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House of Assembly - Fifty-Second Parliament, Second Session (52-2)
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HEALTH CARE (ADMINISTRATION) AMENDMENT BILL

Second Reading

Adjourned debate on second reading (resumed on motion).

Mr VAN HOLST PELLEKAAN (Stuart) (15:32): I resume where I left off just before the lunch break, and I was talking about the community's concern about their reduced access and reduced control over their community assets. Let me be really clear, the community—and in my mind, quite fairly—considers almost everything to do with their country hospitals and country health services to be community assets.

By that I do not say that they think they own them individually, but the community does feel that is has ownership and responsibility for land and buildings, for equipment, for the services even, and for the people who work in these hospitals—the whole range of people who provide services from the cleaner all the way through to the surgeon. They are typically local people, often there are visiting surgeons, and often there are GPs based in the area who do surgery, but they really feel that the whole service there is theirs.

The other very important community asset that they feel belongs to them is money that has been saved, and money that they are going to save, and they really have every right to believe that because, typically, the community has raised that money itself, and even in cases where government money—state and federal money—has come into that area to provide medical support, it was all taxpayers' money to begin with, anyway, so they really have every right to feel that they should have some say over this.

Over the last few years, an enormous amount of that say and that control has been taken away. They do not want to make every single decision. They certainly do not want to interfere with medical decisions, but they do want to participate and they do want to feel that their involvement means something.

With regard to fundraising, there is no denying that an enormous amount of the ability for people to control the way that money is spent—money which they actually raised themselves—has been taken away. I remind members here of the member for Morphett's speech, in which he talked about that in detail. Numerous people have come to me with this concern. I really do think that the Minister for Health does understand this. Having participated in a radio interview with him many, many months ago, I really think he does get this situation, but I believe he is being forced into this by the financial state in which we find South Australia at the moment.

Mr Deputy Speaker, I give you a really cutting example: volunteer ambulance officers. Certainly, with the support of the state government for their station, their ambulance itself or their equipment, but volunteers—people who give of their own free time, ability and skill to support their communities—have actually had taken away from them the ability for a community, in return for the delivery of a free service at a community event, to offer a donation or contribution for that service, and for them to control where the money goes.

SA Ambulance Service is now saying to the community, 'If you want our volunteers to turn up at your community event, whether it be a rodeo or a show, or some community event like that, we will need a $500 payment from you, thank you very much, event organising committee.' What used to happen in the past was the ambulance officers would effectively turn up for free, and they would get that same $500 donation from the community from the events—exactly the same amount of money—but it would go into the local kitty so that the local ambulance volunteers could decide what piece of equipment they thought they needed, or how best to spend that money.

Now what is happening is they are actually being told, 'No, there is a fee for service for your local volunteers to turn up to your local community event; the government is going to charge you for those volunteers to turn up, and they are going to take the money away and spend it where they want.' It may well be that occasionally the money gets spent on exactly the same thing, but what is really important is that the community wants to know 100 per cent for sure that the money is going to stay in their area. They want to know that their donation, in return for their volunteers, is going to stay in their community, and that is exactly the sort of thing that is being taken away at the moment.

There has been a two-year delay on communities being able to even access, let alone decide how to spend, a lot of community money that has been raised. There has been a downturn in people's desire to contribute donations. It might be very, very small in terms of the amount of money—significant with regard to community involvement and desire, but small with regard to amounts of money. It might be bake sales, as the Port Augusta Auxiliary was doing this morning on the front steps of the Port Augusta Hospital. They do that very, very regularly out of the goodness of their hearts, and they raise amounts of money that make a difference.

It might be very significant bequests. It might be something in somebody's will. It might be potentially hundreds of thousands of dollars, or even, in rare situations, more than that. The community is really baulking at this sort of thing, and they are setting up safety nets for themselves, such as trusts and other organisations. So, instead of donating the money to exactly where they want the money to go and for the community to have a say in how that is spent in that area, they are setting up legal protections so that they can do that.

You can imagine, Mr Deputy Speaker, that if you have got to do that, it just blunts the desire of a community, or perhaps an individual who may be well off, to make a really significant contribution. It just takes the good taste out of their mouth if they think that they have to go to that much effort to really, really protect it.

There is also another very concerning financial situation which has been sneaking into the system in the last little while; that is that DPTI (Department of Planning, Transport and Infrastructure) is now the only organisation through which HACs, and hospitals as well, can actually ask for work to be done, and it is charging a 12 per cent service fee on the work that gets done. So, if some money that has been released from the government to the HAC to spend on a piece of equipment is going to be spent, the director of nursing, for example, must go through DPTI to actually procure whatever it is that they want to procure, and DPTI are now going to charge them a 12 per cent service fee for the privilege.

It is just not right. If DPTI could show, in the way that would be required in the real world in a commercial environment, that if you give us all your business, we will derive such significant savings for you through our efficient operations that when we put our service fee on top you will still be better off than if you did it yourself, well sure, that would be fair enough, but that is not the case. There is no opportunity to even test the market. There is no opportunity to even find out whether that 12 per cent service fee is money well spent or not.

It is just a charge. It is a tax, it is a levy, it is a government charge right on top. So, all of a sudden, either the piece of equipment has just gone up by 12 per cent—if you want to look at it that way—or perhaps the value of the money and the outcome of the funds that are available have just decreased by 12 per cent, whichever way you choose to look at it.

It is, of course, particularly alarming, given the complete failure over the last few years of the Shared Services organisation, which has really hit the health sector in our state particularly hard. It certainly has not done anyone any favours in really any part of the state, as far as I can tell—in fact, not even Treasury.

I apologise for forgetting the numbers from a few years ago, but there was going to be a necessary investment to set Shared Services up but, once that was done, savings were going to accrue over the next three or four years that would more than offset that up-front payment. Well, that has not happened, so not even Treasury is benefiting out of this.

It has cut a lot of jobs out of community regional centres where, typically, government agencies had employees doing this sort of work. It has created havoc all the way through from procurement to even just bill paying. It has hurt the business community because they are not getting bills paid on time and, in some cases, service providers in communities have actually stopped serving the organisations because they were not getting their bills paid. It just has not helped anybody, and it has hit the health sector hardest.

I will leave it there. I have spoken on this issue before. Communities deserve to have full recognition for the contribution that they make to their community medical services. They really do value what the government contributes. We all understand it is taxpayer money, whether it is a state or federally provided service. They are very glad when a government decides to put a service into their community, but they have been terribly hurt by the fact that they cannot access money they have already raised, or that they are going to have reduced access to money that they will raise in the future.

The Hon. J.J. SNELLING (Playford—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for Defence Industries, Minister for Veterans' Affairs) (15:43): I thank members for their support of the legislation. The legislation before the house remedies a number of issues and will assist in ensuring the effective delivery of health care in the state. These changes are administrative in nature and ensure the effective operation of health services and remedy some outstanding issues that have arisen due to administrative oversights and past and proposed changes in legislation.

The legislation will enable the transfer of the whole or part of an undertaking from a specified person or body to an incorporated hospital through proclamation by the Governor. The current wording in the act—that is, 'transfer the whole or a part of the undertaking of a body providing services or facilities to an incorporated hospital under this Act'—implied that the body must be providing services or facilities to an incorporated hospital for this to occur. It has not been sufficiently clear that the body does not need to be providing services or facilities to an incorporated hospital for the undertaking to be transferred, although this was the original intent of the provision at the time of drafting the act.

The legislation will now also permit, through proclamation by the Governor, the transfer of all or some of the functions, assets, rights and liabilities from one incorporated hospital to another without the incorporated hospital to which these first related being dissolved. At present, the act only allows for such transfers in the event that an incorporated hospital is dissolved. This new provision will provide greater flexibility for the transfer of functions, assets, rights and liabilities from one incorporated hospital to another.

The current requirement in the Health Care Act 2008 for the South Australian Ambulance Service to have a constitution determined by me as the minister is no longer considered necessary since its functions and powers are already set out in the act. To date, the legislation has not been used to determine a constitution and a constitution is not required for the effective functioning of the South Australian Ambulance Service.

The legislation will give greater flexibility to set fees for the provision of incidental services provided by the SA Ambulance Service and other matters as prescribed by regulation by notice in the Government Gazette. Fees for these services are currently set in the Fees Regulation (Incidental SAAS Services) Regulations 2009 under the Fees Regulation Act 1927. This is an anomaly, as all other fees for health services are provided for under the Health Care Act 2008. This legislation will now align the arrangements for setting fees for all health services.

These incidental fees are defined and are for health services provided by the SA Ambulance Service that do not involve transportation in an ambulance. These types of services are provided when a member of the SA Ambulance Service responds to a request for emergency medical assistance and attends a person's home or some other place to provide any emergency assistance that might be required and the person is then assessed and/or treated at that place and is not transported by ambulance.

The legislation will allow the employing authority to appoint medical officers, nurses or midwives who have skills or experience in connection with the provision of health services, to assist in the performance of the health chief executive's or the department's functions under their professional awards while they are working in the Department for Health and Ageing central office. Persons employed under this provision will be taken to be employed by or on behalf of the crown but will not be taken to be employed in the Public Service. These provisions are consistent with those contained in the Education Act 1972 that allow teachers to be employed to work in the Department for Education and Child Development pursuant to their professional award.

The employing authority will be subject to direction of the minister. However, the minister may not give a direction relating to the appointment, transfer, remuneration, discipline or termination of employment of a particular person. The South Australian Salaried Medical Officers Association and the Australian Nursing and Midwifery Federation (SA Branch) were consulted about these changes and were reassured that the employment, conditions of employment and all entitlements would be continuing for these employees. The legislation assures this continuity through the transitional provisions under schedule 1.

Because of the separate employment arrangements for medical practitioners, nurses and midwives under their awards, the legislation also needs to recognise these employees so that they are covered by the conflict of interest provisions, and they are required to comply with this provision. The legislation will ensure alignment with the confidentiality provisions of the draft information privacy bill by using the same wording used within that bill.

I note that intent is to permit disclosures of personal information 'as required by law or authorised by or under law', thereby providing indication on the scope of the law. I have sought through an amendment the reinsertion of the words 'or as required for the administration of this Act or a law of another State or a Territory of the Commonwealth', since the exclusion of these words would have caused difficulties in enabling appropriate releases of information to be made.

The legislation also adds the term 'substitute decision maker' to the list of persons who may request or provide consent for information about a person to be released, so that it aligns with the provisions of the Advance Care Directives Act 2013 once that act comes into operation.

Lastly, the legislation will correct an anomaly under a previous act in which functions of three incorporated associations were taken over but the incorporation of their association was not cancelled at the time. The functions of three incorporated associations—namely, Lumeah Homes Incorporated, Miroma Place Hostel Incorporated and Peterborough Aged and Disabled Accommodation Incorporated—were taken over under the South Australian Health Commission Act 1976.

At the time of the transfer, the incorporation of these associations was not cancelled and certain assets were not transferred. This provision will enable the Governor, by proclamation, to cancel the incorporation of these associations, transfer their assets to a health advisory council established under the Health Care Act, and make other provisions as seen fit.

I would like to thank all the officers who assisted in the development of the legislation: parliamentary counsel, Mark Herbst and Richard Dennis, and from the department, Kay Anastassiadis, who is in the chamber today to assist me. I commend the bill to the house.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 to 9 passed.

Clause 10.

The Hon. J.J. SNELLING: I move:

Amendment No 1 [HealthAge–1]—

Page 4, lines 35 and 36 [clause 10(1)]—Delete 'or as required for the administration of this Act or a law of another State or a Territory of the Commonwealth'

The intent of this clause is to ensure the words 'or as required for the administration of this act or a law of another state or a territory of the commonwealth' remain in clause 93. The second reading speech may have been misleading, since it indicates the first amendment to section 93(3) of the act would 'limit the disclosures of information required to those that are "required to authorise under law" '. The statement arose from a misinterpretation. The original amendment was simply to ensure alignment with the draft Information Privacy Bill and to continue to provide for disclosure of personal information required by law as reflected in the wording of this amendment. The reinsertion of these words will ensure that this section of the act remains robust and practical.

Amendment carried; clause as amended passed;

Schedule and title passed.

Bill reported with amendment.

Third Reading

The Hon. J.J. SNELLING (Playford—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for Defence Industries, Minister for Veterans' Affairs) (15:52): I move:

That this bill be now read a third time.

Bill read a third time and passed.

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