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House of Assembly - Fifty-Fourth Parliament, Second Session (54-2)
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Parliamentary Committees

Parliamentary Committee on Occupational Safety, Rehabilitation and Compensation: Workplace Fatigue and Bullying in SA Health

Mr PATTERSON (Morphett) (11:06): I move:

That the third report of the committee for the Fifty-Fourth Parliament entitled 'Workplace fatigue and bullying in South Australian hospitals and health services', be noted.

I am pleased to present the final report of the committee's inquiry into workplace fatigue and bullying in South Australian hospitals and health services. Workplace fatigue and bullying in the healthcare sector have been the subject of extensive research and investigation in recent years, with many stories emerging of staff being subjected to unacceptable behaviour by their superiors and colleagues, and/or being required to work unreasonable hours.

The inquiry's terms of reference are outlined in the report. While I will not detail them all here today, the committee was focused on understanding the causes and also the impacts of workplace fatigue and bullying and finding practical evidence-based solutions to reduce both the incidence and the impacts of fatigue and bullying within the SA Health system.

The following definitions from Safe Work Australia applied to the inquiry, whereby bullying was defined as:

Workplace bullying is repeated and unreasonable behaviour directed towards a worker or a group of workers that creates a risk to health and safety.

Fatigue was defined as:

In a work context, fatigue is…mental and/or physical exhaustion that reduces [your] ability to perform [your] work safely and effectively.

In light of this, the committee accepted 66 written submissions from stakeholder organisations, as well as from individuals who shared their own personal experiences of workplace fatigue and bullying. We received a further 24 supplementary submissions, the majority of which were responses to a short questionnaire sent to all individual submission authors. In addition to this, the committee met with 48 witnesses, 13 of whom were current or past employees within SA Health and the remaining representing 19 Australia-based organisations.

While the committee sought submissions from a diverse range of stakeholder organisations and the general public more broadly, the majority of the evidence received focused on the SA public health system and, as a result, our report does likewise. Given the scope and complexity of the inquiry, the committee wanted to ensure that it consulted widely and fully understood all the key issues associated with workplace bullying and fatigue. It is for this reason that we developed a survey to assess the experiences of healthcare professionals with workplace fatigue and bullying. This resulted in a total of nearly 2,300 valid responses being received, and an overview of these results is available within the report.

The committee also undertook a site visit to a selection of SA Health sites, including Flinders Medical Centre, the Royal Adelaide Hospital, the SA Ambulance Service headquarters and Lyell McEwin Hospital. I would like to thank the member for Davenport for joining me at all four sites and also the Hon. Tung Ngo from the other place, who joined us at the Royal Adelaide Hospital.

It certainly gave us an opportunity to speak directly with SA Health staff about a range of important issues, including rostering practices at Flinders Hospital; the human resources procedures at the Royal Adelaide Hospital; the fatigue risk management in place at the Ambulance Service, which certainly, while in the end simple, actually made it very effective, and there were some good learnings we made from that visit; and also the incident reporting tools at the Lyell McEwin Hospital.

The evidence received by the committee clearly indicates that there are serious and widespread issues in the health industry, which have been protracted and are certainly ongoing and require urgent consideration and attention. The SASMOA junior doctors survey results showed that 70 per cent of junior doctors stated that bullying and harassment was a problem in their workplace. Dr Chris Moy, the President of the Australian Medical Association South Australia branch, gave evidence regarding major problems with regard to SA Health over a long period of time. He stated:

…firstly, a failure of leadership and accountability over many years…is best exemplified by the Royal Adelaide Hospital, which I think has had lost years of unstable leadership with CEOs changing every year while the NRAH was being built. This has led to particularly toxic culture being allowed to develop and that is what you are seeing now.

He then went on to speak about the traditional leadership structures, relating them to fish rotting at the head. When you think of that description, it certainly is a description of leadership that sounds very familiar to 2017 Oakden review into the Oakden aged-care facility, which stated, 'The fish rots from the head,' regarding failures of senior leadership. The Oakden review led to the ICAC commissioner, Bruce Lander, releasing his damning report into the matter, entitled 'Oakden: a shameful chapter in South Australia's history', in which Mr Lander stated:

…the evidence I have received makes it quite clear that, to a large extent, what was occurring at the Oakden Facility was unknown to ministers and chief executives.

To me that is astonishing. They ought to have known.

As I have said previously, the evidence the committee heard clearly indicates that bullying and fatigue issues in the SA Health system have been protracted and ongoing. You have to ask: is this just another case where previous health ministers, which includes the current Leader of the Opposition, did not know about the serious bullying and fatigue issues but ought to have? That is why the Liberal members of the Parliamentary Committee on Occupational Safety, Rehabilitation and Compensation established this inquiry into bullying and fatigue in the SA Health system through the committee's own motion on 16 October 2018: it was to shine a light on this very serious issue.

In reflecting on the evidence gathered throughout the inquiry, the committee has made 27 recommendations aimed at reducing the impact of workplace fatigue and bullying in SA hospitals and health services. The nature of these recommendations was informed by the evidence the committee received which, as noted previously, focused predominantly on issues within the SA public health system. That being said, a number of the recommendations are sufficiently broad as to apply to the health sector more broadly.

The committee found that the high-pressure nature of the work undertaken in hospitals and health services, coupled with the need to work long hours, shiftwork, overtime and on-call work, all as part of a 24/7 operation, creates an environment that places health professionals at greater risk of workplace fatigue and bullying. This is exacerbated by a poor workplace culture and a lack of contemporary management skills among many clinical leaders. The committee also received evidence of inadequate complaint resolution processes, leading to issues remaining unresolved and discouraging staff from reporting inappropriate behaviour.

Workplace fatigue and bullying can have detrimental impacts on the health and wellbeing of healthcare professionals. These impacts on both mental and physical health often stem from unsafe working practices, such as working excessive hours, having inadequate breaks and working irregular shift patterns. Further to this, both workplace fatigue and bullying can create a risk of emotional and physical burnout amongst staff.

The committee's recommendations aim to address areas where we see weaknesses in the way that workplace fatigue and bullying are currently being managed. The recommendations broadly fit within four key themes. Firstly, there is improvement to systems and processes. The report includes a series of recommendations focused on ensuring that SA Health takes a risk-based approach to preventing workplace fatigue and bullying and that it has sufficiently high-quality data to allow it to do so.

Secondly, there is complaint management and resolution. While preventative measures are a key focus of the recommendations in this report, the committee received evidence to suggest that existing SA Health complaint management and resolution processes have deficiencies that need to be resolved. Thirdly, there is having appropriate levels of accountability. The committee sees the advent of the new local health network governing boards as an opportune moment to improve accountability in addressing workplace fatigue and bullying so that each local health network can set themselves key performance indicators and try to actually attain them, knowing their own local conditions, and be held to account as well.

To this end, the committee has included a series of recommendations designed around the local health network boards, reporting against key performance indicators relating to workplace fatigue and bullying. The committee also sees SafeWork SA as playing a greater and more proactive role in ensuring that hospitals and health services are providing safe working environments for their staff and reducing the impacts of workplace fatigue and bullying.

The final group of recommendations relates to accreditation processes. During the inquiry, the committee wrote to both the ACSQHC and the Australian Council on Health Care Standards, which is an approved accrediting agency that undertakes accreditation against the NSQHS standards and is the main agency used by SA Health. We invited them to make a submission or to attend a witness hearing. Both organisations declined on the basis that they did not view workplace fatigue and bullying as being within the scope of their accreditation activities, given that there are no accreditation standards dealing directly with workplace fatigue and bullying. As such, they did not feel that they could contribute to the inquiry.

The view expressed in their response certainly did concern the committee, especially in terms of the potential impacts that workplace fatigue and bullying can have on patient outcomes. The committee is certainly concerned with the approach taken by the ACSQHC, given that the current NSQHS standards, particularly the clinical governance standard, are arguably broad enough to encompass consideration of workplace fatigue and bullying-related matters.

The committee does acknowledge that it has no jurisdiction over these bodies; however, given the importance that the NSQHS accreditation standards have in ensuring patient safety, the committee sees this as being an opportune mechanism through which to drive meaningful change, not only in the SA Health system but also in other jurisdictions with serious bullying and fatigue issues. This would be done by requiring the hospitals and health services to treat workplace fatigue and bullying with the same level of seriousness as other risks to patient safety.

Hence one of the recommendations was that the Minister for Health and Wellbeing work with the commonwealth Minister for Health to facilitate the introduction of changes to the clinical governance section of the National Safety and Quality Health Service Standards. These changes should explicitly address workplace fatigue and bullying matters and be incorporated as part of the Australian Health Service Safety and Quality Accreditation Scheme, coordinated by the Australian Commission on Safety and Quality in Health Care.

The primary aim of such changes is to ensure that medical professionals have a healthy and safe workplace, allowing them to provide patients and consumers with safe and high-quality care. Ultimately, workplace fatigue and bullying can lead to serious negative effects in the performance of staff, which can then impact on patient safety. It is for this reason alone that it is important that workplace fatigue and bullying in SA hospitals and health services are addressed as a matter of priority.

In the time remaining I would like to thank everyone who took the time to contribute to the work of the committee during the inquiry, including those who gave up their time to make submissions or appear before the committee at hearings. I would particularly like to thank the individuals who provided written submissions and appeared before the committee. Many of these individuals recounted their own very personal and often traumatic stories of fatigue and bullying to the committee, and the committee is extremely grateful to them for sharing these experiences. On many occasions we heard from witnesses who said that they have provided this information before and that nothing has happened. It is for their sake that it is so important that positive action occurs.

I would also like to thank members of the committee for their input and deliberations throughout the inquiry. Specifically, my thanks go to the member for Davenport, the member for Taylor and, from the other place, the Hon. John Dawkins, the Hon. Tammy Franks and the Hon. Tung Ngo. Finally, I would like to express my appreciation to the staff who supported the work of the committee during the inquiry, including parliamentary officers Mr Simon Macdonald, Ms Anthea Howard and Mr Phil Frensham, and research officer, Mr Eugene Braslavskiy. I commend this report to the house.

Mr GEE (Taylor) (11:20): I would like to add my contribution to the third report of the Fifty-Fourth Parliament by the Parliamentary Committee on Occupational Safety, Rehabilitation and Compensation, entitled 'Inquiry into workplace fatigue and bullying in South Australian hospitals and health services'. Firstly, I would like to thank the committee staff. Originally, we were assisted by Mr David Pegram and Ms Anthea Howard, followed by Mr Simon Macdonald and, finally, Mr Phil Frensham and the committee's research officer, Mr Eugene Braslavskiy.

I would like to acknowledge the members of the committee: the Hon. John Dawkins MLC; the Hon. Tammy Franks MLC; the Hon. Tung Ngo MLC; Mr Stephen Murray, member for Davenport; and the Presiding Member of the committee, Mr Stephen Patterson, the member for Morphett. I would also like to give thanks to the Hansard staff.

The inquiry commenced in October 2018, nearly 17 months ago, and it became clear fairly early on that it was going to take significantly longer than we had anticipated. I think it is important that I add my thanks to all the people who contributed to and participated in the inquiry. We received 66 submissions, 23 from organisations and 47 from individuals. We also received an additional 24 supplementary submissions. The committee heard from 48 individual witnesses. The terms of reference for the inquiry are as follows:

(a) The factors contributing to workplace fatigue and bullying in South Australian Hospitals and Health Services;

(b) The impact of workplace fatigue and bullying on the health and wellbeing of health care professionals;

(c) The impact of workplace fatigue and bullying on quality, safety and effective health services;

(d) The extent to which current work practices comply with relevant legislation, codes and industrial agreements;

(e) Opportunities, costs and impacts of measuring fatigue and using risk management tools, audit and compliance regimes, including those in other industries…to reduce the occurrence or impact of fatigue and bullying;

(f) Measures to improve the management and monitoring of workplace fatigue and bullying;

(g) The extent to which fatigue, including a comparison to other industry sector practices, is a factor that is taken into account during investigations into medical misadventure;

(h) Any other relevant matters.

I will briefly talk about some of the evidence received by the committee during the inquiry. I feel as though really we were just scratching the surface. SA Health is a huge organisation that operates across a huge area 24 hours a day, seven days a week and comprises an enormous number of diverse and complex processes and procedures. We heard that much of the system is under considerable pressure most of the time and that fatigue is commonplace, even affecting employees at the beginning of their shifts, and even before work and during downtime and days off.

The report identifies that causes of fatigue include the type and nature of work. These are highlighted on page 19 of the report:

…high-pressure environment in which many staff work makes them vulnerable to workplace fatigue and bullying. Common frustrations such as job pressure and stress can result in creating an environment where bullying and fatigue are able to flourish.

Healthcare professionals have a level of responsibility for the health of their patients, which can predispose them to a higher risk of psychological distress. The impact can be particularly pronounced for first responders and emergency service workers. Heavy workloads can also result in aggression and dissatisfaction between staff. This was highlighted by Dr Chris Moy from the AMA by way of an example of what this looks like 'on a day-to-day basis in SA hospitals'. Dr Moy said:

This is Dr A of one ward ringing Dr B on another ward requesting him to assess a patient for possible admission to Dr B's ward to which Dr B says, [expletive] and puts the phone down, and that's the end of the discussion…That second consultant—consultant B, Dr B—is going to say [that] because he's got no beds, and he's been up for five days.

It is generally accepted that shiftwork is a significant contributing factor to fatigue, and shiftworkers, particularly those who work night shifts, are at a higher risk of fatigue.

The Australian College of Nursing also noted that in a profession where your job is to care for people in pain and suffering, there is a risk that this may be internalised and result in compassion fatigue, ultimately leading to professional burnout and job dissatisfaction. The Australian Nursing and Midwifery Federation noted that 'challenging behaviours and violence is another safety issue that our members are regularly subjected to and is also a major contributing factor to work fatigue and bullying'. Also identified as a cause of fatigue was poor workplace culture.

Evidence received by the committee suggested that poor workplace culture is a key cause of fatigue and bullying in hospitals and health services. One of the key issues identified is the hierarchical nature of the workforce, which has allowed a culture to develop where junior staff do not feel like they are able to speak out about issues without prejudicing their career progression.

SASMOA noted in its submission that managers frequently receive no training in how to manage. There is no instruction, no mentoring and no framework for medical managers. There is no advice on what is and is not acceptable behaviour and there is no auditing of behaviour. In the last round of enterprise bargaining, SASMOA attempted to include a clause regarding the monitoring of medical managers’ style and approach to address concerns about bullying; however, this was rejected by SA Health.

The committee also heard evidence to suggest that there is cultural pressure on staff to work long hours. In response to a question on whether it was a fair assessment that a large part of fatigue-related issues is due to lack of veracity of timesheets, Bernadette Mulholland from the South Australian Salaried Medical Officers Association agreed that this would 'correlate with fatigue and bullying'.

Anita Filleti from Medical Insurance Group Australia (MIGA) also confirmed that MIGA receives reports from its members that there is a pressure to not report their full hours worked. This pressure was demonstrated in a number of examples provided by submission authors. One individual described a situation where they had to take carer's leave due to their child rapidly developing a life-threatening illness.

While on leave, they continued to receive revised rosters, had repeated requests from a colleague to make up time and their head of unit verbally expressed the view that it was appropriate for them to make up the time because it was not they who were sick. There is an entrenched culture of mistreating trainee medical officers throughout SA Health, which perpetuates the bullying and burnout of our young doctors. One of our young doctors said:

The only time I ever complained about excessively onerous rostering, I was told in writing, 'It doesn't matter what's in your EBA, this is what’s expected of you by the director of physician training at the CALHN hospital.' I was so exhausted and demoralised by this stage that I didn't have the will or the strength to escalate the complaint so I just quit my job.

I am going to run out of time before I even get through a fraction of this report so, instead of going any further with this, I will just indicate that with an organisation of this size the behaviour is so entrenched that it is very difficult to point the finger of blame at anybody. I was disappointed that the Presiding Member pointed at previous health ministers and the Leader of the Opposition. I think the committee identified this as something that is solely the responsibility of the government—

The SPEAKER: Member for Taylor, with respect, your time has expired. Did you want to just wrap up, or are you done?

Members interjecting:

The SPEAKER: Yes, I am trying to be fair and give him an opportunity to wind up.

Time expired.

Mr MURRAY (Davenport) (11:31): I, too, rise to speak to the third report of the Parliamentary Committee on Occupational Safety, Rehabilitation and Compensation, entitled 'Inquiry into workplace fatigue and bullying in South Australian hospitals and health services'. I will start by proffering my thanks, though I will not detail it as other speakers have done, first and foremost to those who gave evidence to the committee both on a personal and professional basis.

It was heartening to see the large number of professionals committed to doing what they could to elucidate or enlighten us as to better ways to address the two primary criteria of our inquiry, which were the measurement and management of both bullying and fatigue-related issues, which are particularly troubling. All members were united in their concern about some of the stories we heard from people relaying their stories of bullying and/or fatigue-related issues as well.

My thanks also go to other committee members for your shared commitment, notwithstanding our political and philosophical differences on many issues, to ensuring that our health system is run as well as possible and that we address these two issues in particular. I also want to thank the staff who were particularly helpful in enabling us to get through a considerable amount of work and helped us prepare a series of what I think are fairly cogent recommendations.

By way of background, I was extraordinarily keen to see an inquiry into bullying in particular. As the member for Davenport, my electorate includes the Flinders hospital and a large number of the people who work at Flinders hospital. The evidence provided to me on the doorsteps and in shopping centres in my electorate by a large number of people working in the health system was that they were systematically bullied—in this instance regarding the failures of the Transforming Health system, but that is not the point. The point is that if it is possible to bully people successfully with regard to one issue, then by definition it is possible to bully them about anything in particular.

I just want to touch briefly on what are for me some of the major takeaways. As the member for Morphett described, as an overview we have made 27 recommendations that are directed at improving a number of things: systems and processes, complaint management systems, the need for accountability and, similarly, the need for enhanced accreditation. The size of the problem is enormous in our health system. You can measure it any way you like, but it has been a longstanding issue on both counts of bullying and fatigue-related issues.

I will not go into detail regarding the extent to which they are issues; they are detailed in a variety of tables and graphs in the report. Suffice to say, the health system experiences and exhibits significant issues in both those. What I do want to take the opportunity to do with the time available to me is cover off what, for me at least, are the major or pertinent recommendations.

I point the parliament to recommendations 2, 3, 4 and 5, which primarily deal with issues of accreditation. It is the committee's view that the health services should have a series of processes in place to enable accreditation of facilities to take account of their relative performance insofar as management of bullying and related issues is concerned, as well as having a working fatigue and related risk management system in place.

Recommendation 2 talks about accreditation at our hospitals, and likewise recommendations 3, 4 and 5 are, as I said, related. Our view is that professional boards and colleges, etc., should, as a matter of practice, be addressing these issues as part of the accreditation of a facility. If we are collectively serious about stamping these out and addressing these in our system, then the accreditation of our health services and health facilities should cover those off.

I will provide a quote. The member for Morphett has touched on it, but it is astounding, in my view, that the committee wrote to the Australian Commission on Safety and Quality in Health Care as well as the Australian Council on Healthcare Standards and invited them to make a submission and they declined because, in their view, they could provide nothing to us because accreditation does not take into account either of these two very important issues.

The second recommendation I want to point to is recommendation 12, which covers the use of timecards and/or hours reporting. To me, it is completely axiomatic that it be a legal requirement that timecards are not falsified. If timecards are not falsified, then we cannot have a situation where people are working longer hours than is indicated. The evidence to the committee, repeated evidence as well as anecdotal evidence I have heard in speaking to health employees, is that they are pressured; subordinate staff are pressured to falsify their timecards and show fewer hours worked on those timecards than are actually correct.

My very strong view is we should legally mandate that it is a major offence either to submit a false timecard or procure one. I point to the fact that operators of heavy machinery and our pilots are mandated, for very obvious reasons, to have place in appropriate fatigue management processes, in particular, yet in our health system it seems, at best, to be optional. That is unconscionable in my view.

Recommendations 19 and 20 relate to the HR systems and bullying and record keeping. The evidence we heard indicated that, quite frankly, the record keeping for bullying, in particular, and/or HR-related issues is woeful at best. There are no proper systems, and each of the local health networks are effectively silos: they have their own processes and they have their own 'systems'. There is no consistent methodology across them for measuring, tracking and managing the issue.

Without that consistency, and without a failsafe process to enable the management of the system all the way up to the top to know that all bullying accusations are recorded and managed properly, by definition it is not possible to properly address them. So I point people in the direction of that particular set of benchmarks. In my view, the primary suggestion emanating from the report and the overwhelming need, again in my view the number one issue, is the fact that there are no consistent KPIs or benchmarking for our health facilities to enable a drill down or assessment from the department, down to the LHN, down to the hospital department and the subdepartment. To the question of why that is important, it is important because we heard time and again evidence from people of silos or pockets of bullying with no reporting up and no visibility. No knowledge means no attempt made to address it.

Without that, it is not going to be possible to isolate problem areas in hospital departments, hospital networks, etc., and address them. In my personal view, every manager in the health department should be assessed and made accountable for KPIs for the wellness of staff and, in particular, the susceptibility of staff to bullying. This is a relatively cheap and easy process to implement. It is the number one issue, in my view. If there is a will to do so, then it should be done. I cannot stress enough that, to me at least, that is the number one problem. If it is addressed properly, it will also enable a considerable uplift in staff morale.

In closing, I will recap our summary from page 106 of the report, which I think is also pertinent. The fact is that these issues have been raised as part of other reviews and reports. None of this is news. The reality is that we need to address these, and we need to address them quickly if we are serious about addressing these as serious issues. That said, I commend the report to the house.

Mr PICTON (Kaurna) (11:41): I rise to speak in relation to the inquiry of the Parliamentary Committee on Occupational Safety, Rehabilitation and Compensation into workplace fatigue and bullying in South Australian hospitals and health services. Clearly, this is a very important subject. Clearly, bullying and workplace fatigue among our more than 30,000 people who work in SA Health have an impact not just upon those staff themselves but on the hundreds of thousands of patients who require services at our public hospitals and health services every year.

What is clear from this report is that bullying and fatigue issues are not going away. They are only increasing and becoming worse, and everything that needs to be done to stop that should be done. There is a very clear connection between the issues of fatigue, shortage of staff and bullying and harassment that takes place. It is clear from the report, it is clear from what we have heard from our health professionals and it is clear from what we have heard from different experts that more and more pressure placed upon our staff can equal some horrible results in terms of bullying and harassment and ultimately worse outcomes for patients and risks to their safety and the quality of their health care.

I think that when you look at the report you can see that sadly many of our staff are working far too much. Many of our staff are working without being compensated for the work they are doing. Many of our staff are being pushed to their limits, and that creates cultural problems and bullying and harassment problems across our staff. This is an issue across all the disciplines of health. There are issues that have been clearly articulated in terms of the medical workforce, but it is much broader than that, including nursing, allied health, paramedics and so on.

If you look at the report, you can see very clearly that through the survey work that was done for the report, which I think was a good approach for the committee to take in terms of getting some direct primary-source information to feed into their work, the number of hours worked over a typical seven-day period in some cases is quite dramatic. In a seven-day period, full-time equivalent hours would be 37½ hours.

But when you look across medical, nursing, midwifery, allied health, ambulance, as well as administration and facilities staff, many people are working more than 50, 60, 70 hours, sometimes over 78 hours. The highest levels are when you look at medical staff and ambulance staff, where many people are working over 78 hours in just one week—one seven-day period—which is clearly not sustainable and clearly not permitted under the proper enterprise bargaining and workplace laws. But that is happening and it is creating issues of fatigue.

You can also see in the report very clearly where the reporting is happening. You can see the top areas for people having witnessed harassment or bullying in the current workplace over the past 12 months. The top-line figures are in the Northern Adelaide Local Health Network (NALHN) and the Women's and Children's Health Network, where 51 per cent of people in both those areas have witnessed harassment or bullying in their current workplace over the past 12 months.

Next in line is the Central Adelaide Local Health Network (CALHN), representing The QEH and the RAH, where 50 per cent of people have witnessed harassment or bullying; then the Southern Adelaide Local Health Network (SALHN), 49 per cent; Country Health, 49 per cent; and SA Ambulance, 48 per cent. Compare that to the public sector as a whole, which is 37 per cent, so it is significantly higher in Health.

For people who have been subjected to harassment or bullying in the current workplace—so this is not just someone saying, 'I have seen it happen to somebody else, but it's actually happened to me'—the top-line figures again are in the Northern Adelaide Local Health Network, where 32 per cent of people have been subjected, and 31 per cent of people in the Women's and Children's Health Network. Coming down from there, it is 29 per cent of people in SA Ambulance Service, 28 per cent of people in both Country Health and SALHN, and 27 per cent of people in the Central Adelaide Local Health Network.

This is very important because, when you look at what is happening right now in our health services, you clearly have these people who are overworked you clearly have people who are pushed to their limit. They are clearly experiencing the effects of that in terms of harassment and workplace bullying in the system and what we are having is a process of cutting those staff, making the problem even worse. Some of the first places that were highlighted were some of those places which have reported the highest percentages of people who have witnessed bullying and harassment in terms of the Northern Adelaide, Women's and Children's, and Central Adelaide local health networks. They were the first people to put up their hands and say, 'We would like to cut our clinical staff.'

That is a process that is underway at the moment. There are hundreds of applications that the government is considering and, if those applications are accepted, they are not going to replace those people with more clinicians coming in. Those positions will be abolished. The work will have to be spread amongst the smaller number of people working there, and that is only going to increase the fatigue and the pressure. Ultimately, we see the result of that in a lot of the bullying and harassment that is taking place.

Many key medical, nursing and other professional groups participated in this inquiry, and I thank them for their work and their ability to stand up and say that bullying and harassment should not happen and that we should get to the root causes of why it is happening to stamp it out. In that vein, just last weekend, we had a summit from the Australian Medical Association, led by its new president, Chris Moy, who has made very clear that in his term he wants bullying and harassment to be one of the top priorities for the AMA in terms of stamping it out. I was delighted to be there, along with the member for Morphett and the health minister.

During that presentation at this summit, some other very startling statistics were presented on what is going on in our health system right now. This was part of the AMA Hospital Health Check Survey to review what is happening in terms of fatigue of staff and also in terms of bullying and harassment. You can see very clearly that there are many people who are pushed to their limits in the system. For instance, between 5.6 and 29.8 per cent of doctors at teaching hospitals said that they worked more than 15 hours a fortnight of unrostered overtime.

Between 15 per cent and 23 per cent of participants in different hospitals and health services had annual leave applications denied. When leave was approved, a lengthy approval process was experienced by as many as 40 per cent of doctors. Between 37.5 per cent and 56.9 per cent of doctors reported rarely or never taking sick leave when they should. Between 43.8 per cent and 69 per cent of doctors indicated concerns about making clinical errors due to fatigue. Very clearly, the connection is being drawn there by the medical staff themselves between their fatigue and the impact upon patients.

At one hospital, 70 per cent of respondents reported being concerned about their personal safety due to fatigue—for example, experiencing microsleeps driving home from work. Between 18.8 per cent and 38.9 per cent of surveyed participants said that they were unable to take mandated shift breaks. As Dr Moy articulated at the summit, good people go to these jobs, have an unrealistic workload when they get there, and it does not take very long for the pressure to build and for them to start acting in ways that they should not and they might otherwise not.

That is borne out in terms of bullying and harassment, where between 53.8 per cent and 61 per cent of surveyed participants in the three major teaching hospitals reported experiencing personal bullying or harassment from consultants, registrars or nurses. Patients and family members were identified as being responsible for bullying or harassment by between 13 and 22 per cent of participants.

There is a whole lot of data, going hospital by hospital through these figures, and you can see very clearly that the issues are in some of our major teaching hospitals. The government need to address this issue, they need to take action and they need to stop cutting the staff, which is making it worse.

Mr PATTERSON (Morphett) (11:51): I thank other members for their contributions and for acknowledging what a serious issue bullying and fatigue is in our SA Health system. I thank the members for Taylor, Davenport and Kaurna. From those contributions, we heard about the serious issues that are in place in the SA Health system.

I should say from the outset that there was quite clear evidence that many SA Health employees are doing really great work. The overwhelming majority of them are dedicated professionals and they are working very hard to deliver quality results to the community. There are stories of their being fatigued but not wanting to take leave because they do not want to let down their fellow health professional because they know that load will just go onto them. The member for Kaurna commented that the government should do this, and that is what we have actually done. We went into this inquiry—

Mr Picton: You are cutting staff.

The SPEAKER: The member for Kaurna will not interject out of his seat.

Mr PATTERSON: —in the very early days. He fails to acknowledge that this government has put in—

Mr Picton: You are cutting staff.

Mr PATTERSON: —$1 billion over four years—

Members interjecting:

The SPEAKER: The member for Kaurna is called to order, as is the member for Davenport and the member for Kavel.

Mr PATTERSON: —back into the health system. We have reactivated the Repat. You talk about cutting staff—well, what about the Repat? Where is that? Cut. What about Noarlunga, where you are? Were you fighting for that? Cut. In fact, the member for Davenport and I—

Mr PICTON: Point of order, sir.

The SPEAKER: Member for Morphett, please be seated for one moment.

Mr PICTON: I believe standing orders say that members should direct their comments through the Chair.

The SPEAKER: That is true. I caution the member for Morphett and remind him he is not on the wing playing for Collingwood anymore—although it was great to see him when he was. Member for Morphett.

Mr PATTERSON: What I should say is that we are doing something about this as well in regard to the emergency department. The member for Davenport and I took this very seriously. We went to all four sites. We went to the Flinders hospital, and we saw their emergency department and the very real pressures they are under and what they need there. They have an ageing demographic in that area, so this government has committed funding to increase the capacity of that emergency department for the very reason to help those staff out—because they are fatigued. These issues have been ongoing for a long time.

Mr Murray interjecting:

The SPEAKER: Member for Davenport! The member for Morphett has the call.

Mr PATTERSON: I would remind members that there is action being taken and it is very pleasing. I think it is as a direct result principally, although there may be other reasons as well, of the AMA's culture and bullying summits last week. Dr Chris Moy came and gave evidence to the committee around bullying and fatigue. It is a good thing that there is progress and that this is being taken seriously because we have shone a light on it.

As Dr Moy said, it is a line in the sand. He sees this as one of his biggest challenges, and it certainly is because it is about good people working in a system and making sure that the culture around them encourages them to be their best and, in turn, give very good and safe service to their patients, who are ultimately many South Australians, so that is very important. The member for Davenport also spoke about the real importance of having KPIs and having transparency so that this can be compared.

If we look at what is going on in other jurisdictions, Western Australia has been doing a Hospital Health Check Survey since 2015 and, surprise, surprise, all the hospitals are suddenly taking action in this regard now that the light is being shone upon them to the point where it impacts them because junior doctors want to choose hospitals that rate very well in terms of the health check. So if this can be introduced into our South Australian system, where we have yearly reporting where you can drill down into different local health networks, that can only be good.

To finish on a positive note, in terms of other information that Dr Moy gave us, in regard to what has happened in other hospitals and how they can turn culture around, it does take time, but the first way to address it is to recognise it, which is what this committee has done, and then once it is recognised, it can be turned around. Royal Prince Alfred Hospital had similar issues to those we are now experiencing at the Royal Adelaide Hospital and they have been able to turn that around and eliminate the culture of bullying that was going on. The flow-on effect of course then becomes safer patient outcomes for the South Australian public. I thank members of the committee for their work on this report and I commend the report to the house.

Motion carried.

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