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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2022-06-15 Daily Xml
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Motions

Regional Health Services

Mr ELLIS (Narungga) (10:37): I move:

That this house—

(a) recognises the serious shortage of doctors and other medical staff in regional South Australia;

(b) acknowledges that regional South Australians are just as worthy of access to quality health care as those in the metropolitan areas;

(c) notes that incentivising doctors in regional South Australia has not worked and that it is time to guarantee it;

(d) calls on the state government to ensure the equal distribution of general practitioner doctors around regional South Australia, now and in the future; and

(e) calls on the state government to establish a dedicated department of regional health to support access to quality health care across South Australia.

It is a wonderful honour to move this motion today. It is not necessarily a pleasant one but an honour nonetheless because I suspect that this is the issue about which the most significant majority of regional South Australians feel most passionate. It is not an exaggeration to say that regional health care is the issue about which I get approached most in the street. It is the subject of the majority of the meetings I have in my office and, personally, was the primary reason I was inspired to run for parliament in the first place.

We are all elected, and I am sure everyone is here with the greatest of intent, because the voters wanted us to get things done. For the government that mandate is an obvious one on the back of a strong election result. Similarly, I think it is obvious for us as regional representatives that health care is something that voters want action on. Enough platitudes by politicians, it is time for decisive action to address the shortfall in doctors and medical practitioners in regional South Australia.

We are very lucky on Yorke Peninsula and in the electorate of Narungga to have some tremendous, long-serving general practitioners staffing private clinics in towns the length and breadth of the electorate. They are extraordinarily hardworking and serve a significant population in their private clinics. Such is the demand on their specialist services that there can often be a significant wait for an appointment. That is of course not the fault of the wonderful GPs who do serve our communities; it is more a symptom of a shortage of doctors around regional SA so that that burden is spread amongst too few to treat far too many.

Unfortunately, that shortage of GPs has bled into our public health system as well. Over the past decade or so, GPs across the electorate have withdrawn their services as on-call doctors at our local hospitals because of the impost on their time and the relative lack of compensation, especially when compared with the locum doctors working the same shifts in the same hospitals.

That has led to a locum model that does not lend itself particularly well to continuity of care for people who rely on our local hospitals, and that, I would submit, does terrible things for the bottom line of our local health networks. It must be an expensive proposition to run: having to transport locum doctors in, house them for the duration of their shift and pay them for their time at the hospital.

Therein lies the most significant issue that we have in our electorate: a shortage of regional health professionals. As has been articulated, this is the case for doctors in our clinics and hospitals and also for nurses, pharmacists, dentists and others. It often feels to us as regional South Australians as if we are less worthy of those services that people in the city might well take for granted, which obviously should not be the case.

Those in regional SA are just as deserving of the ability to show up at an ED and expect to see a doctor in a reasonable time, and we are just as deserving of the ability to make an appointment to see a GP at a clinic and expect to get an appointment in a reasonable time frame. I submit that currently this is not the case.

We have significant issues in hospitals up and down the peninsula, from perhaps our biggest hospital at Wallaroo—which is the subject of many inquiries to my office about waiting times for those who show up at the ED and the standard of care provided by locum doctors and a whole raft of other issues that need to be sorted out quick smart—to smaller sites at Maitland, Minlaton and Yorketown and our wonderful community-owned hospital at Ardrossan, which does an exceptional job serving that wonderful community there on the coast. All of them are facing issues that can basically be boiled down to a shortage of trained staff and a difficulty in manning shifts at their hospitals.

Over the course of the previous government, and I hope it will continue as we progress through this one, I have been pleased to secure significant capital investment at hospitals up and down the peninsula. There is a brand-new surgery at Yorketown, which is currently filling lists of minor operations; there was a significant investment of money at Ardrossan, which helped cover the cost of manning their ED for uninsured patients who presented; there were significant alterations at the Snowtown Lumeah Homes that widened the corridors to allow sufficient room for hospital beds to be transported up and down the corridors; as well as smaller but no less meaningful upgrades elsewhere at other hospitals.

Despite all that wonderful work in upgrading the facilities, none of those works can overcome the difficulties in attracting health professionals. The locum model of staffing at public hospitals has been a disaster. We have doctors there sporadically with no attachment to the area, no ties to the people they are treating, and whose daily remuneration distorts the market and makes it difficult to attract doctors on a more permanent basis. The key part of this motion, and the part I will be clinging to most strongly as we progress through the debate, is that it has come time for action. It is time for the government—state and federal governments, I admit—to guarantee the equal distribution of doctors around our great state.

There are a large number of incentive programs on offer to encourage medical professionals to work in the country, the latest of which was an initiative of the previous federal government to offer to repay or to forgive the HECS debt of a medical practitioner who relocated to the country and to regional South Australia. This is an excellent initiative on paper, a tremendous idea—just like all the other incentives that are out there and available to try to attract doctors to regional SA.

There are more than enough carrots. It is time to get the stick out. None of the incentives are working like they should and it is time to guarantee equal distribution. Despite all these incentives, there remains a shortfall in doctors in regional SA and I would submit, as is contained in this motion, it is now time to take proactive action to ensure that all corners of our great state are serviced by the required number of doctors. We cannot leave regional health care to chance, that the incentives will finally attract a sufficient number of doctors to the parts of the state that need them. We need to now guarantee the equal distribution of doctors around the state so that those who need them can access them.

I fought hard over the course of the last government to secure funding to employ doctors at Wallaroo Hospital—a relatively rare thing in this state, to have staff doctors rather than rely on locums and local GPs. Unfortunately, despite that funding being provided—and thanks in no small part to the distortion that arose as a result of those locum wages—those three FTE positions have been advertised at the Wallaroo Hospital on three separate occasions to no avail. Each time we advertise we get a small number of applicants and by the time we reach the negotiation phase they have fallen through and reverted back to servicing hospitals around the state as a locum. We have not been able to attract anyone to take up these roles.

Compounding the issue, and this is particularly disappointing from my perspective, I know that there are local GPs who have previously served the hospital on a rotational basis and who are keen to maintain their skills. Those GPs genuinely enjoy working in that hospital and would be keen to re-up their commitment and rejoin the hospital and do small shifts here and there—not whole day shifts, not 12-hour shifts, but small shifts here and there—but they are being frozen out by the local health network, which is beholden to locum agencies.

Unfortunately, when these LHNs attract a locum agency these agencies can have a tendency to demand a full day or a full three-day block to ensure that it is worth their locum's time getting out there, which makes it very difficult to provide small shifts for local doctors to fit in with their work at the clinic.

A further part of this motion calls for the establishment of a department of regional health. While I do not profess to be an expert in the machinery of government and how it all works, I have formed a view that, no matter from which party they originate, the job of the Minister for Health and Wellbeing is too large of a task for a single person.

In addition to that, I have also formed a view that the problems, or at least some of the problems that we face in regional SA, are quite distinct from those that are being faced in the metropolitan area. As a means to ensure those distinct issues receive the attention they deserve, I believe that the current department could be devolved so that regional SA has its own hierarchy.

This new hypothetical department would work with the local health networks established by the previous government to ensure that local hospitals are equipped to deal with the issues as they present themselves. We would also, I believe, be better placed to develop policies that would proactively solve the problems before they present themselves. Having a minister, or at least an assistant minister for regional health, means we would finally have someone banging their fists on the table in the cabinet room on our behalf to ensure that we get the outcomes that we deserve in regional SA.

In concluding, the time for action is now. Enough of the platitudes; we need decisive action to guarantee the equal distribution of doctors around the state. As I said at the opening, this is the issue about which I think the majority of regional South Australians feel most passionate. It is really a hot-button issue that gets brought up time and time again and is a source of great frustration for people who desperately need health care.

When they show up to an ED in a situation that cannot wait, that cannot be put off, and they have to sit in the waiting room for a number hours before they can be seen by anyone, it can really be distressing, and it is a terrible shame when those people give up being patient, jump in the car and have to drive off to Adelaide. It is two hours in an uncomfortable car that could otherwise be spent in getting treatment. Not only that, but it deprives the hospital of a statistic that might otherwise be used as a help to justify increased services.

Even if those people do not go to the hospital and decide to go to Adelaide straightaway rather than wait around for a service, it means that we do not get those numbers through the door; consequently, when it comes time to argue for an increased service, we are faced with the proposition of having to deal with a set of numbers in a table that shows that the hospital is not as busy as it used to be and that there is no need to continue to improve services there or to provide the same level of service that used to be there.

It is imperative and it is vital that we now take proactive action to ensure that we get those services. I know that the voters in this state expect it from us, and I am hoping that the parliament as a whole—not the government, not the opposition, but parliament as a whole—can step up and provide that very thing. I commend the motion to the house; not only that, I also urge this parliament to use it as a trigger for action. We have reached the tipping point and cannot wait any longer. I look forward to the debate progressing.

The Hon. C.J. PICTON (Kaurna—Minister for Health and Wellbeing) (10:48): I thank the member for moving this motion. I do have some amendments in relation to the motion. I move to replace (c), (d) and (e) with:

(c) notes that previous approaches to incentivising doctors in regional South Australia have not worked and that it is time for new strategies;

(d) calls on the state government to work with the commonwealth government to ensure the equitable distribution of general practitioner doctors around regional South Australia, now and in the future; and

(e) calls on the state government to work with regional clinicians and communities and regional local health network boards to support access to quality health care across Australia.

In doing so, I have tried to keep the crux of what the member for Narungga has moved in the parliament because I know his passion for this issue, and its importance in terms of all regional members of this parliament is an issue I have spoken about a number of times already to the member for Narungga in this house since we have been elected. I have also spoken many times to members such as the member for Giles, who has raised this issue repeatedly with me since my time in parliament, as well as the member for Mawson. I know this is particularly an issue for Kangaroo Island as well.

We have seen the situation get worse and worse, unfortunately. We have seen the situation deteriorate over time. While I think there has been a lot of goodwill from successive governments of both persuasions to consider this matter, we have not seen significant action that has really turned the dial for this situation, which is getting worse. As the member for Narungga has said, that means we have communities that need a local doctor that do not have one. We have communities where we are now, at great expense to the taxpayer, flying in and out locum services to those areas. We now have a professionalisation of locums, where it is easier and better remunerated to become a professional locum rather than become a local doctor in a particular area.

I am concerned to hear what we have heard from the member for Narungga today, that he has general practitioners in his local area who would like to work in the hospital, who would like to work in the emergency department, perhaps not at the full extent that they had previously, but they would like shifts here or there to maintain their skills and provide support to the local area. That is absolutely something that I am keen to chase up with the member for Narungga to make sure that we do everything we possibly can to have those GPs connected back into the system.

This is something where we clearly have had a lack of proper workforce planning for the state for some time. We are inheriting a situation where we do not have a state workforce plan. The previous government said that they would do work in this space. We have a number of regional medical plans and other professional plans that have been put in place, but there has not been a significant extent of implementation of the recommendations.

There are a lot of glossy booklets that are sitting on shelves but have not been put into action. As the new minister, I am particularly keen that we put these recommendations that we know have been in place for some time into action and get to work. We need to work with the local health networks, we need to work with the local communities and we need to work with the federal government.

The federal government have a particularly important role to play here because they control a whole lot of the levers that are impacting this issue. They control the levers at universities of how many doctors graduate and in which universities across the country. They control levers in terms of Medicare payments, how much doctors are paid and what incentives are paid. I think that is a very important reason why we need to include in this motion the role of the federal government in providing for regional doctors in South Australia. That is why I have added that in my amendment.

The other element where I have made an amendment is in relation to the suggestion of a new department of regional health. I will have to agree to disagree with the member for Narungga because I am not advocating for a new department to be put into operation. If I thought that would lead to more doctors being in place in South Australia, then I would have no doubt about doing so, but I think that would lead to more bureaucrats, to be honest. To put words in the member for Narungga's mouth, probably the last thing the member for Narungga would like to see is more bureaucrats in South Australia.

I would like to see more money devoted to health service delivery. We have inherited a situation and a new system in place for local health network boards across South Australia. That is not something that I have sought to rip up and replace, but I do want to see them operating effectively, and I do want to see them playing an important role in delivering recruitment and retention of medical staff on the ground. The experience of that has been variable from location to location.

There are areas in the state where we have been doing that well. I look at the Riverland Mallee Local Health Network board, which has been ably led by some medical leaders in that area who have been doing an excellent job in not only reconnecting with local general practitioners but also creating innovative training pathways for general practitioners, particularly in terms of the Rural Generalist Program, which has really been spearheaded by Professor Paul Worley in the Riverland LHN.

That is what we want to see happening across the state, and I want to see that same level of enthusiasm we are seeing up there applied right across regional areas in South Australia. It is important that we work on that with the federal government and also the universities, and I know universities in South Australia have enthusiasm for doing more in this space.

There has been an issue where the previous federal government pulled back a number of medical training places in the hope they would go into regional training. All that has happened so far is that we have had a new regional medical school developed—I believe in New South Wales—but not in an area of significant shortfall as we see in South Australia. We have not seen any benefit of that coming to South Australia, and there are still places for students that have been held back.

We will be advocating that South Australia gets our fair share of those. I know, from discussions with both Adelaide University and Flinders University, that they are both eager to play their role in terms of training more doctors in regional South Australia. Ultimately, the more doctors we have who come from regional areas and who get trained in regional areas, the more likely it is we will see doctors ending up working in regional areas.

As well as that, we need some to properly develop and implement programs such as the GP Rural Generalist Program, which I am a strong advocate for. We need to work with local communities, and I have spoken to a number of local councils that are keen to play their role in helping to attract workforce into their areas.

The other element I would like to highlight in my remaining time is that, while I know the focus of this motion is specifically on doctors, we also have an issue with a range of other health practitioners: nurses, midwives, allied health professionals. We see significant shortages of these in a number of areas across regional South Australia at the moment, and we need to take action in those areas as well, working at both the training level and the attraction and retention end.

We know there was a protracted negotiation in terms of doctors and their contracting arrangements that I think led to significant anguish for a number of doctors, and a number of doctors have spoken out and a number have left the workforce over the course of those negotiations. I am glad that in the final days of the previous government that negotiation was completed, and I am certainly working to get those arrangements in place as soon as possible to make sure that doctors can be properly remunerated and that we have the best possible attraction and retention.

I thank the member for Narungga for his motion. I support it with some amendments, and I look forward to working with him and other regional members to make sure we address this very high priority issue.

Ms PRATT (Frome) (10:58): I rise today to support the motion, in full, that has been presented by the member for Narungga. Regional health is incredibly complex and, as both a regional member of parliament and the shadow minister for regional health services, I am committed to doing all I can to advocate for and strive to provide better services for regional people.

I am excited about the opportunity to advocate for regional health and prepare policy as we head towards the next state election, with an opportunity to present an alternative vision for regional health for South Australians at the March 2026 state election, whilst also holding the government to account for their strategically located regional commitments and providing constructive ideas to better our system going forward.

As the shadow minister for regional health services, I am proud to be working alongside two fellow regional members of parliament. In the health portfolios, I note the member for Schubert and the member for Chaffey, which, in turn, triples our voice in this space. It is worth noting that the Labor government does not have a dedicated minister for regional health, and I commend the leader of the South Australian Liberal Party for his vision and his commitment to services in the regions. I cannot ever recall that a Labor regional member of parliament has held the health portfolio in a Labor government, but I can assure the member for Narungga that we are collectively banging our fists on the shadow cabinet table in relation to regional health services.

I am no stranger to the acute challenges facing regional South Australia in relation to the procurement, access and retention of healthcare and health professionals and the impact this has on the everyday lives of regional people and our communities. Although Premier Malinauskas and his health minister have declared that services should not be limited to one's postcode, that sentiment does not translate into practice. I will never begrudge funding and investment into regional SA but, on the face of it, the only health-related capital works programs coming out of the budget are to be found in our bigger regional centres like Port Augusta, Mount Gambier and Mount Barker. Of course we welcome those investments, but you will not be surprised that I will keep calling for more.

Given the estimated completion dates that are set out in the forward years, past yet another election, I think the local members are entitled to be disappointed that this government have put their projects in the slow lane. We are all aware in this chamber that our regions are the economic powerhouse of this state. The economic contribution of South Australia's regions was around $31.2 billion in the 2020-21 financial year. My own electorate of Frome is the third largest contributor to the economy, representing $4.5 billion of the gross regional product.

I reference this because these successes from hard work mean more money back in the local economy too. Our farmers are spending money in towns, their families are growing, the schools are filling up and the doctors who appreciate the lifestyle choices and work-life balance that should be possible for a country practice are on the table. Recruiting and retaining general practitioners is a national challenge, and it will now be a matter for the Albanese Labor government to work with the states to address this critical service to regional Australia.

As we know, health care takes many forms, all of which play an important role in the overall health outcomes for individuals and communities; they are the preventative, acute and emergency layers of issues. The imbalance of the health workforce around the country will likely only be resolved through the implementation of a range of policies to get more GPs, nurses and allied health professionals to the areas where they are needed most.

The Deloitte 'General Practitioner workforce report' revealed that by 2030 the demand for GPs in Australia would rise by 17.6 per cent in the regions and 47 per cent in major cities—quite a challenge, I think. One of the reasons is an ageing workforce, with the report finding the workforce would lose about 1,500 GPs to retirement in the next three years.

Although much has been said about the need to incentivise graduates to choose general practice instead of specialising, and then the need to incentivise GPs to choose to live in the country, this is still a challenge that governments, clinics, practices and local hospital boards face together. It should not be for communities to solve this issue, but they do suffer. Securing GPs in regional areas is multifaceted, and along with my neighbours, the members for Narungga, Chaffey, Stuart and Schubert, I relish the chance to be a part of the solution.

The Malinauskas Labor government has had a chance to be a part of the solution. In fact, they had 16 years of opportunities to be a part of the solution—in this instance, an opportunity to alleviate the rising cost-of-living pressures on ailing patients, but they failed at the first hurdle. The state budget afforded this government an opportunity to put their money where their mouth is and double the rebate for the Patient Assistance Transport Scheme, commonly known as PATS.

Our loved ones do not choose to be sick, but when the only specialist service is in the city the complications and inconvenience pile up. Families need to plan for days or weeks away from the farm or town, plan for pets to be cared for and stock to be fed, for the grandchildren to be supervised and work to be rescheduled, and they also need to book and often pay for accommodation. I think the inconvenience is clear.

I have raised in this place the need for the support of this scheme, but the Labor health minister's response was to point to local infrastructure investments down the track and, although I welcome any dollar being spent on country health, these projects are set to be completed after the next state election and they are not going to assist regional people with acute or emergency health issues now. I am grateful for the conversations I have already had with members in this place about the health priorities and challenges in the regional areas we represent. No two communities are the same.

Finally, I extend my thanks to the member for Narungga for moving the motion and continuing to advocate for improvements in regional health. His community will be pleased to know that the member has successfully moved this motion as an extension of his commitment to achieving better outcomes for regional health services and improved standards of living and I share those sentiments.

I note his interest in the establishment of a dedicated department of regional health based on the New South Wales model and I look forward to future conversations with the member for Narungga, as well as within my own party, to explore innovative policy ideas in the regional health spaces. I support this motion.

Mr HUGHES (Giles) (11:06): I rise to support the amendment, but in so doing I fully acknowledge the sentiment contained within the original motion. People from regional South Australia know that the issue of access to professional health care is probably the biggest issue. As the member for Narungga said, many of the people who come to see him come to see him about issues to do with access to health care. Some of these issues are longstanding and complex and it is a mix between what happens at a federal level and at a state level.

We have a public health system in this state and in the other states that is underfunded, even though it is the largest budget item, and there is a history to that underfunding in the public health system that partly dates back to the Abbott government. The Rudd-Gillard government put in place an agreement with the states that recognised the real cost increases that were happening in the public education system.

What Abbott did—and it was one of those broken promises, along with a lot of other broken promises—was change the formula and put in a different cap, which had a detrimental effect upon the public health system throughout Australia. We are now talking about billions of dollars that would have gone into that system that did not go into that system and it is why the states are agitating with the current federal government for an extra $5 billion a year across the nation to go into the public health system.

Some of the consequences took time and I guess COVID was the straw that broke the camel's back, but it was policy decisions made by the Abbott government that cascaded down through the years that had a major impact on public hospitals.

Another area that generated a lot of concern—and there were efforts, but the efforts were probably in many cases misapplied—is the availability of GPs in regional communities. We know that, when it comes to GPs, it is essentially a federal issue. We know that there is a maldistribution of GPs in this state and in other states. We know that there is a disproportionate number of GPs in the city, especially in the more salubrious parts of our cities. There is almost an inverse relationship between where the health needs are and where the GPs are.

In country South Australia, there is a mortality gap of around two years compared with the metropolitan area, and there is more chronic illness in regional areas. You have to pull that apart because some of it might well have to do with access, but some of it is to do with other social determinants of health. My electorate has probably one of the worst examples of social determinants of health at work. That is in the APY lands, where the average life expectancy is around 52 or 53 years. It is not about Closing the Gap—that is an actual chasm when you are talking about the health needs of people in the APY lands.

The suggestion here, as proposed in the original motion, is to set up what the minister quite rightly said is another bureaucracy. I do not think that is going to help. It has been alluded to that that was done in New South Wales. If you look at the stats in New South Wales, if you look at some of the things that are happening in New South Wales when it comes to health, that approach has not worked. It is not going to work here because the health system is a system as a whole. The largest country hospital is actually the RAH.

For a whole range of reasons, we have to come to Adelaide because the types of services, the types of intervention you need, are not going to be in a country hospital in the main. It was said that there has been no-one on our side from the regions who has been Minister for Health. That is not accurate. A former member for Giles, Frank Blevins, was the Minister for Health, and a good minister—a good minister across a whole range of portfolios. We do face a complex problem of how to get more GPs and more specialists into country areas.

PATS has been mentioned. The Marshall government had four years to do something with PATS and it failed to do so. When we were in government, we did carry out a review—

Mrs Hurn: What are you doing now?

Mr HUGHES: Give us a chance. We have just been elected, so give us a chance. I am sure I will be lobbying the minister, as will other people, to do something about PATS. When we were last in government, we did have a review of PATS and we increased their funding by 30 per cent. There are clearly other things that need to be done. We also carried out major investment, admittedly in the major regional hospitals. It was a very significant investment where we did get extra services in some of those hospitals. You can do the buildings and you can do the capital works, but the challenge is getting the professionals to come out to regional communities.

It can be a life and death situation. I have recounted a previous incident in my life that involved a major car crash just outside Wudinna. If it were not for the doctor, the GP in Wudinna who stabilised that person in that car crash, that person would have died. There is no GP now in Wudinna. That is potentially tragic, and that has a major impact on the people in that community and the surrounding areas. I think the doctor just gave up in frustration. He had had enough. In my electorate, Quorn is going to lose a longstanding doctor. It is going to be very hard to replace Dr Tony, one of those old-fashioned doctors, on-call 24 hours a day. People choose their lifestyles; they feel they do not want to live that sort of life the way other doctors did in the past.

I have seen services downgraded in major regional hospitals but, as I said, I have seen other services built up. It is complex. When we talk about the previous Labor government, there was significant investment in a range of additional services in regional communities. I would be the first to admit that when it came to the smaller hospitals in the final budget, or the final half-year budget, we did allocate $140 million for capital works in the smaller hospitals and that should have been done sooner, in my opinion.

When it comes to GPs, we are going to have to work with the federal government to address this. I have always been of the view that we should take a far more robust approach to the allocation of Medicare provider numbers. It is overserviced in parts of the city and totally underserviced in parts of the country. Other countries allocate GPs on the basis of their population ratios. The point made by the member for Narungga is about an even distribution. That is great, but you need the tools to do it, and one of the tools might well be how you allocate Medicare provider numbers, along with other incentives, along with other models of health delivery, to get people back out into the country.

In some parts of the country—and I have seen it over the years—it is not just the medical profession but a whole range of professions that once upon a time used to be part of your community, used to live in your community, that are now more likely to be fly-in fly-out. There is a whole raft of underlying, more complicated issues when it comes to addressing that, but this is a major issue. Hopefully, we can collectively work on it to get something done at the state level, but it does require serious federal government input.

Mr TELFER (Flinders) (11:16): I rise to speak in support of the member for Narungga's original motion and as the member for Flinders, where we have 11 regional hospitals and health services as well as a number of very important Aboriginal health services across the electorate. Every time I get up and it is pertinent, I want to remind this place and the state that our regions' economies put $29 billion into our state's economy and to keep that in context when we are looking at the services that are needed to service those communities. For mine in Flinders, I have travelled across and heard from many community leaders, many community members, and it is clear from those discussions that regional health across my region is the number one priority.

Concern from my communities about the recruitment and retention of medical professionals is always front of mind, and it is the biggest health challenge for my electorate, especially for those communities that are away from large population centres. I also agree with the words of the Minister for Health about the challenges around the recruitment and retention of nurses, midwives and allied health professionals within our communities.

Without appropriate medical services, we are losing those who are most vulnerable in my community: the elderly, the young families, those who add to a balanced and fulsome all-inclusive community. These people are forced to leave communities where there is no medical support, and we cannot afford to let that happen in communities like mine in Flinders.

I was encouraged when the former government looked at the opportunity to develop and implement the Rural Generalist Program, a program which was specifically geared to making sure that those people looking at getting into GP practice have the skill set and the breadth of knowledge necessary to be able to service the dynamic regional communities we have. It is the full range of age that these GPs in our communities serve, from the very young, or even those who are yet to be born, to the very old at the end of their life and everything in between. It is a wide skill set that is necessary, and that Rural Generalist Program is a key one in making sure that those students who are currently studying medicine have that necessary skill set.

That is really about the long-term arrangements, the long-term capacity for our communities, but short-term solutions need to be put in place as well. The current arrangements for our smaller regional centres are not working and we need to develop structures, incentives and arrangements that actually reflect the needs of our communities. The recruitment process for our GPs is not working. If you look at some of the websites of the organisations that are tasked solely with recruiting GPs, they are not dynamic. There is a job notice. They are not being proactive enough.

We have communities within my electorate of Flinders—councils, local government—investing tens of thousands of dollars around recruiting GPs. This is local government looking at doing the job of other levels of government. We are at the point where everyone has to fend for themselves. We have regional communities competing against each other to try to source a GP from a very small pool, often looking at overseas arrangements. Short-term expensive locum services referenced in this place are not sustainable. They provide no certainty, no continuity and actually undermine the long-term sustainability of our communities.

I certainly agree with the member for Giles that there is opportunity for us to explore the different mechanisms around the Medicare provider number system to guide GPs into areas where there is a need. I am keen for the state government to be proactive in asking the federal government to look at these sorts of solutions.

Where I come from it is the Eyre and Far North Local Health Network, and I share some of that area with my colleague the member for Giles. Those who have been out there and looked at some of the medical practices and hospitals would know that there is a significant distance in between. The electorate of Flinders spans hundreds of kilometres, and there are hundreds of kilometres in between the 11 hospitals across the electorate.

At the moment, we have arrangements whereby doctors are being told: if you are considering coming to a community such as Cowell on the east coast of Eyre Peninsula, you can come to Cowell, but you have to service Elliston as well on the opposite side of the peninsula, some 200 kilometres away. At the moment, there are short-term arrangements for a GP from Ceduna to come a few days a fortnight to service the town of Wudinna, aforementioned in this place. Again, that is a couple of hundred kilometres of travel time added onto the time in the consultation room.

Kimba is currently without a doctor and, sadly, has been for a number of years. Wudinna is without a doctor. Cowell is without a full-time doctor. Port Lincoln, the major regional centre, the hub of the seafood industry as I have spoken about in this place, has a shortage of doctors. We are at a point where even the major centres in our state—Port Lincoln, Whyalla, Port Augusta—are struggling to recruit and retain GPs as well.

We have unique arrangements in South Australia. The point has been made that the RAH is actually a regional hospital. That may be so, but we need to make sure that arrangements are in place that make our communities sustainable. We cannot say every time there is something a little more complicated than an elevated heart rate that we need to send people off to the Royal Adelaide Hospital. That hospital is already struggling from the burden of nearby patients, let alone trying to draft in more country patients.

We need to invest into our regional communities, invest into our regional hospitals and incentivise and guide doctors into our regional communities. We need arrangements that suit the needs of our dynamic communities. It is time for real action, not just strategies, not just working groups. We need real action on regional health and real outcomes for our regional communities.

The Hon. D.R. CREGAN (Kavel) (11:23): Adequate regional health care is vital to the Adelaide Hills community, and I have campaigned strongly on this issue. The recent investment by the state government in respect of the Mount Barker hospital is welcome. Also welcome is an investment to ensure that a second ambulance crew can operate out of the Mount Barker station. That station, as I understand it, will be completely rebuilt.

It was totally unacceptable that only a single ambulance had operated at Mount Barker since 1992—since 1992. Ensuring that there is adequate investment in Adelaide Hills health care is a shared responsibility across all governments. The former government formed the view that by executive fiat there needed to be a new city in the Hills. It is not a separate suburb of Adelaide; it is a new city, and with a new city come new investments to support a population—a population that is growing rapidly.

But of course there is population growth right throughout the Hills, from Lobethal in the north through Woodside, Inverbrackie, Littlehampton, Nairne, through Hahndorf and into Mount Barker and further south into Strathalbyn, where I acknowledge the government is also making investment to support ambulance services.

One of the clear-eyed benefits of being an Independent is that you can serve your community well ahead of any political interests, but you can also give credit and criticism where it is due. I acknowledge the investments being made by the government and also the additional investment of $36 million to bring forward works at Mount Barker. But, as I say, and I emphasise, a former Labor government decided that a new city would be built at Mount Barker and the obligation to fund services in my community continues.

Left unresolved is the need for a 24-hour doctor service at the Gumeracha hospital. Dr Geoff Symons and others in a local medical practice have committed their lives to ensuring that there is adequate service for my community and for communities served by the member for Schubert. I acknowledge and thank the member for Schubert for ensuring that there will be a community forum on 26 July.

The forum will be deep in her electorate but, as I say, these services affect my electorate and it is generous of her to include me. I am hopeful of ensuring that there can be a further meeting with the Minister for Health and the community representative, Dr Symons, in relation to these unresolved issues. Regional health care is complex, but it is not beyond the wit of policymakers to resolve the issue that lies extant at Gumeracha. Of course the relationship with the commonwealth is important, and the Monash funding model has caused difficulties for communities that are on the edge of the funding line.

We must do more to ensure that the Adelaide Hills community is well served by adequate health resources and services and that we have, as we rightly expect to have, the same level of service as those in the city are able to experience. My community is not second class or second rate and will not tolerate a failure to invest to ensure that we continue to support country health care and regional health care.

Mr BELL (Mount Gambier) (11:27): I rise to support the motion and commend the member for Narungga for getting it on the Notice Paper, particularly at No. 1—a very good effort from a good Independent member of parliament. In Mount Gambier, the state's second largest city, there are numerous issues around health. Almost weekly there is correspondence with my office or people stop me in the street to talk about an experience that either they have had or have been involved in the health system, so it is certainly something that needs continual and ongoing attention. I am confident in the minister and his experience and that those issues will be addressed over time.

There are people like Rebecca Kurzman, who has contacted me several times around occupational therapists and the lack of access her six-year-old daughter has had in that area, and even telehealth being delayed. It is in two-week blocks and almost like a drip-feed out: you cannot be seen in this two weeks, then of course the appointment comes up and then in two weeks' time it is cancelled and another one is made for another two weeks henceforth. There is also Lesley Braithwaite, who needs specialist cancer treatment, and part of that is not covered by the Patient Assistance Transport Scheme.

Certainly, there are many local issues that we will continue to fight on. An issue of great concern, which has been raised in here before, is the attraction and retention of professional health staff to our area. I think of smaller areas and the difficulty that they would also be having, because if the state's second largest city is facing issues in terms of attracting and retaining doctors and the allied health professions then that will be magnified in other areas.

To give some context, I asked a question of the minister on 1 June this year about why the COVID-19 ward was closed in Mount Gambier. He indicated that, in effect, the hospital was running with a shortage of 70 full-time equivalent staff. That is a massive number of people. In fact, very few industries would be able to run with 70 full-time equivalents out of action on a normally fully functioning roster. It has been in the paper recently that we have had Code Whites.

I then look across the broader Limestone Coast region to Penola, Naracoorte and Keith, which had been a continuing issue of great concern for the local community. It is pleasing to see that the incoming Labor government has made some serious attempts at addressing some of those issues, in particular with $9.5 million for the Keith hospital and health service. Quite frankly, that is the type of commitment that I would have expected four years earlier. Everybody has known that it was an ongoing cause of concern, and to have a budgeted commitment now—it is in the budget—of $9.5 million is fantastic for the Upper South-East or the Upper Limestone Coast area.

Obviously, $8 million for the Naracoorte hospital is welcome news for a facility that needs urgent attention, and the emergency department will be the beneficiary of that commitment. There is $24 million for the Mount Gambier hospital, which comprises $8 million for the emergency department and $11.4 million for mental health beds. I will flag with the minister that I would like to see some rejigging of that. There is no point having beds sitting there if you do not have the staff and trained professionals to support and treat those suffering mental health issues.

My greatest emphasis with mental health and all health-related issues is early intervention, so repurposing some of that $11.4 million into early intervention so that issues can be addressed earlier instead of waiting until they hit an acute stage and the person ends up in the Mount Gambier hospital. There is $7.4 million for additional paramedics. Again, that is a very good commitment. There is also $4.6 million for drug and alcohol services in Mount Gambier. If we want to talk about the most prevalent drug out there that causes great community damage and personal damage, it is of course alcohol. I am glad that we have a focus on addressing that in the state's second largest city.

I am very pleased with the Malinauskas Labor government and the commitment they have made to health in the Limestone Coast. I think it is long overdue, and it will go some way to addressing perhaps some of the physical structures around health, but we keep getting back to staffing and attracting people to regions.

A lot of work can be done around revitalising our regions. A cooperative between the federal, state and local councils to promote the benefits of relocating to a regional area, whether it is cost of housing, lifestyle, a great place to bring up kids—all of that type of stuff—really needs to be promoted across Australia and across the world. I think we could have a targeted drive to revitalise and repopulate our regional areas.

Just employing one doctor in a small regional town is not the answer, because we find that that person is on duty, whether officially or unofficially, 24 hours a day, seven days a week, 52 weeks of the year, and of course their burnout rate is quite high. It has to be much greater than that. Some ideas I have had floating around include, firstly, the Patient Assistance Transport Scheme needs more money. People in the regions deserve exactly the same standard of care as those living anywhere else in our state.

The Royal Flying Doctor Service is flying to Mount Gambier three times a day with empty planes on the way down and full planes on the way up, which means that a number of people, once they have finished their treatment, are left to find their own way back to Mount Gambier. There is a return service three times a day. The facilities at the Royal Flying Doctor Service are amazing and they would be waiting in comfort until that next flight goes down to Mount Gambier. Having those planes full on the way back to Mount Gambier provides a better service of care for those who need to come up for treatment.

I would like to see the government work collaboratively with the commonwealth and look at a bonded doctors scheme, very similar to what used to happen with bonded teachers, where there are large incentives to help pay for university courses, but those people would be bonded back to regions for a period of time, whether it is four, six or whatever number of years is appropriate.

Of course, our kids need to be supported earlier in schools. Country kids more than likely will return to the country once they have finished their degree, so supporting country kids with early intervention in schools, with career pathways, government support to help pay for it, means that we can see country kids becoming country doctors and returning back to country. I commend the member for Narungga for this very important motion.

Mrs HURN (Schubert) (11:37): I, too, rise in full support of the motion moved by the member for Narungga. Regional health, I believe, is one of the biggest issues facing South Australia and our health system more broadly. One of the key pillars of strength of the former Liberal government's approach to health was that it was all centred around delivering better health care to people closer to home and, regardless of where you came from in regional South Australia or where you came from across the state, there was investment.

I was so pleased to see investment in capital works and services right across South Australia, including in the regions. One of the most difficult problems that has yet to be solved and one of the biggest challenges—and it has been touched on by almost every single member in this place—is how we can attract and retain our local doctors. This is something on which we must work with the commonwealth, and I am pleased to see that that is on the radar of many people in this house. We must look at ways to incentivise GPs and health professionals to come to our regions, and we need to retain them in our local areas.

I would like to touch briefly on a couple of local issues in this space, in particular the Gumeracha emergency department. I acknowledge the member for Kavel and the work that he is doing in advocating for the reopening of the Gumeracha emergency department. This is something that I, as the Liberal candidate and now as the proud member for Schubert, have been advocating for.

It is absolutely an issue of critical importance to the local community, and I would like to acknowledge passionate local advocates like Joel Taggart, and our hardworking doctors, in particular Geoff Symons, who heads up the Gumeracha medical practice. They have been working around the clock for many decades in Gumeracha and, indeed, the northern Adelaide Hills. It is safe to say that COVID has put a number of pressures on them and their staff.

COVID was the catalyst for the closure of the emergency department in Gumeracha and I am really disappointed to see that this is yet to be addressed by the new government. Indeed, I note reports in the Courier today that the Minister for Health has failed to get back to passionate locals like Joel Taggart. I certainly welcome the member for Kavel's commitment in working to facilitate a meeting with the minister. I thank him for spruiking our local forum that we will be having to address this issue, because if you go anywhere in Gumeracha or in the northern Adelaide Hills, it is the main issue that is raised, and I can see why. It is such an issue of importance that we must see it addressed.

I would like to pick up on a number of comments that have been made across the chamber: that now is the time for action when it comes to regional health. We do not need important capital projects being put in the slow lane as we have seen in this latest state budget. We need action on the ground now. It is critically important. We do not need more projects being put in the slow lane. We do not need more reports being done. We know what the problem is and we must all work across the chamber, across the political divide to see these issues addressed.

As the member for Schubert, it would be remiss of me to have an opportunity to talk about regional health without mentioning the Barossa hospital. It is something that has been spoken about for over 30 years in the Barossa Valley community. It was something that the former Labor government failed to act on for 16 years. In our four years in government, we managed to build momentum to such a point where we had money in the budget for the very first time, we had 16 sites narrowed down to two and we had clinical expert planners in the field looking at what services would be housed in this hospital.

It is time that we get on with delivering this hospital. I am very pleased to receive a commitment from this new government that the process of the Marshall government will be followed through with. This is absolutely music to the ears of my local community. I will be watching it like a hawk. Once again, I wholeheartedly support the member for Narungga and indeed all regional MPs in this place who have spoken so passionately about their regional communities and I look forward to supporting this motion.

Mr TEAGUE (Heysen) (11:42): I am very glad to take the opportunity to speak in relation to the motion. I commend the member for Narungga for his thoughtfulness in light of experience in bringing the motion to the house, highlighting as it does the importance of making sure that we provide for regional health, both in capital terms and by practical measures—some of which have been referred to by the member for Mount Gambier just now.

I think it is important to highlight—and it should go without saying—that which the member for Narungga highlights in paragraph (b) of his motion, that 'regional South Australians are just as worthy of access to quality health care as those in the metropolitan areas'. That should be at the core of health policy in this state.

Let's be really clear about the context in which this motion is brought. The Marshall Liberal government, over the course of the last term of government, went about the process of restoring regional health in a stepwise and thoroughgoing way, whether it be through the structural processes of the local health networks (mine being the Barossa Hills Fleurieu Local Health Network) or by getting to grips with the discrete and particular needs of those local regional communities.

What we saw before that of course, infamously, was the destruction that was wreaked by Transforming Health, the ideological approach to health of the previous Labor government, characterised as it was by a notion that by centralising health services—and this negatively affected metropolitan South Australians as well—somehow you are going to deliver a better outcome. The opposite is so clearly true.

As one way to illustrate it—I have spoken about it before and it is just a really good example of how those two diametrically opposed approaches make such a difference—I had the honour when I was first elected to represent the community of Strathalbyn, and now it is in the good hands of the member for Hammond. In January 2017, the then health minister (and it is no simple use of an analogy) at the stroke of a pen and from that central vantage point determined to close a community aged-care facility and render Strathalbyn without even the aged-care facility such as it had become at Kalimna.

It was a stroke-of-the-pen decision made at a distance from the community and without any apparent understanding of the nature of what Kalimna meant to the community. It was also in the context of what had been a decade or more of neglect in keeping up with necessary investment in Strathalbyn, but the solution that was applied in the context of that central approach distant from community was to say, 'Alright, at the stroke of a pen we will close that down.' Those residents of the local community, supported as they were by the investment of the broader community in the facility, were then told, 'Right, well, you can go and find your aged-care needs elsewhere.' It was a complete lack of appreciation for how that facility played an important role in the community of Strathalbyn.

Happily, the community spoke up through the course of that year. They made it really clear that the history of Kalimna, the objects of Kalimna and the present day of Kalimna all were about health for local aged-care residents but also health of community more broadly. The only way to appreciate the value of the concept of that facility was to have a close and connected understanding of the local community.

The response of the Marshall Liberal team in opposition, and it was then delivered immediately in government, was to understand that need, how is it addressed and then to act to make the difference. I am eternally grateful to Minister Wade for working through that with me in the diligent way he did through 2017, making sure that those funds were budgeted in 2018 and then continuing to work in the years that followed to ensure that where further work was needed to be done then it could be.

The result so far has been the building of a brand-new aged-care facility adjacent to the hospital. That has taken the stress and the heat out of the hospital, which, as in so many regional towns, can come to be a de facto aged-care facility, and that in turn puts stress on the hospital. It takes the heat out of the hospital and it can get back to doing what it needs to do. The facilities for the hospital in the course of that were improved and faith was kept with the Kalimna project, with the result that the community have greater confidence that they can then engage and benefit from the delivery of health services throughout the state.

In one sense, it serves as an anecdote to proper engagement with the regions with a view to delivering good outcomes, and it is one that can be repeated. It is that approach to health that is about not only delivering capital funding but also working in a dedicated and steady way with individual communities to make sure the response meets the needs of those communities.

I cannot leave that topic without stressing that, when we talk about the reopening of the emergency department at Gumeracha, we talk in the same breath about the need to reopen the emergency department at Strathalbyn—also closed in emergency circumstances during the pandemic. The government has charted a course out of the emergency declaration, and that is good news, but you have to do more than just signal a return to normality and away from declarations. You have to then act to bring back normal conditions to our regional towns and communities, and that includes reopening the emergency department at Strathalbyn. It must be done as a matter of urgent priority. The investment has been made so that that hospital can provide those services, and it should be done as a matter of priority.

I am the odd one out in the family in some ways. My brother and my sister-in-law are the leading lights as far as regional doctors are concerned. They have lived and breathed it all their life. I continue to hear from them about how to get GPs and other medical folks working in the regions and in the remote parts of the rest of the country. I am sure I will continue to hear from them, and I just take the chance to applaud the work they do every day in their local community, and I certainly endorse the need for health in the regions to be ever stronger and better resourced.

Mr WHETSTONE (Chaffey) (11:53): I, too, rise to make a contribution to a very good motion by the member for Narungga. He obviously understands and recognises the shortcomings when providing a good medical service in the regions of South Australia. For far too long we have seen people of the regions having to travel extensive distances with the shortcoming of having those services in our local hospitals or in our local towns due to the shortage of medical practitioners.

In the great electorate of Chaffey, I have a number of hospitals, probably more than most. I deal with the Renmark Paringa hospital, which is an institution that has been there for many decades. We also have the Riverland General Hospital in Berri, which is the centrepiece of health services in the Riverland. We also have the Barmera hospital, which has been closed a number of times in a recent period due to staff shortages, and that has cast doubt over the ongoing viability of that hospital. Congratulations, as those staff have returned and the department has had it back up and running.

The Waikerie hospital has also had the shortcoming of not having enough staff, particularly with the birthing suite and particularly with midwives, to keep that service open. Again, it is still short on midwives and so the birthing suite is still closed. The Karoonda hospital lost services over recent years, but I must say that a centralised model is not really part of the fabric of a regional town.

What we are seeing is that Karoonda continue to lose those expert medical frontline people because they are finding it hard to attract doctors, attract nurses, attract the frontline expertise and retain them in those smaller country hospitals. The Loxton hospital is a very worthy country hospital that does a great job and that is renowned for a great ability, particularly in obstetrics, and I congratulate that community.

I want to comment on all these hospitals that are supported by volunteers. Many volunteers come in and play a role in keeping the doors open and the lights on, raising money for the auxiliary fund, raising money for upgrades in infrastructure into those hospitals, and I think they all should be commended for the great work they do. We all know that regional hospitals are part of the fabric of a regional community.

I would also like to thank all my volunteers as my HAC representatives on those hospital boards. It is imperative that they play a role—as a volunteer, they are the eyes and ears on those health advisory councils—so that they come back to me and give me an update on and an understanding of just what the shortfalls or the issues are at those particular hospitals. As I have said, all six hospitals in the region need doctors, nurses, midwives. They all need frontline staff and administration, and they need their volunteers. It is getting tough, and it is becoming tougher and tougher to retain health professionals in those smaller areas.

While we are talking about providing services, it is very disappointing that the incoming Malinauskas government has seen it fit not to support those who have to travel for health services. Potentially, what we are seeing is a government that again is drawing a line in the sand with a very thin understanding of what it means to travel out of a faraway regional or outback centre to undertake health services.

We are seeing that the PAT Scheme does help subsidise the cost of travelling. We know that the cost of living at the moment is severely impacting the ability of families to travel for those health services. I have had many people come to my office making a decision: will they travel or won't they travel? They cannot afford to. It is not only the emotional strain of having to travel away from home, away from your family, away from your job. Potentially, what we are seeing is that people are forgoing any health appointments or any health treatment because either they cannot afford it or it impacts on their capability of travelling away from home due to the cost.

I think it was just mean. It was mean of the minister and it was mean of the government not to put into their budget help for cost of living, for travelling to those health appointments from 16¢, as the Marshall Liberal government gave a commitment to increase it from 16¢ to 32¢ a kilometre. I think that was just a small token to support those having to travel.

Mental health, suicide prevention and substance abuse play a big role in regional settings, and country hospitals have finite resources in dealing with those issues. Particularly with suicide, it is all around substance abuse. It does have a connection with mental health, particularly with regional work and agriculture. Primary producers are the main victims of those three issues. As the shadow minister for all those three areas, I think the most important thing is the ability to have a visiting psychologist come to regional hospitals and regional settings so that we can identify and treat early the impacts of mental health and substance abuse.

I would also like to pay tribute to the Royal Flying Doctor Service. There are 600 journeys to the Riverland per year. The newly announced transfer facility at Renmark is much applauded. I want to thank both Tony Vaughan and Peter de Cure for their great leadership at the Royal Flying Doctor Service. They do an outstanding job with all the volunteers, raising money to make sure that institution is relevant. It not only provides an outstanding service into the regions but a service that the standard public health system just cannot cope with. They have done an outstanding job. Through the COVID pandemic, some of the work they did was second to none. I thank them for their dedication.

I would also like to thank Flinders University for the training facility at the Renmark campus. It has multidisciplinary health education. I congratulate Professor Paul Worley on his great advocacy and the work he has done over time in bringing those training facilities. We know that the best way to retain doctors is to have regional people, local people, do their training in a local setting. It is the easiest way to retain doctors and health professionals, just like the RACE program under the guidance of Paul Worley.

We are looking for both state and federal acknowledgement that the regional accreditation centre of excellence is a great program. It is about locals living, training and being retained in those local settings, keeping medical professionals local so that we do not have to go out there looking, hunting for doctors, trying to bring them out to the regional settings. We know it is just such a hard job.

In finishing, I also would like to put the government on notice about the COVID-19 clinic that has just been taken away from Berri and moved to Waikerie. We understand that the Riverland west area has seen a significant increase in positive COVID cases in recent times, so the clinic has been taken down to Waikerie, but there is no certainty as to where it will go after 30 June. I am calling on the government to give some certainty and some clarity—transparency, it is called. The minister needs to come out and make an announcement about exactly what sort of service and clinic will be provided to the good people of the Riverland in retaining that vital service.

I thank the member for Narungga for his motion. It is very important for regional South Australia that we have a staffed, relevant health institution, just like they do here in the city.

Mr McBRIDE (MacKillop) (12:03): It is a great pleasure to stand today to support the member for Narungga's motion this morning. It is a very important issue. I cannot go without reading out what it stands for and noting the last point, which I think he also has a spot of bother about. Whatever it takes to solve this, I am absolutely behind him. The motion reads:

That this house—

(a) recognises the serious shortage of doctors and other medical staff in regional South Australia;

(b) acknowledges that regional South Australians are just as worthy of access to quality health care as those in the metropolitan areas;

(c) notes that incentivising doctors in regional South Australia has not worked and that it is time to guarantee it;

(d) calls on the state government to ensure the equal distribution of general practitioner doctors around regional South Australia, now and in the future; and

(e) calls on the state government to establish a dedicated department of regional health to support access to quality health care across South Australia.

As he noted when he brought forward this motion this morning: whatever it takes, but another department? SA Health is a huge department in itself, and obviously multiple billions of dollars are consumed yearly in this department, looking after the needs of South Australians. I am hoping we do not just create another department for the sake of it.

I will move on to why this is so important for the seat of MacKillop, the Limestone Coast and regional South Australia. In our current system, we have GPs out in our regions who are obviously not coping. Perhaps they have deserted, retired, moved on and not been replaced as years have gone by. We now use a locum model system which, as we know, is expensive. Doctors come and go, and it does not provide a consistent level of care. When constituents regionally, in MacKillop, approach a locum doctor, they never know who they are going to see or what the calibre is of that doctor, what their expertise is.

I will give an example to make sure we are all fully aware of the situation. A number of hospitals in my region are being serviced by locums. One of those hospitals is serviced by a doctor who lives on the Gold Coast. He flies down to the Limestone Coast, landing in Mount Gambier, and driving on to the hospital he will take care of for about two weeks. He then returns to his home on the Gold Coast. He is doing a wonderful job in the sense that there is no-one else to do it, but that really highlights where the population and the expertise reside, how they want to live and perhaps why we do not see doctors out in the regions looking after our constituents as we did 20, 30, 40 or 50 years ago.

In my local area, the current doctors out there are coming of age. They are getting close to retirement. We know they are being stretched, and they are not being replaced by new, up and coming doctors. We have talked about incentivising, about quota systems, and there have been conversations at all levels of government, federal and state, about the fact that to get a Medicare number you have to do a placement out in regional South Australia, but no-one has actually made this work. We have not solved it. There has been a lot of talk but there has been little outcome.

The doctors in our regions are being backed up by paramedics. The paramedic model was rolled out in the Kingston/Robe/Beachport/Lucindale area; two paramedics were brought in by our government to back up a very busy GP service. That has been absolutely welcomed, because they are stretched, and there is no doubt that the expertise those paramedics bring helps find solutions to help with our GP shortage. However, it still means that if I want to get an appointment in Kingston or Robe or other medical clinics like Beachport, there could be a wait of up to six to eight weeks for a general appointment for a medical concern.

These sorts of waiting periods, and the angst they cause our constituents, are not borne by our city cousins, who do not have to live through those sorts of dynamics. I have to highlight that our constituents right across regional South Australia are perhaps hardened by having had to take into consideration the vagaries of the medical system that has been in place for the last 10 to 20 years. It is difficult to navigate. If you do want to see a GP, for all the right reasons, it is going to take a number of weeks to do so.

Our volunteer ambulance drivers are affected by the lack of GPs and vice versa. The further they have to go to a hospital with a doctor or a locum in it, the further the local ambulance volunteers have to go to take critical patients for an initial consultation to assess the requirements of the patient they have been called out to. It is becoming more cumbersome, and the time frames that regional constituents have to put up with are greater than ever before.

It is really ironic, what I hear about hospital ramping, which we do not see a lot of in regional South Australia but which is well and truly known about in the city of Adelaide. People complain that it might take 15 minutes to receive an ambulance, or that it might be 15 minutes late because there is a shortage and they are being ramped, and so forth. In the country, ambulances taking beyond an hour is not unheard of, maybe even two hours and the like, and it is getting worse, not better.

It is funny how we talk about the fact that some ambulances might be 15 minutes, 20 minutes or 30 minutes late for a city call-out, but in the country it is okay because we have distance and so forth to work with. On top of that we have a lack of volunteers, on top of that we have a lack of paid ambulance drivers, and on top of that we could actually do it better if there were more paramedics out in our regions, backing up our ambulance drivers as well as the volunteers and our local GPs.

In regard to the local GPs, I cannot really go much further than talking about the Millicent hospital and what it was 10 to 20 years ago. You would probably have to go back 20 years, rather than 10. It was a hospital punching well above its weight. It had two anaesthetists, it had obstetrics and it had a medical clinic attached to it. The medical clinic doctors were well integrated into the hospital, but that has been totally fractured and fragmented and is nothing like what it was in its former glory days.

Yes, it is still working and it does have local GPs connected to the hospital in such a way, with private patients. Yes, we have locum doctors at the Millicent hospital but not the GPs like we used to. There are some surgical operations that are taking place at the Millicent hospital, and that is on the improve, but it is nothing like it was 20 years ago.

All I can say is that it does not take an Einstein or someone very clever to understand that if the intent is to make it worse, or not to actually make it better, then obviously it will fail and will not work as it used to. It takes a mindset, it actually takes a deliberate course of action, and it will take a government that actually wants outcomes to turn this around. I am hoping this new Labor government does not reflect on its last 16 years and that they turn it around and put it in a positive light, following the member for Narungga and his motion. This could be the very start that is required to get this process underway.

Another hospital that is very much of interest is the Keith hospital. I really welcome the funding that has come from the state government and their election promise to lift that budget up to about $1½ million a year and trying to find a model that works, with a paramedic who backs up the GPs. We find it very hard to get GPs into Keith, and I am hoping that the Keith hospital will find its feet and be a really good medical clinic into the future.

The Bordertown hospital is working and functional. There is big talk about a new medical clinic there, with a GP, and building a facility that will attract specialists and will be alike, or very much akin to, what is going on at Nhill with their medical clinic. I really welcome the time that it comes to fruition, if it does. Bordertown is a very industrial town with a growing population and a shortage of housing, and it will be welcome to see those sorts of medical facilities being built there.

By way of housing, we also heard that local GPs and new GPs, when they go to a town, are subject to the affordable housing problem. They do not want to buy the million-dollar house in the local town or an expensive house. They want affordable, modern and neat accommodation in our local towns if they do go out and want to work in the regions. The housing shortage is affecting our new GPs. Hopefully, this government also sees that the housing issue can help our doctor problem as well.

I would also like to touch on the fact that we have hospitals like those in Lameroo, Pinnaroo, Naracoorte and Penola all suffering from a shortage of doctors. I fully support the way that the member for Narungga has brought this motion to the parliament, and I hope the Labor government comes on board and supports it as well, for all the good outcomes that can be arranged. I fully support this motion.

The Hon. D.G. PISONI (Unley) (12:13): It has been a terrific debate today and we have learnt a lot about regional South Australia. Regional South Australia does suffer, more so than other regions in Australia, in the delivery of services for those who live outside of the main capital. It really is a matter of scale.

We hear about locums, and in an earlier speech we heard about the locum who was flying down from the Gold Coast. The missed opportunity there is that that doctor is not living in the community. If that doctor were living in the community, there would be that doctor's salary that would be spent in the community, that doctor's children would go to the local schools, and the doctor's spouse would also likely work in the community. There would be a connection with the community that is not there with locums.

I know that one of the biggest challenges I was dealing with as the minister responsible for skilled migration was increasing that population in the regions. If we look at why it is difficult in South Australia, it is because there is such a big difference between the size of the capital city, Adelaide, about 1.3 million people, and our regional cities.

If you look at Hobart, for example, it has about 300,000 people, or a little less. The next largest city in Tasmania is Launceston, with 80,000 people. If you contrast that with South Australia, there are 1.3 million people in Adelaide and the next largest city, Mount Gambier, has about 28,000. It is a significant difference in what services you can deliver effectively and constantly and the quality of life that you can offer between a city the size of Mount Gambier and a city the size of Launceston.

By taking on the challenge and working to increase the population in regional South Australia, we will be doing two things: we will be increasing demand for services, such as rural doctors and health services so there can be a permanent presence in those cities and those regions, and providing a permanent workforce. We saw through the pandemic just how the regions rely so much on a transient workforce, whether they be backpackers, tourists or Pacific Island workers coming in at different times.

The problem with all those solutions is that they earn their money in the regions and then they take it away with them and do not spend it in the regions, so again it is another missed opportunity. It is a bit like the chicken and the egg really: you need to have the lifestyle and the services available for people to choose to live in regional South Australia.

I think that there is no doubt that it is changing. We have certainly seen growth in those regional areas within a couple of hours' drive of Adelaide where people for lifestyle choices have decided they can work from the regions. They can work from Clare, for example, and work from home and participate in the statewide economy. We are seeing more and more of that with our digital economy and how things are changing.

A couple of years ago, I visited the Clare childcare centre, which was doubling in size, and I asked what the driver was of the growth. It was the fact that people from Adelaide or people from outside of Clare were moving to Clare, working in local businesses or working in their own businesses or moving their businesses to Clare, and developing that demand for those extra childcare services in regional South Australia.

They took advantage of the incentives that were there to introduce paid traineeships to the childcare centre, rather than the traditional institutional method where students would go to an institution, either TAFE or a non-government provider, to gain their qualification in child care. They would do that while they were being paid to deliver and gain their on-the-job experience. That has also had the impact of seeing more opportunities for young people in the regions to start their careers and be supported in doing that.

I know that many of the speakers on this motion today spoke very passionately about rural doctors, but it is an issue that is related to all service delivery in regional South Australia. It is a massive opportunity for this government, as it was for the previous government, to focus on the regions and to encourage those regions to grow.

We expanded the GigCity network into Whyalla and Mount Gambier so those who lived away from Adelaide would still have that connection to the world through very fast internet connection and very cheap internet connection by being able to participate in the expanded GigCity network that, until then, really was only an Adelaide-based internet provider that was offering cheap high-speed internet.

This means that even educational services can be expanded into the regions, which is very important, because we need to encourage those young people who are leaving school in regional South Australia to start their tertiary education in regional South Australia, just like we are seeing in the Hub in Port Pirie, where students are starting the first year of a number of degrees, mainly in the health area.

They are still within their communities and are not travelling down to Adelaide or moving to Adelaide. That is being delayed by a year or two because they are able to have those services delivered through a local hub, where they are developing their community ties and expanding their friendships in the community. It is tying them to the community and giving them the ability to make a decision when they get their qualifications to come back home and use their qualifications where they grew up.

It is a very complex issue, there is no doubt about that. There is not a one-size-fits-all. I commend the member for Narungga for raising this issue and for his motion. It is a big picture project for the South Australian government. There is no single solution for regional doctor shortages or service shortages in South Australia. We know that if we can increase demand it will have a snowballing effect. We will see more people choosing to live in the regions for lifestyle reasons: because of technology, they will choose to live in the regions. That will increase demand for those services, and it will make it more attractive for regional doctors and other health providers to make the regions their home. I commend the motion and thank the member for Narungga for bringing it to the house.

The Hon. L.W.K. BIGNELL (Mawson) (12:22): I rise to support the amended motion because, representing the south-western side of the Fleurieu Peninsula and Kangaroo Island, we know how bad things are for general practitioners and the resultant health services that people are getting. I know that when the health minister was in opposition he was always at the end of the phone when I would ring him, and he would speak directly with practitioners on Kangaroo Island about how things can be improved; and I have great faith in the health minister that we will achieve that. It is not going to be easy. This is a problem right across Australia, but it does need a different approach and I am very pleased that the health minister is right across all this.

I would also like to take this opportunity to thank him, our Treasurer and our Premier for their commitment in the budget for $10 million for the Kangaroo Island hospital—I think that is really important—as well as the new ambulance stations and extra paramedics and ambulance officers on the Fleurieu. We are moving in the right direction, but more needs to be done. The very fact that we are in here talking about health in regional South Australia and we are talking about rural GPs is a good thing. It just shows the people in the area that I represent, and other regions, that as leaders we are in here taking the matter very seriously and we appreciate the circumstances that they have been going through for a number of years now.

Mr PEDERICK (Hammond) (12:23): I rise to support this motion by the member for Narungga and commend him for it. Regional health: where do you start? We certainly need to see what we can do to make sure that we have the right conditions—and to attract doctors and other medical workforce not just to work in the regions but also to live there—and we must make sure that we look after the ones that are in place. As time goes on, and we have seen it over and over again in recent times, doctors nearing retirement age fear for the communities that they have lived in. They have loved to be there and, when they are about to retire, they wonder what will happen next.

Certainly, I have been lobbied by local doctors at Murray Bridge assisting with running the emergency department there to make sure that we can get enough on-call doctors. I note that it is operated by a private service, the Bridge Clinic. They have been doing it for decades as a service contracted to governments of all colours. They do a great service, but they would certainly like more support. I know when we were in government, until recently, there was some support supplied there as well, but it is contracted to those private clinic doctors, as it is in a lot of areas across South Australia, and they certainly would, as I said, appreciate more support.

I note that in the town of Murray Bridge, which is my biggest town in the Rural City of Murray Bridge, there are two other clinics. They operate as day clinics, which is great, to service the needs of the ever-growing population of Murray Bridge and the surrounding districts. It being a popular town only an hour south-east of Adelaide, a lot of people, a lot of farmers, from right around the state retire there. They do not want to live in the city amongst all the concrete and bitumen, which I appreciate, but they want to be within reach of good services.

We do get this issue, though, that not just any doctor these days can turn up and work in emergency departments. They have to be credentialled and that is another level of training that must take place. I have been meeting with the doctors at the Mannum health services as well, talking about the needs not just of the doctors there but of the nurses, whether they be at Karoonda, which used to be in my electorate, or Mannum, which still is in my electorate, and the shortage there.

Also, as I indicated, we must make sure that we retain doctors, make sure everything is in place, whether it is the right conditions or whether it is the structure of how they get paid and supported. It is very much a different world in country South Australia. The difference in what happens if you land in emergency, for instance, is brought up at times. Some people cannot get their head around it, but in most places in the country, because they are on-call doctors for the emergency units, if you do not get admitted to hospital there is a gap fee.

One thing the gap fee does—apart from infuriate some people, because they have to pay a gap fee for this kind of service in the country, and I acknowledge that—is it does keep people out of emergency. It does keep people out of emergency, so they attend their own doctor if they do not need to address an urgent situation. But the issue, and it would be an issue that the health minister in the new government would be well aware of, is that it would be well north of $40 million annually to fund that service not having a gap fee. It was interesting that in the city two years ago, in Adelaide, numbers dropped heavily in emergency attendance, by about 70 per cent, which was probably (not probably; I am sure it was) because people were scared of the risk. They thought hospitals were full of COVID.

There are obviously strategies that we put in place. We put in rural generalist training, which can take up to 12 years—that is up at Berri in the Riverland—to get doctors used to working in regional conditions. It is tough. I have been around a while, but when I was young the local doctors would do the operations, they would do all the childbirth work, they would deal with the accidents and they would see their patients. I do not know when they slept, and I think that is the issue.

There are a lot more doctors on the scene now, and I commend those doctors for what they did. We are now more heavily reliant on overseas-trained doctors, but their credentials do not match up with the requirements of the South Australian health service or the Australian health services when they come in from overseas. They are a much-valued group who come in to support our communities in regional South Australia, but when they come here they have to retrain. A lot of them work in aged care and other fields while they are doing that training to get accredited to be a full-blown, accredited doctor in South Australia.

It is not without its issues. Some people cannot work out why the place is so isolated when they come from overseas, and it takes a while to get used to the lifestyle. It does not matter what you do. I know that, as a community, we fixed up the nurses' quarters in Tailem Bend for a doctor but, as the demands and needs of that family grew and they needed to be in Adelaide for education, university and other matters, they left.

I guess it is the beauty of the bush, and sometimes it can be the tyranny of the bush. The bush is a great place, I love it, but obviously for a lot of education needs, as well as professional needs, people want to be in the city areas. I have never forgotten a speech that a former member for Kaurna, the Hon. John Hill, gave here one day. I just about fell over when he said that they were having trouble attracting doctors in Reynella. I thought, 'Wow! If they're having trouble at Reynella no wonder I'm having trouble getting a doctor to Pinnaroo.' That speech in the house has always stuck in my mind.

We must do all we can, as we did. We put in the rural generalist training. I was proud to deliver, as part of the Marshall Liberal government, a new $7 million emergency department in Murray Bridge combined with $3 million to update the operating theatres there, which is going very well. Obviously, we have seen the commissioning of a new ambulance station under us at Strathalbyn as well. In recent times a new five-bay station was built in Murray Bridge. I note that under our watch we instigated the 36-bed aged-care and dementia ward that was opened in Strathalbyn, and I see that it is still in the budget.

The future of Kalimna might be fleshed out a bit in estimates. It was shut down by the previous Labor government before the 2018 election, and those residents were essentially kicked out in the cold. However, it is pleasing to see that an aged-care centre of some kind will be built there into the future. I will be watching that as time goes on as the new local member for Strathalbyn as the member for Hammond, because as the population ages we certainly need to look after them.

There are so many things that we need to do to make sure that we get health care right, not just in city areas but across the state, and make sure that we can put in place the right programs to attract not just doctors but other healthcare workers. I commend the motion by the member for Narungga.

Mr ELLIS (Narungga) (12:33): Do I close the debate prior to the amendment being considered?

The DEPUTY SPEAKER: No, you close the debate and then we will put the motion, which will be the amendment first.

Mr ELLIS: Thank you for your guidance, Mr Deputy Speaker. What an uplifting day we have had, or what an uplifting time we have had to start parliament this fine Wednesday. I have to admit to those present in the chamber that on previous Wednesdays I have sat here considering whether what we were doing was the most proficient use of parliamentary time.

On Wednesday mornings, without reflecting on any motions that might be on the Notice Paper at the moment or previously debated, there have been some rather inane motions put to the parliament, but this morning this is a tremendously important one. The regional health motion, as many members have said, is a particularly important motion to those living in regional South Australia.

It is wonderful to hear what appears to be unanimous support for increased action to try to address the shortage of regional health professionals across our wonderful state. Thank you to each and every member—I will not list them all due to the vast quantity of them—who has made a contribution in support of the original motion and the amendment in some cases. It is much appreciated.

I do want to quickly touch on a couple of things, the first being that there have been a number of contributions celebrating capital investment in different hospitals around the state, which is a wonderful thing. I am equally as proud of the capital investments we have made across the electorate of Narungga as well and I do not wish in any way to denigrate any investments made in our regional hospitals whatsoever, but the intent of the motion was about the health workforce rather than any capital works.

I would like to make the point that, in a lot of instances where that money has been spent upgrading those facilities, the anticipated or hoped for influx of new professionals has not necessarily eventuated. It has not been like Kevin Costner in Field of Dreams: 'If you build it, they will come.' We are still waiting for those doctors to show up. While those capital works are great, there needs to be some actual work done. The rubber needs to hit the road on some actual work to guarantee the equal distribution of doctors around the state.

We accept it as fact that for police, teachers and other vocations there needs to be some prioritised work done to make sure that the communities that need them have access to those different vocations. There must be a similar answer to the problem that is the regional health workforce. We need to make sure there are a discerning number of positions available in different parts of the state to ensure that those areas that might not otherwise have access have access to that key vital service. If we accept that it is possible for police, teachers and other vocations, I am sure it must be possible for our regional health workforce.

That being the case, I would like to particularly thank the shadow ministers—the shadow minister for regional health and of course the shadow minister for health—for their contributions and support and look forward to ensuring that they aid us in our plan for increased action on the regional health workforce. I would also like to thank the Minister for Health for his contribution and amendments. Old habits die hard. There was a little bit of trepidation when he informed me that he intended to amend the motion, but I have to admit that it is a rather reasonable amendment and I do not intend to impose three minutes of bells upon the wonderful people of this chamber. I will let that amendment pass and hopefully the motion thereafter.

There is one part of the original motion that has not found its way into the amendment and that is the word 'guarantee'. That is the one thing I would like to see happen—some actual guarantee (and I am sounding a little bit like a broken record), some proactive action to ensure equal distribution. I would like to see a guarantee, some actual action, but I will not die in a ditch over it.

Pardon me if I am jumping around, but I acknowledge again an oversight on my behalf. The minister has done an excellent job including 'the commonwealth government' in paragraph (d). That probably should have been there right from the get-go. Thank you to him for that. Finally, he expressed concern about not wanting to put words in my mouth. On this occasion, he is more than welcome because he is dead right.

We do not want extra bureaucracy further clouding the wonderful work of the health department, but there must be a way to ease the burden on the Minister for Health. It is just a massive job for whoever takes it on, irrespective of their party. By separating that into regional health and metropolitan health, there would be an opportunity to have a greater focus on each. With those words, I accept the amendment and hope that the motion passes as well.

Amendment carried; motion as amended carried.

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