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House of Assembly - Fifty-Second Parliament, Second Session (52-2)
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PATIENT ASSISTANCE TRANSPORT SCHEME

Mr BROCK (Frome) (12:04): By leave, I move my motion in amended form:

That this house strongly urges the state government to undertake a complete review of the current Patient Assistance Transport Scheme (PATS) to ensure that the budget ensures that the level of reimbursement for rural patients is relevant to today's cost of living and that persons requiring to attend specialist services that are not available within their own location are not disadvantaged, as is the case under the current system.

Before I speak, I understand that since I put this on the Notice Paper the state government has instigated a review. I congratulate the government on doing that before we debate it in this house, and I am very thankful. However, I would also acknowledge that the introduction of the PAT Scheme was a great initiative when it was first introduced, and it has certainly assisted rural patients to be able to afford to visit the required specialist services in Adelaide that may not be available at rural hospitals.

At the time of the introduction, the amount able to be claimed was realistic to the cost of living; however, the cost of living—in particular, the cost of utilities and also council rates—has increased dramatically and the reimbursement has now lost the desired effect. I might add that, from my understanding, the scheme is available to all South Australians who reside within the distance required under the conditions of the scheme, irrespective of any income.

The previous review of the PAT Scheme, which was conducted in 2011, was a review of the administrative process to enable clients using the scheme to have easier access to application forms and quicker turnaround rebate times, which is arguably still not happening in many instances. A few of the other so-called benefits were also introduced as a result of that review but nothing tangible that will assist rural people to pay for their medical needs.

Recently, a constituent reported to my office that he now has to pay up-front for bus fares and accommodation and then send the receipts to PATS, waiting from four to six weeks for his rebate. This constituent is his wife's carer, and they have to travel to Adelaide regularly for her appointments. He told me that it is making it very difficult for them, on top of all the increases in power and water they have to pay. In October 2011, the South Australian Council of Social Service's 'Cost of living summit: post-summit report' stated:

Utilities such as electricity, gas, water and sewerage are an essential household cost, but price rises over the last 10 years have meant that they are also one of the key drivers of cost of living pressures. This is particularly the case for low income households for whom utilities form a much greater proportion of household expenditure.

In this report, on page 6, table 5, it was stated that utilities increases over the last 10 years for the following were: electricity, 137.1 per cent; gas, 100.3 per cent; water, 114.4 per cent; utilities, 124 per cent; and CPI, all groups, 33.3 per cent. These increases have hit the less fortunate very hard and yet the costs of the reimbursement have remained constant for the last 11 years. I ask: is this fair?

This report came out at the end of 2011, and these same utilities that were spoken of have increased enormously over the past two years, as we are all aware. The ABS 2003-04 Household Expenditure Survey states:

Indicators of financial stress occurred in greater proportions among low economic resources households than other households in 2003-04. For example, 38% of low economic resources households reported that within the last 12 months they could not pay utility bills on time and 26% had sought financial assistance from friends or family [or NGOs], while for other households the proportions were 11% and 8% respectively.

The same report went on to say:

Going without meals in the last 12 months due to a shortage of money was experienced by 12% of low economic [resource people], compared with 2% among all other households.

Fast forward nine years and many of my constituents report to me that they are in the very same position, and they have this added burden of having to travel to Adelaide regularly to attend specialist appointments that are not available in Port Pirie, Clare or other regional hospitals and trying to pay for the cost of their health care.

I would add that I am very grateful, as are the people in my electorate of Frome, for the extra services, particularly chemotherapy beds and the dialysis chairs at Port Pirie and Clare; however, there are still numerous services that are only available in Adelaide. The biggest issue with PATS is the amounts of rebates paid: the fact that people have to pay for the first $30 of any claim and what is not covered. Access and equity should be the key points of this scheme.

I know the government may say that $30 is equitable to what people would have to pay if they lived inside the 100-kilometre radius from the place of appointment, but what is not equitable is that people living in Adelaide or towns where treatment is available pay very little, if anything, to attend these appointments, and this in itself is not equitable. Why must there be a 100-kilometre distance travelled limitation? I certainly am not advocating that this 100-kilometre distance be increased.

Since PATS was introduced in 2001, the fuel subsidy has not increased and the scheme users are still being paid a rebate of 16¢ a kilometre, but in fact unleaded petrol has increased by an average of 72.4 per cent in rural areas across South Australia from 2001 to 2012. This information came from the Australian Automobile Association. Once again, it is a question of equity. In addition to this increase in fuel costs, general cost of living expenses continue to surpass all concessions and rebates, including the PATS rebates, and therefore these erode in value over time. So, the gesture of the PATS reimbursements ends up being negligible. I hark back to October 2011 with the SACOSS Cost Of Living Summit report that I mentioned earlier. It states:

...health expenditure can be a real challenge—with the real danger that those without sufficient income simply miss out on services. For some people, such as these with chronic illness, the cost of allied health services can be as crippling as the cost of direct health care.

It is my opinion that the limitation of claims for reimbursement from the PATS is ridiculous; so many procedures cannot be claimed for, including specialist dental treatment, specialist sport treatment and allied health procedures, such as assistance from dieticians and physiotherapy. Many of these specialist procedures are not available in rural areas or there are lengthy delays to get an appointment, and this is not beneficial to patients who have urgent medical needs.

Quite often, there are specialists who visit regional areas but a patient cannot get an appointment for six months or more, and the patient cannot claim for the PATS rebate because they choose to attend an earlier appointment in Adelaide. Or, if a person has had a previous procedure done in Adelaide, they cannot claim the PATS rebate for the continuation of the treatment appointments with that particular doctor if a specialist of that field visits the area they live, even though it may not be their treating doctor.

This is a bone of contention, especially with one of the organisations which has various specialists who, when they go to the country, are coming out for individuals, not as a doctor treating any general person who has visited one of the previous doctors there. Once again, this is an issue of access and equity.

It is a well-known fact that the most vulnerable and disadvantaged people who are on low or limited incomes are also, for the most part, more likely to suffer from ill-health and require specialist or hospital treatments that are not generally available in rural areas, which gives them no option but to travel to attend appointments in Adelaide. People who find themselves in a situation where they have to travel to Adelaide for specialist or hospital treatments that are not available to them at their local hospitals or medical practices quite often defer treatment because they simply cannot afford to travel.

I know people who have been asked to go to talk to a specialist in Adelaide and they have had to save up two or three pensions to ensure they have enough money to be able to have that pre-treatment. Those same people ultimately end up being a bigger drain on the healthcare system because they end up being admitted to hospital.

I have said to the current Minister for Health, 'Prevention is better than cure.' If you allow a person to go down and receive preventative medication and treatment, then that person does not have to go into the hospital system. For example, the $150 allowance is not any great financial drain on their budget and it is far cheaper than having somebody in the hospital system where it costs about $1,000 a day, and again, it is an impost which I believe is false. I know it comes out of another budget, but the point is we need to prevent these things from happening.

I strongly suggest that prevention or early diagnosis would save SA Health in hospitalisation costs. As I said earlier, there is an old saying that prevention is better than cure. The SACOSS report mentioned previously states:

There is growing anecdotal evidence that points to an increasing number of people on low and middle incomes deciding either to not seek needed medical care because of co-payment requirements at local surgeries, or not filling prescriptions in order to have money to pay for other essential services.

I would go further and say that, if the PATS rebates did cover the cost of people having to travel to get medical assistance, more people would do so and health costs would not increase: quite the opposite, in fact. By keeping people healthy and out of hospital, this state government and the new government coming in, whoever it may be, would face far less impost and financial burden.

Again, I welcome the current review, but I call on this government to play fair and make the health system accessible and equitable by giving rural people reasonable rebates through the PAT Scheme. Everyone, regardless of where they choose to live, should be entitled to basic levels of living standards, and this includes the provision of timely and cost-effective health care.

I strongly recommend to this government that the review that is being carried out look at increasing the rebates for fuel and accommodation and deleting the co-payment for treatment, to ensure that this scheme is targeted to rural patients who need it most and that the level of assistance is relevant to today's cost of living.

In closing, I again thank the Minister for Health for arranging the current review. I have had a great response from constituents in my electorate. Dr David Filby, who is undertaking the review, came into my electorate and we held public forums in Clare and Port Pirie with relevant key stakeholders, which gave him a better understanding of the issues. We were able to put facts and figures directly to him.

Those people have put in submissions, and I encourage everybody else to put submissions in, because if you do not put a submission in and do not argue about it then the government of the day will say that there are no issues. I strongly recommend that the review come out positive for constituents.

Mr PEGLER (Mount Gambier) (12:17): I certainly have supported the government in conducting this review that is in the process of being done by Dr Filby. We must bear in mind that, when Dr Filby started this review, he was looking into all the different issues that embrace the Patient Assistance Transport Scheme.

The consultation paper that he put out did not make any recommendations whatsoever. It basically addressed all the different ways that perhaps we could make the scheme work better and sought public comment so that, when he does finalise that review later in the year, there will be recommendations in that review.

On the review itself, I would not support making the distance greater than 100 kilometres. I do not agree with that at all. I also do not support having a means test for PATS, because probably the only way you could do that is by those people who are cardholders and there are a lot of people in rural communities who are not cardholders but are in need when it comes to health issues. They may have to travel and often there will be families who may have to travel, and it can put them in great financial difficulty at a time when they do not need that, so I would not support any means test.

I do support the fact that there has to be a better system of administration in place for the PAT Scheme. I also feel that there should be a more succinct and better system for pre-paying those people who do not have the money to pay for an airfare from Mount Gambier, for example, which will cost anything up to $600 return. They just do not have that money. In talking to the financial counsellors, I am sure that a system could put in place that would work well where those people working in with the PATS administration would basically be able to say yes or no straightaway and make it much easier for them.

I have always felt that when the PAT Scheme originally came in CPI should have been attached to it. I do note that when the electoral funding bill went through this house, where the political parties would stand to gain substantially, they had no problem putting CPI on that, and there were many millions of dollars involved there. PATS costs about $8 million a year out of a $5,000 million health budget and I am sure that just a small increase on that $8 million would make a big difference for a lot of people out in the rural areas.

There are quite a few anomalies with carers. When somebody brings a person up to Adelaide they are reimbursed for their accommodation that night. They go to the doctor the next day and then if he puts that person straight into hospital, that carer cannot necessarily be reimbursed for the accommodation that night. Of course more often than not, people have to come up here the day before and go home perhaps the day after seeing their doctor. That puts greater extra costs on those people because it is impossible to find accommodation for $30 a day.

I think there should be a proper comparison with the schemes in the other states. We also have to be careful in doing that because if you look at Victoria (and a lot of our people go to Victoria for medical procedures) the health services in regional Victoria are a hell of lot better than what we have in regional South Australia. That means that most of those people in regional Victoria do not have to travel anywhere near as much as people in regional South Australia. That does happen a bit because of the density of population but if you look at the services in south-west Victoria compared to the south-east of South Australia, the difference in population is something like 102,000:64,000, yet the health services in Victoria leave us for dead.

To give you an example: south-west Victoria has up to 10 resident psychiatrists and south-east South Australia has none. That is a mere example. They have MRI machines and many other services that we do not have in the South-East, so not only do I want to see the PATS being much fairer on country people, but I also want to see better health services in the country.

One of the other problems they have with the PAT Scheme is the fact that you basically have to fill out three forms whenever you wish to make a claim. Often there are people who have to come up here in the course of treatment over many weeks. They have to put a separate claim in every time they come with those three forms for each claim. That seems ridiculous to me and I am sure that that could be fixed. Of course there is the limitation on the types of claims where no dental services are covered and many other different types of services, so I think we have to look at that.

The PAT Scheme is certainly a good scheme in that it does help country people seek out those services and reimburses them a bit, but I am sure that if the reimbursement was more, many of our country people would have their health issues looked at at an earlier stage and perhaps save the state and those people more money. I welcome this review and I would ask everybody to look at the review in the first stage as opening up all the issues that are covered under PATS.

If there are any other issues, I am sure Dr Filby will look into those, and I look forward to seeing the end result of the review. But I must say that I feel that there is going to have to be more money put into the PAT Scheme, and perhaps if we went back to when the PAT Scheme started and attached CPI to that, it would make it much fairer for everybody.

The Hon. R.B. SUCH (Fisher) (12:25): I would like to move to amend the motion, as follows:

After the words 'to ensure'—Delete the words 'that the budget ensures'.

The motion would thus read:

That this house strongly urges the state government to undertake a complete review of the current Patient Assistance Transport Scheme (PATS) to ensure that the level of reimbursement for rural patients is relevant to today's cost of living and that persons requiring to attend specialist services that are not available within their own location are not disadvantaged, as in the case under the current system.

I commend the member for Frome for putting this forward. People might wonder why, given that I have an urban electorate—or it is mainly urban. I have a beautiful piece of rural South Australia around the Clarendon area but, overwhelmingly my electorate is urban. We represent all regions in this place—we are the Parliament of South Australia, not just the parliament of the city—and I strongly believe that we should have a charter, or something along those lines, to ensure that people, as far as humanly possible and irrespective of where they live in South Australia or what they do, are entitled to good health care and education, and so on.

There is a parallel in Victoria where, with all legislation that is adopted, they ensure it meets what is called a charter of human rights. What I am suggesting is not quite the same but something that would be a benchmark to ensure that people who live outside of Adelaide, for example, are not disadvantaged in respect of health care, education and so on. I have had some direct experience in this issue as an ambassador for men's health, in particular prostate cancer.

I was in the Riverland, in the member for Chaffey's area some time back, and one of the issues that was reported to me was that people who had cancer had to travel to Adelaide for treatment because of some of the specialised technology. That may have been corrected in recent times in terms of new equipment and additional equipment in the Riverland and elsewhere, but I think there are still a lot of country people who have the disadvantage of not having ready access to the most sophisticated technologies in medicine and so on, and I think they should.

I do not think it is asking too much that the community have regard for people who live outside the metropolitan area. If you have something like cancer you do not want to burden the person and their family and carers with added concerns about the cost of travel and having the treatment in a major centre and so on, so that does need to be addressed.

The system needs to be something that is available to everyone. I do not believe you need to means test something like this. I think basic health services are right. We know that people in country areas tend to have poorer health outcomes than people in the city. We know that in respect of a lot of cancers people in country areas do not have as good an outcome as people in the city, so any system than can help people access the most advanced medical treatment or the relevant treatment, then I am all for it.

In relation to the other point made by the member for Mount Gambier, I think a transport scheme is good. The other thing is having the specialist services and latest medical technology available locally as much as possible, certainly in regional centres. I support this motion and, of course, I support my amendment.

Dr McFETRIDGE (Morphett) (12:29): By leave, I move to amend the motion, as follows:

Insert 'more' between 'is' and 'relevant' in line 3 and delete all words after 'are' in line 5 and replace with 'provided with greater levels of assistance.'

The amended motion would read:

That this house strongly urges the state government undertake a complete review of the Patient Assistance Transport Scheme (PATS) to ensure that the low level of current reimbursement for rural patients is more relevant to today's costs of living and that persons requiring to attend specialist services that are not available within their location are provided with greater levels of assistance.

The PATS is a vital scheme for many people in rural South Australia who have to attend specialist medical services right across the state, whether they are coming to Adelaide or going to a major regional centre. For many people, the cost of getting there and the time involved in getting there is a severe impediment to receiving prompt and top-level health care.

The cost of running a car nowadays is something we all need to be aware of. According to the RAA website, the cost of running a Commodore is around 85¢ per kilometre, a Toyota Camry is around 75¢ per kilometre, and a diesel Cruze is around 64¢ per kilometre, so the money that is being paid at the moment is less than the running costs. People are obviously being expected to pay for their own health and welfare. We all have to travel to hospitals and doctors in the metropolitan area, but when you have to travel hundreds of kilometres, sometimes several times a week for many visits, those costs can mount up.

Money that could be spent on primary health care (in other words, better nutrition, paying power bills, having heating and cooling on, looking after yourself and generally staying fit) is sometimes consumed in collateral damage, these collateral costs of getting to see a health practitioner. Of course, when you have to stay in Adelaide or a regional town away from your home overnight, the costs of staying in a hotel or motel are considerable, and the money that is paid under PATS is a fraction of the real cost.

There is a genuine, serious issue here. We do not want anybody in South Australia to be disadvantaged. We have a health system that is offering the very highest level of modern health care in South Australia. The demand is huge, and the way it is being managed by this government certainly leaves a lot to be desired, and the costs are blowing out in many areas. But the costs that should not be blowing out are for people having to access health care for themselves or their families.

This motion is one that we can support in its amended form. The government is undertaking a review; we look forward to the outcome of that review. I hope that the sentiments reflected in the amended motion I have just moved are fulfilled by the government's review. I know my country colleagues will certainly have something to say about their experiences. Their constituents are all involved in accessing regional health care and having to travel, so I look forward to listening to their contributions about this.

In the last state election, the Liberal Party did commit an extra $4 million over four years, as well as promising an immediate review then. I will be interested to see what the state government comes up with; we have had the review, but will they put their money where their mouth is for the sake of South Australians? As we all know, South Australia does not end at the tollgate, Gepps Cross or the top of Tapleys Hill Road; it is a much bigger state than that. It is a wonderful state, and all South Australians should benefit from the opportunities they have to access health care in this state, and not be penalised by the cost of travel or accommodation.

Mr VAN HOLST PELLEKAAN (Stuart) (12:34): I, too, rise to speak on this important motion that the member for Frome has brought forward. I also am pleased to follow the member for Morphett who, leading to the last state election, was the opposition's shadow spokesperson for health and one of the key people involved in our policy that would have put an additional $4 million over this term—$1 million a year extra—into PATS if we had been elected. While I understand exactly why the member for Frome is bringing this forward, it is a bit unfortunate that he even needs to bring it forward because, if we happened to be in government at the moment, it would have already been taken care of. This is a very important issue.

Health issues are indiscriminate in regard to who they affect. It does not matter whether you are male or female, young or old, wealthy or poor, Aboriginal or non-Aboriginal, whatever you like. Unfortunately, you can be faced with very difficult health issues. If you happen to live away from specialist care that is necessary to treat those health issues, then you are disadvantaged, and the heart of the PAT Scheme is to try to contribute to reducing that disadvantage. It is an exceptionally important scheme to people in regional South Australia because there are none of us who have not either been affected with poor health requiring specialist treatment ourselves or who do not have close friends or family members in exactly that situation, and then we are affected indirectly but very meaningfully.

In regard to this motion, as members would know, there is also an inquiry looking into this issue at the moment and I, like some of my colleagues, have already made a submission to that inquiry. I also ask the house to consider a speech that I made here on 22 July 2010 on exactly this matter. This is a very important issue affecting the people of Stuart and other country areas of the state. I will not go over all the things in my submission and all the things that I said back in July 2010 because they are already on the record. Unfortunately, they have not been addressed yet by this government. They have not changed.

One thing that has changed, though, is that the government has directed the officers who oversee the payment of money to patients under the PAT Scheme not to reimburse expenses for accommodation for a carer accompanying a patient to hospital in a situation when the patient is in hospital for a few days, the carer has to come down to look after that person but, of course, the carer needs accommodation outside of hospital. The government has directed the people who oversee the PAT Scheme not to reimburse the carer's accommodation, even when the medical specialist has requested that the carer accompanies the patient.

Even when it is in writing that the medical specialist has said, 'I know you will be in hospital and I know your carer will spend most of his or her time with you in hospital but will have to stay overnight somewhere else, I would still like them to come and accompany you,' the government has said, 'Do not reimburse that carer's accommodation.' That is a change the government has made in the last few years, and that is a very unfortunate change.

Country people appreciate the support they get, but let's be quite clear: $30 does not go very far for a night's accommodation in Adelaide. Even for the cheapest budget accommodation you can find it does not go very far, but country people still appreciate some contribution compared to what may be two or three times that in a really stock standard motel.

Country people really do appreciate the 16¢ they get per kilometre contribution to their travelling cost, even though anybody doing it for business (including any government employees who might happen to use their personal car for work use) will actually be reimbursed by the ATO at 72¢ or 73¢ a kilometre They still appreciate the fact that they are getting a 16¢ contribution. They are glad to get whatever they can get towards the cost that the household is incurring when they have a seriously sick person.

What this is all about at the moment is the fact that it has not increased at all. It is an unacceptably low contribution, as costs have gone up and up, particularly fuel costs for country people. You get an advantage when you drive down to Adelaide in that you can fill up on some cheaper fuel, but you have to fill up at home before you go. The cost of country fuel has gone up enormously in the last few years. The cost of city fuel has gone up as well, but not to the same extent. People really do need this support.

I think it is also very important to consider what other areas of care PATS might be able to cover that it does not cover at the moment. I would suggest that the cost of dental care should be considered, not necessarily specialist, high level care as it applies via specialist treatment to medical care, but I think it would be very worthwhile for the government to consider whether if you live more than 100 kilometres away from a practising dentist that perhaps you could access some PATS support so that you can get to your regular dental check-ups, because we all know that if you do not get to your regular dental check-ups your dental health will deteriorate significantly and that will have a very significant impact on your health more broadly.

We now know that there is a very strong link between dental health and heart disease, and that is a concerning issue—alarming, surprising, I would not have guessed it, but it is true. So, I think that is a very important thing that the government could consider. Unfortunately, there are a lot of people who, if they live more than 100 kilometres away from a dental practice, just will not go. That is particularly concerning when it comes to their kids. If they do not have regular check-ups for their kids' dental health then those kids are quite likely to be set up for poor health in a wide range of ways throughout the rest of their lives. So, I would like the government, as part of this review, to consider that very seriously.

I am also reminded of the fact that two years ago the government guaranteed me and guaranteed this house that it would do a complete review of country health via the Social Development Committee, a standing committee of parliament. It has not honoured that commitment. It is exceptionally disappointing that that has not been honoured because this exact issue could have been dealt with two years ago if it had kept that commitment.

Minister Hill (at the time) said that he was more than happy to do it. In fact, we actually sat down together and developed the terms of reference—I put some draft terms of reference to him, he made some suggested changes, which I agreed to, both our parties agreed to them, we put it forward and he said, 'I have no fear of this country health inquiry,' and yet the government has not honoured that commitment.

So, I guess I am very cautious when I deal with the government on country health issues. I am pleased that the inquiry into PATS has been established. I have put a submission on behalf of the people of Stuart to Dr Filby, who is undertaking the inquiry. I encourage all members of parliament with an interest in country matters and in health in general to put a submission forward to that inquiry, because it is a very important issue.

This is not an issue of choice. This is not about: do you want to come down to Adelaide to see a Crows or Port Adelaide football match? This is not about: is there a test on? Would you like to come down? Can you afford it? Have you got friends to stay with? This is about your health. This is about specialist health. This is about a necessity to see a specialist more than 100 kilometres away from where you live, who typically is in Adelaide.

It is about the fact that you cannot avoid it. It is about the fact that you may be any person from any walk of life in country South Australia and need to do that. It is about people getting a fair contribution from the government towards the costs they incur when they do that. I wholeheartedly support the fact that the upper house has established this committee, and I wholeheartedly urge the government to take this issue very seriously.

Mr PENGILLY (Finniss) (12:45): I would also like to say a few words about this particular motion. The issue of PATS is a critical issue in my electorate, and it extends to both sides of the water. The distance is an important issue for people on the Fleurieu because some of them fall within the boundaries and others are just out of it. The ridiculous part is that if some of them drive on one particular road they qualify, but if they drive on another road they do not. That is how silly it is. However, I am more concerned about the management, or the mechanics, of how this PAT Scheme is put into operation. I say that because if, for example, you live in the electorates of the members for Giles, Stuart, or Flinders, or you are well over 100 kilometres from Adelaide, generally speaking you do not have much choice but to drive unless you are able to fly.

To the best of my knowledge—and I will stand corrected, if necessary—there has been no query of PATS claims on the road for those who choose to drive over and back. Yet, in my electorate, over on Kangaroo Island, the people who need to use the PAT system for transport are regularly getting done over by the bureaucrats in the health system over their period of travel. It is necessary on occasions for them to come up the night before on the boat or the plane—and they only get a limited fee on the plane, and I can understand that—but they are then queried. If they wish to stay longer than the day because they are required to have treatment, they are then taken to task and told, no, they must return that day or whatever. Whereas, if you drive no one really knows when you come over all go back.

I am not suggesting that people would put down the dates on the mileage claim to suit themselves, but I have ample evidence—and this is an issue that regularly comes through my door—that island residents in particular are taken to task if they choose to stay for a day or two, or three, longer than the period, because they only have the ferry to go on, or the plane, and it is an opportunity sometimes just to stay over. It is not used as a reason to go on a month's holiday or anything else. That is an issue about which I have written to Dr Filby—of blessed memory from his former days in the health commission, and from memory he disappeared in late 1993, so it is interesting to see he has been resuscitated by the Labor government to undertake this review at the moment. We will see what comes out of that.

Any attempt, in my view, to extend the distance required over 100 kilometres is blatant discrimination against country people. As the member for Stuart broadly said, you never know who is going to get ill and it does not matter who you are—I'm not feeling too toffee today myself, actually. You do not know who is going to be ill and who is going to have to come to the metropolitan area for specialised treatment. Although in many areas of regional South Australia we are able to undertake a range of medical procedures and investigations, it is quite clear—and it is not only in South Australia—that the metropolitan areas and the capitals are where the vast majority of the medicos are, and that for intensive investigation and treatment you have to go to, in this case, Adelaide. I am hoping that this is investigated fully.

As I said, I get a bit fed up—and I am sure other rural members do as well—with country people being discriminated against by the powers that be in metropolitan areas. I think this is one of the sad reflections on what is becoming a grubbier and grubbier government, after reading the paper today. I think the centralisation, in true Bolshevik fashion, of the education department and health in particular has pushed all these decision-makers into the city and taken everything away from the regions.

I am hoping that, in this particular case, there might be a bit of fairness given to rural people. Rural people do not look for handouts, and governing, at all levels of government, is about what people need rather than what people want. There has to be a balance struck in difficult financial times. I would suggest that, once again, it will be difficult to see what comes out of this particular review, but there has to be some equity and fairness for country people—there just has to be—and I do not think that applies at the moment.

While we can spend hundreds of millions of dollars building football stadiums and $40 million building a bridge and heavens knows what else around the traps, we scrimp and save on assisting everybody in the community of South Australia, and that annoys me intensely. I do not know why this attitude prevails. I guess I do know why: it is purely political. The PATS review that is currently taking place will be an interesting exercise. I have encouraged my constituents to make submissions. I think they closed last Friday.

Mr van Holst Pellekaan: Dr Filby said they could take another two weeks.

Mr PENGILLY: Okay. They have extended it by two weeks, so perhaps I will remind my people again via various means that they should put in a submission. As members representing all electorates, we have the opportunity to speak in this place and put a few things on the table and, as a member representing a rural electorate, I strongly urge the government to take notice of this.

If they can stop fighting amongst themselves for a while and what not, they might be able to sort a few things out. In the best interests of my electorate, I ask that, firstly, it is not extended beyond 100 kilometres and, secondly, that little bureaucrats sitting in Hindmarsh Square do not make decisions that are blatantly discriminatory against people in my electorate.

Mr WHETSTONE (Chaffey) (12:52): I too rise to support the motion and also the amendment put forward by the member for Morphett today. PATS is obviously a very important part of the health system for people who live in the regions and who are seeking medical treatment. It was brought to my attention in my first term as the member representing the people of Chaffey that the reimbursement process has serious flaws.

It has serious shortcomings with the way in which those people are, I guess, put in a position of having to seek medical treatment and the hardship that they go through to undertake that treatment. In many cases, as the member for Stuart has said, we have seen the shortcomings in country health over a number of years. Those shortcomings continue to manifest and cause people some serious angst when seeking medical treatment.

The burden of needing medical treatment and having to travel is one of the issues, but it is what the people from the regions have to go through to get to a place of medical help and undertake that treatment, which primarily means having to travel to Adelaide. I see that the constituents of the member for Mount Gambier have the luxury of deciding whether they travel to Victoria for help or whether they travel to Adelaide.

It all comes at a price, and that price might be, potentially, taking time off work, having to take a carer with you, and the cost of travel. Since the last review in 2001 on the reimbursement, particularly with the fuel reimbursement, looking at 2001, the cost of fuel was about 90¢ a litre. If we look at what the price of fuel is today, it is around $1.55 and we are receiving about a 16¢ rebate. So, I think that that is one of the issues. Obviously, the cost of accommodation—$30 a night is such that hardly anyone is going to profiteer when it comes to reimbursement.

I did hear the member for Morphett talk about primary health care, particularly in the regions. If only the government weighed up more of a long-term strategy rather than trying to appease people for the short-term gain. Why are we not looking at increasing our health care in the regions, rather than trying to centralise a lot of procedures when people do have to travel to Adelaide?

I will use the sad example of cancer treatment, and it is ongoing—whether it is the diagnosis, having to visit doctors to set up that medical procedure, and particularly having to make multiple trips down to Adelaide for treatment, whether it be chemotherapy, radiation treatment or ongoing treatment for people.

When they are travelling and having to take time off work, they are going through a very emotional time, particularly with cancer treatment, and that is an extremely challenging time, not just for the patient but for the family, and usually that carer that travels with the patient is a family member. So, again, it is the hardship that they are going through but it is also the emotional strain that they are encountering over that time.

Looking at the upgrade of regional hospitals is something I will also touch on, because we are lucky enough that the regional hospital in the Riverland is undergoing a facelift at the moment, increasing the amount of facilities in that hospital. But, sadly, we had a $41 million upgrade which was then reviewed down to a $36 million upgrade with, potentially, no less facilities with that reannouncement. The chemotherapy unit, for instance, has been put in place, but it does not have any furniture. We have a chemotherapy unit without the ingredients for people to sit down and be treated.

Mr Pengilly: No chairs.

Mr WHETSTONE: No chairs. I think I spoke in this place a short time ago about when I went out on a fundraising exercise to raise money for a chemotherapy chair. We have seen people, out of the goodness of their hearts, bequeath money to the hospital to put in chairs. We have seen the Lions Club in the Riverland up in Berri raising money through a calendar program for another chair.

Where are this government's priorities? They need to be looking at the primary health care within the regions so that people do not have to travel to help with their health procedures and it is not going to cost the government. They really need to look at the cost benefit of putting the chairs, for example, in that chemotherapy unit without having to have people travel to Adelaide and then claim back on PATS. That is another way that people will be able to utilise the PATS facility without increasing the budget particularly with PATS.

Again, I revert back to the cost of living and just exactly what people are having to go through to travel from the regions down to the city and go through that very hard time. I have a number friends at the moment who are travelling from Chaffey or the Riverland down to Adelaide to undergo cancer treatment, and I am seeing what they are going through. It really does pull at the heartstrings, just looking from the outside in at what those families are going through: the hardship, the time that they are taking off work, the time that their carers are taking off work to go with them, and the cost. But, it is also to the detriment of their business, so it is having a flow-on effect.

The member for Stuart has said that he approached the previous health minister with a review of Country Health. That was actually going to happen, but it never did, so that is a very sad indictment on the current state government that does have 26 seats, 25 in metropolitan or almost metropolitan Adelaide. One seat, in Giles—

The Hon. L.R. Breuer: I can carry the load, as can my colleagues from the country!

Mr WHETSTONE: You can carry the load, member for Giles, so stand strong on the review and stand strong on lobbying for more money to be put back into PATS. I seek leave to continue my remarks.

Leave granted; debate adjourned.


[Sitting suspended from 13:00 to 14:00]


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