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House of Assembly - Fifty-Third Parliament, First Session (53-1)
2014-10-29 Daily Xml
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Health Care (Administration) Amendment Bill

Introduction and First Reading

The Hon. J.J. SNELLING (Playford—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Arts, Minister for Health Industries) (12:04): Obtained leave and introduced a bill for an act to amend the Health Care Act 2008. Read a first time.

Members interjecting:

The DEPUTY SPEAKER: Yes, but he is not alone, member for Heysen. No-one knows all the standing orders.

Members interjecting:

The DEPUTY SPEAKER: You had to look up arrest.

Second Reading

The Hon. J.J. SNELLING (Playford—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Arts, Minister for Health Industries) (12:05): I move:

That this bill be now read a second time.

The Health Care Act 2008 came into effect on 1 July 2008. The act changed the way hospitals and health services were administered in this state to ensure that the health care system is responsive to health care demands both now and into the future. The act has brought together hospitals and health services to deliver services that meet the needs of their local communities, while at the same time providing for greater coordination and accountability of services, with the minister and chief executive ultimately responsible for the delivery of services in South Australia. The act has provided, and continues to provide, a solid governance basis for the system as it strives to reform health services and provide effective and efficient modern health services that meet the changing health service needs of the community.

The Health Care Act (Administration) Amendment Bill 2014 before the house seeks to make a number of amendments to the act, aimed at ensuring the act continues to function effectively and meets the administration and governance needs of the South Australian public health system, and to clarify the intent of some of the act's provisions.

The bill is the same as that which was passed in the House of Assembly of the Parliament of South Australia on 30 October last year and read a second time in the Legislative Council on 31 October 2013. The bill was not progressed at that time due to the subsequent prorogation of the parliament. The bill will therefore be familiar to those members who were sitting members of the previous parliament. I seek leave to have the remainder of my second reading explanation inserted in Hansard without my reading it.

Leave granted.

The Bill covers seven areas of amendment, which I will now outline in detail for the benefit of members.

Fees for services provided by the SA Ambulance Service that do not involve ambulance transport

Section 59 of the Act allows the minister to set fees, by notice in the Gazette, to be charged for ambulance services. An ambulance service is defined in the Act as 'the service of transporting by the use of an ambulance a person to a hospital or other place to receive medical treatment, or from a hospital or other place at which the person has received medical treatment.'

The Act, however, does not currently provide a basis for the minister to set fees for services provided by South Australian Ambulance Service paramedics that do not involve transportation in an ambulance. These type of services are those where a member of the South Australian Ambulance Service responds to a request for emergency medical assistance and attends a person's home or some other place to provide emergency assistance, and the person is then assessed and/or treated at that place but then does not require transportation by an ambulance. These services are commonly referred to as 'treat no transport' services.

Fees are currently set and charged for these services, under the Fees Regulation (Incidental SAAS Services) Regulations 2009 under the Fees Regulations Act 1927. This situation is an anomaly for fees charged by SA Health for the provision of health services, as all other fees for services are provided for under the Health Care Act 2008. The Bill therefore makes provisions to allow fees to be set for incidental services such as 'treat no transport' services and to be set in the same way as all other fees for health services under the Health Care Act 2008.

Employment of clinicians in the Department for Health and Ageing (central office)

This amendment is technical in nature and seeks to provide an appropriate mechanism for the employment of doctors, nurses and midwives to work in the central office of the Department for Health and Ageing. There are a number of positions within central office that require the professional skills, qualifications and clinical knowledge that only medical practitioners, nurses and midwives possess. These are existing funded positions within the department to provide independent professional advice to the Chief Executive, the Chief Public Health Officer and the minister.

The department employs medical practitioners, public health medical practitioners and nursing and midwifery staff to undertake key clinical advisory functions related to their professions. For example, as part of its public health role, the department receives notifications of prescribed diseases and medical conditions and these notifications may require public health responses. For example, doctors and nurses are employed in the department to provide a public health clinical response to diseases such as meningococcal disease where advice needs to be given as to which of the people in contact with an individual who has meningococcal disease need to receive antibiotics. The department's clinicians also provide advice on immunisation to doctors, nurses and the community, receiving over 16,000 calls per year. Clinical expertise is essential within the department both for policy advice and for linkage with professional clinical networks.

In South Australia, a medical practitioner, nurse or midwife working in a public hospital is employed pursuant to the Health Care Act 2008. The relevant industrial awards and agreements, that is, for medical officers: the South Australian Medical Officers Award and the SA Health Salaried Medical Officers Enterprise Agreement 2013 and for nurses and midwives: the Nurses (South Australian Public Sector) Award 2002 and the Nursing/Midwifery (South Australia Public Sector) Enterprise Agreement 2013. These awards and agreements not only outline the conditions of employment for these clinicians but also recognise specific career structures and continuing professional development requirements for these professions.

It was previously thought that clinicians could also be employed to work in the Department for Health and Ageing's central office under section 34 of the Act, if they performed functions in connection with the operations or activities of an incorporated hospital. However, the Act as currently worded does not support this, and clinicians working in the department would be required to be employed under the Public Sector Act 2009, pursuant to the South Australian Public Sector Wages Parity Enterprise Agreement: Salaried 2012, as the department is defined within that Act as an administrative unit of the public sector.

It has become apparent to the department that this is not an appropriate employment mechanism because the SA Public Sector Salaried Employees Interim Award and the South Australian Public Sector Wages Parity Enterprise Agreement: Salaried 2012 do not recognise the qualifications, entitlements and continuing professional development requirements for these professions. The government believes that clinicians who choose to work in the department should be able to retain any entitlements in line with their professional award. Continuing these professional entitlements will also assist the department to continue to attract and retain suitably qualified medical practitioners, nurses and midwives and ensure flexibility in the workforce across the department and the public health system.

The employment and conditions of employment of clinicians currently engaged to work in the department remain secure since the bill includes specific transitional provisions that ensure this. The provisions should also provide certainty to these employees that their employment, conditions and entitlements are not in any way altered by the previous oversight and by the introduction of the new employment mechanism as set out in the bill. The South Australian Salaried Medical Officers Association and the South Australian Branch of the Australian Nursing and Midwifery Federation have been notified about the government's intention to correct the anomaly that exists and to ensure equity with those working in incorporated hospitals and they recognise that this is a needed technical amendment.

Proclamations to dissolve three now non-operational incorporated associations and transfer their assets to the appropriate incorporated Health Advisory Council (HAC)

The bill includes specific transitional provisions to resolve some ongoing issues related to three non-operational incorporated associations namely, Lumeah Homes Inc. (Lumeah), Miroma Place Hostel Inc. (Miroma), and Peterborough Aged and Disabled Accommodation Inc. (Peterborough) that attempted transfer of their assets and their undertakings to their local country hospital sites in the 1990s and early 2000s.

At the time of the attempted transfers, the associations, and hospitals involved, which were then incorporated under the former South Australian Health Commission Act 1976, determined that the assets, liabilities and undertakings of the associations should be transferred to the hospitals. However, these transfers were never legally effected and as such the assets legally remain with the non-operational incorporated associations, although they have in practice been managed by the country hospital sites since the time of the transfers.

Since then, the Health Care Act 2008 came into operation and Health Advisory Councils (HACs) have been established for specific geographical country communities. The functions of these HACs include holding assets on behalf of the country hospital sites to which they relate. The country hospital sites are all part of the Country Health SA Local Health Network Inc. If the assets of the non-operational incorporated associations had been legally transferred to the relevant country hospital sites at the time, they would now rightly be held by the relevant HAC. The transitional provisions included in the Bill will allow for these outstanding issues to be resolved and for the assets to be formally transferred to the appropriate local HACs, as is envisioned by the Act. The HACs that will formally receive these assets are the Lower North HAC, Lower Eyre HAC and the Mid North HAC. It will also enable the cancellation of the incorporation of the named associations whose functions were taken over under the South Australian Health Commission Act 1976.

Remaining areas of minor amendments

The Bill includes a small number of other minor amendments that are necessary to improve the functioning of the Act, and to clarify the intent of certain provisions. These amendments include:

a minor amendment to the wording of section 29(1)(b) of the Act, to clarify that a body under the Act does not need to be providing services and facilities specifically to an incorporated hospital for the undertaking of that body (or part thereof) to be transferred to the incorporated hospital. That is, the body that will be transferred may not have been providing anything to an incorporated hospital, but it can still have its assets, liabilities and undertakings transferred to an incorporated hospital under this section.

a new provision to be inserted into Part 5 of the Act to allow the Governor, on application from the minister, to make proclamations to transfer functions, assets, rights and liabilities from one incorporated hospital to another, without the incorporated hospital to which these first belonged being dissolved. At present the Act only allows for these transfers to be made in the event that an incorporated hospital is dissolved. The proposed new provision is expected to provide greater flexibility in the establishment and management of incorporated hospitals over time.

removing section 49(5) of the Act which allows the minister to determine a constitution for the South Australian Ambulance Service (SAAS). This section is not required given that the functions and powers of SAAS are clearly set out in the Act. A constitution has not been determined for SAAS since the Act came into operation, and is not required for the effective functioning of SAAS.

two minor amendments will be made to section 93(3) of the Act. The first amendment is to indicate more precisely when disclosure of information can be made legally, that is, disclosures can be made when 'required or authorised by or under law'. The current wording which reads 'required by law' does not adequately reflect the situation where disclosure of information can be authorised in some circumstances by or under law. The second amendment is to add 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, which will come into operation on 1 July 2014.

I commend the Bill to Members.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

3—Amendment provisions

These clauses are formal.

Part 2—Amendment of Health Care Act 2008

4—Amendment of section 29—Incorporation

This clause amends section 29 of the principal Act by substituting subsection (1)(b) to allow all or part of the undertaking of a specified person or body to be transferred to an incorporated hospital.

5—Insertion of Part 5 Division 1A

This clause inserts new Division 1A into Part 5 of the principal Act. That new Division consists of section 32A, which enables the Governor to transfer functions, assets, rights and liabilities of one incorporated hospital to another and to make other related provisions.

6—Amendment of section 49—Continuation of SAAS

This clause deletes subsection (5) from section 49 of the principal Act.

7—Amendment of section 59—Fees

This clause substitutes section 59(1) of the principal Act, allowing the minister to set fees for the provision of incidental services provided by SAAS and defines what such incidental services are.

8—Insertion of section 89

This clause inserts a new section 89 into the principal Act. The new section enables the employing authority to appoint certain skilled or experienced people to assist the CE or the department in the performance of their respective functions. The new section also makes provision regarding the nature of such employment arrangements.

9—Amendment of section 92—Conflict of interest

This clause makes an amendment to section 92 of the principal Act that is consequent upon the insertion of new section 89.

10—Amendment of section 93—Confidentiality

This clause amends section 93 of the principal Act to clarify when confidential information may be disclosed, and who can consent to its disclosure.

Schedule 1—Transitional provisions

1—Employment

This clause makes transitional provisions that allow the CE to determine that certain employees of the department will be taken to be employed under new section 89 as inserted by this measure.

2—Cancellation of incorporation etc of certain associations

This clause makes transitional provisions in respect of 3 incorporated associations. The functions of the associations were previously taken over under the South Australian Health Commission Act 1976, but the incorporation of the associations was not cancelled at the time and certain assets not transferred. The clause allows the Governor to correct the anomaly in each case.

Debate adjourned on motion of Mr Gardner.

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