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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2009-06-16 Daily Xml
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STATUTES AMENDMENT (PUBLIC HEALTH INCIDENTS AND EMERGENCIES) 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.

There were two sets of amendments moved in the other place and two issues raised by the opposition in this place, and I said that the government would happily consider them between houses. We have now been able to reach a consensus, and I thank the opposition for its cooperation.

The first of the amendments related to the circumstances under which elements of the Controlled Substances Act can be put aside so that in an emergency people other than doctors can issue drugs to assist in the handling of a pandemic. The effect of the amendments is to tighten the circumstances under which the minister can modify the operation of the Controlled Substances Act to specify that it is for medical purposes. That provision was moved by the opposition in the other place and accepted by the government.

The second set of amendments relate to the declaration of a medical emergency. The opposition moved that before the health chief executive can do that he must obtain the approval of the minister. The chief executive is also required to obtain the minister's approval for the Public Health Emergency Management Plan to be put in place. In practical terms this would have occurred anyway, but this makes it necessary by statute, and the government was happy to accept that amendment.

The legislation can now go forward. I believe it is unlikely that we will need to use these emergency powers during the management of the current swine flu pandemic, but it is important to have these powers to allow the health system to manage health emergencies. If, for example, this current swine flu was a more virulent form of flu—similar to what is anticipated bird flu might be—then it would be very important to have these measures in place.

We are managing through cooperation and using the existing systems. For the benefit of the house, I will make a statement later today updating the parliament on the handling of the swine flu pandemic. The advice I have this morning is that we now have 86 cases in South Australia and we are rapidly moving to same situation in which Victoria finds itself, and we will need to change the status, I anticipate in the next 24 hours or so, in relation to how we handle this virus. I will certainly have more to say about this later in the day.

I commend the amendments to the house. This is important legislation. I thank the opposition and the other parties in the other house for their cooperation in passing it through the parliament as rapidly as they did. We tried to get cooperation across the various parties so that it was unanimous support, and with these amendments we have reached that kind of consensus. I thank the Deputy Leader of the Opposition for any assistance she may have provided.

Ms CHAPMAN: At the time that this bill was introduced to the parliament in early May 2009 we had no confirmed cases of swine flu in South Australia. I think there were some 18 or 20 suspected cases under investigation, but negative testing resulted. We were pleased to do what was necessary as an opposition to support the government in introducing any legislation that may be necessary for the purposes of managing, containing and maintaining, according to World Health Organisation guidelines, in the event of a pandemic developing. In that regard, there were hasty attendances to briefings and the like.

As a result of the necessity, we felt as an opposition, to support the government in making that assessment and dealing with legislation, we agreed to the second reading and passing in this house of the bill without amendment. However, as the minister said, we flagged that there were some aspects of the bill that at first blush we felt were either unnecessary or too broad in their potential application. One of those was that, during the period of a declaration of a major incident, emergency or disaster—the different categories that apply in the legislation—the application of the Controlled Substances Act requirements may be modified or suspended. We felt that that was too broad and that identification of what was to be modified should be clear.

As this parliament is well aware, the Controlled Substances Act deals with a number of things, in particular the regulation and prohibition of a number of drugs and substances well recognised as dangerous or potentially dangerous if either consumed or distributed by people who are immature, unqualified or inappropriate or who would be abusive of the use of those drugs. So, it is important legislation.

We felt it was critical to ensure that the strict rules under that legislation have the capacity to be suspended or modified in the event of an emergency; for example, if a vaccine needed to be distributed, as was anticipated may be the case in the swine flu epidemic, as it was, we would need to consider the suspension or operation of the strict rules as to who could apply, supply and distribute and make provision for the injection or otherwise of the vaccine. So we thought that in those circumstances persons without the medical qualifications required by the act might need to be employed for the purposes of a distribution effort relating to an emergency or disaster.

In another place, after some discussions it was agreed, I think with all the relevant parties involved, that the modification to the Controlled Substances Act be confined to circumstances where it was either to meet a demand for drugs for medical purposes arising from the incident, emergency or disaster or to meet an ordinary demand for drugs for medical purposes, despite interruptions to the medical services or supplies or other difficulties arising from that incident, emergency or disaster. As indicated, the government agreed to that and in another place that amendment was made. Indeed, we welcome it because we consider this to be a sensible resolution to an important aspect of the bill.

The second area was that we considered (and I made quite a lengthy submission on this to the parliament) that both the minister and the cabinet should take responsibility for the decisions made to declare an emergency or disaster (even in a health circumstance) or, if there is going to be some action plan developed in the event of an emergency, disaster or incident, then again the cabinet and/or minister should keep responsibility in their corner. They are the people who are elected. They, of course, appoint persons in departments to carry out the policy of the government, but they are the ones responsible. We felt, therefore, with the shift in the legislation to the nomination legislatively of the chief executive officer of the department as the person who would both decide on and prepare the relevant plan and/or the actioning of it, that it should be in the hands of the minister, with or without consultation that he or she may have with the cabinet.

A compromise was negotiated and the government indicated it would support an amendment to the public health management plan in relation to the endorsement of the minister, requiring that the plan be approved by the minister. To be frank, consistent with what we have said previously, we think that is back to front. We think the minister, with his or her cabinet, should be making these decisions. Of course they have departmental people, including chief executive officers, to work up these things and provide them with advice. They also have a responsibility to consult with both the broader spectrum of departmental people who have experience in other departments (which I understand they have done) and also the broader community. The chief executive officer can then be vested with the responsibility to implement the plan. Although we still think that it is back to front, it is an improvement, and we welcome the fact that the government has added the qualification that this be with the approval of the minister.

It is particularly important because I note in the budget announced by the Treasurer a couple of weeks ago, which we will be discussing further in parliament, that in the forthcoming 2009-10 year a significant reduction is proposed in public health funding. In the 2008-09 budget, that is, the year we are about to complete, $36,279,000 was identified as expenditure; in fact, $56,784,000 was spent. As we often have with budget papers, the explanation is that a whole lot more immunisation programs were rolled out in that year than had originally been budgeted for—and that is quite a legitimate explanation.

Additional revenue came in from the commonwealth to enable us to provide a universal childhood vaccine for meningococcal, for example, and there had been some revision of the population estimates and funding was available for one-off vaccines for HPV, infanrix hexa and others. That is noted. However, in this year's budget (2009-10), we have $42,098,000. In fact, that is $14 million less than we spent last year in the budget.

Of course, it raises the concern about how this will be applied. The chief executive officer and, under him, the head of the public health unit within the health department, will be making decisions as to the application of vaccines. There appears to be absolutely no provision for swine flu immunisation. I know that we have had to deal with some of this bill on the run because of the intensity of the public's expectation, which is reasonable. As we now climb to some 86 cases of identified swine flu in the South Australian community, they are not only expecting the good management of that by government but by this parliament ensuring that, when we vote for the budget bill, we have sufficient provision.

My understanding—and it is from media reports to date—is that a vaccine has been developed in laboratories in Victoria. I think a Swiss company has the national contract—international contract probably, with other nations as well—to provide the vaccine when it has been duly hatched. In my limited knowledge of how this works scientifically, the vaccine is developed. It is incubated in chicken eggs and various other things. It is developed so that we end up with literally millions of vaccines that are then trialled and distributed to the population for its protection.

We need to be clear that not only do we need to pass legislation to give everyone all these extra powers to do things to ensure that the general population is protected and that health care professionals are armed sufficiently in such a circumstance to be able to act to protect the population generally but also that they have the resources. We know from previous discussions in this parliament that a big stash of masks has been kept. They have been here since the bird flu plan was out. We have those ready to distribute, if we need them. However, on the face of it, there is no provision in the current budget (2009-10) for the distribution of vaccines for these purposes, that is, to the general public.

There could be several reasons for that. First, there is no provision for it from public moneys. Secondly, if you do get a vaccine, you have to pay for it and therefore it will not show in the state budget because they will not be making provision for it: it will go on the Medicare bill and/or private health insurance to provide for vaccination and/or treatment of those who are infected. I raise that because I know that we have had to deal with this bill with some haste in ensuring that we cover all bases to protect South Australians, but, as the minister has already made clear, we are moving out of a stage of containment into maintaining what we have, which obviously means treatment for those who develop other health aspects relating to their being confirmed swine flu carriers.

The situation is such that this legislation will cover all bases. An example which was given and which is reasonable is that our current emergency management legislation was not clear as to whether a person could be ordered to be confined or detained in their own home during a period in which they may be identified as still, I suppose, alive to contamination and passing on the virus to others. On our reading of the legislation, we thought there was adequate provision under the public Health Act and the Emergency Management Act which have, as the parliament is aware, very extensive—penetrating, in fact—powers.

For example, the State Coordinator under the Emergency Management Act has power to direct a person to submit to a decontamination procedure, direct any person to stop any work or operation, close any premises or place and direct or prohibit the movement of persons, animals or vehicles, and we felt that legislation was adequate. However, remember that it was the government's initiative to transfer some of these rather extensive powers under 'supervision' and to replicate a number of those in a newly defined health emergency under the Chief Executive Officer of the Department of Health, and that he or she would then have the power to deputise others as authorised personnel to undertake these tasks.

To err on the side of caution, we supported the government amendments in that regard to make it absolutely clear. We did oppose the position on the need for a new army of people to be deputised in the Department of Health and the singling out of a health emergency. For the reasons previously indicated, the government has at least curtailed the potential application of that by a requirement that any public health emergency management plan would have to be approved by the minister and that the implementation of a declaration in one of these categories would also require the approval of the minister, and that initiative has been welcomed.

It is not an easy task to deal with a public health problem and its containment when a vaccine has not already been developed; it adds to the level of responsibility. I have been complimentary of the Department of Health—and, in particular, the public health officers—in relation to notification and keeping the public informed, as well as keeping some calm in those circumstances. I think that, in a number of ways, it has done that since early May. It offered very promptly to provide a briefing to the opposition as to what was occurring. What has been disappointing, which I think will not be remedied by this legislation, is that, in recent times, we are still being given only the daily raw data of the number of people who have swine flu in South Australia.

We still do not get information about the suburb, the town or the region in which they are living, which in my view is deficient. We need to have that information so that the community can be forearmed and forewarned, particularly if there is no money in this year's budget for our public health officers and others to make a significant purchase of the vaccine when it is released. At least if they know what is coming they will have time to save up their money to pay for their own.

The Hon. J.D. HILL: I thank the opposition once again for its support and cooperation with respect to these measures. This is a new set of provisions, which will give the health department and me as health minister (and subsequent health ministers) the opportunity to declare a medical emergency.

This is something that will be used, I guess, fairly infrequently but it is a suitable set of powers that we believe is necessary in circumstances where a full-blown state emergency does not exist. They link in very well with state emergency powers, and the provisions in this legislation ensure that, if a state emergency is brought into play, the powers in the medical emergency legislation would then flow into the broader emergency arrangements. So, this is a sensible provision.

The deputy leader raised some budgetary matters and some matters about the particular management of the swine flu pandemic in South Australia. Whilst they are not particularly relevant to this legislation they are pertinent, I suppose, and I am happy to try to provide a broad understanding about where the government is going.

In relation to the budget for public health, as the deputy leader said, there were some substantial one-off payments last year, particularly from the commonwealth in relation to the HPV vaccine, which was provided free of charge to young women in South Australia. I believe that most people who are entitled to receive the vaccine have now received it. That explains, I think, largely why there was a greater expenditure last year.

In relation to the development of a vaccine for swine flu, my understanding is that trials have begun, and we would expect to see stock available in July/August (or around that time) that could be supplied to the public. How it would be made available in Australia is yet to be determined, but normally flu vaccine is made available through private practitioners (GPs), public hospitals and other community organisations, and some businesses make it available to their staff.

The commonwealth government has protocols in place which makes it free-of-charge to people over, I think, 65 years of age, Aboriginal people over the age of 50 and some other vulnerable groups, and I would assume (although I do not know for certain at this stage) that similar arrangements would be put in place. The health department, of course, makes it available to its own workers.

Whilst I acknowledge that there is perhaps a minor budgetary matter in relation to this, it is not something that I think would cause us great concern. However, we will work this through with the commonwealth.

After the flu has been through South Australia and Australia, the seasonal flu vaccine for next year will, as I understand it, pick up whatever elements the public needs to be protected from in relation to swine flu, and they will be included in the vaccine that will be made broadly available next year. So, we are really looking at just one season.

Australia, I think, will suffer swine flu in a larger way (and I am talking about by volume here rather than by clinical degree) than other jurisdictions, because it is coming into our country at the beginning of our winter. It emerged in other countries at the end of their winter (presumably, it had been there in winter and was incubating), whereas it has become noticeable in Australia at the beginning of our winter. So, I would expect that a large number of people in our community are likely to suffer from this illness.

So far, it has been relatively mild. The majority of people who have contracted it have been young people, and there are a couple of possible explanations for that. The health department is thinking through what resources are required to manage the growth in swine flu in our state: the number of beds and the kind of equipment and drugs, and so on, that are required.

I can assure the deputy leader and the house that appropriate provisioning is being made for the management of this flu. However, in relation to this legislation, I think these are sensible provisions. Once again, I thank both houses for their cooperation in managing the rapid movement of this legislation through both houses of parliament. I commend the legislation to the house.

Motion carried.

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