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House of Assembly - Fifty-Fourth Parliament, First Session (54-1)
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Motions

Cheltenham Place

Mr PICTON (Kaurna) (11:04): I move:

That this house—

(a) notes that Centacare's Cheltenham Place HIV service delivers important services for sufferers of HIV in South Australia, including respite, advice, social support and community outreach for this very vulnerable population;

(b) condemns the cruel closure of the Cheltenham Place HIV service in the 2018 budget;

(c) recognises Cheltenham Place's continued importance to hundreds of clients suffering from HIV/AIDS and the impact upon these clients by the removal of these services;

(d) notes that the removal of these services will see more costs on the health system through the increased use of emergency departments and acute hospitals; and

(e) urges the government to reverse the senseless and ill-informed axing of this important service.

In the state budget of September last year, we saw, sadly, a number of cruel and heartless cuts, closures and privatisations. One of the cruellest cuts and closures was the government pulling all funding from this HIV service provided at Cheltenham Place. This was not a service that made the front page of the paper very often. This was not a service that most South Australians even knew the location of, but it was a service that was incredibly important for people who are sufferers of HIV in this state.

This government, in a completely callous and uncaring way, cut all funding to this service in their first state budget. They did it without a plan for what was going to happen to those services. They did it without a plan for what was going to happen to those people afterwards. They just decided to strike a line through all funding being provided to that HIV service. It was cruel, it was calculated and it was designed that way because they thought that maybe people did not care about sufferers of HIV in South Australia.

Well, we do care and I was appalled by this decision we saw in the budget, not just because we know that it is going to impact sufferers of that horrible condition, not only because we know of the great work that happened there until it was closed under this government but also because we know that it was actually providing an overall benefit to the state budget and a benefit to our social services. By providing the services, providing that primary community health care, it was ultimately saving money in the long run for acute care and other social services that are now going to have to step in and provide care for those individuals.

Last year, I visited the Cheltenham Place service that, until it was closed, was in the electorate of Unley, just off Duthy Street. It was in an old building that I understand had been used many decades ago for various Housing Trust services. It was a service that was used by sufferers of HIV to get support, advice and various social services. Sadly, a number of the people they dealt with, but not everybody, were homeless or had been homeless or had housing insecurity.

We saw that service continue to improve and evolve over previous years. In the last couple of years, they had signed up to a new model of care where they were undertaking more services outside the centre and doing more clinics in people's homes to help them. It was something that was signed up to by the previous government, based on what we knew was going to be the best way of supporting people in South Australia who have that condition.

Unfortunately, despite the fact that this new contract had been entered into, despite the fact that they worked on a model of care, despite the fact that Centacare, which were providing the services, were constantly being told by the health department bureaucrats themselves that they were providing a good service, that they were delivering what they needed to and that they were meeting their benchmarks they were provided under the contract, wham, in this budget the entire funding is cut.

If you talk to Centacare, I do not think they would have been happy, but they would have been satisfied if they had lost the service but somebody else was providing it. They would have been satisfied if it was not going to be a Centacare service for people suffering with HIV but it was going to be provided by somebody else, if the government was stepping in or if something else was happening to provide care for those people. But the government decided to cut all that funding and replace it with zero. They replaced it with absolutely nothing whatsoever.

There was no plan at all for those people, just an enormous cut that affected a group of people that this government probably thought was not going to make a difference in marginal seats or a difference to whether they win the next election, so who cares? I think the people of South Australia actually do care that we have a caring society that looks after people in very vulnerable situations.

It became quite clear after the budget that the government did not even know exactly what they had cut and did not know what this service actually was, because the Liberal government described it in their budget papers as the closure and cut of a service affecting only homeless people with HIV. To be honest, that sounds pretty bad by itself, but it was a broader service than that. They did not even know that it was a broader service. They knew nothing about it. Some Treasury official or adviser in Rob Lucas's office, or Rob Lucas himself probably, just got out the highlighter and thought, 'We don't care about this,' and decided to cut it with no plan whatsoever.

When the outrage started about the cut to this service, and when it started to be reported in the media, the health minister defended it by saying, 'Our modelling shows that this is not going to be an issue.' On the one hand, Centacare had the stats to back up the fact that the very small investment in this program was producing a much greater benefit for the health system overall. A small investment in this primary community supporting care meant fewer visits to hospitals, less demand on housing services and less demand on other community support services, so it was actually a net positive for the budget. Removing this funding is going to cost the budget more.

Then we had Stephen Wade, who is becoming noted for his complete spin in this portfolio, going out and saying, 'We have our own modelling that shows something different. We have our own modelling that shows that that is not going to be the case.' It was only through various FOIs that we were able to prove that there was no modelling whatsoever. The government does not have any modelling that disputes what Centacare had in their modelling, which is that this would actually save the budget overall. Not only is it helping people and providing care in the community but it is saving the budget overall.

The government cut funding for this program in a cruel way. They did not know what the program was. They did not know what services it provided. They did not know that the health department had been going around saying that they had been delivering on their contract, delivering on their new model of care and doing a great job. At the same time, we had the health minister saying they had different modelling, but it was actually a lie and they had no modelling whatsoever.

This is an outrageous cut in this budget. It is something that this house should condemn. It is something that this government should reverse in their budget coming up in the next month to make sure that this service is replaced by something else because we are now the only state that does not provide any service like this. We are now the only state that says that sufferers of HIV should not have a dedicated centre to help them manage what is a very complex disease.

Obviously, we have had significant advances in terms of HIV care, but that is why a new model of care was put in place to help those people because it is still a complex disease to manage. It still requires a significant number of drugs to be taken. It still requires constant management. If that does not take place, the person, who might have a range of particular issues affecting them, whether they be mental health, social or socio-economic issues, if they are not getting the support to take the medication as they need, could be in a much worse situation overall. They could be an increased burden on the health system, particularly if they are not getting this medical support.

But the cuts did not stop there. We saw the cuts happening to SHINE SA clinics as well. We saw a callous cut to SHINE SA in the budget, which has forced SHINE SA to close two vitally needed clinics in the north and south of Adelaide. The Davoren Park clinic has closed and the Noarlunga clinic has closed and, because of that, there are no sexual health services in the north or south of Adelaide. People now have to come to the city or go to Woodville to get access to those services now due to Liberal budget cuts.

We have removed HIV support and we are removing those services that are trying to prevent people from contracting sexually transmitted infections in the first place, plus we saw a very large cut to any other contractor that the government had in place in relation to sexual health services. Why did the government single out sexual health and HIV services for these cruel cuts? Why did they do it? I think it is only because they thought they could get away with it. I think it is only because they thought that South Australians would not care about these people and would not care if they did not have these supports in place.

However, ultimately, I think people do care. Ultimately, I think people want to make sure that everybody in this state is looked after and that everybody in this state gets the care they need. The Liberal Party itself is going to face the fact that, if it keeps cutting programs like this that affect people, the pressure on emergency departments is only going to grow. The more people who go to emergency departments, the greater the cost is going to be for the government overall because that is the most expensive type of care.

As Centacare's own modelling shows, from what has happened at the Cheltenham Place centre over the life of their support there over the past 20 years, they have saved the government money overall. There was a range of support services provided at Cheltenham Place, including in-home and outreach support; psychosocial rehabilitation support for recovery; resilience and, ultimately, reintegration into the community; over-the-phone counselling, advice and practical support; and group activities on site at Cheltenham Place, allowing people with shared experiences to connect with one another, gaining practical skills for reintegrating into the community.

They helped connect their clients to other support services, both internal and external to the HIV sector, supporting their clients to stay engaged with those services. At times, they offered clients short-term respite over the course of three nights, but this was not part of their core business, particularly with the updated model of care that happened recently under the previous state government. They assisted with hospital avoidance and early discharge. They estimate that they supported 10 people to leave hospital early and assisted another 37 to avoid hospital in the 2017-18 financial year.

Based on the estimates of AIHW, they were saving twice as much as it cost to run. They were saving $800,000, whereas they had just a $418,000 annual cost. Compare that $418,000 with the $23 million that this government is spending this year on interstate corporate liquidators KordaMentha. Plus, of course, compare that $418,000 with the $800,000 that it is going to cost to look after these people in emergency departments and hospitals due to this cut.

Cruellest of all is that not only did the government cut this funding, not only did they do so without any proper analysis or any proper assessment of whether or not this was going to be a good thing, but neither the Premier, the Treasurer, the health minister nor the minister representing the Minister for Health could even be bothered to go and visit Cheltenham Place. They cut this funding and they closed this clinic without even taking a five-minute drive to get down to Duthy Street and see the work that had been provided there for the past 20 years for sufferers of HIV, a centre that is now not going to be there at all.

It would have taken them an hour to go and visit it. They might have changed their mind or they might not have, but at least they would have had an understanding of what they were cutting and what they were doing. Minister Wade could have left his leafy tower in Hindmarsh Square and visited this service instead of cutting it without even speaking to the sufferers and the people on the front line providing this service, and I think he should stand condemned for that.

The Hon. D.C. VAN HOLST PELLEKAAN (Stuart—Minister for Energy and Mining) (11:19): The government seeks to amend the member for Kaurna's motion. I move to amend paragraphs (a) and (c) and delete paragraphs (b), (d) and (e) so that the motion reads as follows:

That this house—

(a) notes that Centacare Catholic Family Services made a historically significant contribution to the South Australian HIV/AIDS response; and

(b) recognises that people living with HIV, and their supporting community, continue to be able to access a comprehensive range of HIV-specific and mainstream health services.

Mr Picton: Where? Where can they do that?

The SPEAKER: Order!

Mr Picton: That's a lie.

The SPEAKER: The member for Kaurna will not accuse members of lying. If he did, that would be highly unparliamentary.

The Hon. D.C. VAN HOLST PELLEKAAN: Mr Speaker, I ask that you ask the member for Kaurna to withdraw and apologise.

The SPEAKER: Member for Kaurna, please withdraw and apologise.

Mr PICTON: I will withdraw.

The SPEAKER: And apologise, please.

Mr PICTON: If I have to, I apologise.

The SPEAKER: You do not have to do anything. I think the member has apologised; we get the point.

Members interjecting:

The SPEAKER: Yes, let's get on with it.

An honourable member interjecting:

The SPEAKER: Order!

The Hon. D.C. VAN HOLST PELLEKAAN: I accept the member for Kaurna's apology.

Mr Picton: It's rubbish.

The SPEAKER: The member for Kaurna is warned for a second and final time. I am ratcheting it up, and if he continues he will be leaving the chamber this morning.

The Hon. D.C. VAN HOLST PELLEKAAN: Thank you, Speaker. The member for Kaurna has told the house that his apology is rubbish; I accept it, nonetheless.

The SPEAKER: I do not think he said that, but let's get on with it, minister.

The Hon. D.C. VAN HOLST PELLEKAAN: It is important that this house, and everybody who is focused on this matter outside this house, fully understands that the member for Kaurna's accusations about the Treasurer's just taking a highlighter and crossing things out of the budget without looking, thinking or caring are completely false and deliberately misleading. His suggestions that the health minister does not care and is not interested are again completely false and misleading. Nothing could be further from the truth. In fact, the amendment makes it very clear how very highly the government values this service.

The government acknowledges the important contribution of Cheltenham Place in the South Australian response to the HIV epidemic, when palliative care and respite care for people diagnosed with HIV were required because HIV was a terminal diagnosis and inevitably led to AIDS. Cheltenham Place provided individualised psychosocial rehabilitation and respite.

In 2019, South Australians living with HIV can expect to live a long and productive life because of significant advances in treatment. The treatment advances are so effective that a person living with HIV who remains on daily treatment and maintains an undetectable viral load is unable to transmit the virus to another person. It is something to celebrate when we can say that HIV rates are trending downwards across Australia.

In 2017, under the previous Labor government, SA Health commissioned a Master of Public Health student to conduct a review of sexual health programs commissioned by the department in South Australia, including comparisons with interstate and overseas jurisdictions. This review, commenced by the former Labor state government, found that respite services for people with HIV, such as Cheltenham Place, are not needed to the extent that they were in the past.

SA Health has worked with service providers to support the transition of people affected by the closure of the Centacare Individualised Support Program for People with HIV to alternative services. SA Health has not received any reports that former clients of Cheltenham Place have not been able to have their care and support needs met since the closure of the program on 1 January this year.

These people will continue to be able to access a range of services—and many already do—that support people living with HIV in the community, including the HIV Enhanced Primary Care Coordination Program at the Royal District Nursing Service, the MOSAIC Counselling and Case Management program and the HIV Women's Health Program at Relationships Australia, and the SAMESH program at SHINE SA. SA Health remains committed to providing contemporary, evidence-based models of care, support and prevention to ensure that the diverse and evolving needs of people at risk of or living with sexually transmissible infections or blood-borne viruses in this state continue to be met.

SA Health will continue to provide over $8 million in non-government grant funding for sexually transmissible infections and blood-borne virus programs this year. So, far from the completely unfounded accusations and personal attacks from the shadow minister, the government is following in the work of our predecessors, the former Labor government, and in fact making good use of that work. There are studies that they commenced that found the services are not needed anymore to nearly the same extent that they previously were.

Mr Speaker, you would think—we would all think—that instead of attacking the Treasurer, the health minister and the government, the member for Kaurna would think that it was a good thing. You would think that he could find it in his heart to actually be pleased that this service is no longer needed to the same extent that it previously was. Instead of being pleased for all South Australians and Australians, in fact, all he wants to do is use this in a political way to try to cause grief and harm and further disappointment to people. You would think that he would find it in his heart to find the good news—

Ms Cook interjecting:

The SPEAKER: Order!

The Hon. D.C. VAN HOLST PELLEKAAN: People who suffer with these diseases need as much care and support as possible. They do not need the opposition talking down their situation. As has been made very clear, an enormous amount of money is being spent in this area, and the information provided by the previous Labor government makes it very clear that not as much money is required now as was previously the case.

Ms COOK (Hurtle Vale) (11:26): I rise to support the original motion very clearly put forward by the member for Kaurna, the shadow minister for health and wellbeing, which, in a nutshell, condemns the government's cutting of the vital program at Cheltenham Place looking after the needs of people suffering HIV. I started my nursing career in the mid-eighties, and in that period of time we looked after some of the first people who suffered this dreadful thing called AIDS.

It was a terrible disease that we knew very little about, but we knew that when they caught this disease at that time it was fatal. There was very little we could do but watch people suffer the consequences of either a secondary illness like pneumonia or just terrible wasting away. They were isolated. People were frightened to go anywhere near people who suffered from HIV, known as AIDS, and we had to wear masks and gloves. Their family members were wrapped in plastic, basically, as they tried to show love and affection. It was just dreadful.

Over the years, yes, things have changed. Thank goodness for research, for caring scientists, caring legislators and caring people in our community. Life expectancy for people with this disease has changed, but to see the government come out with this hypocrisy, the absolute nonsense they are talking about—that it is all sunshine and lollipops and that we do not need Cheltenham Place—is just mind-blowing for me. I cannot believe that this motion, put forward by Anna Tree—hang on, sorry—

Mr Picton: That's what it says.

Ms COOK: I think Anna Tree is the person who works in the office, by the looks of it. A significant part of the motion has been cut out and changes have been made that make no sense at all. I am gobsmacked. I will support vehemently the reinstatement of funding and anything we can do to get Cheltenham Place back into the health sector and the wellbeing sector to the nth degree. The government needs to reverse the cuts. We knew, when this government came in, there would be cuts. The public were not aware of all the cuts that were going to happen, but they certainly have been coming thick and fast.

This cut is particularly cruel, with Cheltenham Place being a service that provides the only residential support and respite for people living with HIV. Almost 100 people a year access Cheltenham Place. I invite the member opposite who made the contribution, representing the minister in this place, to visit and talk to the people who will suffer as a result of these services not being available. I know you get this. They will tell you that they need the services that were provided there because they are not provided anywhere else. I understand that you have been given lines about this and I understand that you are supporting it, but I know you know, so I invite you to go and talk to them and lobby in this place on their behalf.

What Cheltenham Place does very well is support people who are suffering the consequences of their illnesses and are discharged early from hospital. People save the government money by not being in hospital any longer and by also avoiding those quick bounce-backs to hospital that happen. Most importantly, it enables people living with HIV to be with family and friends in a place that is not clinical. We know that improves wellbeing and improves outcomes.

Many of the people who use Cheltenham Place also suffer the secondary effects of this isolation and the terrible feeling people have with diseases that are unable to be effectively cured. They often have significant mental health issues through this isolation and worry. Those people are a particular cohort that needs the support of Cheltenham Place. There are also others who have drug and alcohol dependency. Of course, for people who experience homelessness and who are out on the streets after being discharged from hospital after an exacerbation of an illness, it is almost a death sentence. We cannot afford that happening to the good people in South Australia who, through no fault of their own, have this terrible illness.

Centacare is a highly professional and experienced organisation that operates Cheltenham Place. They have been making such a difference and they need to be supported to continue, not have their funding cut. The Australian Institute of Health and Welfare produced research showing that Cheltenham Place, through the work that they do, saves more than $800,000 in the health budget. These numbers do not go down: they go up. Soon, we will be talking about saving $1 million if we allow them to continue.

There is $800,000 being saved and a cut of $411,000. I am no genius when it comes to operating a credit card, let me tell you, but I can see that there is a $400,000 difference here. I really think this makes good economic sense. Hey, I am a mad, crazy leftie and I think it makes sense, so if I think it makes sense it must. It is cruel, it is reckless and, honestly, it is a pretty stupid cut. What makes it even more devastating is that we are only just starting to get the upper hand.

Credit for the lines coming out from the government. Yes, we are making some gains here. The prep treatment in place, the prep trials, are doing a great job. This almost speaks to the complete hypocrisy of the health minister, who is cutting such a poofteenth of a nonsense of nothing out of the budget, yet he was lobbying everywhere in the prep trial. He was everywhere, and now he is nowhere to be seen because he has cut the budget and run. However, during the prep arguments that we were having when we were in government and the health minister was then the opposition spokesperson, he was all over it.

We are just starting to make inroads from the good work that happened in a bipartisan way, and now we are seeing this cut. It is disappointing and it seems that there was no consultation. The sector believe it is brutal, and they had no idea it was coming. Had the government consulted, they may well have found out what we all know: this service is vital. This service has to stay. It must be reinstated in full. It makes a tangible difference to the quality of life of people living with HIV, and their families and friends.

This government does not seem to care about queer South Australians at all. I say that for a couple of reasons. Before the election, we heard about this cut to Safe Schools, which has been an incredibly successful program. The only crime for Safe Schools was being attacked by crazies on Sky News After Dark. That is its only crime. It is fearmongering. Ask the young people who have participated in this program, and they will tell you it has enlightened them, supported them and kept them safe. I know that there are people on that side of the chamber who do not agree with this cut and do not agree with this program being binned. It is a vital program.

Then we have SHINE. Where do young people in Noarlunga, Davoren Park and Elizabeth go when they need to talk? Who do they go to when they need to have a conversation about sexual health? I visited one of our local high schools last year and spoke to some of the teachers. One of the biggest indicators of lack of success is a compromised sexual health education system where young people end up getting pregnant and fall out of school because they can no longer attend. They leave school, have a baby and do not get back to education. The indicator is that these people are on a spiral pathway and it is not to success. SHINE helps these people.

This government has cut the guts out of SHINE, and we have seen it disappear from Noarlunga and Davoren Park, two of the most valuable services. The government has to reverse the cuts. They are cruel, heartless and mean and they do not make sense. You do not risk an $800,000 impact on a health budget worth billions for the sake of a $411,000 budget saving and you definitely do not cut essential HIV services that are keeping South Australians safe.

Mr PICTON (Kaurna) (11:36): I thank the member for Hurtle Vale for her speech and her eloquent explanation of why this funding and support were needed, and the excellent work that was being provided. I express my disappointment at the speech we have heard today from the Minister for Energy and the amendment that has been moved by him. According to the notes he has tabled before the parliament, this amendment was drafted for him by Stephen Wade's office and his adviser in his office. The amendment deletes from the motion that there is an issue and that there is a problem with the government callously cutting this funding.

I am particularly disturbed by the speech we heard today from the minister, who said that cutting this funding was a good thing, that the government should be applauded for cutting this funding and that no-one has complained, so this is all fine. I think that is ill thought through. I think that is an uncharacteristically poor effort by this minister because this was not an issue where the government undertook significant analysis, saw that there were too many support services available and ran a comprehensive program, investigation, consultancy, study or even spent five minutes looking at this issue before deciding to cut this funding.

No-one knew about this before it popped up in the budget. The government did not even know exactly what program they were cutting, and the minister was talking in the media about analysis that was later proved not to exist. There is nothing replacing this. The government have abolished a program, a service that was needed, that was re-signed in 2015 under a new model of care to help people, and they have replaced it with nothing. They have done that without one bit of evidence—zilch—and without one bit of analysis. So, for the minister to come in here today and say that this was a good thing, that this is no longer needed, shows how out of touch this government is.

I think it is a disgrace that the government has cut this. I think it is a disgrace that the government is continuing to defend it. I think it is a disgrace that the minister's adviser—who, I have to say, is an individual I once had respect for—is now the one drafting this garbage in this parliament, saying it is a good thing that this money has been cut, saying that sufferers of HIV are not picketing at the front doors of the parliament so this is all fine. These people are just trying to make their way as best they can and if they are not getting support, if they are not getting services in the way we have provided them in the past 20 years—and every other state provides a similar service—they are not necessarily the people who are able to mount a campaign against this.

We are going to see increased health demands on our services, we are going to see increased hospital presentations, we are going to see increased demands on our homelessness services and we are going to see increased demands on our social services. That is not going to happen through a picket line: it is going to happen by an increase in those services. The minister is pretty out of touch if he thinks that is going to be the way we will find out if there is going to be an issue. The issue is that there will be a resulting increase in demand.

We have a health minister who spent his entire time as the opposition health person saying that he supported more prevention, that he supported more primary health care, but what has he done when he has come into office? He has finally got the opportunity, after the 12 years in opposition, to be in charge of the portfolio, and he is cutting those services he once trumpeted as being important, that the minister's adviser used to trumpet as being important. Now we have them cutting those services.

I am incredibly disappointed about this. The minister says this is all about playing politics; unfortunately, I have to say I do not think this is going to be a deciding matter in the election. This is a moral issue about where you stand on the issue and, even if it is not going to win you any votes, as a state we should have a government that is willing to stand up and say that the most vulnerable in our community deserve to be supported. Even if the most vulnerable in our community are not going to be the ones in target seats, we should be making sure their services are protected. I support the original motion.

Time expired.

Ayes 23

Noes 21

Majority 2

AYES
Basham, D.K.B. Chapman, V.A. Cowdrey, M.J.
Cregan, D. Duluk, S. Ellis, F.J.
Gardner, J.A.W. Harvey, R.M. (teller) Knoll, S.K.
Luethen, P. Marshall, S.S. McBride, N.
Patterson, S.J.R. Pederick, A.S. Pisoni, D.G.
Power, C. Sanderson, R. Speirs, D.J.
Teague, J.B. Treloar, P.A. van Holst Pellekaan, D.C.
Whetstone, T.J. Wingard, C.L.
NOES
Bedford, F.E. Bettison, Z.L. Bignell, L.W.K.
Boyer, B.I. Brock, G.G. Brown, M.E. (teller)
Close, S.E. Cook, N.F. Gee, J.P.
Hildyard, K.A. Hughes, E.J. Koutsantonis, A.
Malinauskas, P. Michaels, A. Mullighan, S.C.
Odenwalder, L.K. Piccolo, A. Picton, C.J.
Stinson, J.M. Szakacs, J.K. Wortley, D.

Ayes 23

Noes 21

Majority 2

AYES
Basham, D.K.B. Chapman, V.A. Cowdrey, M.J.
Cregan, D. Duluk, S. Ellis, F.J.
Gardner, J.A.W. Harvey, R.M. (teller) Knoll, S.K.
Luethen, P. Marshall, S.S. McBride, N.
Patterson, S.J.R. Pederick, A.S. Pisoni, D.G.
Power, C. Sanderson, R. Speirs, D.J.
Teague, J.B. Treloar, P.A. van Holst Pellekaan, D.C.
Whetstone, T.J. Wingard, C.L.
NOES
Bedford, F.E. Bettison, Z.L. Bignell, L.W.K.
Boyer, B.I. Brock, G.G. Brown, M.E. (teller)
Close, S.E. Cook, N.F. Gee, J.P.
Hildyard, K.A. Hughes, E.J. Koutsantonis, A.
Malinauskas, P. Michaels, A. Mullighan, S.C.
Odenwalder, L.K. Piccolo, A. Picton, C.J.
Stinson, J.M. Szakacs, J.K. Wortley, D.
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