having a miscarriage in an emergency department in New South Wales. Well, let me tell the house that we have had one of those here in the last 18 months at the Flinders Medical Centre. A woman went to the emergency department for assistance (and she went public about this) and, as a result of failing to be attended to, miscarried on the floor and had to clean up her own mess. Ultimately, she left the hospital and the state, because she was so horrified by the experience.

If we were to have any of the national reporting bodies (all of the people who provide us with these reports each year, and I will refer to those in a minute because they are very important when we look at the new health performance council’s role) come to us saying, ‘These governance reforms have been magic. They have been brilliant. They have not only saved us money, but they have helped patients to get access to health services,’ then I think it would be important for us to have a look at.

In South Australia, on health we spent $3 billion last year and we are going to spend another $3 billion this year and, as I have said, that is a combination of state government funding, commonwealth funding, revenue earned from health services in South Australia, some interest and some other smaller grants and the like. But overwhelmingly, it is from the state and commonwealth governments. Yet, the key performance indicators from the reports that we have, including the state of public hospitals report, the productivity report and the Australian Institute of Health and Welfare report, tell us that we are still the seventh lowest of all the states and territories in this country for money spent per capita on public hospitals. Compare that to the statement that I read out from Dr Armitage’s time. Even after the State Bank collapse, they were able to make a very significant contribution.

These reports tell us that our readmission rates for patients is the highest in the country. We are at 4.8 per cent when the average is 2.8 per cent. We are second to bottom in four or five categories in the emergency department relating to patients seen on time. We are the worst performing state in the country for elective surgery, and I might say that last year in 2005-06 (the last reported year) we did 800 fewer elective surgery procedures than in 2004-05. The government’s own website in February this year tells us that 1,085 people were waiting more than 12 months for their elective surgery—a 21 per cent increase since June 2006. The average waiting times have blown out under Labor and they are a disgrace—yet all that money and no delivery of service.

If we could go to New South Wales and see a monumental shift in improvement of its position on these key performance indicators where there is a national comparison as a result of its governance reform, then, sure, we would be looking very carefully at the analysis of that, and we would obviously, if there were a successful outcome for New South Wales, we would have to review our position as to the success of that and look more carefully at what it was doing.

Apart from all those, we have had just this week the disclosure that, in the past 12 months, the number of hospital workers injured at work has more than quadrupled than that of the past three years. So, the report from last year states that over the preceding three years the claims of injuries to hospital workers (nurses, attendants, etc.) who are carrying out their daily functions with patients at the coalface has increased four times. There is something going wrong with the management.

I heard the Minister for Industrial Relations tell the parliament today how proud he is of SafeWork SA’s performance and how it is going so well and all the general palaver about how fabulous it is. His government’s own workers, whom he provides workers compensation for, have had a massive increase in claims as a result of his government’s management of workers compensation. He cannot even blame WorkCover for this one. WorkCover does not provide compensation for state government employees: the government does. It manages its own. I have been watching this in the education department and the health department because they are by far the single biggest employers in state government and by far the biggest cost in relation to workers compensation claims.

The increase in the value and number of those claims is alarming. When the Minister for Health comes in here and tells us how he is under pressure to ensure that we retain, retrain and offer incentives to both attract and retain people in the health workforce and we have a fourfold increase in injury for those who are working in these facilities, then, in my view, that is a very unsatisfactory situation. If I were the Minister for Industrial Relations or the Minister for Health, I would be asking some serious questions about what is happening there because, in the precious workforce numbers that we have of people out there at the coalface, we need every one of them to be able to ensure that they are fit, willing, able and capable to undertake those duties. We are desperate for them. We are hardly going to attract new people into the industry of providing health services at whatever level if they face a workplace environment provided by the state government which fails to look after them and which costs the rest of the community a heck of a lot of money.

Under Labor, valuable health funds have been used to build up bureaucratic systems rather than provide extra patient services, and clearly the government has not provided a better health system. Even the governance changes in New South Wales have not made one scrap of difference to those outcomes for New South Wales. If there is some report hidden away, firstly, I wonder why they are not swinging out at the Premier. Iemma is out there saying, ‘Wasn’t I a fabulous health minister? Look what I have achieved.’ There is deathly silence about that issue. For the first time since Labor’s State Bank collapse, the South Australian government can invest real dollars into health. We have a booming economy courtesy of the federal government’s economic policies and windfall tax collections via the GST and related taxes. There is no excuse not to be meeting most of our health demands.

There is no excuse for the poor performance of this state and, here we are, with a Labor government which has been squibbing on the promised levels of health funding for service delivery and which has an open cheque book when it comes to the expansion of the Public Service within the health department. Now we have a situation where South Australia has a very low per capita spend on our community for mental health, which is alarmingly low, and I think that is a tragedy.

As I said, the government has announced that it will abolish the regional boards, but the bureaucracy will stay. What a familiar ring: out goes the board but the bureaucrats all stay. What savings, if any, will come from that? What is the purpose of having them out there if they are 10 or 15 minutes away from the rest of their colleagues sitting in Hindmarsh Square? I ask this question: how is that possible that they are able to provide any level of benefit of service out there in those circumstances? Why are they not coming back to headquarters?

Why are we not having some cost savings in relation to bureaucracy when these things are dismantled, rather than just in relation to the good people who take on these board positions. I will, in fact, refer to those now. Members of the regional metropolitan boards that are about to be axed, as I understand it, are to stay in their positions until June next year, or until such date as the implementation of this legislation. Most of them, as I understand it, are prepared to stay on.

In the weeks after the government announced the health budget for this year, their health plan and the announcement about the Marjorie Jackson-Nelson hospital, I was horrified to hear the statement by Ray Grigg, the chairman of the Central Northern Adelaide Health Service. He was concerned about the government's complete bypass of his own board. He had been there for a couple of years. He tried to assist with the government's reform; he was kept completely in the dark about this health plan; failed to be consulted about that and, yet, here is this public announcement.

Ray Grigg publicly spoke out about the way that they had been treated. I wish to record and thank those people who have been on the board for the service they have given and the work that they have undertaken: Mr Ray Grigg, Professor Carol Gaston, Ben Yengi, Professor Derek Frewin, Juliet Brown, Dr Kay Roberts-Thomson, Dr Mike Rungie, Peter Bicknell, Tanya Hosch, Dr Tamara Mackean, most of whom will stay on for the transition period, as I understand it. I certainly thank them for that contribution.

The Southern Adelaide Health Service board of directors, chaired by Clive Armour, is to go west, so to speak. Other members of the governance committee are: Ray Blight, Bevin Wilson, Dr Richard Wilson, Ian Yates, Professor Anne Edwards, Robyn Pak-Poy, Dr Helena Williams, Elizabeth Furler, Graham Inns and Alice McCleary. I am not sure why some people have been given titles and some have not in the annual report. I do not mean any disrespect if I read those names incorrectly from the 2006 annual report. I thank them also for their service.

For the board of the Women's and Children's Hospital—boy oh boy, have they had a hard road to haul. It has very little capital funding from the state government; some sections of its hospital have been described as war zones; it has heavily relied on the generosity of organisations such as the McGuinness McDermott Foundation; and they have been told that, under the restructure under the new health plan, a whole lot more people could come from the Modbury Hospital, because obstetrics will be closed there, yet—hello?—they will not get any extra money and there will be no extra beds or cots to facilitate this. I think they are facing a very difficult period.

One senior paediatrician who has come forward has even asked the government to consider—if it is going to build a new, great hospital on North Terrace—the Women's and Children's Hospital going to join them to at least have a chance of having some decent facilities. The answer—no. Not, 'Look, we'll consider it' but, 'We have considered it and—no.' The people on this board will be chaired by the Hon. Carolyn Pickles, who is known to some members. Other members include Dr Elizabeth Rozenbilds, Professor Justin Beilby, Mr Peter Bleby, Mr Greg O'Connor, Ms Jane Cooper, Mr David Everett, Ms Judy Gillett-Ferguson, Dr Di Hetzel, Ms Alice McCleary, Ms Ruth Miller, Professor Dorothy Scott, Dr Nicola Spurrier, Professor Don Robertson, Dr  Nigel Stewart and Ms Debra Walker.

In acknowledging this board, I want to say that it has been very interesting to read of the work done by that board. With some data information provided by the department to enable them to do this, they have identified what needs to be done at that hospital, giving the government a report at the end of 2006 highlighting major areas of risk if the government fails to deal with matters. This is not just not liking the paint colour in a children's ward or a little bit of paint falling off an area of the facility: these are high risk indicated features of this hospital which can cause a direct health negative to its patients—who are children—and, of course, the women who now go there for obstetric and gynaecological services, and also the staff.

The risk of infection control is identified as extremely high in this report. I think it is a very brave board that makes a recommendation as to what should happen, but that is its job, and that is good. I give credit to the Hon. Carolyn Pickles and her board for undertaking that work and presenting it to the government. It is not their fault that the government says, 'Oh well, bad luck, you're not going to get a feature in our capital works program. We'll put it on the list and we'll think about you in the next century.' The board has done the work, and I give them credit for that. Of course, they have not spoken out because they are still employed on the board.

It is probably unlikely that one would see a chairman with the Labor pedigree of Carolyn Pickles do so. She would not want to do something to perhaps embarrass a government of her own political persuasion. Nevertheless, I give her credit for actually presenting the report to the government. It has now become publicly available through FOI and been widely read. It highlights an area for which she has taken up the challenge. They are just a few. A whole lot of boards are going, apart from the Repatriation General Hospital, which, as I have indicated, will retain its board.

I also want to refer to the fundamental difference between the government and the opposition. This is a fundamental philosophical difference between the Australian Labor Party and the Liberal Party of Australia; that is, we do not like central control. We actually support what has been described as subsidiarity. I mention it because it exposes the fundamental difference between us and them. This is the underlying principle of decentralisation; that is, that decisions should be made at the level closest to the community affected by those decisions. That is a summary of its definition. It is important, and it is why the Liberal Party supports and respects levels of government, whether it be local government, our own state parliament, or the federal parliament. It is why we recognise the federal system, and it is why we support and endorse the protection of decisions that are made at a local level. That is the fundamental difference.

For those who have been following this debate carefully, they would appreciate that in the last 50 or 60 years, but particularly since 1972 and the debate that preceded the act that we are about to repeal, at every opportunity Labor administrations centralise, and they muck up. When Liberal administrations are in power they decentralise, and they clean up. I do not doubt for one moment that, come 22 March 2010, the Monday morning after the next state election when the Liberals are in power, we will be cleaning up again.

An honourable member interjecting:

Ms CHAPMAN: Sure, we can count. You have the numbers in here to press ahead with central control again, and you will muck up again.

What is interesting is that, even if the government was to say, 'Well, look; we can find some little example around world where this is worked', the British tried the central model, and it did not work. When I was in London in October-November last year, the nurses union was marching in front of the houses of Westminster against the shabby management of health by the then Blair administration. It had mucked up. It tried to do a little regionalising to get rid of the local units, but that did not work. Nobody in Streaky Bay, Port Augusta, or down to the South-East at Bordertown was actually out there taking responsibility for the decisions to be made on the health service delivery in those areas.

It is a fundamental flaw, and it has been repeated historically over and again, but for some dogged reason the Australian Labor Party, like a dog with a bone, will not let it go. There is not a morsel of meat left on the bone, yet the government still keeps trying to gnaw away at a dead idea—a dead ideology, which causes damage financially and, therefore, damage to the people of South Australia every time it tries to do it. If the government came up with one example of where this type of governance has produced better outcomes in the world, I would be happy to listen to it.

I wish to refer to the health performance council. In terms of the measures that the government is introducing to give a local voice, to ensure a level of accountability to the parliament, and to provide a high level of advice to the minister on health developments and directions, we are going to have a health performance council. When this health performance council was first initiated in October 2006, I noted that the minister proposed to establish 'a new high level independent health performance council which will monitor and review the health system, provide advice to the ministers on health outcomes, and will have a reporting role directly to the parliament.' That is a snapshot of his quote about what was to be done, and it was to coincide with the dissolution of the boards, which is what this bill is all about.

One of the aspects of this new performance council was that it would have even a federal representative on it, and on the face of it that would not be such a bad idea. If you needed one at all, perhaps it would not be a bad idea to have a federal person on it to keep abreast of what is happening nationally and coordinate all the other data and reports. At the time I was very concerned to note that, when the minister made the announcement about the new health performance council, he had not even asked the federal department whether it wanted to put someone on it, and guess what!

When he did ask, they did not want to come on it. Why would they want to come on to a South Australian health performance council, which they have absolutely no power to influence, and then take the bucket for all the negative aspects? If all the key performance indicators were not met, if the directions were not adhered to, if there had been a failure of any of the processes or bad outcomes for patients and complaints from the professional and clinical side, whether medical nurses and the like, why would they line up to be part of a system over which they have absolutely no control and be prepared to carry the can?

Nevertheless the minister told us that the health performance council will be an independent body, and that he will have access to high level advice, independent from the department. What is all this about? He has a 25,100-person department; yet he needs a second body to give him high level advice. What on earth is going on here? What is his department doing? That is supposed to be one of its roles. In fact, the health department already has what it and the minister have described as a high level unit for the purposes of providing advice to him.

That unit publishes a Social Health Atlas of South Australia, a thick comprehensive document (the third edition came out in about 2006, and the first edition back 15 or 16 years ago), and minister Hill commended it as a major resource for policy makers, planners, service providers and community members working towards the future health and wellbeing of South Australians and, in particular, to deal with issues of healthy life expectancy and inequality in health. He pointed out that it was available on the website. There was interactive software to access all this information.

There is a whole production team in his own department to coordinate data and statistics and put all this together and tell him what is happening in health, who they are servicing, profiling areas that need service, giving him advice on what needs to be done—every statistic-collecting capacity available already exists in his own department, yet he says he will have a health performance council, comprising people he will appoint, to give him high level advice.

Already available to the Minister for Health is a wealth of Australian Bureau of Statistics information—probably too much! When you go on to its website, it is like a war zone trying to access the information you want as there is so much of it. We have the Public Health Information Development Unit, to which I referred, which publishes the atlas and provides all the reports, data, information, assessments and so forth to the minister.

We have the Australian Institute of Health and Welfare, which gives us an annual report on every state and territory health division around the country. We have the State of Our Public Hospitals Report, another annual report that tells us what they are doing, whether they are performing and how they are going in comparison with other states. We have the Productivity Commission report every year, again to advise us on the performance of the public sector, amongst other things, and health departments in each of the states and territories around the country.

We have the annual report that the minister brings to the parliament every year—not just of his department but also on all the boards under that, including the regional boards and country health units. He comes in one by one and tables them. They tell us—perhaps arguably a sanitised version—what is happening around the state in health. Nobody writes a report telling all the bad things, so one has to say that by way of advice they are not as valuable to the minister as to what might be comprehensively going on in those units, but at least they are a resource.

We have the Auditor-General's Report, which tells the minister every year if there has been a muck-up in the department, what is being done about it and what his department is saying it will do about it, and, if there is a qualified audit, how it is being remedied or what instruction the Auditor-General has issued by way of recommendation to effectively remedy that. Then we have the budget papers. They are prepared by Treasury under the hand of the Treasurer, and it is unlikely to expect that there will be any glowing disclosure of what the government is doing about something that is awful in the performance level, but it sets out in the subprograms the key performance indicators, and generally some statistical information (albeit skeletal) about the performance of these programs, and an indication in a summary form about those that are performing, whether they will be continuing and, if not, sometimes a brief explanation as to why they are being excluded from funding in the forthcoming budget, or what programs are being introduced to assist those currently being aided by such a service.

We have myriad pieces of information that are not only available federally but also at the state level, currently collated by thousands of people in the health department, yet the minister says he needs a health performance council to give him high level advice. Let me say this: the quality of the advice that he gets will be significantly impeded by one factor—one important factor. It will not matter how brilliant are the qualifications of the people he appoints, and I hope they are people who have very broad experience in health administration and health service delivery.

Hopefully, he will have a broad spectrum of people who know and understand the complexities of a public health service and who are able to manage the competing interests in an unbiased way to give him that advice. But it will be impeded by a very important factor—that is, this health performance council will be serviced by a secretariat of people out of the department. It does not have a budget to employ its own staff, and it does not have the capacity to have its own allowance to undertake consultations. It will have a secretariat, so I am advised in the briefings, of people from the department. We will have two, three or four people—I do not know how many the health performance council will get—out of the department who will have to prepare an annual report.

Members must remember that the chief executive is the new employing authority, and he will be the boss of these people. These people will not have a relationship of responsibility and accountability to the health performance council, no matter how brilliant the composition of that council as appointed by the minister may be. They will be responsible, legally and in every way, to the chief executive. The chief executive may say to these people, 'I know you have to go to a meeting to take minutes for the health performance council but I still need you to do this.'

Secondly, when it comes to the collation of information and data, what they will be handing on to the health performance council is the data that has been prepared in their own department. How can this be an independent health performance council that reports to the minister who brings the reports to this parliament if the people who are doing the preparation work and providing the data are collating it from material that I have just told members is available publicly and also data out of their own department?

Are they going to go to the health performance council and say, 'Here is the data on our emergency health problems, and it is showing a rather dangerous deficiency in the capacity of our metropolitan hospitals to attend to these people. We have this list of outcomes, and it is very difficult, but this is the data here'? Will they provide information that will be the downfall of their own department?

This is ridiculous. This is a situation where we will have a health performance council advising the minister on what clearly will be sanitised information from the department because there is a direct link, a loyalty and an obligation between those employees and the chief executive. Do you think they will go in there and say, 'The chief executive has misunderstood and has failed to deal with this'? That is not going to happen. So, how can we expect the health performance council to genuinely investigate, call on information from the health department, identify and assess the services that are being delivered, assess the long-term direction of where we should be going through all of the services in health, and also be able to understand that they will be totally impartial, without having their own independent employed staff directly responsible to them?

So I urge the minister: if he is serious about having a health performance council which has this role and which he has identified will also be important so as to be able to identify the significant trends, identify where things are going wrong and give advice on the priorities for future health systems, reviews and so forth (I suppose it is a bit like a continuous Menadue report or a continuous committee that sits), then, for goodness sake, give them some slack and some capacity to be able to perform independently, as the minister says they should be able to do.

As to the four year report, I do not know how much use it will be for us to receive a four year, in arrears, report, the first of which will be due not before 2012. That is two years after the next election. Perhaps that is convenient: I do not know. But, what is the point of having a four year report? I say that in all sincerity. At the moment, we have an annual report from the department which is tabled by the minister. Under the new structure we will have one, presumably. We may have a separate report from Country Health SA—I am not certain how that will apply—and one from the department itself under the chief executive. But, whatever the number, we will have that report. They already give us a whole lot of information.

In fact, they explain trends and why there has been a large number, or an increase, or a failure to achieve certain time limits and outcomes. They have all that in the annual report. So, we do not need the performance council, which will be using the same people and the same data to provide that information, trotting into the parliament and saying, 'We have been transparent and accountable about what we are doing because we are going to give you another report.' What utter nonsense!

At first blush, a health performance council may have looked like a good idea but, on careful analysis, I am gravely concerned that not only will it be a waste of time and money (whatever it will cost to set this up, and the time of the expert panel he may appoint to give him advice, when we have thousands of people in the department to give that advice) but it will also be a false presentation to the people of South Australia that they will get a higher level of accountability and transparency, which they clearly will not. I think that is shameful and disappointing, but I think it is a reality. Therefore, I do not feel very confident that the health performance council will achieve its goals.

I also wish to canvass the question of adverse events. There is a new procedure with respect to the disclosure of information for two purposes. They are to ensure that we make information available for research and also to ensure that, when an adverse event occurs, we have a full, frank and open admission of information to make sure that we get it right next time. The principle is the same. I was advised in committee that that is largely a replication of what is in the legislation under the current act, and that it will be protected. There is, I think, an extension to protect those who come forward and make a statement. If a nurse comes forward to disclose information in relation to an adverse event, he or she is protected. I think that, largely, that has been considered.

The other area that I wish to briefly raise is the private hospital regime. Members will recall that, at the outcome of my contribution, I indicated that one of our concerns was that the bill only partly deals with governance—namely, of public hospitals—and gives us a hint that, although it would still provide for a licensing and registration structure for the future of private hospitals in operation in this state, it would be the subject of review. During all the time that we have spent reviewing the public sector aspect, why have we not dealt with the question of our private hospitals?

I am very concerned about this. I have made some public statements with respect to my concern about the minister's statements. For example, on 15 November 2006, he made a statement on ABC Radio—a promise, in fact—that local hospitals would also retain their assets and funds. However, in the draft we saw an opt-in, opt-out idea. Unfortunately, with the submissions that have been made, I think we have seen some pull-back with respect to the government.

Some will say, 'That is typical: they throw out an ambit claim. They throw in a red herring with a draft ready to pull out, when they know that they will get a knock-back in the community on that. It makes them look good, because they have listened and they have amended it, so when the final draft comes out they have taken the edge off that.' However, they have said, 'No, we are going to presume that you are incorporated in the subsequent units unless you elect otherwise. So, you can hold your own assets at the local level.' They backed off that one at 100 miles an hour.

However, what has not happened is this: according to what we have been advised, no apparent review has been undertaken at all in relation to the licensing and regulation of our private hospitals. We have a number of private hospitals in the state. There are 13 private hospitals in country regions. They are: Ardrossan Community Hospital, Hamley Bridge Memorial Hospital, Blackwood and District Community Hospital, Keith and District Hospital, Moonta Health and Aged Care Service, Noarlunga Private Hospital, Northern Yorke Private Hospital, Riverland Private Hospital, McLaren Vale and Districts War Memorial Hospital, Mallala Community Hospital, Mount Gambier Private Hospital, South Coast Private Hospital and Stirling District Hospital. These are the hospitals that currently, through the SA Health Commission Act (which we are about to repeal), have a licence to operate and, subject to complying with the terms of that licence, they largely look after themselves. They are commonwealth funded.

It is fair to say that some of them have a bit of a hybrid role. They are a private hospital, but they undertake some duties for the purpose of providing public health under state funding. An example is the Keith and District Hospital, which, from memory, has about 15 or 16 beds; some acute and some aged. It is a commonwealth funded facility, but it has two beds that are funded by the state government because it is on a highway and provides a service primarily for potential trauma with respect to accident victims, and that obviously justifies making available some facility for public beds.

I think it is a very sensible mutual arrangement, where a local community decided, when the SA Health Commission came into effect, that it would not be wrapped up into this whole bill. The community decided that it would elect to stay independent, and it did, and we have a licensing procedure for it to be able to be registered and, therefore, able to operate. The state government—and, indeed, this government—has continued to maintain that position. It has a relationship with them where it has said, 'We will give you some money. We do not want to have our own hospital there; it may not be justified financially,' and so on, 'However, we need to have some public beds available. We will provide the funds for two beds to be kept open,' which is obviously to staff them, and the like.

These hospitals frequently service communities where no other hospital is available for acute services; there is only a small number of them relative to the number of towns and communities in South Australian regional areas. As members will appreciate, they may also draw people from nearby districts who travel to the hospital to receive services because they do not have a private hospital in their local town. Therefore, they do have a bigger captive market and they undertake a very important and responsible role in those towns and districts in particular.

I was very disappointed and concerned to read in the minister's contribution that he considered that there needed to be a review of this area, yet he did not want to do it in this bill. Even though we are completely repealing the old bill, he did not want to review it because he did not want to confuse matters. How ridiculous is that? This is not confusing the matter. We are doing a comprehensive repeal of this legislation and considering a whole new structure, yet he is saying, 'I do not want to raise the private hospitals matter.

I will translate that to the current act and we will review that because we do need to review it. It does need some changes, but I do not want to confuse the matter.' That is code for 'I will not tell you what I will do about these hospitals.' I think that is a very unsatisfactory situation. It just indicates the government's level of respect for and understanding of how important these hospitals are in their communities and the services they provide.

The government is saying that the public sector is good enough to think about and to review its governance and so on, but then is saying that, in relation to these private hospitals—there are only 13 of them, for goodness sake—we will not confuse the matter by introducing the reforms that we have in mind for them. My concern is that is really code for the minister saying, 'Yes, I will deal with these in due course. There will be some things that they will not like either, but why upset people in country communities now when we are trying to placate them by telling them about how we will give them a voice in the community, when we could be on a path of significantly changing the operation of these private hospitals and what obligations and responsibilities will be imposed on them under a licensing scheme and the cost of it. We will not do it now.'

That is the answer from this government: 'We will not do it now but, in the future, get ready, it is on its way.' I think private hospitals have every reason to wonder why they deserve this lower status. Why do we deserve to be dismissed at this point when a comprehensive review is being undertaken? What will happen to us? Are we an endangered species? Will we be overburdened with bureaucracy? Will we be squashed out of the equation and, if so, what will the government do about it?

Another issue is the performance of the department once the chief executive has complete responsibility. I have not seen this chief executive's current contract of employment. I expect it requires (as with most of them at a high level) a level of demand that certain duties be undertaken and a commitment to their job description. I do not know whether any performance clauses or bonuses are available, but it is my understanding that some rewards for achieving profit lines are operating under this government.

One I was told about recently involved SA Water and that executives have a profit bonus share; that is, a bonus payable in the event that they achieve a certain increased profit for the corporation. I do not know how widespread that is across departments or corporations. In SA Water's case, it has an obligation to hand over its profit every year to the government. There has been much criticism over time of the government's taking the cream off the top and failing to provide sufficient capital works to maintain the infrastructure at a reasonable standard.

I think this question is important considering that this chief executive will have such an extraordinary power at the end of this process. Is he under any bonus arrangements? Is there some benefit to him if he is able to shave off a portion of the budget or if he is able to make some cost savings? Will any benefit be payable to him if he is able to close a service without World War III breaking out in the local community? We are entitled to know what bonuses and incentives are there, if any, to perform and, in particular, if any others in the department enjoy that—

The Hon. J.D. HILL: Mr Speaker, I rise on a point of order. I have listened to the deputy leader now for close on 3½ to four hours. She is now asking questions about the performance arrangements in relation to the CE of the department, which strikes me as being completely outside the legislation that is before the parliament. It does not relate to his contract of service one iota. I ask you to draw her attention to the matter that is being debated.

The SPEAKER: I have to admit that I have not been closely following the deputy leader's speech. She is required to speak to the bill and cannot address other issues that perhaps would be better suited to a grievance. She needs to speak to the legislation in question. I will listen to the deputy leader's speech and, if I think she is straying from the subject matter, I will draw it to her attention.

Ms CHAPMAN: Thank you for your indication, Mr Speaker. As you were not possibly listening to my riveting contribution, let me explain that I had been—although not in a disparaging way—calling upon the government to identify if there are any performance arrangements with the chief executive, because this bill (which I am sure you would have read thoroughly) is about the change of governance of health administration in South Australia. One of the most significant features of it is that the chief executive, who has a very important role already, will get all the power. Once the local boards go, the chief executive will be responsible for all staff and the employing authority (which he has under the public administration legislation), and they will not be responsible to any other board. It is important if there is any performance outcome. I have made that contribution and I only repeat that for your benefit so you understand the importance of it to this debate.

In the area of health advisory councils the government proposes to introduce, as a means of continued advocacy, representation from local communities. The metropolitan boards go altogether and there are various other boards that disappear (the Ambulance Board, and so forth), and we will have governance by chief executives who are all accountable to the chief executive of the health department. So, the chief executive of the SA Ambulance Service will no longer sit independently and report to the Minister for Health (as he now does, having been transferred from emergency services); he will be accountable to the chief executive of the health department (Dr Sherbon).

All the local unit boards and regional boards in country hospitals and health services will be abolished and those regions and areas, and the bureaucracy attached to them, will be accountable to one incorporated board—namely, Country Health SA—which will have a chief executive accountable to the chief executive officer. There will be some CEOs in the metropolitan boards to which I have referred (Central, Northern, Southern, and the Women's and Children's health service aggregate regional groups) who will survive the transition, and those chief executives will also be directly responsible to the chief executive of health.

A number of concerns were raised by country health boards. I visited a number of those boards and had discussions with them, having viewed their hospital and health services and allied health facilities. Indeed, I enjoyed having the opportunity to apprise myself of the facilities out there, how they were functioning, and of the importance of the services they were delivering, and I met with local clinicians and general practitioners, who are well known (particularly in country areas) for playing a very important role in services both to the hospitals and the public.

They certainly have a very strong role, whereas I think it is fair to say that there is such a variety of other clinicians who play a very important role in our metropolitan hospitals, through sheer proximity and the level and diversity of services they provide. They expressed their concern; as did patients or former patients, patients on waiting lists, people concerned about the provision of services, people seeking new services for their area (such as the introduction of a chemotherapy facility), and people who were desperately trying to save services, such as obstetrics at Kimba and Cleve, rather than having to drive to the Whyalla or Port Lincoln hospitals.

Whether they were trying to save services or seek new services, or whatever, I was able to enjoy the hospitality of a number of the boards and members of the public as well as concerned community members—often people who had a role either at an executive level or as members of local government. They also play a very strong role in the provision of services and keep a close eye on service delivery in their areas because, as local employers, they understand how important it is to attract and retain other industries and a workforce in rural and regional South Australia.

They are very familiar with its importance and in places such as Elliston, on the west coast, the local hospital (as I am sure the minister would know) is the biggest single employer in town. It was not unusual to go through towns and find that, apart from the local school (if they still had one), the health service was the major player in the financial security and survival of the town because of the workforce it employed. It gave an opportunity for a number of people, both skilled and unskilled, to be available to undertake work in those facilities and to continue to be able to live in rural and remote regions, and I thank them for that.

I have viewed a number of submissions presented to the government—and not just because some of them are on the website (I am hoping that all of them will be). We have viewed those and I propose, during the committee stage, to refer to a number of the concerns raised on particular issues. However, I think it is fair to say that, of the submissions received, the most significant concern has been that if they are to become an advisory body to the minister on issues important to their local area, be an advocate for their community, and if they are to receive complaints or concerns from their local community and ensure that those are passed on (so that they become a complaints body with an advisory and advocacy role for their community) what happens with the advice they give? Will it be taken on board? Is there any process by which they actually have some accountability from the minister or his department when they present that advice, or will they come together at monthly or bimonthly meetings (or whenever they choose to meet), present reports and send emails, and have absolutely no response whatsoever?

I think that in the initial period of consultation on this matter most of the community was prepared to carefully consider what the government was presenting in a genuine attempt to try to improve the situation—which was important to do. Most of the community were also prepared to consider that the government was attempting to relieve local boards of the burdensome and cumbersome responsibilities that were sometimes beyond their capacity so that they were not having to deal with the tiresome exercise of trying to balance the books with a limited budget and always having to put up submissions for extra money, and feeling as though they were not getting anywhere with the frustration of running it. So, there was almost a feeling that this was an attempt by the minister to rescue them from this responsibility and that it was all too hard, that health was so complex and difficult and something that really was far beyond the capacity of ordinary volunteers out in the community.

But it became pretty clear to me, and to other members who will speak on this bill, that these board members started to see through this, and they said, ‘Health has always been complex. We might have new pieces of equipment that we do not understand or how it operates now, or we may have a variety of product to choose from, but we have chief executives, matrons and the directors of nursing. She soon comes into us and tells us whether or not this is useful, and we listen to her advice.

We still have the experts, so to speak, at a clinical level and we have the access to the people in the department to call for some advice on the selection of a particular product or service. We have people who can tell us whether or not we are complying with quality controls and what needs to be done to do that. We make sure then that we follow through on that. We see that as the minister, his apparatchiks or members of the new Country Health SA board or other employment at this point—Mr George Beltchev, for example, or any of his employees at Port Augusta—coming around to tell us that, essentially, in a nutshell, we are too dumb to make these decisions anymore. We are not capable of making these decisions anymore.'

It is a gross insult to the people of these communities who, as I have outlined as briefly as I could during this morning’s presentation, have served in extraordinary ways, consistently and continually, for over 100 years in the case of some hospitals, in the management of hospital administration. Not only that, these people, in this and earlier generations, have run organisations, businesses and local governments in those communities and have become members of this parliament, or members of the federal parliament. They have been successful in business and have operated multimillion dollar councils.

These are the very people who have generated the wealth in this state, the agrarian development of this state and the mining development of this state, which was massive in the 19th century and which had a major revival in the last century, as it is undergoing now. These are the very people who are living out in these communities, who have earned the money to pay the tax to provide those funds to the Treasurer, hopefully, to dish some back out into the regional and country parts of South Australia in order that they may have a share of the tax that they have generated from decisions they have made to provide for the wealth of this state.

It is not good enough for a minister of this government or any of his department to go out there and say to these people, ‘You are not capable of doing this anymore,’ after over 100 years of their generation and previous generations in these districts building these hospitals, raising money for them and making sure that they provide services for the people, whether it was in the prevention of contagious diseases in the early part of last century, or whether it is to ensure that we improve the mortality rates of babies in providing obstetric services, or whether it is to provide for post-war rehabilitation and health services for those from South Australia who came back to those communities wounded and often needing major rehabilitation. To say to these people, after all that, that they are effectively too dumb to even manage the local hospital board and that you need some guru down here in Hindmarsh Square to manage it all is a damn insult.

Every member of this house, particularly those in the government (and I know that there is at least one of them who covers the area of Whyalla, the west and the north) ought to appreciate, and I am sure she does, the significance of the contribution of these people. Of course, I do not think we will see a contribution from her to this debate because her hospital in Whyalla is one of the chosen four. She gets a regional hospital. She gets what the government pronounced as ‘an enhancement of services’. So, she is one of the lucky ones. She also happens to be the only regional member that the Australian Labor Party has in this parliament in this house.

I hope that the remaining members on the government side of this house listen carefully to what is to be said by other members who represent these people out there and have a very clear day-to-day understanding of the importance of the work they have done. They should be congratulated at this point for undertaking, often for no financial reward and at financial cost to themselves and in the sacrifice of personal time with their families and their enterprise or employment, this service free of charge; yet they are about to be axed and they are about to be told that they can be an advisory council.

Here is the great and final blow for these people, the nail in the coffin: the process by which they are to survive. At present, the SA Health Commission allows for a winding-up procedure of boards. If they do not want to function anymore, if it is too difficult for them to operate and they want to give it all over to headquarters, they can do that. There is a winding-up procedure. They can transfer assets, if they have inherited gifts or bequests, for example. That can all be done. That is going to go in this legislation.

The minister will have the absolute power to dispose of any HAC. The danger of this is that, if he does not like their advice or if he does not like the information they give him about what is happening and what needs to be fixed in their district, he can get rid of them. So far, I have not seen any provision in the legislation, which means that, in his obligation to get rid of them, he actually has to put them into another HAC. He cannot just exterminate them, but he can effectively do that by transferring them into another HAC which they neither want to be a part of, nor is it of any benefit.

I will give members an example. Under the legislative reform as provided, the minister can, if he is of a mind to, discontinue a particular HAC, say, Streaky Bay. As part of the western Eyre Peninsula regional HAC, it is coming up with a few ideas that the government does not like. What does he do? He could, of course, make a decision to do that. He is obliged to consult back with the relevant parties. If they cannot agree, he is obliged to go through a mediation process. If agreement is not reached on that, he can get rid of them, but he can only get rid of them by putting them into another one. There is nothing in the bill to protect them against him putting them in with Ceduna, Port Lincoln or Whyalla as a neighbour. He may put them into Mount Gambier. It would seem to be an odd combination.

Let us assume that the people of Streaky Bay—who have a beautiful hospital, a magnificent facility providing all sorts of services: allied, aged, health, acute, etc.—say, 'Look, if we are to continue as a HAC, we want to stay with our western Eyre Peninsula area, or, if we're not allowed to stay there, we'd rather move to Port Lincoln, but don't put us in with Ceduna, because we don't see that there's a cohort of population or a transfer of our services with that town. We don't shop there as much; we provide our own services and, if we need something that we can't get, we usually go down to Port Lincoln rather than go up to Ceduna.' I do not know if that is the case—I am just using this as a hypothetical example.

The minister can say, 'No, I don't like you; you people are too difficult. You're raising too many issues; you're complaining because you haven't got an obstetrics service up there; you're complaining I'm not giving enough transport allowance or ambulance support to get from your hospital to another, because I'm closing down some of your services—or my CEO is—and I'm asking you to transfer to those other services.' So, that is the hypothetical. There is no protection for these people.

They have been lining up to provide this responsibility and this job free of charge for over a hundred years in some districts, and now the sand is just thrown in their face—'We don't need you anymore; in fact, you are obstructing us in a governance structure which is necessary for contemporary 21st-century health delivery. You're in the way—you're going. You can be an advisory council—that's the sop we give to you. You can tell us about the complaints in your community, but we don't have to listen to them. We don't have to do anything with them. We have no obligation to even report back to you, and we can even get rid of you if we don't like you.' It is an utter sham and an insult to these people that our local communities have been treated in this way.

It is a matter that they have raised with me because opposition people are often the only people that they can speak to. They go to their local member and then they come to the opposition member and raise these concerns. They are terrified of what will happen if the consulting group comes marching into their local town to tell them what is going to happen and they buck the system and raise a complaint other than as a concern. If they go beyond saying, 'Minister, would you respectfully take this into account and consider it and allow us to still call ourselves boards rather than councils? From all the submissions that have been received, please understand that health services are critical to our local community, to the support and the very survival of our township,' and say instead, 'This is just not acceptable,' they know the consequence. The consequence is ruthlessly obvious in the provision of capital works and improvement in financial funding for people in the country.

They have seen this government's capacity to rip out financial savings, even when the commonwealth comes along and Christopher Pyne says, 'Well, I'm going to give you some extra money to fund beds.' They do not give any extra money back to the local hospitals. They treat that as a savings, for goodness sake! Yet these people are providing that service out in the regional areas. They take away some of the support of the regional officers out there but not back here in the city. So they know the direct consequence for their bucking the system. They can plead with the minister, they can ask that their submissions be respectfully considered but, at the end of the day, they know what is coming.

It is a tragic situation, because the outcome is that we are not going to see a benefit to health as a result of the cherry-picked portion of the Menadue reforms being placed in this legislation to give the chief executive the power and authority to select workers, where they will work, and in which facility across the state. If he wants to move them or close down a service, he will have absolute control to be able to do that, subject to the current contractual arrangement of that employee. He can move them around wherever he likes. They do not even have a set of permanency rules (like teachers do), because they have not needed one.

They do not even have a structure worked out to secure the arbitrary transfer of people. In the health industry, they come new into the facility, and there is opportunity for employment under the new system. This is the best that I can put it at. I can only hope that if the government does not see a demonstrable improvement in these services, it will be prepared, at least between now and 20 March 2010, to review the decision, offer some amendment, take it on the chin when they muck it up—as they have, I think, with this legislation—and be prepared to amend it. Otherwise, as usual, we will have a major cleanup, Monday morning 21 March 2010.

Ms SIMMONS (Morialta) (17:45): I rise to speak in support of the Health Care Bill. South Australia enjoys a health-care system made up of excellent medical and support staff. However, we know from the work done by John Menadue and the Generational Health Review—and I acknowledge and was glad to hear that the Deputy Leader of the Opposition acknowledged what an important and contemporary document this is—that the governance of our health system is in need of major reform if it is to keep abreast of changes and the future needs of the health-care industry in this state. This is the first review of the health system since the Bright report, which was published over 30 years ago.

A key feature of the public debate generated during the Generational Health Review, as demonstrated in the publication of 'First Steps Forward: South Australia's Health Reform: New Governance', dating back to September 2003, states that the review process and the principal element in its final report was a 'sustained criticism of the current governance arrangements of the South Australian health system'. It states:

John Menadue's concluding comments specifically targeted governance reform as the linchpin of health system improvement. He said, '...we were consistently reminded of poor governance. Governance is a crunch issue where, in my view, good public policy and sectional interests collide. It results in duplication and fragmentation of care. Many clinicians also told us that the present governance arrangements result in serious concerns about quality and standards'...

The publication continues:

The current governance of the health system as envisaged in the South Australian Health Commission Act allows for highly decentralised decision-making and a great degree of autonomy amongst constituent units.

Examination of day-to-day issues reveals examples of tensions and troubles between health units. These include poorly coordinated services, lack of joint or cooperative planning, inconsistent and contradictory regional boundaries, conflicting service eligibility criteria, and duplication of services. Some of the reported problems included; poaching staff from each other in times of shortage irrespective of the consequences; differential employment conditions; uncoordinated ambulance diversions leading to unanticipated demand pressures shifted from one hospital to another with little warning; early discharge without sufficient planning for community support services.

Similarly, there has been criticism of the role and the conduct of the Department of Human Services...in terms of role clarification, micro management, over engagement in service delivery, and operational issues and lack of strategic focus.

We know that if reforms are not made to our hospital system it will eat up our total state budget by the year 2048. This bill will improve governance arrangements. It provides for the CEO of the Department of Health to have direct responsibility and accountability for managing the public health system and not just funding it. This will ensure a greater capacity for the health system to act as a coordinated strategic and integrated system. In fact, as John Menadue says in today's Advertiser, 23 October:

The federal Liberal plans to introduce hospital boards in SA would be...the worst possible thing to do in South Australia.

He goes on to say:

The key to reform in South Australia was getting rid of the hospital boards—they maintain little fiefdoms, silos, they look after their own patch and resist integration.

That is how far behind in the time warp of thinking the federal Liberal health policy really is. In this bill, although the metropolitan health regions will continue to exist, there will be no boards and the CEOs of the metropolitan regions will report directly to the CE of the health department.

Similarly, in the country we currently have 43 hospitals which are separately incorporated. These hospitals will be combined to form Country Health SA, which will be incorporated as a hospital in its own right. There has been evidence in the past of the system not working. Internationally, trends in health reform and health service development emphasise the need to develop better service systems and better integration of care and services.

Again, if we go back to the Menadue report we can see that with these reforms the significance of effective and appropriate governance structures is often highlighted. Put simply, governance arrangements in South Australia are not keeping up with the needs and demands of a modern integrated system of health services. Similarly, the South Australian ambulance service will be transferred to the Department of Health, again with the CEO of the ambulance service reporting directly to the CE of the health department. All these legislative changes will facilitate and improve governance arrangements in our hospital system.

I would now like to highlight a few of the significant changes which will make a real difference in creating this strategic new system. The legislation seeks to set up a health performance council made up of persons appointed by the Governor on the nomination of the minister. These members will be persons who collectively have the knowledge, skills and experience necessary to carry out its functions effectively, and can represent the diversity of South Australia's population. There will be increased accountability of the council. They will report to parliament annually and four-yearly, with the minister tabling the four-yearly report in parliament. To support the work of the health performance council we will establish health advisory councils, which will provide advice and advocacy, and have the ability to manage assets, gifts, funds and trusts for country hospitals.

In country areas they will also be able, where they wish, to transfer their assets to the new Country Health SA board. They will not have responsibility for the management of health services or the employment of staff. This fundamental change has been well received by the country hospital boards to whom I have spoken. These health advisory councils will consist of appointed and elected positions, the majority of whom will be local community members elected at an annual general meeting. So the local community will reflect the needs of the local council, contrary to what the Deputy Leader of the Opposition said earlier today. The minister will have the capacity to appoint up to three members but, essentially, it will be locals who will advise on local health issues. We recognise the importance of this, and this is what is reflected in these councils.

The minister will also have the capacity to set up health advisory councils to provide advice and advocacy for certain population groups (such as veterans or ambulance volunteers) or on ethical issues. The new governance system will see the abolition of the boards of the three metropolitan regions and country hospitals, which will now be established as incorporated hospitals with sites and their own CEO, and a continued concentration, which we need in this state, on the delivery of primary health care. The regional CEOs will report directly to the CE of the health department, who will be responsible for the administration of incorporated hospitals. The staff of the incorporated hospitals employed under the bill will have the same terms and conditions and protection of accrued rights and entitlements that they currently enjoy.

Lastly, I would like to comment on the establishment of the SA Ambulance Service as the primary provider of emergency ambulance services in this state. Consistent with the model in the hospitals, a CEO will be appointed who will report directly to the CE of the health department. There will be provision for certain groups to be exempted at the minister's discretion—for example, the Royal Flying Doctor Service, the state emergency helicopter and hospital retrieval teams. The Minister will be able to provide licences for non-emergency ambulances and the SAAS is able to direct a person holding a restricted ambulance service licence to provide an emergency ambulance service in the case of a state emergency.

I commend this bill to the house, as I believe the new governance arrangements will ensure a greater capacity for the health system in this state to act as a coordinated, strategic and integrated system to help meet the challenges of health pressures into the future.

Debate adjourned on motion of the Hon. G.M. Gunn.

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