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House of Assembly - Fifty-Second Parliament, First Session (52-1)
2010-05-27 Daily Xml
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NATIONAL HEALTH REFORM

Mr VENNING (Schubert) (11:35): Madam Deputy Speaker, before I commence my speech, I just want to take a second to remind the house of the absence of the Government Whip. I think we all know why that is. I wish her, on behalf of myself and my party, all the best; we are thinking of both of them. We do hope for a miracle and we want them to know that the house sends its respects and is mindful of what is happening there. We wish them both the best. I move:

That this House notes the federal government's National Health Reform Plan for all Australia, and, in particular, is concerned—

(a) at the deal South Australia has signed;

(b) that no direct contribution to the cost of the proposed Royal Adelaide Hospital has been offered;

(c) that the Country Health Plan will be even further centralised with the neutralisation of HACs, which took over for the now abolished local hospitals boards; and

(d) that the title deeds of country hospitals will not be held in the community that in most cases built and supports them.

At a COAG meeting on 20 April 2010, all states except Western Australia agreed to the federal government's national health reform plan. This plan proposes structural reform as to who manages the health system and how it is funded, with the federal government to retain one-third of the GST in order to directly fund 60 per cent of the building equipment and services in the 762 public hospitals across the country.

I have to say that, initially, I was in favour of this because I get dearly frustrated about what is happening in health in South Australia, particularly our inability to upgrade facilities, and I had some support for this concept because if the state government could not cope we would give it to the feds, but I am now very hesitant to support it. The federal government will take primary control away from the states in areas of primary care and aged care.

Premier Rann agreed to the commonwealth proposal to hand over control of South Australia's public health system based on a phone call from Prime Minister Kevin Rudd—just one phone call. Other premiers negotiated and managed to net their states a portion of the extra $5 billion over the next four years that the Prime Minister pledged in a bid to get all states and territories to agree to his proposal. In other words, they leveraged their position in order to get a better slice of the cake. When you go to do a deal when you buy a car or property, you never just say yes, yes, yes; you always back off, consider and leverage for a better deal—you never race in. That is good business, and I do not know why we did not do that in this case. Why should we be the first cab off the rank?

Western Australia has still refused to sign and if they do not by 1 July the whole plan will be scrapped. On his return from Canberra on 21 April the Premier said,

We came to Canberra with one aim: to secure more money for an improved health system.

Well, did South Australia really get more money? Did we get a better deal? I think not when you compare what we receive to that of other states. Canberra agreed to New South Wales Premier Kristina Keneally's request for $686 million in federal funds to help New South Wales meet national reform targets for emergency and elective surgery waiting times. Premier Anna Bligh told The Courier-Mail that:

After hours of negotiations Queensland is now more than half a billion dollars better off in the next four years for our hospitals and our patients. It has been a day of goodwill and real effort to overcome disagreement.

Victorian Premier John Brumby held out and managed to have $1.3 billion promised in extra funding over four years for the state's public health system. That works out to 332 more sub-acute beds for 5,000 patients annually to relieve the pressure on public hospitals in Victoria.

What did South Australia get? We got $264 million for more long stay mental health beds, more senior medical staff, expansion of acute beds in emergency departments and elective surgery capital works. Once the plan starts in 2014-15, we will receive $1.1 billion up to 2019-20.

Our Premier was prepared to accept whatever was put forward by the federal Labor government. At this stage it is not even clear if the Rann Labor government's rail yards Royal Adelaide Hospital proposal will be 60 per cent funded under this agreement. The Premier, in a ministerial statement on 12 May 2010, stated:

As a part of this new package, the state government will begin negotiating with the federal government to ensure it pays its fair share of the capital cost of the new Royal Adelaide Hospital.

This indicates that, at this stage, the Premier has not secured any funding commitment from the federal government for the proposed Royal Adelaide Hospital. Wouldn't he have wanted to secure some sort of commitment for this major project before signing on to the deal? What a great leverage position that would have been—an opportunity lost.

I have previously commented that I would support the federal government's health plan if the Barossa was able to get a new health facility as a result of the new funding arrangement. However, if the Premier has not yet obtained a commitment for the proposed rail yards hospital then I very much doubt—in fact, I am certain—that the Barossa will not get a new facility funded from this agreement either.

The Rann Labor government abolished local hospital boards in 2007 and more is the pity. It was a move we, on this side of the house, very strongly opposed—and we still do. It established Health Advisory Councils (commonly known as HACs) as part of its revised Country Health Care Plan. Its Strategy for Planning Country Health Services in SA was released in late 2008.

The Rann Labor government would like to reduce the number of HACs even further and introduce regional HACs to oversee the running of Country Health. One idea is for only one regional board overseeing the whole of Country Health—talk about centralised management! I cannot understand how the Rann Labor government thinks that regional communities can be adequately served and catered for by the health service when all of country South Australia is being managed by one board.

The Rann Labor government's ideas with regard to the management of the health system is largely at odds with what the federal government envisages in 'A National Health and Hospital Network for Australia's Future' policy document which aims to decentralise the management and improve local input. Page 1 of the overview states:

These structural reforms will mean that the commonwealth government changes the way hospitals are run, taking control from central bureaucracies and handing it to the local hospital networks.

I cannot believe this. I cannot believe I am actually reading this. We would fully support that but let's see what comes out in the wash. Let's see how the state government handles it and what the final outcome is.

I would like to make it clear from the outset that I am in no way in favour of another layer of bureaucracy being created in local health networks but I am in favour of keeping the management local because it is more efficient, local and community focused. Management of health service is best when it is kept local. Local communities know what services they need.

I served on a local hospital board for eight years. We made decisions that were for the community and were focused on local health issues. We were not there to support bureaucratic structures or to further the duplication of bureaucracy. We attracted a lot of support for our hospital via volunteer workers. We also attracted a lot of local financial support from bequests, wills, donations and all sorts of things. My own family had such wonderful support from the local hospital (for both my late mother and father) that our family gave a sizeable donation to the hospital. In fact, it fully equipped one emergency room. This is the sort of thing you can get when you have a local community that owns and supports its hospital.

I recently learnt that the Country Health SA board (the HAC) mentioned a new Crown Lands Act in one of its documents relating to vesting of titles or the ownership of assets in HACs. This worries me very much as it appears that what we, on this side of the house, feared from the start (when hospital boards were first abolished) is true: that the Rann Labor government slowly wanted to remove any links and control that local communities have over their hospitals so it can close facilities in the future.

This is separation by stealth: get hold of the deeds; take the ownership out of the local community. After all, most of these communities not only built the hospitals but paid for them to be built on land which they donated. Why shouldn't they keep those titles? They belong to them. It is not another cash cow for the government to cash in on later.

When you take away the management of a local country hospital, or anything else for that matter (and we have seen it with St John Ambulance and its demise in many of our country communities), it ensures that the local support will fall away. Is that what the government wants?

The Barossa's two hospitals at Angaston and Tanunda have in the past been well supported and backed by very proactive local health committees and hospital boards, and I was involved with one of them in a minor way. Now the Barossa HAC has taken over, which I do believe is one of the more active HACs, like Crystal Brook Hospital, where as I mentioned before I served on the board for eight years.

If you want to see a hospital that is so successful, a hospital that is really doing it for its community, a model of what you want to see a community hospital do, it is Crystal Brook. Go and have a look at that; it is a fantastic example of what we would all wish for our communities mainly because of excellent management particularly by Dr Richard Mackinnon and a very supportive staff and a very supportive town community. I hope this house will recognise these urgent desires of our communities and support this motion. These issues are more important than crass politics. I commend the motion to the house.

Mrs VLAHOS (Taylor) (11:46): The member for Schubert's fears are unfounded, and I rise to oppose the motion. South Australia has obtained a significant deal under the recent agreement at the COAG meetings in Canberra. Our hospital system in its current form provides a high quality level of care that is well run by dedicated health professionals, but there is always room for improvements.

No government should ever believe that it should not keep striving for a better health system and for continuous improvements, but now is a time of significant change if it is to meet the sustained needs and be responsive for the future population that is growing and ageing in our country.

South Australia is expected to receive more than $300 million in additional investments to the state from this agreement. These monies will provide additional investments in the areas of emergency departments, elective surgery, subacute care, mental health and aged care. This includes $120 million for subacute beds, which will allow extra beds in the Repatriation Hospital and more long stay mental health beds; $47 million to improve access to elective surgery to contribute to additional procedures announced in the recent election campaign; and $36 million to provide more senior medical staff working after business hours in our hospitals, which will improve access to emergency departments.

A further $29 million in financial assistance for long stay older patients will ensure that fewer older people are placed in acute nursing beds while waiting for nursing home placements. There will be $21 million for aged care to expand multipurpose services, which will allow us to provide more country hospital places and upgrade country facilities to commonwealth standards; $20 million for emergency department capital works to expand the number of acute beds to relieve pressure on our services; $17 million in flexible funding for emergency departments, elective surgery and subacute beds; $13 million for elective surgery capital works, to be used for additional operating theatre equipment and the refurbishment of the Modbury Hospital; and $3 million to expand early psychosis prevention and intervention centre services.

In addition, the commonwealth will in future years fund 60 per cent of the efficient cost of public hospital services. This is a major achievement, given that in recent years the investment split between the commonwealth and state for public hospitals has been closer to 40:60. At present the state government pays about 62 per cent of hospital funding, while the federal government picks up about 38 per cent.

There used to be a 50:50 funding split between the states and the federal government at one point. However, under the former Howard government, the proportion of federal government input began to slide because it refused to keep up its payments to meet the real cost increases in the health sector.

When the new system of funding for hospitals begins in 2014, South Australia will receive the promised 60 per cent funding federally and 40 per cent state funding, which will mean our health system will get a guaranteed minimum of $1.1 billion in extra money for the 20 years up to 2019-20. In relation to the member's concern about no direct contribution to the Royal Adelaide Hospital redevelopment, or no state or territory securing specific funding for individual capital funding projects in the COAG process, what our government did secure was an agreement from the commonwealth that they would fund 60 per cent of the capital expenditure on public hospital services. As part of this new package, the state government will be negotiating with the federal government to ensure that it pays a fair share of capital costs for the new Royal Adelaide Hospital.

As many South Australians know, the new $1.7 billion Royal Adelaide Hospital is being delivered through a public-private partnership, so the state government will not begin to pay for the cost of the building until it takes control of it upon completion in 2016. The new arrangements for health funding come into place in 2014-15. The details of the approach to be used for establishing the capital investments for the commonwealth are still to be worked through, and the heads of Treasuries have been tasked to advise COAG on the mechanisms for meeting the commonwealth's commitment to capital spending.

In closing, with regard to the title deeds for country hospitals, they are currently held by the Health Advisory Council, and there is no proposal to change this agreement.

Debate adjourned on motion of Mr Sibbons.

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