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

Final Stages

Consideration in committee of the Legislative Council's amendments.

The Hon. J.D. HILL: I move:

That the Legislative Council's amendments be agreed to.

I think four amendments were moved in the other place. One amendment which was moved by the government is a technical amendment which clarifies a power in relation to restricted ambulance licences. Another amendment, which was moved by the Hon. Dennis Hood of Family First, requiring the Health Performance Council to review the governance arrangements after a period of three years, was supported by the government. A couple of amendments were moved by the Hon. Sandra Kanck in relation to regional membership of the country health advisory councils. The purpose of these amendments is to ensure that the majority are from country areas, and the government supported those amendments as well. The amendments were consistent with the intent of the legislation, and we were happy to support them. Madam Chair, is this my last chance to speak unless there are questions?

The CHAIR: Yes.

The Hon. J.D. HILL: I particularly want to thank the members of the Legislative Council for their support of this legislation. It is worth noting that all Independent non-major party members of the upper house supported this legislation, and I personally want to thank them all. I spent a lot of time talking through the issues with them, answering their questions and addressing, I hope, their concerns in a reasonable way. I am very grateful for their support. I particularly want to thank the Hon. Dennis Hood of Family First with whom I spoke on a number of occasions. The Hon. Ann Bressington also supported the legislation. I had a couple of conversations with her, and I had one conversation each with the Hon. Mark Parnell and the Hon. John Darley.

I had a couple of conversations with the Hon. Sandra Kanck, and I was very grateful for her support as well. I think I have mentioned all of them individually. I thank them all for their support of this legislation. I think they saw the good sense in it. I particularly want to mention a comment made by a staff member from the office of the Hon. Ann Bressington who told me that, in preparation for the legislation, they had rung around and spoken to many people in country South Australia who were on boards, who worked in hospitals, who were in local government, who worked in the media, and so on. They told me that the overwhelming majority supported the general direction in which we are going. Only two out of 10, they said, were opposed. They had gone through a similar exercise some months ago and I think they said that, at that time, five or six out of 10 were opposed.

Over the course of the consultation period we were able to demonstrate—particularly to the people in the country—that the legislation was not the evil that was being suggested by some, and they were comfortable with the direction in which we were going. We were able to take into account many of the concerns of people in country South Australia, particularly in relation to ownership of assets. I think that was a major issue about which people in country South Australia were concerned, and we were able to address those concerns.

There were some issues in relation to aged bed licence, and I believe we were able to address those issues as well. I think that the process we have been through—which has been a long process—has been highly consultative. We were quite flexible in how we created the legislation to take into account the ideas and suggestions made by people, particularly, as I say, in country South Australia. I want to express to them all, and particularly to those people who work in country health, my thanks for their participation in this lengthy process. I think it demonstrates that if you spend time talking to people a sensible resolution of the issues can be arrived at.

There are two points I would like to make: this is the most significant legislative reform of the health system—I could say ever—but certainly since the 1970s, when the Health Commission legislation was brought in. The Health Commission legislation went part of the way in bringing us to where we are now with this legislation. What the Health Commission legislation attempted to do was to create a system out of disparate organisations. This now goes the next step and really does create one public health system in South Australia, with clear lines of accountability and responsibility, reaching through the CE to the minister. This is the first time in the history of this state (after this legislation is proclaimed) that a minister for health will actually be directly responsible for what goes on. So, the questions that are asked of him or her in the future can legitimately be laid at the foot of that minister.

I am sure the Deputy Leader of the Opposition will avail herself of that opportunity, once the bill goes through. I think that is the way it ought to be. Ministers of health should be responsible to the people through the parliament for what goes on in the health system. At the moment, that is not the case; legally, that is not the case. No matter how much members in here might want to bang on about it—'You are the health minister, you should know; you should do something'—the reality is that the health minister is not responsible for the day-to-day operations of our hospitals, nor is the CE of the health department.

That has been, I believe, a great error in the way we have managed our health system. You have to have proper accountability; you have to have proper lines of responsibility in order to ensure that you have the appropriate levels of safety and quality, appropriate employment strategies, appropriate contracting and appropriate budget control. If things go wrong then there is a process in place to ensure that they are corrected. At the moment, we have a very cumbersome system. This does not imply anything negative about the people who run the system; it is just that the system itself has been flawed.

Once again, I wish to thank the officers of my department, many of whom have worked on this over a number of years now. Over the last couple of years they have put a lot of effort into the development of this legislation through consultation and discussion with a whole range of interested parties. I commend the legislation with the amendments to the committee.

Ms CHAPMAN: I have never attended the coronation of a king or queen, but today must be what it would be like, because when this bill passes today (and we know it will, even with its tiny amendments), we are going to see the coronation of king Tony Sherbon—not the minister for health, but the head of the department and his subsequent successors. That is what is happening today. Any little tinkering around in another place, to try to tidy up what has been a central takeover of health, will be impotent to stop that.

What we will end up with is a situation where the minister, whoever may hold that position, will be trotted out to provide information on a bit of good news or such little select piece of information that the chief executive wants to be released or wants to have the word spread on. The chief executive will send the minister down here so that he or she (whoever holds a position) can provide that information to the house. However, members should be absolutely clear that it is the chief executive of the Department of Health who is the big winner today. He becomes the sole employing authority of some 25,000-odd employees across the state. He becomes the ultimate arbiter of what is presented to the minister to trot in for approval by cabinet as to how the money is going to be spent in the budget. As of today, he will be able to do so without anybody being permitted to raise complaint about what services are being slashed in their local community, who they are going to employ or how that is going to be applied in the local community.

It is fair to say, as the minister said, that a number of boards are about to be axed today—some 60-odd. A number of those have said to the minister and his advisers, 'Okay, we accept this reform.' Well, do they have any choice? These are the very boards that wrote to the Independents and minor parties, while this bill was between houses, asking that they oppose the bill—and I will come back to them in a moment. They were not there lining up in opposition to this bill, just the two of them, as the minister pretends today. They know what death sentence they have today, they know what sentence is being imposed on them today, when they are completely emasculated with the health advisory councils. They got no help from the Independents in the upper house; there were some very interesting speeches, some very passionate concerns expressed, but there was no help when it came to the vote.

Apart from that, we will end up having all the instructions and only the information that is actually provided by the health department—that is, what Dr Sherbon will give them—because we will not even have the accountability of annual reports coming in from these regions, from these boards, any more. Regional board reports will all cease on 30 June. We will have the CEO's annual report from the Department of Health, which will be about 2 centimetres thick and which will tell us, in glossy terms, what is happening with health and how our $3 billion this year and our $3.1 billion or $3.2 billion next year, etc., is being spent. That is what we will end up with, the sanitised version. This minister, and his heirs and successors, will be expected to come into this parliament and answer questions; he thinks he is going to have control of the department and have an autonomous role. What a complete nonsense.

What I say about the government's repeated mantra that after 30 years of reform, having gone back to the Bright recommendations (incidentally, the then Labor government tried to push through an effective health department rather than a health commission, which the Bright report actually recommended), is that the upper house actually saved South Australia at that time. It called for an inquiry and demanded of the parliament that it retain the autonomy and independence of the then health commission from ministerial powers. But no; inch by inch this government transferred that until we have the legislation before us today, which is coming to a close, and which will completely squeeze out anyone other than the minister—who, frankly, will be manipulated by whatever the health department provides to him or her.

The Hon. J.D. HILL: I rise on a point of order, Madam Chair. The deputy leader has reflected on me by saying that I would be manipulated by the health department. I ask her to withdraw and apologise.

Ms CHAPMAN: Well, I hope the minister is strong enough to resist it. However, I actually said that the minister, whoever he or she is, will be manipulated—

The Hon. J.D. Hill interjecting:

Ms CHAPMAN: And I do again; and I confirm that one can only hope that the minister will listen very carefully to this, because I do not want him to be the victim or any of his heirs or successors to be the victim—but he has set up a recipe for that to happen. That is the reality of what is before us.

This is the ridiculous thing: the minister tells us in this house that, 'I need to be accountable, I need to be able to have control over the things happening out there, so that I can come into the parliament and invite the deputy leader to question me about it.' If that were true, why do we even have a cabinet that has to have ministerial responsibility? Why do we not just appoint a Premier and he can make all the decisions, or the chief of staff of the Premier's office with the Premier? It is a bit like having the king and the court jester, and I will let the minister take his pick as to which one he will end up being.

The truth is that if this government were serious about that it would just cancel the whole cabinet. Why do you need a board to manage South Australia's $12 billion budget? We do not need any of these guys or girls sitting along here; we just need a Premier. That is the logical extension of the ridiculous nature of the underpinning philosophy of this legislation, and I want it to be noted in this parliament that only the opposition, the Liberal Party of South Australia, stood up for governance being maintained across South Australia, for it not to be absorbed into the control of the power of one in the chief executive of the Department of Health. The biggest single financial department in this state is now entirely under the control of the bureaucracy.

That is what will happen in a few minutes, and I want it to be absolutely clear that we did not support this. In this state the government has introduced and followed what the New South Wales government did a few years ago. They got rid of all their boards. They thought that they were unnecessary. I was told by someone from the Department of Health in New South Wales that they rue the day they did that because they lost control. Now they have the situation where they are starting to understand the importance of having boards, of sharing responsibility and of the value that other board members can bring into the whole question of governance of a major portfolio. They value that situation.

In Victoria, they have kept their boards. Guess which state in this country is the best performing state in public health on all of the major indicators of performance—namely, elective surgery lists, waiting in emergency departments, re-admission rates? It is Victoria. So, do not ask the state of South Australia to get rid of its boards and follow the model which I suggest has been a disaster in New South Wales.

Just look at the North Shore select committee inquiry. This was an inquiry into the operations and case management of the North Shore Hospital in Sydney—a major public hospital, probably the equivalent of our Royal Adelaide Hospital. That select committee reported on and identified major problems with the governance of that hospital, which no longer has a board. Nobody is there to ask questions or raise alarm bells or to ring up a minister and say, 'We have some serious problems down here.'

Ultimately, a baby had to be lost in a miscarriage to a young mother who attended the emergency department of that hospital. The young woman in question was sent home after having to wait an hour and 20 minutes under an emergency level 3, according to my recollection, when she was supposed to be seen in 15 minutes, and she subsequently miscarried. That was the straw that broke the camel's back, and patient after patient came forward in that inquiry to raise concerns about nobody being there to raise the alarm bells when things went pear-shaped in the operations of that hospital.

Here we are in a situation today where we are completely removing a level of protection for patients, their relatives and the public generally to be able to have some kind of insurance against disaster in what is already a high-pressure profession for those who are working in public health. To have removed this level of protection I think is not only a bad move for South Australia's patients, future patients and the relatives they rely on for their support, but also it will be the undoing of the public administration of those hospitals.

If the minister were really serious about identifying where the real problems are in public sector health, why has he not produced the Paxton consulting report? This is the million-dollar report prepared by the Paxton consultancy (an interstate agency) on the operation and management—in particular, the efficiency—of major public hospitals in South Australia, but the minister has not released it. I have asked him in this parliament to release it and tell us what that report says because, from all the accounts, not only is the operation and efficiency of these hospitals a problem, including their productivity, but also management and governance are serious matters.

What has been happening in these hospitals over the past 18 months? We have seen the situation involving Mr Grigg, the chair of central northern, whose activities involve $1 billion of the $3 billion spent on health each year within the major metropolitan hospitals in Adelaide, except the Royal Adelaide Hospital. If I have left out any smaller hospitals in this instance, I mean no disrespect. I am referring to the Queen Elizabeth, Lyell McEwin and Royal Adelaide hospitals—the major public tertiary hospitals in this state. As chair, I think he was overseas when he was told that there would be a change in structure, and he was not even told that his hospital, the Royal Adelaide, was going and that the new Marjorie Jackson-Nelson hospital was being proposed. The one person who is in charge—

Mr Pengilly: You can see how popular that is.

Ms CHAPMAN: We will see how popular that is, that is for sure. The chair of the Central Northern Health Board ended up throwing his hands in the air and going public to say how disappointed he was in the government's management, approach and advice on this matter. That is how they treat these people; they have now removed them completely. They have effectively been neutered for the last 12 months since it was announced that this bill would be presented to the parliament. It has probably been about 18 months, since about April 2007. It was at about the time, of course, when Dr Sherbon took control as the employment authority for all the workers around the state and the establishment of the new country health office in Port Augusta. At least I know where that is.

Mr Pengilly interjecting:

Ms CHAPMAN: It's where they catch tuna, isn't it? That's right. The important thing is that there has been a dismantling, there has been an undermining, and there has been a preparation out there in the general community for the dissolution of the governance structures which are actually to be obliterated today. They have been weakened, they have been belted about, but the minister says that there has been, effectively, only minority dissent. That is not what happened. These people were told over 18 months ago what was going to happen and eventually they lay down, but the interesting thing is that they wrote to the Independents to say, 'Save us', and of course, they gave those passionate speeches, and we now find ourselves in the situation where they have been removed.

New South Wales—bad example; we followed it anyway. Victoria—good example, and they still have boards. They still have a governance structure which actually invites and welcomes the local community in to have a say, and which has the benefit of contributions from businesses, other professionals and consumers. What do we have? We have a couple of stakeholders in South Australia who profess to be the voice of consumers in this state but who are funded entirely by the government. That is what the government sees as having a voice for the consumer, for the patient who cannot get in to have their elective surgery done. All they have left, I remind members of parliament, is us. We will be the sole voice left for the people who have any concerns about the health services that we are going to have in the future. I send that message loud and clear: we need to do that.

In recent months, three chief executives of major public hospitals in metropolitan Adelaide have either resigned or announced that they are not renewing their contract. They are from the Royal Adelaide Hospital, the Flinders Medical Centre and, most recently, the Women's and Children's Hospital. I do not know how any of those CEOs would have been able to cope with the amount of reform in the proposed restructure under the health plan and the building of a new hospital on North Terrace. How they would have been able to continue to manage those hospitals—the Flinders Medical Centre, the Royal Adelaide Hospital and the Women's and Children's Hospital—as the government has started to dismantle and shrink the services in other facilities, is almost impossible to understand.

How can we be serious about taking services that are currently in metropolitan hospitals back out to the country to relieve some of these major metropolitan hospitals of their chronic workloads without having established support in the country? The government's answer is to slash their services, to rip out 250 people from the country. That does not sound like getting the rural community ready for a transfer of medical procedures from our cramped and overcrowded public hospitals in the city back out to the country. It does not sound like that to me.

About $100 million dollars a year is spent on bringing country people to major metropolitan hospitals in the city for medical procedures. Some of that is necessary. No-one expects to have brain surgery or a heart transplant at Streaky Bay Hospital. Of course you have to come to a major metropolitan and tertiary hospital for some procedures, and we understand that. However, most of these $100 million worth of procedures, even on the government's own account, ought and should be supported to go back out into the country into major regional hospitals.

It is $100 million a year, and we agree with that, because these people have to come to Adelaide. They get some paltry contribution under the patient assistance scheme, which is a commonwealth and state arrangement to assist in transport—once. But what about the multiple trips they have to make? What about when they have to stay overnight? What about when their relatives come to visit them, help them shower or provide a laundry service because you do not get that in a major hospital any more? You have to rely on relatives to provide that extra service. Where do they stay? Who will pay for all that? It is a major problem for our regional residents at the moment.

This governance restructure, this slashing of the voice of the people in the country, will only exacerbate the problem as we move forward. The government's answer to their having a voice is to establish a health performance council. I will not repeat the debate, but I will summarise the position. The minister will appoint a performance council, which will have a legislative obligation to report to this parliament annually and then provide a major report every four years (which will be after the next state election—how convenient!) It will issue a report based on information provided by the Department of Health.

Do you think that Dr Sherbon or any of his representatives in the Department of Health will rush into the health performance council and say, 'We're stuffing up'? No. Will they rush in there with a report and say, 'This is a major problem we have here in this hospital, in this service or in this direction we are going?' No, of course they will not. They will provide the stats just as they do to prepare the annual reports now. They will be the authors of the very information the health performance council is supposed to scrutinise and provide to us as a parliament so that we can be accountable. Talk about Caesar reviewing Caesar: what a nonsense!

We will end up with the same old sanitised report that comes less and less often. For example, I remember that, before we had the regionalised metropolitan system, we received an annual report from the South Australian Dental Service. It was a comprehensive report on how many children's teeth were looked at, how it accounted for its money and how it had been spent on its programs. That could be during the course of audit and estimate hearings in this parliament, and we could ask questions about them. What do we get now—and this will stop on 30 June? What we get now is a little paragraph telling us how fabulous the service is and one line in the budget on the Central Northern Health Service, stating, 'SA Dental Service, $40 million.' How it is spent, who knows? Do we have a clue?

What we will get next is an annual report from the health department stating, for example, 'Money spent: $3.1 billion.' That is the reality and extent of the sanitised information we will receive. So, what I put to members is that the HPC proposal will not be a genuine voice of the people. In the upper house—

The CHAIR: Deputy leader, I draw your attention to the fact that, under standing order 364, your time limit is 15 minutes. At the moment, you have had 18 minutes, so I ask you very quickly to address the subject of the motion.

Ms CHAPMAN: Thank you, Madam Chair. I will then address each of the amendments, and there are four amendments.

The CHAIR: There is only one motion.

Ms CHAPMAN: On the four amendments in the motion, I briefly indicate—

The CHAIR: There is only one motion; therefore, that is the situation.

Ms CHAPMAN: —thank you—that the opposition supports the amendments. The amendment relating to the HPC moved by the Hon. Sandra Kanck provides that the minister must establish arrangements to meet with it on a regular basis. There is no definition about how often that should be. The minister indicates he consents to that. I would hope that would be at least monthly so that we have some genuine reporting, given that this new group will be limited in carrying out its role.

I now refer to amendment No. 2 (the second amendment of the Hon. Sandra Kanck) that a majority of the members of the health advisory council be selected or appointed on the basis that they are members of the local community. We applaud that, but the reality is that this is a council which will have all voice but no power. It has no influence: it is purely an advisory council. I do not see why the minister's amendment (amendment No. 3) to limit the scope of a licence to enable a restricted ambulance licence is necessary. We do not object to it, but given that they have no power to have separate licences, other than the couple that have been protected for emergency work under the ambulance licence, I am not entirely clear as to why that is necessary. However, we are prepared to support it.

In relation to the three-year review period, that is, the amendment of the Hon. Dennis Hood, I indicate that is something we obviously support, again subject to the limitations that the actual council will have. The other matter I briefly address is the Repatriation General Hospital. The bill has come back to us without amendment to this section. We had previously indicated that we supported the Repatriation General Hospital's having and retaining its own board, and so special provision has been made in this bill. The Premier has said to the house—and I quote his words—'This will not change unless the diggers want it.' He has made that commitment to this parliament. Therefore, it is of great concern to me that I hear of a consultative committee being formed (as they tried to do a few years ago) to look into the amalgamation of the Repatriation General Hospital and its governance with Southern Adelaide Health Service.

Here we have this war all over again. Let me tell members that it will be a war because the Premier has made this commitment to this parliament and it is something on which we will not lie down. The minister needs to be clear about this. It is beyond me why they would want to try to push all this legislation through and then announce through some other amendment that either they will completely neutralise this board or try to suck it into the services of a hospital such as the Flinders Medical Centre, which every year struggles even to balance its books.

Let me say this: it will be the Liberal Party again that will be standing up to support the return service men and women of this country and, in particular, South Australians, and that we maintain this entity for them to ensure that, as they return from East Timor—we have a 1,000 of them over there at the moment—Iraq and surrounds—we have 1,500 over there at the moment—they have a hospital with a dedicated service, whether it be for bomb-blast wounds or mental health assistance; and that they will not have to line up at the Royal Adelaide Hospital to get into C3 ward or try to get into Glenside Hospital—half of which will be sold, anyway. They deserve the dignity of having autonomous responsibility over their own hospital. This will be something that we will not let die. With those comments, I indicate that the opposition opposes the bill.

Mr PENGILLY: I support the amendments of the Legislative Council, but I would also like to comment on a sad day for health in South Australia, if this bill goes through.

The CHAIR: I was incredibly indulgent with the deputy leader and allowed her to repeat her second reading contribution. I have given that privilege to her as the lead speaker, but other members will need to confine their comments to the motion under consideration.

Mr PENGILLY: Absolutely, Madam Chair. Amendment No. 2 does cause me some concern because, although we are supporting it, I do not think it is strong enough. Quite frankly, I think it is going to be useless in the context of the overall changes to the health act. That is what worries me.

It is most unfortunate that we stand alone on this. I hope that the government will support the amendments that have come back. I worry that, in a couple of years' time, or 12 months, or even less, we may be back here revisiting this whole issue again. It is simply not good enough to put an amendment that is not going to be strong enough. In saying that, I am not speaking against the amendment. I am trying to say that I do not think that the amendments are good enough to carry the best interests of the South Australian people through this new health act. That is my major concern. It should have been stronger. Unfortunately, it is not going to be stronger. In saying that, we support the amendments.

Mr VENNING: The bill's proposal to abolish existing hospital boards in country areas and to replace them with health advisory councils (HACs) will spell the beginning of the end for many country hospitals. I have raised this with the minister at length. This proposed wind-down of country health would rate as one of the most important issues that I have dealt with in my time here, and that is now nearly 18 years. It is of serious concern for me, because these hospitals are the lifeblood of our communities, particularly the smaller, more isolated communities.

I was amazed this passed the other place last week and I feel as though I have let my people down, because I did not know it was going through and that I have been derelict in my duty. How they all rolled over I do not know. The opposition sat on its own, with the rest of the council voting to support it. I did not even know it was happening and I feel very guilty.

I have made many speeches in this place over the years in support of country hospitals, especially the local ones in my area of Schubert and, indeed, Crystal Brook. In the past five or six months I have ramped up my comments in support of the status quo. For the record, I have five hospitals in my electorate: Angaston, Tanunda, Mannum, Mount Pleasant and Gumeracha, with three boards operating in them.

The CHAIR: Member for Schubert, can you address the amendments, please?

Mr VENNING: I am addressing the issue, Madam Chair.

The CHAIR: The issue has been dealt with. What we are considering now is the amendments—

Mr VENNING: I am talking about the effect of the amendments. The effect of the bill is to remove hospital boards—are you saying to me I cannot address that matter?

The CHAIR: I have allowed the—

Mr VENNING: Well, you give me no choice.

The CHAIR: Order!

Mr VENNING: You are way out of whack, Madam Chair. I can speak on this issue, surely. I have been here for 18 years. You are telling me I cannot speak on this matter? I think you had better consult the Clerk.

The CHAIR: Member for Schubert, please take your seat. The issue before the committee is the schedule of amendments made by the Legislative Council. As I have indicated, I gave the deputy leader great liberty in allowing her to address the issue of the bill. The topic is the schedule of amendments. That does give you quite a bit of room to speak, but the topic is the schedule of amendments and I ask you to confine your remarks to that.

Mr VENNING: Madam Chair, on that ruling I ask you then whether I can make these comments before it goes through. These are general comments.

The CHAIR: The general comments are simply for the purpose of context. I am allowing you some liberty in putting the context, but the topic is the schedule of amendments.

Mr VENNING: The health advisory councils are what I am speaking about. That is what we are going to have in lieu of our hospitals boards. I am very concerned that this is where we are going.

The Hon. J.D. Hill: Just say you do not think the amendments go far enough and explain why you do not think they go far enough.

The CHAIR: The topic is the amendments, not the bill.

Mr VENNING: I have had a lot of dialogue with the minister in relation to this matter and I believe the government has been working for many years towards setting up these HACs. They desensitised the issue and they got rid of certain people. I always received good advice from a gentleman named Mr Trevor Manning (operating in the Adelaide Hills) who, in the end, out of frustration, resigned. They put people in certain places to kill off opposition and to exterminate all individual hospital boards. Volunteers and locals are out and bureaucrats are in. The minister did it with NRM and look at the result—similar outcomes really.

The minister is not satisfied with the stuff-ups; he is doing it again now. There is no more local ownership of hospitals. We will be chock-a-block full of bureaucrats with the HACs now being discussed in this amendment. How can an ordinary volunteer participate in that? Realistically, I do not believe that a volunteer will be able to keep up because, with a HAC, the professionals—that is, the bureaucrats—will totally dominate.

We will no longer have local ownership of hospitals, because a HAC will control a multitude of hospitals. Having served on a hospital board—and that was at Crystal Brook for nearly 10 years—I know about the decisions that are made. What upsets me more than anything is that, with a HAC, I do not believe there will be any local involvement, local fund-raising or local management at all. We will be handing all that over to the machine: the bureaucrats in high places. I am very concerned about what happens with a HAC and whether it will actually own the properties because, at the moment, the land and buildings are held by the community, but with a HAC we are not exactly sure.

I am very critical of Family First in the other place in relation to these amendments. Surely a family-based Christian party like Family First should not have supported amendments like this, nor this legislation. I am just amazed. I have been critical of the other place over the years, Madam Chair, as you know. It is basically there to protect us against legislation like this—a check and balance to stop and modify bad legislation. In this instance, all the parties there—except the Liberal Party—rolled over on this issue, and I am most concerned.

To the Hons Dennis Hood and Andrew Evans I say: shame on you. The Hon. Mark Parnell was a strong supporter of volunteers and against the big brother bureaucracy, as was the Hon. Sandra Kanck. I will not criticise the Hon. John Darley because I did not get to speak to him, as he has been here only a few weeks.

The minister knows that I support him, but I feel that, on this issue, he rolled over for the bureaucrats. The minister told Sir Humphrey (that is, King Tony Sherbon) that he now has total control through this amendment. It means that hospitals like Crystal Brook will be starved, and Pirie will get priority. The minister named the doctor—my doctor—who advised him. I am amazed that he did not have more opposition to this, and this is all on the record.

We are seeing a complete breakdown of our health facilities in regional South Australia, as we have seen with NRM. I will be going to the Hansard and I will say to the minister, 'Well, you did it. You didn't listen to us. You didn't consider what you did with NRM.' This is relevant because the control we are giving to the executive level of government—that is, the bureaucrats—is for massive cost blow-outs and very poor service on the ground, nothing like we used to have before we lost control. This is a victory for the highly paid, unelected, invisible power moguls in our executive government.

As members of parliament, we have all been elected. We are accountable every four years. What has the minister done here? He has effectively taken control away from us and put it out there into the great abyss that is the public machine. Yes, this is a victory for these highly paid people, and I regret it. I apologise to my electorate for not giving them stronger advocacy on this matter. I have failed them. It is a serious matter.

The Hon. J.D. Hill interjecting:

Mr VENNING: Well, I didn't stop it, did I? You can be assured of one thing: there will be less spent on health care in country regions and a lot more on executive-level wages, consultants, training courses, motor cars—you name it. You have seen it; it is going to happen. For Christmas, my wife gave me the complete series of Yes, Minister, and I sit there for hours watching the episodes, one after the other. Well, here is a prime example.

Members interjecting:

Mr VENNING: I don't know about you, but I do not laugh at them any more. I just think, 'Well, gosh, this is text book stuff.' In conclusion, all I can say is that we fought the fight and lost, and I am very sad indeed. I only hope I am wrong, but I am sorry to say that my experience from the time I have been in this place tells me that I am right—and the record will probably show that I am well and truly right. It is a sad day.

Mr PEDERICK: I rise in support of the amendments, but I also have some worries about whether we will have the right support in country areas and whether we will have the right people on these health advisory councils so that the right decisions are made in rural and regional areas. Too many times I have seen mistakes made, with health care workers going into areas with absolutely no idea of what they are getting into, and they do not even make it to their first day on the job. For example, an EODON came into the area, into the Mallee—

Mrs Redmond: Pardon—EODON?

Mr PEDERICK: EODON: Executive Officer, Director of Nursing, for the uninitiated.

Mrs Redmond: I already knew; I just wanted it in Hansard.

Mr PEDERICK: This officer's partner was a scuba diver. Well, unless he wanted to climb down a bore hole, he was not going to do too much scuba diving. So, she did not even make it to her first day on the job. I am concerned that we have the right local representation on these health advisory councils to make sure that the right decisions are made at the local level.

As far as ownership of assets is concerned, it did seem at the early stage of the consultation process that the minister was keen on a centralised pool of money for regional areas. At least the government appears to have listened to the communities and has said that ownership of regional assets can be held locally (or that is how it appears) and the communities can conduct fundraising locally to support these hospitals, which are a vital part of the community.

People who live 250, 300 or 500 kilometres from city hospitals need adequate health care, and it is certainly necessary that there is adequate local input to make sure that things are done right, because no-one can tell me that someone in a silo in Adelaide would have any idea, without consulting with the locals, on what is going on in regional areas. I support the amendments that have come down from the upper house, but we will certainly be monitoring the situation to make sure they go far enough, especially as far as regional health is concerned.

The Hon. J.D. HILL: I want to respond to a number of the comments made by those opposite. First, I understand that members on the other side have a deep, abiding and passionate interest in country health, but they are not orphans—

Mrs Redmond interjecting:

The Hon. J.D. HILL: That is an offensive thing to say. I have given a lot of attention to country health since I have been the minister. Country health in South Australia is not working as well as it ought to be. The systems in place are not delivering good health outcomes to country South Australians. Any of the stats you look at demonstrate that the standard of health care for people in the country is not as good as that enjoyed by people in the city. There is an urgent need for reform of country health, and I am passionate about trying to do something about it.

Members opposite have made some comments about this being all a set-up by the bureaucracy; that Dr Sherbon is behind this. Let me tell you: this is something I want to do. I developed this approach before Dr Sherbon came on the scene; it is something I have been planning since the election—in fact, before the election. In fact, if you are honest with—

Mrs Redmond interjecting:

The Hon. J.D. HILL: Perhaps if the member would listen as I listened to her colleague speak. If members opposite were being honest, they would know that former ministers for health from the other side wished to implement exactly these kinds of reforms. I must say that it is a great tragedy that my side of the parliament, when these matters came before the house some 12 or so years ago, rejected the reforms then for the same kind of base political motives that your side of the house is currently expressing its opposition. In fact, even if you go back to the days when Don Dunstan—

Mrs Redmond interjecting:

The Hon. J.D. HILL: Look, you had a chance to speak; you chose not to. I listened to your side. If you go back to the days when the Dunstan laws were put in place, as the deputy leader said, they were amended in the parliament because the parliament for the same kind of crass political reasons decided against the reforms. These reforms are essential. It is not about increasing bureaucracy. In fact we have already started through Country Health SA reducing the amount of bureaucracy running country health. Every single hospital in the past used to have its own CE; we are now amalgamating those positions so we can put more resources into providing services to people. They do not need a bloated bureaucracy.

Let me just attend to the amendments themselves, and I am grateful for the opposition's support. The one in which the deputy leader expressed some interest was the non-emergency ambulance services. I will explain. Clause 58 enables the minister to approve applications for a restricted ambulance licence. The clause also enables the minister to attach conditions to a licence where it is necessary to do so. New subclause (13a) is a technical clarifying amendment to make certain that the minister has the power to place conditions on a licence that limit the scope of the restricted ambulance service licence to a specified class of services or activities. In other words, we do not want anyone other than the SA Ambulance Service providing emergency ambulances.

Generally, I think the restricted licences allow people to work in the private sector, to take people who need medical attention from one place to another. The amendment became necessary following a recent court judgment on a licensing matter to do with another minister's powers to restrict the licence. The court's decision meant that the minister may not in fact be able to impose a condition on the licence that restricts the licensee to provide only certain services. The amendment advised by the Crown Solicitor's Office addresses this potential limitation of the clause as drafted. This was done for technical reasons, and I cannot explain beyond that, but I am taking on good faith the advice that we have had from the Crown.

I will just raise a couple of other matters. The deputy leader made, in passing, what I thought was a very offensive commentary on the leadership of the health department. I might say that the leadership of the health department is very good. It will now have powers comparable to leadership of every other government department, that is, it can plan, manage, make decisions and budget for the elements within the portfolio.

The member highlighted Victoria as a place which still has boards. What she did not highlight to the house is that all those boards are appointed by the minister of the day. They are not individual hospital boards around small hospitals; they are large regional boards appointed by ministers. Victoria is about four or five times the size of South Australia, so I guess in that larger environment it does make sense to have multiple bits of bureaucracy running the health system, but they are government-appointed boards subject to control by the minister, as I understand it; they are not individual hospital boards trying to run small country hospitals.

The voices of country people will not be excluded, as has been argued by the Deputy Leader of the Opposition. The Health Performance Council will ensure an overview of health services in the state. It is offensive to describe it as a body which will be subject to direction by the department. It is an independent body which will be answerable to the minister of the day and in addition to that all these country hospitals will continue to have health advisory councils which will be excellent advocates for their bodies. They will not be intimidated; they will not stay silent if they do not like what is going on. What they will merely be restricted from doing is attempting to run the hospitals. They do not currently run hospitals, and that is part of the problem. The hospitals are run by managers who are not accountable to anybody except those boards which meet on a monthly basis. What we are doing is ensuring that there is a proper process of accountability for individual hospital management.

Finally, if I can just address the issue of the repatriation hospital. The Premier made some comments in here which the deputy leader quoted. I assume she quoted them accurately. They certainly accord with my memory of the Premier's statements, and I have repeated his comments to representatives of the returned services. It is not the government's intention, without the consent of both representatives of returned service people and the board of the Repatriation Hospital, to change the arrangements that are in place.

Ms Chapman: What about the diggers themselves?

The Hon. J.D. HILL: I am talking about them.

Ms Chapman: You are talking about the RSL—

The Hon. J.D. HILL: Are you suggesting we should have a vote? The returned service organisations can work out how they consult with their members. A variety of processes are in place. I have been talking with them, and they will make a determination and do what their members want them to do. If the deputy leader is suggesting that the leadership of the RSL and other returned service organisations do not represent their members, I suggest it is something she take up with their leadership.

The government will not take any action in relation to the Repatriation Hospital without the support of the returned soldiers for whom that organisation was set up to serve, nor without the support of the Repatriation Hospital Board. We are in consultation and discussion with them, and I understand that the majority of representatives of returned soldiers are supportive of an integration, because they believe it will produce a better service for their members, and that is what it is all about. It is not about arbitrary lines on maps but about what is about the best interests of the people of this state, and this is what this legislation is doing.

Motion carried.

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