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House of Assembly - Fifty-Third Parliament, First Session (53-1)
2014-10-16 Daily Xml
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Motions

Regional Health Services

Adjourned debate on motion of Mr van Holst Pellekaan:

That this house establish a select committee to inquire into and report on—

1. The review by the Health Performance Council on the operations of the health advisory councils in accordance with the Health Care Act 2008.

2. The current provision and plans for future delivery of health services in regional South Australia, with particular reference to—

(a) the role and responsibilities of health advisory councils and the benefits, or otherwise, of the removal of local hospital boards;

(b) amalgamations of health advisory councils in regional South Australia;

(c) trends in local community fundraising for medical equipment and services;

(d) how funds currently and previously raised by local communities are held and spent, with particular regard to authorisation and decision-making;

(e) timing of provision of finalised operation budgets in country hospitals;

(f) ownership and transfer of property titles of country hospitals;

(g) the process and timing of the hiring of staff for new and existing positions;

(h) South Australian Ambulance Service arrangements, including the role of volunteers, fees and fundraising and the benefits, or otherwise, to local community events;

(i) scope of practice of general practitioners to country hospitals and the provision of accident and emergency care;

(j) procurement by Country Health SA and the benefits, or otherwise, to country communities;

(k) mandated fees to DPTI for management of maintenance and minor works;

(l) the benefits, or otherwise, of all rural and remote South Australia being classified as one primary health network within the federal health system;

(m) the implementation of EPAS in country hospitals;

(n) integrated mental health inpatient centres for regional South Australia; and

(o) any other relevant matters.

which Mrs Vlahos has moved to amend by deleting the words 'this house establish a select committee to' and replace with 'the Social Development Committee'.

(Continued from 24 September 2014.)

The DEPUTY SPEAKER: I am calling the member for Schubert and I am going to protect him so that no-one speaks over the top of him because I know that is the sort of behaviour he endorses.

Mr KNOLL (Schubert) (15:42): Thank you, Deputy Speaker. I am certainly at your feet and in need of constant protection. I commend the member for Stuart for bringing this motion to the house. It is extremely important when it comes to the viability of our regional communities. I can think of nothing better than for there to be a select committee into the provision and plans for future delivery of health services in regional South Australia. There is obviously particular reference to quite a number of items.

First off, I will give a rundown of the hospitals in my electorate because it paints quite a good picture of the state of regional health services in my electorate. If we go to the furthest point, across at Mannum, and come back towards Mount Pleasant, those two hospitals are a great example of how co-located facilities in our regions help to bring critical mass so that we can actually keep a level of health services in our regional areas. In both those instances, the hospitals not only provide small amounts of accident and emergency beds but they also provide general practice services as part of it. They also provide quite significant acute aged-care facilities as part of those hospitals and various other services.

In the case of Mount Pleasant, it is a good facility because they were lucky enough to have invested and spent money before the decision to change from hospital boards to health advisory councils, and as such the facility is in pretty good repair. They may or may not have been worried about impending changes to the hospital board arrangements.

In Mannum, the facility is not as good. In Mannum, unfortunately, those high-care beds are not single rooms: they are double rooms. In fact, I happened to see a couple of the rooms when calling on a good friend and patient who lives there. One of the double rooms is actually a thoroughfare out to a sunroom, so these two people's only private space that they have in the world is used as a thoroughfare for other people. There was a plea when I went to visit my friend, from her and others, to upgrade the facility because that would be very high on their agenda. That said, the staff and people there were fantastic and I had only good reports, especially from those two facilities, during the times I was able to visit them.

We move a little bit closer to the heart of the Barossa and there is the Tanunda Hospital. The Tanunda Hospital was built in 1955, and I took my two-year-old daughter there when she slipped over on tiles and was unconscious for a good 20 seconds—the longest 20 seconds of my life. We were lucky that the journey took about 30 to 35 seconds from our home to the Tanunda Hospital. We are lucky that we live so close.

The service we got at the hospital from Dr Jack Irwin was fantastic. He was reassuring and calming and very quickly assessed that Ruby was nothing other than fine and that we as worried parents had done the right thing and there was certainly no need to worry. He did suggest that there was no worry in letting her go back to sleep, but that did not stop Amy and me sitting there and watching her quietly sleep for the first hour to make sure that she was still breathing and everything was okay.

The other facility in my electorate is the Angaston Hospital. The Angaston Hospital, believe it or not, was built in 1910, when the population of the Barossa would have been maybe a tenth of what it is now. Can I say that those two hospital facilities, with fantastic and good-hearted people in those two facilities, are not good enough. Since 1993, the member for Schubert—the member for Custance, or whatever seat it has been over the various times, Kavel or Rocky River, I am a little bit lost in history—has been calling for the merger of those two hospitals and the creation of a new health facility.

This is a 20-year campaign by this community to get the facility that it so dearly needs and dearly deserves. Every single report that I have read, from the 2006 business case to the 2010 business case, has said that this facility is no longer up to scratch and that any money spent on this facility will be wasted because they are only able to keep it at a poor level of maintenance and that a new facility is the best and, indeed, in my view, the only option.

This motion brought forward by the member for Stuart also goes on to talk about health advisory councils, and I will make a number of comments about my interactions with those in a minute.

I would also like to point to a comment the Minister for Health has made, especially during the estimates process. He refused to rule out hospital closures. He also refused to rule out regional hospital closures, which is a guarantee that we had understood was in place prior. That change from saying, 'Nothing is going to change with regional hospitals,' to saying, 'We are no longer going to rule anything in or out,' is a change that makes us in regional areas feel very uncomfortable.

If there are any attempts to close the Tanunda Hospital in my electorate, there will be a veritable army of people ready to mobilise and make sure that the Minister for Health understands that the people of the Barossa are not going to put up with not only not getting the facility they deserved 20 years ago but also having one of their hospitals closed. Just today, the minister said on radio, 'We've been rebuilding our health system over the past 12 years.' How long it takes, I am not sure, but 12 years seems like a long time. He said:

At the moment, we're looking at ways. We've got three clinical groups established who are going to be advising me on ways we can reconfigure our health system to make it work even better and to make it one of the best health systems in the world.

I would say that that is a fairly genuine comment and I would say that that is a fairly valid comment. What I would also say in furtherance to that is a select committee, such as the type that the member for Stuart is advocating, would fit into this review exactly. In fact, it would be a fantastic next step to go along with the other steps that have been taken to make sure that the health minister has all the information he needs in order to make the best decisions.

The motion goes on to talk about the roles of health advisory councils. I am lucky enough to sit on a health advisory council, the Barossa and Districts Health Advisory Council. The role of this council probably needs to be better defined. The health advisory councils are:

…consultative bodies that advise the Minister for Health on issues relating to specific groups or regions.

They are supposed to:

…facilitate discussions, advise and advocate on behalf of their communities, communicate and consult and engage with their communities.

They are great words. When I have sat around the table at my health advisory council meetings, I see genuine people with a genuine interest and understanding of the local health system wanting to help make a difference. These are people with varying degrees of clinical experience, varying from none, such as me, through to people with decades worth of experience. They are people who are earnestly there to do a good job, but they are severely hamstrung by not being able to have true call over the money that they are supposed to be administering. People who want to be able to reach out and broaden their scope and actually deliver for their communities are being stuck in these quite motherhood words of 'facilitate, advise, advocate, communicate and engage'. To me, none of those words mean really too much about doing something, and can I say that the people of the Barossa love nothing more than actually getting on and doing something.

Amalgamations of health advisory councils, which is something that the Premier has put on the table with his review of government boards and committees, is an area that this select committee could look at, because at the moment my HAC is, as they all are, listed under further reform and consideration of further reform, but nobody understands what that means. In fact, I have had a number of people call me asking, 'Stephan, what does this mean?' and I cannot give them a straight answer.

The member for Morphett has said in this house that the biggest country hospital in South Australia is the Royal Adelaide Hospital. As I said earlier today, in reference to another debate on a similar topic, the poor health services in the regions put pressure on nearby hospitals. In our case nearby hospitals are located in metro Adelaide, whether that be the Gawler Health Service or whether that be the Lyell McEwin, and adding pressure to those hospitals by not having a good enough service in my electorate will exacerbate that problem.

With the 30 seconds I have left I would like to give you one statistic. Today is an unremarkable Thursday afternoon. I think the flu epidemic is waning and we are lucky enough not to have Ebola rearing its head in South Australia, but at 2pm today the Lyell McEwin Hospital had an average waiting time of 53 minutes. If we were to invest in our regional hospitals by looking at them through a select committee, I believe that we could get to some better outcomes.

Mr WHETSTONE (Chaffey) (15:53): I too rise to support the motion put forward by the member for Stuart and commend him for another outstanding motion. I think he is doing a great job in keeping the debate going, and on both sides of the house, too. This is a critical proposal put forward to establish a select committee in the House of Assembly to inquire into the current and future delivery of health services in regional South Australia with a revised draft terms of reference. I have gone past the exact terms of reference because there are many.

There are a couple of issues that I would like to touch on. I have five hospitals in the electorate of Chaffey and every one of those hospitals is critically important to the fabric of the towns they support, and surrounding towns. With my reasonably short time in this place, I have become much more aware of just how important these hospitals are. It is as though both my son and I have almost had permanent residency in either the Renmark or Berri regional hospitals over a number of years with sporting injuries and trying to live a bit of a daredevil life. However, I must say that the hospital is a fabric of a community. It is critical that those hospitals are provided with the necessary resources and that those hospitals are able to provide a service to their community and support base and, just as importantly, it is critical that those hospitals provide a service with a financial package behind it.

There is nothing worse than looking at a hospital that has been defunded, destaffed or almost had one leg pulled out from under it because the government has an agenda, that is, they are looking further afield at centralisation. This current Labor government is very focused on centralised services. I think this Premier considers it a badge of honour because his firm belief is that most of the services will be centralised here in South Australia. I think when he looks back in history, he will ponder his belief and see that centralising services has been a mistake.

The future delivery of health services in regional South Australia is critical. As I have said, in my communities in the Riverland and Mallee, the five hospitals I have are supported by health advisory councils. The benefits or otherwise of the removal of the local hospital boards was a very topical discussion and debate over a number of years. The hospitals have moved on and they have recognised that we cannot dwell on the past and we have to live within our means, and I think they have done a remarkable job.

The current HACs which are the eyes and ears of the hospital and the community's needs, I think, give good feedback. There was some talk of my five HACs being amalgamated into one and potentially more than the five into one in a larger region, and the Lower Murray would have come into the fray as well. I pay tribute to the five hospitals and their HAC presiding members and boards because I think they are doing an outstanding job.

Over time it has been realised just how important they are—as I said, the eyes and ears. However, it is as important to know that those HACs also generate interest within the community which leads to fundraising. They also keep people aware, they listen to concerns and, just as importantly, they feed back to government their needs and wants, as well as the issues in their hospital or health services within the region.

Before I go on I would like to acknowledge the presiding members and their hardworking committees: at Waikerie, Justin Loffler and his committee; Berri/Barmera, Josie Nelsson; Renmark/Paringa, Heather Burton; Loxton, Sally Goode; and in the Mallee, Kathleen Gregurke. I think they all do an outstanding job and they are supported by dedicated volunteers on their councils. I think they do a great job and I really do feel that in some way, shape or form sometimes the government overlooks the importance or the contribution that they put in.

I think that the HACs, the administration that they look after, the volunteer hours that they put in and, importantly, the interest that they generate around the auxiliary funds and fundraising to bring that extra budget into the hospital's bottom line is critically important to personalising the hospital and making it more strongly woven into the fabric of their community. I will go on. The primary functions of the health advisory councils are to:

act as an advocate and promote the health interests of the community;

provide advice to the Minister and Chief Executive about any aspect of the provision of health services in the Local Area by Country Health SA Hospital Inc. from the perspective of consumers of those services and in addition, carers and volunteers who interface with the services;

The HACs are volunteer based, and members contribute their time to benefit the community. As I said, those five hospitals manned by their HACs do an outstanding job. They constantly feel as though there is an agenda, and centralising seems to be a badge of honour for this Premier and his government and it has everyone on edge. It has the HACs on edge and it also has the confidence of the community doubting where the government is going. If we look at some of these hospitals that have a certain future, they have fundraising auxiliary money coming in. Hospitals that are controlled by the government have little faith, have little coming in, and I think that has been evident over a number of years, particularly in the electorate of Chaffey.

The HACs encourage volunteers to be involved with hospital work, local councils and with the media to spread the good stories and provide financial support for hospitals through fundraisers. There are donations and bequests, and they engage in training opportunities and carry out community surveys. I think that is quite critical for the running of a hospital and its continuation, and I know that with some of the hospitals in the electorate the accident and emergency sections have been wound back or had their doors closed. Operating theatres have been closed, services have been wound back, funding has been taken away, staff have been taken away, and nurses and specialised areas have been taken away from those hospitals. It makes you wonder just exactly what the future is. But the HACs, the community, will push forward and make sure those hospitals are relevant for many years to come.

The amalgamation of the advisory councils, as I said, was a contentious issue. One thing I pointed out to our regional country health manager was that, rather than attending every HAC meeting perhaps he could attend these meetings quarterly. He stated that attending every one of these HAC meetings within his area—all 10 of them—was taking up his free time. I said, 'Well, welcome to my world. That's what it's all about—it's about doing the job, making sure that you are running a nice, steady ship.' I hope that he takes on board my suggestion that he needs to look at meeting quarterly rather than monthly and keep the interest on those HAC boards. We need to continue the auxiliary money coming into country hospitals. It is critical that auxiliary money is put on the table and spent and not held back by the government to prop up the budget bottom line.

I thank the hospitals, the HACs, the staff, the doctors, all the medical people around the country in regional hospitals, and I look forward to the government supporting the establishment of a select committee in this House of Assembly to inquire into the current and future delivery of health services.

The Hon. G.G. BROCK (Frome—Minister for Regional Development, Minister for Local Government) (16:03): I thank the member for Stuart for bringing this motion before the house. Health services across all of regional South Australia are very, very important, not only to the region but also to people from the metropolitan area who go out into the country visiting their relatives and so forth. They are also a very integral part of the future growth that I see in the regions as the Minister for Regional Development and my travels across all the regions.

There will be a massive increase in employment and opportunities in the regions within the next two years. We need to make certain our regional health services are the utmost and working correctly. To have a review, as the member for Stuart has indicated, is a great idea. I have looked at the Hansard of other speakers in here, and what the member for Stuart is looking for is a select committee to look into the various opportunities that he has listed here on the Notice Paper. However, I also noticed the amendment coming through to allow a select committee to be formed but under the Social Development Committee.

The member for Stuart and others have been trying to get some investigation into this for some time. There is no time frame in the amendment to the motion that the government has put up, and therefore I cannot accept that amendment. I will be supporting the member for Stuart's motion as it appears on the Notice Paper.

Mr VAN HOLST PELLEKAAN (Stuart) (16:05): Thank you to all those who have contributed to this debate. I value and appreciate those contributions, including those of the member for Taylor. I disagree with some of the things the member said on behalf of the government, but I value the fact that she did participate and had the courage to put those things on the record, things which, I suspect, in their hearts most members would not have actually wanted to say.

Country hospitals belong to their country communities. Sure, they are administered by the health department and by Country Health SA but, essentially, they are institutions that are the core fabric, just like schools and sporting clubs. They provide an incredibly important professional service, but at their heart they really belong to country communities. In general, centralisation across the state over the past 12 years is not improving the level of service that country people are getting, and health professionals working in country communities are telling me this themselves. This is not about trying to give doctors and nurses and all the other people who work in health in country areas a hard time; very often they are the ones coming to me and to other country members saying, 'Can you help us with this? Can you support us? We need your support so that we can do better work. We do not want the work we do to keep getting pared down.'

Contrary to what the member for Taylor said on behalf of the government, this would not be a witch hunt and, contrary to what the member for Taylor said about my comments on the Booleroo ambulance just being a bit cute and nobody knowing what was really going on, the reality is that since then, on that particular issue, the Minister for Health has decided not to sell that ambulance. Of course, I thank him for that enormously. There was nothing cute about it; it was a terribly important issue.

There are nine hospitals in my electorate of Stuart and dozens throughout country South Australia: Port Augusta, Kapunda, Eudunda, Burra, Booleroo, Jamestown, Orroroo, Peterborough and Leigh Creek in my electorate. Then of course my constituents also access hospitals at Walker, Quorn and Waikerie very regularly. So this is a very important issue. All these hospitals provide a vital service to constituents and locals as well as people from other parts of the state, including Adelaide, who travel to that area quite regularly. They provide a very good service, but we have to fight to keep that service as good as it can possibly be. We have to fight against a centralisation agenda that would shift resources from the country to the city. We have to work to keep it as excellent as it can possibly be, and even people working in health in the regions want us to do that.

We do value the recent investment in four significant regional hospitals in regional centres, but that cannot be at the expense of the far smaller hospitals, which also play an absolutely vital role. Without continuously improving health services in country areas we will not have significant valuable regional development. It just will not happen.

I appreciate enormously the comments from the member for Frome, the Minister for Regional Development, saying that he would not support the amendment. I think it is completely inappropriate for the government to say, back in 2011, that it would agree to have a motion just like this, an inquiry just like this, taken up by the Social Development Committee, but then refuse to allow it to go ahead—not by omission, but by deliberately thwarting it from going ahead—and then, when I ask for a select committee to look into it (because clearly that committee is having difficulty getting it onto its agenda), to be told again, 'No, look; just trust us. We'll send it off to the Social Development Committee and we'll get them to do it.' Well, Deputy Speaker, history tells me that unfortunately I cannot trust that commitment. The commitment was given before and it was not fulfilled. That is my only experience with regard to exactly this issue back in 2011 and that is why, unfortunately, I cannot and my colleagues cannot accept the amendment of the government. We want to hold to the initial motion and ask that this house establishes a select committee to look into these very important issues.

Amendment carried; motion as amended passed.

The DEPUTY SPEAKER: Member for Morphett, are you standing and wishing to speak?

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