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House of Assembly - Fifty-Second Parliament, First Session (52-1)
2010-09-29 Daily Xml
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OUTPATIENT REFERRALS

Dr McFETRIDGE (Morphett) (14:58): My question is to the Minister for Health. In light of the government's recent policy decision to privatise 10 per cent of outpatient referrals in South Australia, how will—

Members interjecting:

The SPEAKER: Order!

Dr McFETRIDGE: I will start again, if you like.

Members interjecting:

The SPEAKER: Order! I can't hear the member.

Dr McFETRIDGE: I will wait for the health minister to listen—it is a very important question. In light of the government's recent policy decision to privatise 10 per cent of outpatient referrals in South Australia, how will the thousands of South Australians affected by this decision afford medical assistance in the private health sector, and will the government provide assistance to help them with their new medical costs?

The government recently announced it would conduct an outpatient service review with the aim of redirecting 10 per cent of outpatient appointments to private specialists. The government aims to save $22 million per annum. To achieve this, they will have to privatise over 150,000 outpatient appointments per year.

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (15:00): I seek clarification, Madam Speaker. I would have taken this to be a question about the budget that was announced just last week, but I am happy to answer it. I wouldn't want to trample on the finer feelings of those on the other side. Shall I continue with my answer?

The SPEAKER: Yes, I think you'll continue.

The Hon. J.D. HILL: The member for Morphett asked a question about the outpatient services provided through South Australian hospitals. What we are doing is trying to make sure our system works well so that people can get services—

Mrs Redmond interjecting:

The SPEAKER: Order, the Leader of the Opposition will be quiet!

The Hon. J.D. HILL: We want to make sure that our system works well so that people can get access to services as quickly as possible. There are a number of pressure points in the public health system which we have been working on. We have been working on elective surgery, and I am pleased to say that at the end of last financial year there was just a handful of people who had waited longer than the recommended waiting times to get elective surgery. That is no mean achievement, because only—

Mr Marshall interjecting:

The SPEAKER: Order, the member for Norwood will be quiet! He has a very loud voice.

The Hon. J.D. HILL: That is no mean achievement, because several years ago there were thousands of people who were waiting longer than the recommended time. So we have invested a lot of money, changed strategies, invested in good organisation as much as anything else to get that part of the system to work.

We are also working on the emergency department to ensure that we can cover the increasing demand for emergency care in our state. We are investing millions of dollars in new emergency departments right across the metropolitan area, and we are also embarking on a system to make sure that people can be treated and dealt with within four hours, whether they are admitted or sent back home, if that is the appropriate clinical outcome; so we are working on that part of the system.

The area that is most problematic for us, once those two areas are addressed, is the outpatient service, in particular the part of the outpatient service where GPs refer their private patients to an outpatient clinic to be assessed to see whether or not they need surgery or some other intervention. That is a part of the system which is not measured. We do not keep waiting times, we do not keep waiting lists, and so on. Individual doctors in individual hospitals do, but there is no coordination. So when I make a public claim, as I do from time to time, to I point out how well the system is working, individuals will say to me, 'Well I've been waiting so long to get to see a doctor in hospital,' and what they are really talking about is that they have been waiting so long to get to see an outpatient clinic. The reality—

Members interjecting:

The Hon. J.D. HILL: I'm happy to answer the question, but I won't be interrupted while answering it. It is your choice. The outpatient service has not been working as well as we would like it to work. We have looked at how we can make that system work in a way that patients can be assessed as quickly as possible once they have seen a GP to determine whether or not they need some other procedure. It makes no sense to have somebody waiting for a year or so to see an orthopaedic surgeon, for example, to be told, 'No you don't need surgery. What you should have is physiotherapy,' when they could have been having that for the previous 12 months. That part of the system we want to reform, so that it can get access to that kind of assessment early on.

I am not talking generally about the provision of therapy to patients who go to outpatients. We would still imagine that most of that will be done in our public hospitals. There might be some of those clinics that are done in things like GP Plus centres or elsewhere, but the focus in particular will be of that early assessment.

What happens is this: a patient goes to see a private GP, the GP will give them a Medicare-based assessment, and they will say, 'You need to see a specialist.' They will ask, 'Are you a public patient or a private patient?' If they are a private patient they will refer them to a private specialist, who will see them and then work out what should happen. If they are a public patient, often they will go to see an outpatient clinic in a public hospital, and that brings in the delay.

So what we are looking to do is what other states have done. New South Wales, Victoria and the ACT all have these kinds of outpatient clinics within the private sector, so that the GP refers the patient to a doctor in their private rooms; they can get to see them quickly. They will be seen by the senior doctor rather than by a junior doctor, so the assessment will be done quickly without multiple referrals. Then the patient is in the terrific position of knowing what needs to happen next, and we will cut out a lot of waiting time.

The practice in the other states has been, as I understand it, that generally specialists in their rooms will bulk bill those patients, so there should not be any burden for those who are on a pension card or some sort of assistance, and generally the cost for patients is $30 or $40, or of that order.

Can I say that, in South Australia, we have a number of public hospitals now that already have most of the outpatient assessments done in the private sector. For example, I understand that most of that work at Modbury is already done by doctors in their private rooms. There is little inpatient activity done there in terms of that assessment.

What we are doing is reforming the system. The goal of the reform is to make sure that patients who need help get that help faster and can then move into the hospital system if they need to so that they can be assessed. I absolutely endorse this reform whether or not it was to save money (which it will do), but even if it were not to save money I would still want to see it happen because it will produce a better service.

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