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House of Assembly - Fifty-Third Parliament, Second Session (53-2)
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Parliamentary Committees

Social Development Committee: Inquiry into Regional Health Services

Debate resumed.

Mr PEDERICK (Hammond) (11:15): I rise to speak on the inquiry into regional health services, which is the subject of the 40th report of the Social Development Committee. It was very interesting how this reference was established. The member for Stuart tabled the recommendation to have this reference in this parliament many years ago, in 2014, and since that time there has been quite a bit of negotiation around what exact reference points we would use.

There was certainly nervousness on the part of the government in relation to how much we were going to look into Country Health because Country Health, quite frankly, is something that this Labor government has not looked after at all well. I can remember decades ago campaigning out the front of this place to make sure that the Tailem Bend hospital stayed open, and many other events have happened over time.

It was a very interesting inquiry that went on for around 18 months. It was a complex inquiry and I would like to thank the people involved—the member for Fisher, the Hon. Jing Lee from the other place, the Hon. Kelly Vincent from the other place and the member for Torrens. I also note that the Hon. Gail Gago from the other place was Presiding Member of the committee. I certainly acknowledge the secretary, Robyn Schutte, and the two research officers, Dr Helen Popple and Ms Mary-Ann Bloomfield.

I absolutely pay my regards to the secretarial staff in coming forward with the recommendations, which did take much debate, and I certainly commend their work in getting this report in order. What this report highlighted to me was the simple fact of the total bureaucracy involved in delivering services into country South Australia—the seven layers of bureaucracy that people have to go through just to get services on the ground in their communities and with very little interaction with the health advisory councils.

There was a lot of discussion about health advisory councils and how they function throughout the state. Some are incorporated and some are not incorporated, and the government and certainly the department obviously have not communicated well to communities how much influence the health advisory councils can have in regard to health services in their community.

I am involved in several HACs in my community, and I have people co-opted to represent me on those committees. Sometimes, it feels like we are just juggling the balls in the air at another meeting and talking things around and not getting any real action on the ground. Let's hope that after this inquiry we do get some real outcomes and some real benefits for Country Health in South Australia.

One of the biggest issues is around fundraising and what happens with those funds going into Country Health. Over the years, many regions, many regional areas and many single town units have raised hundreds and thousands of dollars—it would amount to millions of dollars across the state—but there is just not the trust anymore about what happens to those funds if they are bequeathed to a health advisory council gift fund.

People are concerned that their funds could be siphoned off, so to speak, and go into something else. A lot of communities have set up other entities to put their bequests into, because people have—and I know this for a fact—been suspicious of donating money into these funds. They want those funds to be spent locally, and administered locally, on items that need to be put into their local hospitals and health care.

The issue here, quite frankly, is that this local fundraising should not have to happen, but for whatever reason there are gaps that have to be filled. I note that in Murray Bridge there was a visiting ear, nose and throat specialist who brought his own equipment to conduct his appointments. When he retired, the health advisory council had to come up with about $30,000-odd to buy some equipment for a visiting specialist. There are all those kinds of concerns that come through.

A big concern was around the percentage of moneys that the Department of Planning, Transport and Infrastructure takes with repair builds and infrastructure builds in regard to Country Health facilities. One of the biggest frustrations—and I talked about it earlier in my contribution—is the simple fact that people feel that they are not part of the process because of the at least seven layers of bureaucracy in Country Health and the fact that they just throw their hands in the air and say, 'Well, what's happening anyway?' I hope that after this that health advisory councils can see what they can and should be able to do in relation to providing health care into the future.

The recommendations around getting a better direct reporting relationship between Country Health and local health networks and health advisory councils include looking at strategic plans appropriately; that the Country Health South Australia Local Health Network revisit the Community and Consumer Engagement Strategy to give health advisory councils greater input through the consultative process; that the Country Health SA Local Health Network recognises health advisory councils' continued input into the 10-year health plans by providing health advisory councils with progress reports on the 10-year health plans; and that, in regard to the annual combined Health Advisory Council Conference, health advisory council presiding members and the Minister for Health meet and discuss relevant matters at that conference.

We have certainly made recommendations, as I have indicated, around how local funds are currently and were previously raised by local communities and how they are held and spent, with particular regard to authorisation and decision-making. One recommendation (recommendation 13) is that the Country Health SA Local Health Network works with health advisory councils to develop a policy and procedure to ensure funds raised by health advisory councils and community organisations or individuals are spent on their intended purpose in order to improve clarity and transparency of processes. Certainly, I have talked about issues around budgeting and how much input HACs can have in regard to that.

In regard to the gift funds, there is a recommendation about lifting the amount that can be got from these gift fund accounts without requiring approval of expenditure from the Country Health SA Local Health Network or the Minister for Health from $25,000 to $75,000. There are certainly recommendations around health advisory councils participating in budget discussions and financial management in line with recruiting staff.

In regard to accident and emergency care, it is recommended that the Country Health SA Local Health Network revisits the findings of the 'Road to rural general practice' report commissioned from the Rural Doctors Workforce Agency and in particular considers implementing the 'Road to rural general practice' model detailed in the report.

There are recommendations in this report about local health advisory councils having more input. I think they should have a lot more input into how we can attract and retain staff, such as the valuable nurses and midwives that we need, and also the attraction of doctors into rural areas across the state. Pinnaroo has not had a resident doctor for a long time—for years—and we need to find a way. There needs to be involvement at a local level, working with Country Health, to make sure that we get the services so vitally needed into the community. Let's hope that this report plays a role in that.

Ms COOK (Fisher) (11:25): I rise to contribute as a member of the Social Development Committee during the inquiry into the delivery of regional health services. Congratulations to the member for Stuart on his strong advocacy on behalf of both his and the broader rural community in bringing this reference to parliament. Congratulations also to the member for Taylor on referring it to the Social Development Committee.

The committee heard many hours of evidence, and undertook journeys to several rural centres, and the many individuals and organisations did a fantastic job representing their communities, so I thank them for that as well. The broad terms of reference were difficult to corral into short hearings and into succinct recommendations. It was an extremely complex inquiry. The member for Torrens and also the member for Hammond brought us a big-picture view of some of those recommendations. I would like to offer support for the recommendation as a whole.

The provision of modern, world-class health care is enormously challenging across the vast distances with special populations such as we have in South Australia. My hope is that, along with Country Health SA, the rural health networks will be able to simplify many processes, and engage and maintain motivated and dynamic volunteers at advisory and service delivery levels (such as with SA Ambulance), and ensure an agile environment that best responds to the local needs of rural communities. There is an enormous amount of goodwill in our rural communities and it was clear to the committee that, given some small changes, this goodwill could definitely translate into a really strong culture within Country Health.

When doing an inquiry like this, it gives committee members a great opportunity to visit regions and see what is happening in terms of health service delivery. I have seen firsthand some excellent and highly skilled clinicians in rural hospital saving lives and working miracles until help has arrived as part of the MedSTAR retrieval service. I would arrive with that team and take the patient back to a tertiary centre for advanced care, but the care that they received before that would be excellent and world-class. I have also seen and heard about enormous challenges rural health centre do face without being able to use the latest equipment and also without being able to staff their hospitals with appropriately skilled clinicians. There are many challenges. Rural hospitals tread a fine line daily.

More than $300 million has been invested in capital investment in rural areas since 2002. That has contributed significantly to better patient outcomes and reduced travel needs in some cases. Four major rural hospitals in Berri, Mount Gambier, Port Lincoln and Whyalla have been redeveloped, as well as other upgrades recently to Mount Barker maternity facilities, Port Pirie GP Plus and the South Coast Primary Health Care Precinct. Mount Barker will also now have access to an on-site 24-hour emergency doctor, which is vital in a growing town.

Chemotherapy services are now available more broadly across country South Australia, with a new Regional Cancer Centre in Whyalla and 14 designated chemotherapy units throughout the regions. It is vital that these patients get their care close to home where their supports are in place. Dialysis units are also at 12 units across the state, and telehealth forms the heart of mental health, cardiology, diabetes and many other specialist access.

We are also investing billions of dollars into our metropolitan hospitals, where at any one time up to a quarter of the patients are from our regions. Of course, it would be ideal for all these patients to receive all their care near their homes, but it is just not practical. With technological advances in interventions, this just will not happen in the acute phase. The specialists do not want to deliver this care in a remote area, away from tertiary care. It is not practical with the cost of the equipment, so we have to strike a balance.

Nevertheless, this same advancement is seeing an increase in the use of telemedicine for consults for rehabilitation. This sees people at home much faster, as they can access their therapist remotely for instruction on how to undertake their rehabilitation post-surgery and post-medical event. A perfect world for all consumers is difficult to achieve, but of course it is worth aspiring to. I am sure that the recommendations from this inquiry will help rural health to move in the right direction. Health is a dynamic world and change is welcome, although sometimes with a deep sigh.

I thoroughly enjoyed my time on the Social Development Committee and that has now come to an end. I have learnt an enormous amount from secretary, Robyn Schutte, in particular. Thank you to the research officer, Mary Bloomfield, who took over from Dr Helen Popple, for the hard work pulling together such a huge piece of work on her first inquiry. Congratulations to my fellow members—the Hon. Gail Gago, a legendary nurse leader; the Hon. Kelly Vincent and the Hon. Jing Lee from the other place; and also the members for Hammond and Torrens from this place—on your diligence and enthusiasm throughout the journey of this inquiry. I commend this inquiry and I look forward to seeing the outcomes of the recommendations.

Mr WHETSTONE (Chaffey) (11:31): I rise to make a contribution on the 40th report of the Social Development Committee. It was great to see the member for Stuart move this motion almost three years ago. I think country members in this place will understand the importance of Country Health. It is important to have the facility, but it is also important to have the professionals there to make sure that the facility is utilised in a proper manner and that those services are upheld because Country Health in most instances is in a faraway place. Not only do the constituents have to travel some considerable distance to get there but they then have to rely on services within those hospitals and medical centres.

The member for Stuart's motion of almost three years ago to establish a select committee to inquire into the future delivery of health services in regional South Australia really says it all. He moved the motion with concerns that Country Health seemed to be fading, services seemed to be disappearing and staff numbers seemed to be dropping away. It became a concern not only to the member for Stuart but to me, obviously having a country electorate, and to the members for Hammond, Flinders and Mount Gambier, who have made contributions because we understand how important Country Health is.

Originally, the terms of reference referred to the amalgamation of health advisory councils in regional South Australia and the benefits or otherwise of all rural and remote South Australia being classified as one primary health network within the federal system. Obviously, following that, the federal government introduced the Country South Australia Primary Health Network, which covered all country South Australia and the HACs were not under consideration for amalgamation. It is an example of the changing health system over the three or so years it took to hand down this report.

During its hearings, the committee heard from 58 individuals and received 71 written submissions, including submissions from my Riverland and Mallee HACs and doctors because they were all concerned, just like I am. The committee reviewed some encouraging evidence that shows that there are some HACs that are functioning as highly effective advocates and facilitators in their communities and enhancing the Country Health system.

The final report contains 49 recommendations. During evidence, Ms Tanya Lehmann, Acting Regional Director, Riverland Mallee Coorong Region Country Health Services, described her relationship with the HACs in the Riverland Mallee Coorong region as a partnership, but not all HACs have the same requirements or need the same type of support. When asked by the committee about how she saw Country Health SA was supporting and promoting the HACs, Ms Lehmann replied that there was a perpetual challenge around communications and supporting how each HAC functions individually.

Ms Lehmann also told the committee that there are still those in the community who will rally to raise substantial sums of money to support their local hospitals. Ms Lehmann stated that the health advisory councils make an incredible contribution to health services in the region. The Riverland and Mallee health advisory councils contributed almost $1.2 million worth of fundraised equipment and infrastructure minor works to the region in the last financial year.

I thank all those people who either bequeathed money or donated philanthropic money, and I recognise the good work of fundraising from a caring local community that put funds into those hospitals. That fundraising would not happen without the health advisory councils not only as a voice for their communities but also as a voice to mobilise the engagement of our communities, which they have and want to have in their health systems through that fundraising. It really connects up with the hospital and its community.

She went on to say that we have other health advisory councils in areas that are not as wealthy, so the socio-economic profile of towns also comes into play in terms of their fundraising earning potential. For example, in Berri and Murray Bridge where the hospitals are much larger, there is somewhat less engagement within the community to get behind and fundraise than there is in some of those small town hospitals.

In the smaller communities where the perceived risk that the hospital will shut down is higher if they do not save it, the more engaged the HAC and the community tend to be with that hospital. She said, 'My observation in the Riverland and the Coorong regions is that the smaller the community the more engaged the HACs are,' not only in being the mouthpiece but also to engage that fundraising exercise.

Another concern raised by several groups from different regional locations was the issue of gap payments for patients treated in the accident and emergency department at their local public hospitals. According to the Renmark Paringa District Health Advisory Council, all patients are required to pay a gap fee of $40 at the time of treatment if they are treated at the accident and emergency department out of hours. Ms Lehmann said that a hospital needs to know that the general practitioners working in the town have access to the hospital as fits the needs of their patients.

One area that is continually raised with me and my HAC members—and I thank those HAC representatives on all my hospital boards—is that they are there to see that 24/7 emergency services are restored to all the hospitals within a satisfactory distance for those patients to travel.

The committee also heard about transport challenges to get to their appointments. Without the assurance of reliable transport on the day to meet those specialist and doctor appointments, particularly for the elderly, some patients may not be able to attend appointments. Members of the Loxton and Districts HAC and the Renmark Paringa District HAC advised the committee during verbal evidence that there are other factors that determine the successfulness of the PAT Scheme. These are identified by the HACs as factors, summarised as:

the usability of the online system for patients to record their transport requirements;

the usability for GPs and specialists who refer patients through the PAT Scheme; and

the subsidy system is too complicated.

I will say that the review of the PAT Scheme took a long time to come down. What I have seen is that the online system is very clunky and very hard for people to work, and a lot of people in country areas do not have access to online facilities. Some people are illiterate when it comes to using online services, so I think that we need to really look at the way it can accommodate all people, not just those people who do have access to the digital spectrum. PATS is complex for people with disabilities, severe illness, literacy difficulties and patients with non-English-speaking backgrounds, and patients may not have access to a vehicle, petrol and accommodation at the site they are travelling from.

Overall, a number of issues were raised, and I think rightfully so. Many of those regional patients and regional health facilities need the care and upgrades that keep the hospitals compliant. Over the last 12 months we had issues at Waikerie. The air conditioner in the operating theatre was no longer operating and there were noncompliant doors, costing around $140,000. The Waikerie HAC had to pick up that bill, and I think that shows the lack of consideration.

There was no surgery at the Renmark hospital and services were centralised to Berri, but there was a lack of transport. We understand centralising health services, but you must have public transport. You must have a connection from those communities that lose health facilities and lose their hospital so that they can get to a central location.

We have heard that there is a $150 million backlog of maintenance and noncompliance issues in country hospitals. Again, the Loxton and Districts Health Advisory Council had to use their own money to upgrade bathrooms in the west wing of the Loxton Hospital to ensure they have disability access as well as a new call bell system. However, there is a shining light: the state government did backflip and then put that funding back into the Loxton Hospital.

Overall, I think this review has highlighted a lot of issues. I hear that money was raised for chemotherapy chairs in the Riverland General Hospital during Dry July, which was a great initiative. I would like to express my gratitude to all the front-line services: the doctors, the nurses, the admins, the ambos, emergency services, kitchen staff and gardeners. They all contribute to a great health system in country South Australia.

Time expired.

Mr BELL (Mount Gambier) (11:41): I rise to make comment on the 40th report of the Social Development Committee inquiry into regional health services. I was listening intently to the member for Torrens' contribution. She indicated that only two-thirds of the HACs actually responded and, in fact, many were confused about their role or purpose. That is not surprising considering that John Hill introduced the HACs as a way of fooling the public whilst taking away the health boards and centralising the services back to Adelaide, depowering communities and taking local decision-making away from locals.

In terms of our local HAC and our local hospital in Mount Gambier, there seems to be a revolving door of issues that keep presenting themselves. The latest is a joint review, which identified that the Mount Gambier hospital is short 10 nurses per week, so there is actually a shortfall of 10 nurses per week. This is being covered up. I will use the words of Elizabeth Dabars, who says that Country Health's lack of response is 'gobsmacking'. She claimed that authorities were trying to conceal the problem from the public. She states:

Overworking our nurses is not a sustainable solution—it's a practice that is not only taking its toll on the health of nursing staff, it presents a ticking time bomb when it comes to patient safety.

Country Health SA is hiding this problem from the public—and that is not fair for patients.

Back in 2015, the then health minister, Mr Snelling, indicated that our renal upgrade was the most pressing issue to face our hospital. It has not got any better because we have seen absolutely no action at all. Currently, 14 patients require dialysis treatment three times a week. It is done in a substandard and cramped room where the infection control, believe it or not, is a yellow line on the ground, and there is a nurse's desk in a corner, no bigger than a standard housing bedroom.

Additionally, there are five more patients on the waiting list to receive treatment, along with 11 patients who are currently in an advanced state of renal failure who may require dialysis at any time. The Mount Gambier hospital unit is the only renal dialysis south of Murray Bridge and is servicing a population of approximately 84,000 people. Recent upgrades to the renal dialysis units at Noarlunga, Gawler and Maitland hospitals have been funded by the state government, and I welcome those upgrades; however, it is time that the Mount Gambier hospital received its upgrade.

I guess what concerns me the most about the actions of Country Health SA is the number of nurses who come to see me to report issues. Every single one of them says the same thing: 'If I am found to be talking to you I've been told I'm going to get the sack.' You wonder what type of state we live in when a public servant such as a nurse is actually frightened for their job security if they reveal issues as they occur. This culminated back in 2016. Mind you, the chair of the HAC went on radio and said that I was scaremongering and that calling for a report into our emergency department had no basis whatsoever.

Country Health SA, and credit to them, actually instigated a departmental review—it was not an independent review—that found a number of issues needed urgent attention, and they came up with 22 recommendations. The first was a shortfall of funds to the tune of half a million dollars a year, $536,000 per year. I give credit to the health minister, who secured that funding which is now flowing into the Mount Gambier hospital's emergency department—this is not the hospital, this is just the emergency department.

In late 2016, there were a number of other recommendations, and I will go through just a couple of them. Unfortunately, many of these still have not been enacted and we are into 2017, coming to 2018 very shortly. The key recommendations were:

proceed to recruit a new ED director as soon as possible;

review and restructure the recruitment process for junior RMOs;

an electronic patient tracking system should be introduced;

the implementation of a staffing escalation process for the ED during times of increased activity;

a formal patient flow initiative be implemented at the Mount Gambier and Districts Health Service; and

the category of admission within the ED to be thoroughly reviewed and justified.

They are just the key recommendations out of 22 from this departmental report. Had the HACs been working as I believe they were designed to work—in fact, as I said at the start, they were probably designed to fool people that they still had a say when everything was actually centralised back—these issues would have been raised and promoted by the HACs.

Going on to the renal dialysis upgrade, which I have spoken about in this place many, many times, it is so urgent that the community is now holding major fundraisers. That culminates, in a couple of weeks' time, in a Bollywood-themed ball and dinner out at The Barn Steakhouse, where organisers are aiming to raise about $100,000 to go towards the $1 million upgrades needed. I commend all the organisers, particularly Maureen Klintberg, who has been a tireless worker within our hospital as well as in the fundraising section of that. Going through, with her, some of the complications and difficulties she has had in having this was quite staggering.

The last part I want to talk about is Transforming Health. It has obviously now been canned; there are now upgrades to metropolitan hospitals which we were told we were not going to need because we had this new shiny hospital, the third most expensive building in the world. Now, out of political opportunism reasons—in fact, that is what the Premier has actually stated, that this is a political decision—those upgrades are occurring in metropolitan hospitals.

I do not necessarily have an issue with that because I think we should have a world-class health facility, but what I do have an issue with is that country hospitals continue to be neglected with a $150 million maintenance backlog that needs to be addressed as soon as we can. Come March next year, I am really hoping we have a government that looks after country South Australia as much as this current one has looked after metropolitan South Australia.

Mr VAN HOLST PELLEKAAN (Stuart) (11:50): I rise to add my comments on the Social Development Committee's inquiry into regional health services. There is a very long history to this report. I believe it was back in April 2011 when I first asked the government if it would undertake this work, and I was told by then health minister, John Hill, that if he and I, Liberal and Labor parties, could agree upon sensible terms of reference then he would be more than willing to do the work. We had a very good positive conversation. I took him at his word and I still do not doubt what he had to say at the time.

We sat down and together we came up with the terms of reference which we both agreed on. His view at the time was that he had nothing to hide, that Country Health had nothing to hide and that he was more than willing to have an inquiry. My view at the time was that there were a lot of areas that needed to be addressed, a lot of areas where rural people, whether they be healthcare providers or healthcare receivers, had a great deal of concern and that these things needed to be looked into.

Deputy Speaker, you know that I have not been in government so I might be unaware of exactly how difficult it can be, but from that point on the processes of government have meant that we are today finally discussing this report in parliament many years later. I have to say, though, that through that process and a succession of health ministers, we have finally got to the terms of reference being inquired upon and reported upon.

I want to thank my colleagues particularly who have supported me over many years to not let this fall off the state Liberal opposition's agenda. I would also like to thank the hundreds and hundreds of people in regional South Australia who put their time and effort into providing information towards this inquiry over all those years, because when the government first agreed to do this report, I think it was back in late 2011 or it might have been early 2012, people got ready to go and they started putting their submissions together then in anticipation of being able to provide the information they wanted to.

Of course, they did not get to provide that information until last year and this year, but I would like to thank those people as well because good people from within and without the health system have contributed in a very positive way to this report. The desire for this report, the terms of reference, and the interest of people making submissions are not because those people want to bag the health system. It could not be further from the truth. Regional people in South Australia know very well that they want a good health system in country areas. They are very aware of the fact that by international standards they, we, are exceptionally fortunate in South Australia, but we have to fight to stay at that high standard.

We in regional areas also have to fight to keep our high standard relative to the standard in metropolitan Adelaide. We have seen over nearly a decade now that I have been actively involved in this work, and much longer for other people who have been involved longer than me, a transition of focus from the government, with resources moving from the country to the city area.

I remember very well asking former treasurer Kevin Foley about this in parliament when he was, at the time, in my opinion, boasting about the increased funding that was going into health back then in country areas. I said to him, 'It is not even keeping pace with a health cost index,' inflation in health, essentially. 'You are in real terms going backwards in country areas, but in real terms you are not going backwards in city areas,' was essentially what I said to him at the time. He in his usual style said, 'Yep, that's right.' So there was no doubt it was not an accident, no doubt that he was not aware of it or anything like that. It is just what he saw, as treasurer at the time, as the right thing to do. Clearly, that is not the right thing to do.

If we jump forward to our most recent budget, I was highlighting the fact in a public radio interview that unfortunately in the state government's most recent budget there was not one dollar to upgrade a regional road, not one dollar to upgrade a regional school and not one dollar to upgrade a regional hospital. The current Treasurer's comment on that was, 'That's all okay because country people will get to come down and use the new Royal Adelaide Hospital shortly whenever they want to.' It seems unfortunate, at least from the treasurers' perspectives over time, that not much has changed.

It is good that this report has been done. I thank the Chair of the committee, the member for Fisher, who has done this work in a very straightforward and open way and received submissions from those people who were allowed to make submissions. What I am talking about there is the fact that hundreds and hundreds of people, as I said before, came forward with their submission. But I would say that there are 10 to 15 people who work in Country Health SA who have come to me over the last few years and said, 'Would we be allowed to make submissions?' I said, 'From my perspective, absolutely, yes. From the parliament's perspective, absolutely, yes, but please don't get yourself caught out. Please do check with your managers and supervisors within Country Health SA about whether you are allowed to make a submission.'

Picking up on the comments that the member for Mount Gambier made a little while ago, and no doubt others as well, it happens very regularly that people currently working in Country Health SA say, 'I would love to share this information, but I am just not allowed to. I am told in no uncertain terms that I can't, and I fear for my job if I do.' Two people have come to me with essentially that perspective in this current week, and it is a huge shame that that has happened.

They came to me unprovoked. They are not people I went to seeking information, but people who came to me not at hospitals, not in health forums, but in totally different community forums saying, 'I want you know this, but I am not allowed to say it. Dan, can you try to help?' Of course, the conversation goes on to say, 'Yes, of course I will. Yes, of course I will do my very best to do that, but if I can't have some substantiation of the information that you are giving me it makes it very difficult.' That is something that has clearly not changed at all. As I say, even as late as this current week, that is still what is going on.

I briefly turn to the new Royal Adelaide Hospital. We on this side, including country and outback representatives, want there to be an outstandingly good hospital in Adelaide. There is no doubt about that. Let's put aside for today all the previous debate about renovate on site versus brand new, etc. We want there to be outstandingly good hospitals in country South Australia. We know that country people come down to Adelaide for medical care and service all the time, and we appreciate that. We do not expect that cardiac surgery, for example, will happen anywhere else in the state except in Adelaide, and country people accept that. If you need that sort of support you will have to come to Adelaide for it, but that is not true of every single service at the moment.

Country people deserve to have their hospitals supported. Country people deserve to know that, when they need care that could appropriately be delivered in country areas, they can receive that care. It is a great shame on this government that that opportunity has been taken away step by step, steadily and slowly, over the last 16 years of this government. People deserve to know that they can get care near home. In the same way as nobody in Adelaide would expect to be in a hospital 300 kilometres away in Port Augusta, people in other parts of the state deserve to know that they do not always have to come to Adelaide.

Debate adjourned on motion of Mr Snelling.

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