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House of Assembly - Fifty-Second Parliament, First Session (52-1)
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HEALTH AND COMMUNITY SERVICES COMPLAINTS (MISCELLANEOUS) AMENDMENT BILL

Second Reading

Adjourned debate on second reading.

(Continued from 27 October 2010.)

Dr McFETRIDGE (Morphett) (16:06): I indicate that I am the lead speaker for this bill. The opposition will be supporting the bill, although there is quite a bit we need to put on the record, particularly with the number of reports having been tabled in the last few days in this place. The bill is something that is going to assist all South Australians to achieve what we all want, and that is a safer health system and a much more efficient way of voicing any concerns and complaints.

The bill was introduced by the minister in October last year, and it seeks to amend the Health and Community Services Complaints Act, as a result of an independent review undertaken by Ernst & Young, which was tabled in parliament in March 2009. We should also remember that the Social Development Committee of the parliament produced a report into bogus, unregistered and deregistered health practitioners. The committee conducted a very intensive and thorough investigation and produced a comprehensive report. I know that some members of that committee will want to contribute to this debate. Their report around that issue was one of the impetuses for making these changes.

The Health and Community Services Complaints Commissioner was established in 2005, and the annual report it puts out always seems to be a little bit late, and I have made some inquiries about that. I think it was the Minister for Water who talked about some of the reports he likes to have put through the Auditor-General's thorough investigation process, and those reports come out late because they are not top priority, and that is a shame. The implication that has been put to me is that it is not a top priority for the Auditor-General to look at the Health and Community Services Complaints Commissioner's annual report. That is no reflection on the Auditor-General; it is just the burden his department is under.

However, the report was tabled the other day. It was supposed to be tabled by 30 September 2010, which is four months ago. It was given to the minister on 12 November, a couple of months after its due date, and we saw it tabled in this place on Tuesday. There are comments in this annual report that I think should be put into Hansard because there are some significant issues in the report, particularly the commissioner's foreword, that raise serious discrepancies between her current attitude and that expressed by the operational review report in May 2010, which was conducted by ZED Business Management.

The commissioner's annual report talks about how the office of the Health and Community Services Complaints Commissioner was opened on 4 October 2005 and how the Health and Community Services Complaints Commissioner provides free information and assistance to resolve complaints about public, private and non-government health and community services, including child protection services. The commissioner encourages direct resolution with the service provider first, and that is important. We need to have a complaints system, whether it is through the public hospital system or through this commissioner, that does provide a 'without fear' approach for direct resolution of complaints.

It is interesting to note the commissioner's comments in her foreword. I will talk about the response by the government to the operational review which, as I said before, does fly in the face of some of the issues the commissioner raises in her foreword, and I will talk about those in a moment. The commissioner says:

As I write this foreword, the HCSCC is once again preoccupied with securing sufficient core funding to meet the responsibilities conferred by the South Australian parliament through the Health and Community Services Act 2004. Many independent statutory complaints agencies find it difficult to secure adequate funding to meet their legislated functions. In particular, those functions that would minimise escalated complaints by enabling them to be dealt with locally, fairly and quickly. Especially concerns and complaints arising from the experience of people who are vulnerable or disadvantaged, people who don't speak up, are hard to reach, and who are most likely to be missing out.

The commissioner's report goes on:

When essential services are struggling to meet the gap between increasing demand and less capacity, and feeling assailed by unrealistic expectations of their services, complaints may seem to be inevitable, largely insoluble and of little or no value.

The commissioner continues:

The messy, emotionally charged business of complaints handling is hard to measure in economic terms. Yet governments spend millions on inquiries after things have gone wrong. Many health, disability and child protection services could tell you the cost of defending legal claims, but would be unable to tell you the cost of complaints. This also means that the cost benefits of preventing or reducing complaints, and of improving complaints management, remain invisible. Likewise the benefit of complaint lessons when used to minimise a recurrence of harm or loss remain invisible.

For those who recognise the individual and public value of good quality, independent complaints agencies it is timely to ask some questions about how we sustain adequate funding for this work. For example:

Should the service providers complained about fund or contribute to funding independent statutory complaints agencies—

these are the commissioner's views, certainly not my views—

What about a citizens rights levy?

We know that levies are being put on all over the place, but a citizens' rights levy is what the commissioner has raised here. The commissioner also raises the issue of 'combining the knowledge, skills and experience among South Australia's small and diverse statutory complaints offices'. So, amalgamation of a number of offices. These are some issues in this annual report of the Health and Community Services Complaints Commissioner that the government might want to consider. The report continues:

Meanwhile, emerging evidence in health services demonstrates that if people's basic rights to access and use services are met, significant benefits flow. In particular, benefits in timely and appropriate use of services, self management and better treatment outcomes.

There are certainly some questions to be answered there. The review that was done by ZED Business Management in May 2010 raised issues that I hope the government has looked at, certainly in its initial response, which I will detail in a few moments. I do not think the commissioner can take a lot of pleasure from these.

The annual report talks about the issues that the commission has faced. It talks about the costs associated with providing the service in South Australia, and it is interesting to note that there are about three complaints a day to this complaints commission whereas there are about 25 complaints a day to public hospitals around South Australia. The commissioner looks at the cost per head of providing the commission's service. In South Australia it is 74¢ a day; in other states it ranges from $9.58 in the ACT to $2.28 in Queensland. It is a bit cheaper in Victoria, at 47¢ per person.

However, when we look at the costs per complaint, that is where the South Australian complaints commission does have some questions to answer. It is about $1,500 per complaint, and I understand that this is a significant issue with those who are examining the efficiency of the office. Compared with interstate, the cost per complaint is hard to justify.

The commissioner raises other issues in her annual report, such as national health professional regulations and accreditation. There are concerns about ensuring the responsiveness of time lines, transparency and accountability of complaint management, about individual registration, and formally registered health professionals through the Australian Health Practitioners Regulation Authority (AHPRA) in Melbourne.

We have heard just recently that in South Australia up to 150 health practitioners and I think over 1,000 nurses are having difficulty re-registering under the national registration scheme. The office in Melbourne is taking something like 3,000 phone calls a day from around Australia. It is a significant issue. When we debated that bill in parliament we were concerned that there would be some teething problems, but it looks more like significant headaches, backaches and stomach upsets as well.

The commissioner, in her annual report, talks about serious complaints and vulnerable clients. She states:

During 2007-08 several serious complaints involving vulnerable adults that were handled poorly prompted the [Health and Community Services Complaints Commission] inquiries about complaints management and reporting in services funded by government departments.

We know that there are complaints made about all government departments. Some of them are valid, some of them are vexatious, and some of them may be just trivial; but it is important that, whether it is the 1,000th complaint you have had for the day—and hopefully it is not at that level—that the complaint is dealt with extremely swiftly so that it can be either dismissed or resolved. The commissioner raises serious complaints about vulnerable clients particularly—never mind just ordinary clients, but those with difficult needs who need to be looked after. I hope the government takes notice of that comment.

The commissioner notes in her report the 30th Report of the Social Development Committee into Bogus, Unregistered and Deregistered Health Practitioners. As I have said, the report by the parliamentary committee was comprehensive. I will let some of the members who were on the committee and who participated in the inquiry talk about that. The commissioner looks forward to changes to the Health and Community Services Complaints Act that will go through today to solve problems raised by that parliamentary committee.

The Mental Health Act, as we know, came into force in July last year. The commissioner is concerned about community visitor schemes. I tried to look on websites to see where our community visitor schemes were going. I understand that they are being put in place and will be in service by 1 July this year. If the minister can give us more information on that at some stage that would be good.

There is a significant issue in South Australia, still, and the commissioner notes this in her report, about advance directives, which are falling under a number of categories. In fact, she states in her report that there are three South Australian laws which have different advance directives, and that would create legal problems for anybody, never mind mere mortals like me who are not lawyers. It states:

Research has found that this is too complex for consumers, carers, health service providers and lawyers to understand.

So even lawyers cannot understand this. It states:

As a result, advanced directives are not being used effectively, leaving families and clinicians without clarity for end of life decision-making. This can result in distressing, unwanted and expensive medical interventions.

An issue that will come before this parliament involves the voluntary euthanasia bills that will be debated fairly shortly in this place. I would think that advance directives will be discussed during that particular debate.

The Health and Community Services Complaints Commissioner charter of rights is mentioned in the report. I know that it has been a topic of discussion amongst the number of people who are involved in the health sector. The Have Your Say consultation report came out on 1 October last year. We are looking forward to seeing the proposed health and community services charter of rights to see what the time line is on that, minister, to have it delivered as either a piece of legislation, which I assume it will have to be, or, if there is some other way of doing it, what the charter is going to have in it.

I will not do much more with the annual report other than to say that there are a number of areas where the commissioner has talked about complaint resolution services. The inquiry service is staffed Monday to Friday 9 to 5 and is accessible by phone, email, fax or letter. That seems adequate; however, with three complaints a day perhaps there are some concerns there. I think the operations review that was conducted does look at that, and I will go into that directly.

The thing I should say here is that what people say about their contact with the commissioner's office, in their attempt to raise complaints, is interesting. When talking about trying to raise their complaints with providers, one of the complainants said:

I tried to bring up my concerns with the provider but I was too worried about repercussions. I need their care and don't want my services to stop.

Another person said:

I telephoned them [the provider] three weeks ago and nobody rang back.

There is a final comment here that says:

I don't agree with the information sent to me in response to my complaint. I think it contains inaccuracies and I feel fobbed off.

The commission is there to make sure that the people who feel fobbed off, feel they are being neglected or are worried about repercussions have a safe avenue of lodging their complaints and having them dealt with in a fair and open fashion.

That is the annual report of the commissioner in which she raises a number of issues, but I think the most important one is the last part where she says the commission's role is a vital role for the people of South Australia, to make sure that all complaints about health and community services in South Australia are dealt with in a fair and open fashion, and, you would hope, at a reasonable cost. However, that is an issue.

As a result of some of the issues that were being voiced around departments and among some of the stakeholders about the way the office was operating, an operational review was conducted. The findings of that review were handed down last year by ZED Business Management. I will not read all 100-plus pages of the report but I need to quickly go through the executive summary and look at the analysis of the 28 findings that the review made because it is really important when you consider the costs of running the commission (which the commissioner wants to have increased) and then some of the issues that are raised in this report.

There are 28 findings and the first is that there was a low level of effort by the Health and Community Services Complaints Commissioner on a number of core functions prescribed under the act, including reporting and trend analysis, increased awareness and capacity building. To me, that is a fairly serious issue in itself. We need to make sure that there is maximum effort put into handling every single complaint. That is a serious issue that needs to be addressed by not only the commissioner but also the government.

Another finding is that the volume of complaints managed by the Health and Community Services Complaints Commissioner (which I will call 'the commission' in future for the sake of Hansard) appears low, averaging three complaints per day, especially in comparison to the South Australian public hospital system averaging 25 complaints a day. We do know that some of those complaints to the South Australian public hospital system are extremely serious complaints, and we will talk about patient safety a bit later on. I would have hoped that people in South Australia now would not have to complain either to the commission or to the public hospitals, but I guess when you are dealing with issues as complex as people's health and medicine there will always be some issues that people either do not understand or misinterpret or there are cock-ups.

In relation to the cost per inquiry, as I said, the commissioner did it by state and territory per capita, and we were way down at 74¢, but this report talks about the fact that interstate comparison identified that the average cost per inquiry per complaint for South Australia is $1,526, representing the second-highest cost behind Queensland at $2,342 and double that of Western Australia at $738. We really do need to get that cost down so that the commission can do its job for as many people as possible.

Providing more money to a commission that is operating in the same way does raise questions. I know that the commissioner is doing her very best—I have had discussions with her and been to her offices—but, obviously, there are some issues that need to be addressed and we hope to be able to give her as much support as possible.

In regard to the way the commissioner's office is working, South Australia recorded the second-lowest ranking across all jurisdictions for inquiries and complaints per staff member. South Australia recorded 67 inquiries or complaints per full-time employee. I suppose you have to ask the question: are people just not reporting? That can be compared with Western Australia where there were 203 inquiries. Victoria was the highest at 383 complaints per full-time employee. We had 67, which is quite low, and, while I would like to believe it, I do not believe it is because everything is as open, transparent and understandable as it might be. The bottom line, I think, is that some people are not reporting because it is just too hard or for some other reason they are just accepting their lot in life.

They say in this report that the commission is achieving good resolution rates for inquiries and complaints, at approximately 48 per cent within 24 hours. So, the commission is doing a good job in some areas, but there are other areas that we need to look at.

The other finding is that the number of core obligations are not being delivered. This is not the fault of the commission. A charter of rights is being worked on and should be delivered shortly. The establishment of a health and community services advisory council is being dealt with in legislation. The systemic trend analysis and reporting is an issue. Increasing awareness of people's ability to complain and avenues for lodging of complaints is an issue for the commissioner. Training and education of service users and service providers is an issue, and I understand that the commission has now expanded that role. I think it might be an RTO, I am not sure, perhaps the minister can tell us. The operational review into the commission continues to raise further issues.

Finally, there is a perceived lack of accessibility to core commission services, particularly with the phone inquiry service only available Monday to Thursday from 10 until 4, and no drop-in capacity. If you are going to have a service like this it needs to be accessible. You should not be able to make totally anonymous accusations through a commission like this. I think there are other areas where people's privacy needs to be protected, and that is at the frontline services, the hospitals and other health delivery services. You should be able to say, 'This isn't working', or, 'There is an issue here', without having to put your own future in jeopardy. A career-limiting move, as some people might say, should not be an issue.

The report into the operational review of the commission was responded to by the government, and was tabled on Tuesday last in this place. It is interesting that, of the 10 recommendations from this report, the government either agrees with them directly or in principle. The one that I think the commissioner will be particularly disappointed in is:

It is recommended that the current base funding for the commission of $1.25 million per annum be maintained at existing levels.

The government agrees with that. When you look at the cost per complaint, I think there is an issue there. We should be able to reduce the cost per complaint. I think the commissioner would be more than happy to look at ways of improving service delivery, and I know that that is her intention. She does have a good heart and she means to do the right thing.

The things that the commissioner is going to have, hopefully, to assist her in delivering her services will be an improved IT system, because replacing the IT system is one of the recommendations in the operational service review. It states:

It is further recommended that the commission consider the South Australian Health Single Common Complaints and Incident Management System across the public health system which is being implemented in early 2011.

If the minister would give us a bit more detail on that that would be good because the South Australian health response was that they agreed in principle to that.

Establishing a formal success criteria for the commission was thought a good thing by everybody, including the government. Establishing a formal staffing strategy: I think there are issues with the numbers of staff in the commission for the output. The review has raised that and the government is going to do something about it; it is agreeing in principle here.

So, the government does agree with those 10 recommendations. Reading the commissioner's annual report, I think there are some concerns that we need to make sure that not only the commissioner and the commission but also the people of South Australia are able to see action on. That will then, hopefully, deliver a service that is the best in Australia, both in terms of intent and in terms of output.

This week we also saw a very important report tabled in parliament, which was the review of the public health system's performance for 2008-10 by the Health Performance Council. The Health Performance Council was set up under the Health Care Act 2008 and its job is to report to the parliament on the performance of the South Australian public health system.

The terms of reference of the Health Performance Council are interesting to read. The Health Performance Council's review of the South Australian public health system was undertaken in accordance with its mandate under the Health Care Act, part 3, section 11. The act specifies that the functions of the Health Performance Council (HPC) are to provide advice to the minister about the operation of the health system, along with a number of other things, including seeking and obtaining the views of the health advisory councils, advisory committees and any others that they seek to contact.

We will be seeing these reports every four years, which will be interesting. I notice that in New South Wales they are reporting on the performance of their hospitals every three months now, on the net. They are interesting reports to read. It would be interesting to see whether we are looking at something like that in South Australia. They are very open, comprehensive and precise reports.

The executive summary of the Health Performance Council's report is interesting. The whole report is a comprehensive report of 173 pages, but the executive summary says that the Health Performance Council was established in 2008, as I have said, and the council reports against the South Australian Health Strategic Plan 2008-10.

The council became aware of many valuable and essential health services and functions that were undertaken by South Australian Health that were not covered under the South Australian Health Strategic Plan. That is a concern to me because, as Professor Paddy Philips said at a public function, 'You can't know what you don't measure.' It is important, not only for the people who are using these services but also for the people who are monitoring these services, like the Health Performance Council and the Health and Community Services Complaints Commissioner. It is important we know what is going on out there and we are able to measure performance and, just as the review of the commission is benchmarking, we are able to benchmark what is happening in South Australia.

I was quite surprised, actually, that some of these areas were not part of the South Australian Health Strategic Plan that the Health Performance Council could look at. This includes dental care in South Australia that was commenced by the South Australian Dental Service. There were nearly 170,000 cases of treatment by the dental service, which should be looked at, could be looked at and, when reported on, I am sure it will be a positive thing.

There were over 5.5 million tests performed by SA Pathology. The performance council, obviously, is not going to look at 5.5 million tests, but they are going to look at the performance of SA Pathology. It will be interesting to watch what happens with SA Pathology with the move to the new Royal Adelaide down at the rail yards, because I know there are issues being raised by the Royal College of Pathologists about that move, and I look forward to seeing some positive outcomes there.

One of the really nice things here that I would have thought the government would have wanted the performance council to look at is that, during 2009-10, there were 19,575 women who gave birth to 19,872 new South Australians.

The Hon. J.D. Hill: A stunning turnaround under my leadership!

Dr McFETRIDGE: It is a credit to South Australia that we are turning out so many new South Australians. I hope that they do one for mum, one for dad and one for the state. That would be great. Being parochial as I am, as a South Australian, it is the best state in the best country in the world. What better place! While one of my grandchildren was born here, one was born in Melbourne, but they are both back here now for a much better future.

Talking about my grandchildren and children generally, the Childhood and Adolescent Vaccination Programs were not looked at by the Health Performance Council. I think this is a good area for them to look at, because there are probably some exceptionally good things happening there. We see the anti-vaccination lobby out there every now and then with their junk science—and it really is junk science—and we need good reviews of what is going on with vaccination programs in South Australia so we can discredit the junk science that is out there.

I read somewhere that South Australian Hills dwellers, as in Mount Lofty Ranges, had one of the lowest rates of vaccinations for children. I think that that is a real worry for all of us in this place, as well as our health professionals and, also, those kids who are not being vaccinated because there is nothing more sure than that a thorough vaccination program will give exceptionally good protection to our children.

It says in the report here that there are many good results in many areas, and I am happy to praise up the good things that are happening in South Australia because it is a great state. But there are some areas of concern, and one of the areas of concern that the Health Performance Council talks about—and it is going to be more of an issue for the Health and Community Services Complaints Commissioner—is how our lifestyle illnesses are being dealt with—people waiting to be treated in hospital, and their treatment in hospital, not because, as we saw in the past, of accidents and illnesses, but because of lifestyle diseases such as asthma, chronic obstructive pulmonary disease (COPD), renal disease, diabetes, heart failure and obesity.

Obesity is obviously the one we hear about all the time but there are so many other lifestyle diseases now which are going to be an increasing burden on our health spend, and we can see that there are going to be more and more issues with making sure that the people who are affected by those diseases are dealt with as fairly as possible, even though many of these diseases are self-inflicted.

Changing lifestyles, I think, is going to be one of the big challenges in health. It is easy to tell people to slow down on the roads by increasing speed cameras and decreasing speed limits, but to tell people to change their lifestyles is going to be a real challenge for us.

The Health Performance Council's report goes on to state that, while achieving results in other areas, there remains a challenge. One of those, unfortunately, is the lack of integration and communication with providers within and across services in both the public and private sector. Making sure that we are talking to stakeholders and people who are at the coalface of our health system is so important, and the government—fairly, or unfairly and, in many cases, I think quite fairly—is accused of the announce and defend. I think it needs to be improved and, as it states in the report on page 11:

The development of performance measures that demonstrate effectiveness and system outcomes is challenging. However, in the Health Performance Council's view, this is essential to the achievement of greater public accountability and system improvement.

So, as Professor Paddy Phillips said, 'You can't know if you don't measure'. The Health Performance Council states here that you should be measuring these things, and knowing what is going on, and setting realistic targets for all of them.

I am glad the minister came in here and talked about the four-hour targets, because I have been watching this for a while. I have had some issues with it, and on 9 June 2010, the health secretary, Andrew Lansley, told the UK parliament that they would be abolishing the four-hour targets. In reply to a question, the health secretary stated, 'I was very clear in what I had to say—I'm going to abolish the four-hour A&E target.'

I would love to have a target that is achievable, that is real, and not just an arbitrary target, and that is what we all need to be cognisant of. We need to make sure that all of our targets are real, because in the British case, in the Mid-Staffordshire NHS area, there are a number of reports that have been done there that really show the fiddle factor that was coming in, forcing doctors and nurses to move people around inappropriately, and putting lives in danger.

I read somewhere that, I think, 1,200 people died as a direct result of either misappropriate treatment, misappropriate discharge, or some other fault in the system where hospitals were trying to meet these targets so that they could get their funding. I think that that is not the case here in South Australia, but we should never, ever get into that position where we are putting pressure on our health workers to meet arbitrary targets.

On page 12 of the Health Performance Council's report, it states that more dynamic committee relations are needed, and this is what the Health and Community Services Complaints Commissioner would like to see. The need to talk, to communicate, to explain—I know in my veterinary practice that you needed to make sure that people understood exactly what was going on, and you need to try to explain extremely complex circumstances and conditions to people who have no knowledge whatsoever, no understanding of the science of biology behind veterinary science or, in this case, human medical science.

There are areas where people's expectations are completely unrealistic, and there are also areas where people just have no comprehension of what is going on, and I recognise the fact that we need to make sure that we are communicating in a manner that is going to cut off complaints even before they arise so that people do understand that their expectations are unrealistic.

The problem we have in South Australia with adverse events is certainly a reason for complaints, both to the commission and to the public health system. The commissioner does not really deal with that to a great extent in her annual report. It is touched on in the Health Performance Council's report, and I know that the commissioner is involved with the Health Performance Council, so there is an overlap, anyway. Key finding No. 9 states:

While substantial work is underway to improve the safety culture and to monitor adverse events within the public hospital system, further work to both understand and improve patient experiences and clinical effectiveness of in-hospital and out-of-hospital care is indicated.

In its response to the Health Performance Council's report that was tabled in parliament on Tuesday, the government has outlined that its patient/client satisfaction surveys have been undertaken in South Australia. I looked at these during the estimates process, and I think the figure of 88 per cent rings a bell—but it was 88 per cent year after year after year. So, the level of satisfaction was peculiarly regular—but I hope that it is greater than 88 per cent.

What we need to do is to make sure that we are not kidding ourselves and pretending that we have a greater level of satisfaction than we actually have. We have a very hardworking public health workforce in South Australia, which is highly dedicated—and I should say it is also the case for private health—but we need to make sure that that satisfaction level is not in any way trivialised or unrealistic because of the limited way we are measuring it.

I would like to hear from the minister a little more about the safety learning system that is being implemented in South Australia. I wanted to have a look at that on the website, but I could come up only with the Australian Safety and Learning Systems, which I think is a private consultancy service. This safety learning system replaced the AIM System (and I will have a bit to say about that in a moment), and that was the Australian Incident Management System. Some serious issues surrounded that late last year, and I hope that, as at 1 December 2010, with the replacement of AIMS by the safety learning system, the issues of reporting and ensuring that complaints are followed up through the South Australian health system are as efficient as we can possibly have them, in parallel with the complaints commission.

In June 2010, the SA Health Consumer Feedback and Complaint Advisory Group was established, and this group incorporates membership from the regions, safety and quality, Health Consumers Alliance and the Health and Community Services Complaints Commissioner. So, the commissioner is involved, as I said. However, it is a real concern for us to make sure that we are working together to achieve a great outcome and not trivialising it in any way, and I am not accusing anyone of trivialising complaints in South Australia.

However, some comments have been made by former health bureaucrats in South Australia about the outcome of the South Australian Patient Safety Report 2008-09. Once again, with statistics, it is how you categorise, qualify and quantify things that determines how you can interpret reports. It was stated—I am fairly certain of my facts here, but I am happy to be corrected if I am wrong—that there were only 15 sentinel events in South Australia in the 2008-09 year. Sentinel events are obviously extremely serious events, but turn to page 16 of the Patient Safety Report and look at falls. During 2008-09 fall incidents rated as SAC 1 included nine patients who died after falling, 20 patients who required surgical repair of a fractured neck or femur, two patients who sustained other injuries that required surgery, and one patient who sustained a fractured skull. I would have thought that those were all sentinel events.

In total there were 7,333 falls of varying categories in our hospitals. Now, any fall can be quite serious. In fact, a good friend of mine was at one of our public hospitals—and he does have some mental issues, unfortunately; he is getting older—and fell out of bed about four times before they did something about it. Fortunately they did do something about it, but let us not pretend that it is all sweetness and light when there are serious issues here.

Leaving falls, let us look at the other area of medication. Giving the wrong medication, or not giving medication at all, is a very serious issue for patients. Reactions to that medication and complications because of a combination of medications is of real concern. While the commissioner does not talk about that in her annual report, referring back to the Patient Safety Report there were 5,865 cases where there was an omission and/or a suspected omission or where the wrong medication was given to a patient.

We have thousands and thousands of patients going through our public hospital system, so I am not trying to blow this out of proportion; however, if you were one of those 5,865 people it would be pretty important to you. I used to tell the vet students who came into my practice that their levels of compassion must never drop off; I did not care if it were the 20th cat fight they had seen that day, they must never forget that it is that person's cat. We need to be well aware that if we were one of the 5,865 people who received the wrong medication, or did not get our medication, it would be a serious error.

Medication-related errors are amongst the most common medical errors and the most common threat to patient safety, according to this report. Omissions or suspected omissions of medication were at the top of the rank. Fortunately overdoses were a lesser problem, but the wrong medication is a serious issue there.

Regarding clinical management, I have spoken to the ANMF, and I speak to our doctors and nurses and our allied health professionals almost daily about the terrific job they are doing, but there are still issues with clinical management. There were 4,000 incidents involving the clinical management of patients in the 2008-09 year. I would be interested to see what the Patient Safety Report has to say in the next few months when it is released.

I do not use those figures as a means of putting down people in our public health system. It is just that we should not kid ourselves; let us be aware that there are issues there. I want all those levels to be zero. In a system as complex as our health system, as diverse and tested as our health system is, we will never get to that level, but let us make sure that we are still trying to achieve that as far as we possibly can.

A moment ago I talked about the safety learning system that has replaced the AIM System. I was happy to read that, but was concerned last year when I was told that the South Australian Incident Management Centre, the contact centre, was reducing its hours of operation. It is a bit like the complaint about the Health and Community Services Complaint Commissioner; if you can only get on the phone between 10 and 4 five days a week, then you cannot make the complaint. That is one way of reducing complaints, but it must be really frustrating for people who do have an issue.

However, the incident management contact centre was, from 5 October 2009, reduced from 6.30 in the morning until 10.30 at night seven days a week. You are still able to use voicemail after that, but there is nothing like being able to talk to a person on the line. I hate 'push button 1' or 'push button 2', or having to go through a series of voice menus to get somewhere. When you are stressed, when you are challenged, when you have got a sick relative or child or you are unwell yourself and you have got an issue, you want to talk to someone about it and have some action taken. Whether it is through the 10 till 4 phone hours of the commission or whether it is through the reduced hours of the AIMS contact centre, it is not good enough. I hope that the new system is going to improve on that. I look forward to the minister telling us about how it is going to be improved.

Part of the improvement process, though, is consultation. That was brought up in the Health Performance Council's report. One of the major lobby groups which is involved with the Health Performance Council is the Health Rights and Community Action group. They have come to see me on a number of occasions. They gave me a copy of one of their reports. It is two years old now, but it is still relevant. I will read some of the issues that they put into this report. They expressed similar concerns when we last spoke. The Health Rights and Community Action group carried out a survey to assess consumer feedback on the complaints mechanisms operating in South Australia. It states:

Since then a number of consumers have contacted HR&CA regarding issues with health complaints which raised concerns as to whether the H&CSCA had improved the way complaints are handled. As a result of this feedback HR&CA decided to conduct another survey along similar lines as the survey carried out by the Consumers Association of South Australian in 2002...70 people came forward and shared their experiences and problems.

It is not a lot of people, but it is significant that they were brave enough to come forward. It continues:

This survey, along with the 1995 Australian Study into Health Care and many other reports shows that many consumers continue to experience Adverse Events in the health system.

We just spoke about those. Let's hope that we are going to see some improvement there. Adverse events in Australia cost in excess of $800 million a year, according to this report—$800 million. I am surprised that it is not more than that. Let's hope that we are able to reduce that. That does not include the human cost; that is only the financial cost. Let's hope that we can reduce that, because it should not be so. The report continues:

Those who did not lodge complaints stated health and personal issues, followed by lack of knowledge and support and fear of retribution as the main reasons for not lodging complaints.

That is what I said before, that you must be able to do this in an open fashion. If you feel in some way aggrieved and you do fear retribution, that is a terrible position to be in in the first place. However, if you can do that anonymously and, if we have a system in place where people receiving anonymous complaints are able to thoroughly investigate them without sledging people, that is desirable. I think it was working with the AIMS contact centre before, but not now. Let's hear what the minister has to say about that.

There was an increase in the number of consumers who were thinking of litigating compared with the previous survey. This is a survey that has been done by the Health Rights and Community Action group. Litigation should be the last resort for these sorts of concerns in the health system. You should be able to do it with the provider, have unrealistic expectations explained away and have issues dealt with without having to enter into the legal system in this state. Certainly, that is one of the things that would be a real disincentive for anybody to continue on pushing a complaint that they did not feel was being dealt with appropriately. The report by the Health Rights and Community Action group states:

Consumers surveyed expressed significant dissatisfaction with the way complaints were handled by service providers.

That is why it is good to see the review into the way the Health and Community Services Complaints Commissioner is working. It is good to see the Health Performance Council's report coming out, because we do need to keep improving as much as we possibly can.

The work of groups such as Health Rights and Community Action is very important. I encourage all groups involved in dealing with patients' rights in any way, shape or form to keep being active, keep in touch with all of us, keep on the government's back, contact the opposition and talk to the people in the hospitals at the coalface, because there are complaints resolution systems being set up within the hospitals. They should be working, and working well. I have looked at the websites today and there are flow charts of the way complaints are handled in hospitals. They are relatively straightforward in theory, but in practice that is often not the case and that is why we see complainants going off to the commission; and this bill is all about improving the commission's ability to do its task.

Looking at some of the particular clauses in the bill, the charter of the Australian Human Rights Commission is being incorporated into the legislation. The content of the charter has been improved so that a person should be entitled to be supported by a person of his or her own choice when making a complaint about the provision of health and community services. There will be a community visitor scheme, which we talked about before, and having a support person is important. We saw that in the Mental Health Act recently, that is, having support for people who, in this case, feel aggrieved or, in other cases, have an illness and need support by a carer or a relative.

The assessment of complaints against aged care facilities, as it should be, is being put under the commonwealth Aged Care Act 1997.


[Sitting extended beyond 17:00 on motion of Hon. J.D. Hill]


Dr McFETRIDGE: In this particular case we have no problem with the commonwealth legislation being used not as part of this legislation but as a reference for complaints against aged-care facilities. The bill talks about notifying providers of any action that may be taken against them, and the commission must now allow at least 28 days to make representation to it from the provider.

Division 5 is a new part, and it is a good part. It is all about the Social Development Committee's report, that is, action against unregistered health practitioners. It also talks about those who would be considered to be bogus practitioners. It says that the Governor may by regulation prescribe a code of conduct relating to the provision of health services that fall outside the ambit of operations of a registration authority.

These are the guys you see on the adverts for some of the health funds—the fish slappers and crystal twisters of this world. They do need to have codes of conduct. I know in veterinary practice there are a number of areas in which people are operating where I would like to see codes of practice, and I am looking at regulation to cover veterinary chiropractors, veterinary dentists and farriers.

I was sent a photograph the other day of a horse's hoof. The horse was the favourite in a race at Morphettville. I have shod a lot of horses in my time and whoever backed this horse should be able to sue for fraud because that horse was never going to be able to run on its merits having been shod the way it was. It is an issue I will raise with the minister for sport. I digress slightly but, as well as having codes of practice for our human unregistered health practitioners, I think there is an area in veterinary practice that I will raise later. We need controls in both areas.

One of the clauses states that the commissioner will be able to take interim action if in the opinion of the commissioner action under that section is necessary to protect the health or safety of members of the public. My concern is that we need to be able to stop those people continuing to do what they are doing. I understand that the commissioner can do that, because under section 56C the commissioner may:

(a) make an order prohibiting the prescribed health service provider from providing health services, or specified health services, for a period specified in the order, or indefinitely.

You cannot allow people to continue on in the way they are, ripping people off, putting people's lives in danger and, in some cases, killing people. I understand that there were heart wrenching stories told to the Social Development Committee by people who had been done over by dodgy health practitioners. I am sure that the member for Hammond and other members in this place will give details of that in their contributions.

I strongly support naming and shaming these dodgy practitioners, and it is in this bill, 'publish a public statement'. I think that people who are found to be offering services which are dodgy and putting people at risk should be named and shamed and immediate action should be taken to stop them from continuing what they are doing.

The appeal process, 56E, is of concern, and perhaps the minister can tell us about this. Can these dodgy practitioners still work while the appeal process goes on? My reading of this, and I am a humble veterinarian not a lawyer, is that they can continue to work while there may be orders against them but they are appealing to the administrative and disciplinary division of the District Court. So, if we could find out what is going on there.

The amendment to section 67—Establishment of Council, which is the Health and Community Services Advisory Council which was established under the original act, there are two more people who are going to be added to that, and that is:

(f) one person who, in the opinion of the minister, is qualified, by reason of his or her experience and expertise, to represent the interests of carers;

which is a great thing:

(g) one person who, in the opinion of the minister, has appropriate experience and expertise in relation to the quality and safety standards of health services.

So, that is another good area. I have one question here that was put to me. Subclause (e) in the original bill provides:

Two persons who are members of a registration authority (not being members of the same registration authority) who, in the opinion of the minister, are qualified, by reason of their experience and expertise, to represent the interests of the public.

That registration authority, I assume, is the national authority and not the state-based authority, because they no longer exist. So, if we could make sure that that is cleared up.

The functions of the advisory council have been expanded a little bit in here. Certainly, educating and informing users, providers and the public of the availability of the means for making health or community or service complaints or expressing grievances, and we talked about that earlier, is in the bill, and that is the reason that we are supporting this legislation.

'Protection of identity of service user or complainant from service provider', I think that is important because we must make sure that we are not putting at risk the health or safety of a person because they feel that they do not want, in any way, to be identified.

The final clause in the bill is insertion of section 86A—Assistance to other agencies, which provides:

Without limiting any other provision, the commissioner may assist, and provide information to, a person concerned in the administration or enforcement of a law of the state...

We need to cross-reference as much as we possibly can in making sure that this legislation is not just a little silo on its own, but that it is making sure that our whole health system has improved.

There are a number of other members who want to speak on this tonight in the 55 minutes that is left, so I will conclude my remarks there. We will go into committee. There are a few questions that we need the minister to answer. With that, I conclude my remarks by saying that the opposition supports the bill but there are other members who want to raise issues of concern and/or experience.

Ms SANDERSON (Adelaide) (17:04): I rise today to speak briefly on the bill before the house. I support the need for health consumers to have an avenue of address for any issues that arise in relation to the treatment that they receive by registered health practitioners. For many, a significant health issue is a stressful and difficult time in their lives, and for those who care for them. I will not refer to the merits of specific legislative amendments proposed, except to say that I am very pleased that the government has addressed the need to recognise the role of carers and the contribution that a support person can make when a consumer has an issue with the treatment received.

I will mention a couple of situations experienced by a constituent that I have referred on to the Health and Community Services Complaints Commissioner. Most recently, a constituent was seen at The Queen Elizabeth Hospital following an injury sustained to her knee. The constituent raised two equally important concerns with me. The first was her frustration of wrong diagnosis at The Queen Elizabeth Hospital which, upon second diagnosis at another medical facility, resulted in immediate surgery.

My constituent's second complaint related to the manner in which she was consulted and informed of the diagnosis. I understand that, due to a lack of space, my constituent was consulted and diagnosed in the general waiting area. This caused my constituent much embarrassment as she was asked questions in relation to her personal medical history and medication taken during this procedure within earshot of other waiting patients. I am sure all members in this house would agree with me that this was not an appropriate place to conduct such a consultation, although it does perhaps indicate a health system in crisis management.

I will also share a personal story about my mother's cancer treatment. Three years ago my mother successfully underwent treatment for bowel cancer at the Modbury Hospital, where she was taken care of very well. Upon completion of her treatment, a follow-up appointment was made three months later for a scan. No results were given and no further follow-up or consultation was made by the hospital. 'No news is good news,' she thought and did not follow this up.

A trip to her local doctor about three years later for an asthma prescription led to the local GP inquiring about her cancer. The GP did blood and urine tests, which showed up negative, and requested scans. It was then found that the cancer had returned to three different locations in the body. Put simply, a failure of administration to properly case manage a patient has meant the cancer is now inoperable and that invasive treatment of intensive chemotherapy and radiation is now the only choice available. These examples illustrate that mistakes do happen and no industry is infallible, and that such mistakes within the health sector can have grave consequences.

In closing, I realise that we do not live in a perfect world and that mistakes inevitably happen. Even though patients have the option of seeking remedy through our judicial system, this is not a pathway that many patients wish to take for numerous reasons, including money, time, effort and poor health. Therefore, it is essential that there are other avenues for patients to address their concerns and seek resolution. The Health and Community Services Complaints Commissioner serves such a purpose and I commend the proposal to amend such legislation to strengthen the role of the commissioner.

Mr PEDERICK (Hammond) (17:08): I rise to speak to the Health and Community Services Complaints (Miscellaneous) Amendment Bill 2010. I was on the Social Development Committee when we held the Inquiry into Bogus, Unregistered and De-Registered Health Practitioners, and our report was tabled in the parliament on 3 March 2009.

This was a very interesting committee to be on at the time. I will not go into too much detail, but there were many heart-rending stories of people that have had experiences with bogus and unregistered so-called health practitioners. There were people who had made claims to people that they could cure cancer, and these people put their absolute faith in these—well, witchdoctors, I suppose you could call them. Some of these people did not even use the paths they could have through the normal health practices and doctors because they put their absolute faith in these other so-called practitioners.

We had some very emotional presentations, I must say, from people talking about loved ones that they had lost, who they thought they had done the right thing for in going to these practitioners, and the end result was that partners and friends had died, and that is very sad. They put their faith into people who are, basically, peddling snake oil. It was very moving and very tragic to hear these stories, and I commend all the people who presented to the committee or brought in written submissions. It certainly tested the emotions of everyone on the committee, and very emotional stories and submissions were presented to the committee.

Some of these pedlars of so-called health benefits, were quite voyeuristic in what they were doing, and some of the procedures they took were quite disgusting as well. I do not want to go through that too much here but some of the photographic evidence we saw was just inappropriate to say the least, on how these people operate.

So, I am pleased—having gone through the committee process, and having heard the submissions on how these bogus operators operate—that under this bill there are some provisions made for penalties for operating inappropriately, and this will bring them under legislation to control how they operate.

As I said, it was a very moving experience hearing these submissions and, again, I commend the people who presented to the committee. My condolences go to people who lost loved ones through getting poor advice from bogus health practitioners. It is my hope that this legislation will help stamp out some of these snake oil pedlars, keep them under control, and I hope it will promote people to get proper health advice and look at all the options, instead of just taking some misguided advice from people who claim that they have the ability to heal people.

The sad thing is that the end result is that someone loses their life. It was a great tragedy and you could see the there was great emotion in these people because some of these incidents had happened not that long before we had the committee hearings. I commend the bill and wish it speedy passage through this place.

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) (17:12): I thank members opposite for their contributions and their support for this legislation. The shadow minister raised a whole range of issues in relation to the health complaints commissioner and I do not disagree with his essential analysis, and I will not go through the points that he made because they are not really pertinent in a direct way to this legislation.

This legislation strengthens the health complaints commissioner and gives the commissioner additional powers, particularly in relation to the bogus and unregistered practitioners, which the members on the other side have already referred to. This is an area, I think, that all members of this place and, in fact, the broader community, are very much concerned about—those people who purport to give hope and service to people who are dying and, in fact, they are just exploiting them both in a financial sense and, in the case of at least one that the member referred to, in a sexual sense as well. It is hard to imagine how another human can do that to somebody who is in such a vulnerable position.

So, quite frankly, I hope this legislation allows us to deal with those people and put them where they belong. I really do thank members opposite, and on all sides of the house, for their support for this legislation. There were a number of questions that the member for Morphett asked me. I cannot actually recall what all of them were now, but I am happy—and I understand we want to go into committee—to address them in committee, and I will have some support next to me, and they will be able to assist me. On that point, can I thank Lee Wightman from the department, who has been largely responsible for organising the health department's response to this, and also parliamentary counsel, Simon Gill, who has done the legislative work on it. I do commend the legislation to the house and I thank members for their contributions.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 to 5 passed.

Clause 6.

Dr McFETRIDGE: Clause 6 talks about the content of the charter and provides that 'a person should be entitled to be supported by a person of his or her choice'. The commissioner, in her report, talked about the Community Visitors Scheme, which will be commencing. Can the minister tell us a bit about the Community Visitors Scheme and when that will start, the time line?

The Hon. J.D. HILL: The Community Visitors Scheme is scheduled to start from 1 July, the beginning of the next financial year. The department is working on the elements of that as we speak, so that is when it should be in place.

Dr McFETRIDGE: Will those people be appointed by the government, the department or by the victims, I suppose, of complaints? How is it going to work?

The Hon. J.D. HILL: I might have to get further advice for you on that. It is the mental health part of the portfolio. So, the visitors will be visiting facilities that look after mental health consumers. I am not entirely sure of the process by which people will be appointed, although they will be people who, presumably, have the skills and who are familiar with some of the issues. However, I am happy to get an answer for the member.

Dr McFETRIDGE: I am sorry, minister; I will read that in Hansard, I promise.

The Hon. J.D. HILL: I do not actually know the process by which people will be appointed. I guess some recommendations will be made to me, based on people who have the skills and attitude and who have been through a training process and can do the job, but exactly how it works, I do not know.

Clause passed.

Clauses 7 and 8 passed.

Clause 9.

Dr McFETRIDGE: In relation to the codes of conduct relating to the provision of health services that fall outside the ambit of operation of a registration authority, we saw with the public liability legislation a few years ago that there were serious concerns about insurance and developing codes of conduct for sporting bodies. That was very difficult in itself, and I envisage quite a few issues with developing codes of conduct for these health practitioners. Are there codes of conduct that exist already and, if so, in what areas, and what sort of time line are we expecting to develop these codes of conduct?

The Hon. J.D. HILL: I think six months is the kind of broad estimate. However, New South Wales has been through this, so our legislation is largely modelled on what New South Wales did. So the code of conduct would say, for example, that if you purport to deliver a health service that was not in a registered area, you must comply with some basic standards: it would need to be a clean premises and you would need to operate in an honest way in terms of bookkeeping and so on. You could not make claims for the service—and this is a critical one—for which there is no evidence. So, you cannot say, 'Take this pill and it will cure cancer.' You just cannot say that. That is, on its surface, a basis for a breach of the legislation. It would be things of that order.

Someone who does massage, for example, may be able to say, 'This may assist in the management of pain associated with X, Y or Z.' That is possibly okay. What they cannot say is, 'Come to me and I will massage away your coronary condition or your cancer' or whatever it is. I think that it is probably applying the same sort of standards that corporate law would apply to any other business, but in the medical area.

Dr McFETRIDGE: That is what you would expect, and it is great. However, I still have a concern; it may not be addressed by this legislation, but you could perhaps just tell me. I am pleased that I have not seen anyone in this place wearing those bands with a crystal in them that you can buy at the moment. If you wanted a bogus piece of medical equipment that has to be the epitome of it, yet they are selling thousands of these things.

I see that the ACCC has said that people who want their money back can get it, but people are still selling them. I think there should be a code of conduct, because people just cannot make those claims. People seem to be able to get away with it under consumer legislation; perhaps it should be under this sort of legislation.

The Hon. J.D. HILL: That is really for the ACCC; it is a trading thing. We are talking about people who provide a service that purports to be a health service. So, if they say that they will do something that will cure something, or fix something, and they cannot, in any scientific way, prove that that is the case, then it is a breach. In terms of selling a product, the ACCC says that if you sell a product then it has to comply with a certain range of requirements. Essentially, it has to do what it says it will do. I was not aware of the crystal bracelets. I assume they cure something or make you feel better?

An honourable member interjecting:

Dr McFETRIDGE: I do not think they actually look pretty. At first sight you might think they are a watch, but they are just a little crystal that people put on their wrists. They swear by them, but that just goes to show the psychosomatic effect out there with so many things.

If I move on to new section 56E in clause 9, the issue I raised during my second reading contribution was whether these practitioners continue to work during the appeal process. Perhaps I have missed something, but I would have thought there were reasons you could appeal.

The Hon. J.D. HILL: It is a good question. The order starts immediately, and then the person against whom the order has been taken has a right to appeal. They cannot practice while they are going through that appeal process, as I understand it.

Clause passed.

Clause 10.

Dr McFETRIDGE: The additions here are paragraphs (f) and (g). The question concerns paragraph (e) and about two persons who are members of a registration authority (not being members of the same registration authority). Obviously, state-based has gone national here. What is in place and who decides who is on the council?

The Hon. J.D. HILL: I am just having it explained to me. It is a technical nicety, really. AHPRA, which is the national authority, has a series of boards which exist underneath it, and those boards are the bodies which do the registration. There are still multiple registration boards in existence, so the legislation will still hold under those arrangements. The goal is that we do not end up with two doctors or two nurses, that we have a mixture of skills, as you probably appreciate.

Clause passed.

Clauses 11 to 14 passed.

Title passed.

Bill reported without amendment.

Third Reading

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) (17:27): I move:

That this bill be now read a third time.

Bill read a third time and passed.

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