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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2024-08-28 Daily Xml
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Motions

Regional Health Services

Debate resumed.

Ms O'HANLON (Dunstan) (12:01): I move the following amendment:

Delete paragraphs (c) and (d) and substitute:

(c) implores the state government and Yorke and Northern Local Health Network governing board to investigate improvements in health services to the Yorke Peninsula including in Ardrossan and at the Wallaroo Hospital.

The Ardrossan Community Hospital was closed from 13 November 2023 following a decision of the hospital's board to surrender their private hospital licence. This resolution was made as a result of their unsustainable financial position despite annual contributions of consecutive state governments of $180,000 a year to supplement costs.

Due to the hospital's ongoing challenges in sourcing an appropriate clinical workforce, particularly for medical coverage, the hospital's inpatient activity declined significantly over several years. This resulted in a reduction in separations from 236 in 2020-21 to 79 separations in 2022-23. The decline in activity resulted in the rerouting of ambulances and patient activity to Maitland Hospital, which is an SA Health site managed by the Yorke and Northern Local Health Network that is less than 20 minutes away from Ardrossan.

The government has already made a considerable additional investment into the operational and capital works budget of SA Health sites, including across regional South Australia. Specifically for the Yorke and Northern Local Health Network, this includes a $45.9 million increase in operational expenditure in 2024-25 when compared to the final Liberal government budget in 2021-22, equivalent to an increase of more than 26 per cent.

Specifically for capital works there is $20 million currently in this year's budget for local works, particularly focused on the Port Pirie emergency department upgrade and the surgical suite upgrades in Clare. This equates to a 500 per cent increase in capital works budgets compared to 2021-22. In addition, our commitment to improve regional ambulance resourcing will include improved coverage for the Yorke Peninsula, including 12 new paramedics and a community paramedic to start in Wallaroo in 2025, as well as six new ambos in a new regional medical transfer service crew that has already been on our roads since July.

While there is no mechanism to guarantee an equal distribution of health professionals, as drafted in the member for Narungga's original motion, the government has taken several steps to boost the health workforce. This includes more than 200 additional FTEs already based in the regions since coming to government, as well as the announced trial of the single-employer model to attract trainee doctors to the regions starting next year.

The Yorke and Northern Local Health Network Board, led by Board Chair John Voumard, will continue to consider ways that health services can best be delivered in the region, including whether there is enough demand for outreach services, such as community or allied health, to Ardrossan over time.

Ms PRATT (Frome) (12:05): I rise in great support of this motion, and thank the member for Narungga for bringing a motion that reflects his community in quite a lot of detail when it comes to regional health services. I want to take a moment to unpack the original motion, which the opposition supports in full, just to better understand what it is that the member for Narungga is raising, not just with the house but, in fact, with the government.

The original motion reads, in clause (a), that this house 'recognises the dire impact that the unfortunate reduction of health services in Ardrossan will have on the town and surrounding community'. I would argue that this a dire situation for any town in regional South Australia at the moment, when it comes to a concerning retreat from this government seeing regional health as a priority.

Clause (b) states that the house 'congratulates the hardworking staff and volunteer board on their perseverance in keeping the community hospital as long as they have'. Again, I would state that this is applicable to many country volunteers who find themselves on a health advisory committee (affectionately known as a HAC), and that it is statewide in regional South Australia.

The motion goes on to recognise the wider degradation in regional health services and as the shadow minister for regional health I concur with that observation. The motion implores the state government to do all it can to address the reduction of these health services in South Australia, and my country colleagues are on their feet every day, when it is possible, in this house to bring attention to the plight of regional health services under this Labor administration.

In recognising the impact to the Ardrossan Community Hospital, the member for Narungga also broadens his horizon and asks us to look at the woefully undersized Wallaroo Hospital. It is certainly not lost on me, as the member for Frome—sharing the Yorke and Northern Local Health Network, the same LHN as the member for Narungga—that we recognise the busyness that Wallaroo Hospital sees as it swells during the summer season, so it is extremely important that the member for Narungga and the opposition recognise the importance of Wallaroo Hospital for the Copper Coast and Copper Triangle.

As an aside—and the member for Narungga may not know this—as part of the government's budget last year, with its commitment to investing in the rollout of the Sunrise electronic records management software program, our LHN, the Yorke and Northern, is one of the last to fulfil that commitment; both Wallaroo and Clare hospitals are at the point where they are the last to come online. Clare Hospital, in negotiation with Wallaroo, and because summer is coming, made a friendly pact that Wallaroo would get this done first. So Clare is yet to come, hopefully by the end of the year, because we need that data system, that database, talking to itself.

I note that the member for Dunstan has risen to make an amendment, and I politely suggest that she go back to the Minister for Health's office and get some better notes to read from, because in reference to the money that the government says it is pouring into the Port Pirie and the Clare hospitals upgrades, I can say—with authority as a volunteer and a community member on the HAC—that that upgrade has already blown its budget of a committed $4.5 million, and that $1.5 million will be taken, with approval, by our HAC.

Regarding money raised by our volunteers, we hark back to those strawberry fetes and hospital auxiliary boards. Local communities like my grandparents understood what they were fundraising for and where that dollar was going. We are definitely seeing a retreat from the government in terms of investing in regional health, because HACs are having to fund, through their gift funds, more and more services.

When it comes to regional health services more broadly, the opposition is very clear that the Liberals understand country health. Representing the bulk of regional South Australia, we are the regions when it comes to prioritising country health. When the Minister for Health talks about hospital avoidance programs, where better to start investing in regional health to work towards diverting our country patients away from this chaotic city system.

When it comes to the Ardrossan Community Hospital, the former Liberal government certainly was tracking closely its financial commitments to the hospital. I know that hundreds of thousands were provided to offset that substantial cost in providing 24/7 public emergency care, and more was pledged. Should we have been successful at the 2022 state election—we know the result—our commitment to country health would never have wavered.

While no such commitment really stemmed from this current Labor government as they rolled in action, soon after that result the Minister for Health and Wellbeing was on the public record declaring in no uncertain terms that he had no interest in providing support to our community private hospitals. I recall very clearly that that was kicking off with the Glenelg Community Hospital, asking for some similar compassion and attention. We go on to see, with the exception of the Keith community hospital being reabsorbed and returned to the public system—although that really was not ever their prime intention or outcome—that this government really has turned its back on community and private hospitals, those smaller community and private hospitals, with disastrous effect.

I start with Ardrossan, but I include the McLaren Vale and Districts War Memorial Hospital, and for different reasons the Stirling Hospital, which has seen great success because of local advocacy—and I encourage the member for Narungga to continue his support with that action group—Ardrossan, McLaren Vale, Stirling, Victor Harbor and Glenelg, notwithstanding in a separate elevated middle category the Western Hospital.

It is not an exaggeration to state that our largest private hospitals nationally are quietly very worried about the rising costs of providing health services, yet here we are in our state with historic highs in ramping, a government that has no solution for a health system in crisis, an obligation now to buy private beds and no communication between the public and private system to get some synchronicity or harmonisation.

The main concerns from the Ardrossan community late last year, when these hard decisions were being made, was that the closure of that hospital certainly would put further pressure on an already struggling health system, and we know that is the case. The closest hospital is 23 kilometres away in Maitland, and the Ardrossan community is arguing that it must continue to provide that 24/7 emergency care for the region.

Despite those local campaign efforts, we know the accident and emergency services have closed. We recognise the importance of maintaining facilities and services for an ageing population. I commend the Ardrossan community, through the member for Narungga, for their ongoing commitment, their passion, their advocacy, their desperation, I would guess, to fight for what they have had and to preserve it going forward.

I contest that we are witnessing a Labor administration that is not only failing regional health but retreating from investing in it. I point to common topics that will continue to be prosecuted by us, whether it is about an inability to incentivise, recruit or retain our general practitioners; the impact of the GP payroll tax, with great consequences still to come, I think; or no plan for midwifery services to stabilise those options for maternity patients statewide. We are still the only state without a country-based regional radiation therapy service. It is a long shopping list, and we will use every opportunity to call that out. I commend the original motion.

Mr TEAGUE (Heysen) (12:15): I rise in support of the original motion. I commend the member for Narungga for his sincerity, his eloquence and his dedication in advancing the motion in its original form. This is an occasion where I really think that the house deserves to have the participation of the minister in this debate. The minister really does need to tell the house what is this Labor government's attitude to addressing the needs of rural and regional South Australia.

This issue, this challenge in Ardrossan, as the member for Frome has just put it so well, is not a singular challenge. This is an issue that is faced by community private hospitals throughout the state, small communities and large. Indeed, the challenges of these community-run hospitals is something of pressing concern now throughout the entire country.

As the house well knows, I have come and reported this to the house on many occasions over the last year and a half. I can speak from firsthand knowledge of the challenges that have been faced by the Stirling community hospital in my electorate of Heysen. That has been a story of struggle and of achievement. It has come by applying some core expertise in terms of understanding what the compliance needs are for the hospital, and it has come with a constant rededication to working on the model that is going to be best fit and viable for the local community, but, importantly and centrally, it has reminded all of us of the need for the community to work hand-in-hand with the government of the day to ensure that the hospital's services are well supported and sustained.

In reporting the good news that the Stirling Hospital board had turned around what it feared might be the course that the Stirling Hospital was on in the middle part of last year, to reassure the community that it would not be closing its doors, it would not be selling and moving to rented premises in Mount Barker but would instead be continuing, I had to report that that was no thanks to the Malinauskas Labor government. In fact, on the contrary, as the house knows and as the minister knows, it was as early as the first moments of stress being widely announced by the Stirling Hospital leadership.

It was on 31 May last year in this house, in response to a question from me about what the Malinauskas Labor government was going to do to help the Stirling Hospital, that the Minister for Health immediately and thoroughly washed his hands of the whole thing. He said, 'It's a private hospital, nothing to do with us, and we won't be doing anything to help.' That is despite the fact that only a few months prior to that he had been only too happy to come up and help hold the scissors, cutting the ribbons on the improved facilities at the hospital. So this is a matter of seriousness. It ought to be a matter of priority concern for this state Labor government.

We know that the federal Minister for Health, Minister Butler, has been so exercised by this challenge that is affecting small rural and regional hospitals around the country that he has had to step in and have a thorough re-look at the sorts of accreditation criteria that are being applied and that are putting a further burden on these hospitals. He knows that if they all close their doors, one after the other, then the burden comes onto the public health system all the more.

Against the background of what we now know—the famous, single most significant lie told to the South Australian people that got this mob elected, that they will fix the ramping crisis and that health will be improved under the Malinauskas Labor government—it has all gone completely in the wrong direction. They now have the shame and ignominy of these massive ramping data and the hospital system in constant crisis. You name the colour—yellow, white—it is just sustained. It is a complete crisis ongoing in the public health system, and yet we see public and community hospitals that are left to struggle through.

It is well that the member for Narungga talks about the benefit of having an op shop by your side providing funds. Stirling is no exception. Stirling Hospital has benefited from hundreds of thousands of dollars, over that near century of the hospital's proud history, of contributions from the Stirling op shop. Now that the hospital has said that it is going to stay put, the op shop has continued with those commitments, making further tens of thousands of dollars of commitment, and it is well that that should continue.

So it is disappointing, in these circumstances, that the government presents the member for Dunstan to indicate some kind of proposed amendment to this motion. We would have been better off in hearing from the member for Dunstan about some of that farming community history that we heard about yesterday, and about that appreciation of just how important regional hospitals are for our regional communities. That would have been a more helpful contribution to this debate.

I cannot emphasise how real and pressing this is. The focus of this motion is particularly the Ardrossan community, but we have certainly found common cause. I often reflect on the fact that I am very much the odd one out in my family, not being medical. I have no particular medical expertise to share. I pay particular tribute to my brother and my sister-in-law, most relevantly for their continued dedication to general practice in the regions and in the remote parts of Australia, in the Northern Territory and in Queensland in particular. I know the hard work that regional GPs do, and I know the hard work that they do alongside and together with our regional private community hospitals. It is well that we should apply our priority resource to supporting the dedication of those individuals and those communities.

Closer to home, I think in terms of the member for Narungga's linking of the needs of the community in Ardrossan with what ought to be done to amp up the services at Wallaroo, I can speak with some near firsthand knowledge. My niece was born at the Wallaroo Hospital. I know what it was like to have to resort to the nearest fully fledged public hospital in the district. There is no doubt that there is a core role for the public health services in the region to work together with local regional hospitals within their network. I thank, appreciate and acknowledge the work of John Voumard in particular, and the local health network. That work is vital.

But all of these elements together cannot progress, cannot thrive and will be under terminal stress if the hospitals are met with silence and abandonment from the government in their moments of need, and if they are overborne by regulation and accreditation burdens which are not fit for purpose. Those are important matters for the government to reflect on and to act on.

They have had plenty of time. It is not just today. The story of the Stirling Hospital runs in parallel with that of Ardrossan which runs in parallel with that of McLaren Vale. Of course we know the story of Victor Harbor, and it is happening in the urban areas of Adelaide as well. It is time that Malinauskas Labor stood up and supported regional hospitals in South Australia.

Mr PEDERICK (Hammond) (12:25): I rise to support this motion by the member for Narungga in supporting not just healthcare needs on the Yorke Peninsula but across broader South Australia and certainly, in particular, in my seat of Hammond and surrounding areas. Some areas of Hammond have interchanged over time, and at the moment the Mallee areas of Lameroo, Pinnaroo and Karoonda have all gone into different seats–Lameroo and Pinnaroo into MacKillop and Karoonda into Chaffey. They have certainly had their different challenges over time in attracting health professionals. I have seen, sadly, a bit of racism over international doctors coming to one location years ago, and that was a tragedy in itself because that community then lost their doctor.

Certainly, everyone deserves decent health care across this state. In the bigger scheme of things I would like to thank the volunteer ambulance service personnel around the state for what they do in supporting the paid paramedics to get the healthcare helicopters out and, for those further afield and further-flung hospitals, the Royal Flying Doctor Service for the work they do in looking after not just country South Australians but those who need those services out in the bush.

Country health is a challenging space, and sadly we see too much money just burnt up in health. We see the state Labor government pouring billions and billions of dollars into health as they try to fix the ramping crisis that they said they would fix at the last election, which they will not fix, by the way. They will just pour in billions and billions of dollars, and it just keeps getting thrown at essentially a festering wound.

We have seen the most expensive building in the world built here in Adelaide—the new Royal Adelaide Hospital. Before it was built, it was always going to be too small. Yet when we saw the new Angas Street hospital built, the new Calvary, that hospital was built for a third of the bed price of the Royal Adelaide Hospital. Why did that happen? It was because it was built in the private sector. Commercial & General built it. Jamie McClurg and his team do a great thing, and thankfully he is the builder doing great work in North Adelaide, finally building some towers after decades of maladministration in regard to that land, but that is another story. You just have to question where the wastage comes from.

Certainly, over time, living at Coomandook—and I have said this before—we have had emergency services at Tailem Bend. I believe they are not there anymore, but it was a great service to have, whether you drove in or needed an ambulance to come. You would ring up and get the doctor to come in to make sure that a doctor was there. We have similar triage arrangements at the Murray Bridge emergency department now, where doctors are on call. This happens in most sites across South Australia, because they are contracted out. Murray Bridge is contracted out to Bridge Clinic, which does a magnificent job, alongside the other two clinics that are based in Murray Bridge.

I have written to the other two clinics about getting more support for Bridge Clinic, which is happy to cooperate with the other two clinics to attract more doctors to assist with the emergency management at that hospital. That has not been forthcoming. Bridge Clinic get criticised for having a so-called monopoly, but they want the support and they need the support to carry on, and they do a great job. Certainly, since the new emergency department was built, with my urging through my team and under the Marshall Liberal government, it has been a great boon for our area. But as the population expands, we are going to need a massive upgrade in health services in the Murray Bridge area. Certainly, with a tripling of the population over the next 40 years it has to be front and centre of governments going into the next few decades.

Emergency departments are quite vital but they get abused to a degree—that might be too strong a word—but during COVID we saw 70 per cent of people stop attending emergency departments, like the one at the Royal Adelaide Hospital, because people were actually scared to go into emergency departments because they thought they would catch COVID. That means—and I do not think the number has changed, and I am happy for someone to tell me if it has—that 70 per cent of people attending an emergency department do not need to be there.

The problem we have, though, is that people are having trouble getting into general practitioners (GPs) and so that is their option. What happens in most country hospitals with emergency department access is that there is a gap fee if you do not get admitted. It is usually not very large but it does impact people, and I get that—we certainly get the references that come to my office for that kind of thing—but guess what? The way that works is that it literally keeps people out of emergency departments who do not need to be there.

That gap fee is variable, and I get that. People think we should have free health care—well, nothing is free in the world. I just mentioned before about the many billions of dollars getting poured into SA Health and we still get the same outcome. It just does not work. I think it would be too simplistic, to a degree, but I certainly believe that ramping could be fixed without—and here I am trying to help the Malinauskas Labor government—

An honourable member interjecting:

Mr PEDERICK: Trying to help all South Australians. I think it could be fixed without spending a single dollar on any infrastructure. I do not think the public would stand it, mind you, but if there was a gap fee for people turning up to emergency who did not get admitted, I think you would see a drastic reduction in people attending emergency departments. I do not think it would be something politically saleable for probably anyone, but the reality is that there are billions and billions of dollars being forged into SA Health and it takes 30 per cent of the state's budget, but where are we going?

There is more infrastructure being built, more people not being able to access general practitioners, and more people being ramped for over 100,000 hours, I think, since Labor came into office. The simple fact is that we need more support at our regional hospitals because that will keep regional people out of Adelaide as much as possible, notwithstanding the fact that 30 per cent of patients in Adelaide hospitals are country people; 30 per cent of patients can be up here for elective surgery, emergency needs and that kind of thing.

We need more support in the regions, which are vital to this state's economy, whether it is in the farming sector, the mining sector, or whether it is in all industries across the board, the value-add sector as we have in my area with the food processing industries. We need to have those support services close to home so that we do not have to be rushing off and clogging up a system that is already clogged beyond control.

Where I think the billions of dollars should be invested is in local health services, whether they be on Yorke Peninsula at Ardrossan or Wallaroo or over on the West Coast at Port Lincoln and surrounding areas, and certainly in my area, whether that be at Murray Bridge, which obviously will need an expanded service and a new hospital over time, Mannum or Strathalbyn, which does not have a functioning emergency department at the moment and certainly needs an upgraded service there for a community that is expanding. If you do not class that as regional then look up the road at Mount Barker: they are having a few hundred million invested there for a new hospital over time.

I think it would be a lot smarter investing billions of dollars into country health services right across the state than what I see as some of the waste going into a project that is not fixing the problem that the Malinauskas Labor government said they would fix, and that is ramping.

Mr TELFER (Flinders) (12:35): I rise to speak in support of the original motion from the member for Narungga and to highlight that, indeed, there is a significant challenge which should be faced by this government. I note the amendments that have been put by the government. I am surprised by the amendments, really, and a bit disappointed because if you take out the aspect that we note that this comes as a part of a wider degradation in regional health services, you are missing the whole point of the motion—you are missing the whole point.

Both the mover and the seconder I understand are now members of parliament representing inner metropolitan seats, but I thought that both, with experience in regional centres, might understand what is being faced at the moment. In regional South Australia, our communities are at risk of not being sustainable because of the lack of investment and the degradation of our health system.

I am on my feet today and will share some of the stories from my electorate. These are stories that are mirrored when I speak to people all around regional South Australia and which have already been mentioned by some of the other regional members of parliament. I was in the member for Narungga's electorate speaking with communities that reflected exactly the same things that my community are reflecting. It is the same in the South-East and the Riverland, in the Mid North and the Upper North. If there is not a recognition from this Labor government that there has been a wider degradation in regional health services and regional health infrastructure, then why are we even bothering to look at this? The rest of it is just icing on a really flat cake.

We need a health system in our regions that effectively keeps our regions pumping the amount of money into our state's economy that is needed for us to continue to function. We need sustainable services as far as GP delivery goes within our regional areas if we are truly going to maximise the opportunities that we have. Even if it is not within a motion, I hope there is recognition within this Labor government that there needs to be investment.

I am going to share a few specifics about what is happening in Flinders because it truly is worrying. I have spoken in this place about the challenges that have been faced previously at Streaky Bay. Streaky Bay is a community that has a longstanding sustainable population, which has sustained GP and health services for a long period of time. That should not have changed, but the model and the structures that support that seem to have changed.

It arose that with the private practice closing there was not the leadership from within state government, the local health network or the health department to actually fill the gap necessary. Who filled the gap? It was the local council. The District Council of Streaky Bay for several years has basically been subsidising the health delivery into the Streaky Bay community because of the lack of leadership and the lack of awareness from within the health department. Hundreds of thousands of dollars of ratepayers' money has gone into propping up what should have been delivered by state and federal governments.

The same goes for some of the challenges that are being faced all the way around my electorate. Only last week, I heard—after the fact, obviously not before—that the health minister visited my electorate. He visited Streaky Bay, specifically. One would think if there was awareness of what the current delivery model looks like, there may be a courtesy call, there may be an email, there may at least be an awareness that local government—the council there at Streaky Bay—have been playing a key role.

But in fact, a visit to Streaky Bay by the health minister did not include any recognition of the local council: no phone call to the mayor, no phone call to the CEO, no heads-up that at least they were going to be there or thereabouts. They found out afterwards through the social media post. That is just a total lack of awareness—bloody-mindedness—from the health minister when it comes to regional health and knowing the different aspects.

We had the local health network slowly guiding the minister just to the areas they wanted him to see and not to the areas that he should have been looking at and the community say he should have been looking at. There was no phone call to the mayor, no phone call to the CEO and no awareness of what those structures look like.

At Elliston at the moment there is really a stand-off between the health department—our local health network—that wants to try to minimise what they are responsible for versus what the community need and the community expectation is. We have doctors and health professionals who are willing to help drive a solution in these communities—like Elliston, like Wudinna—whose solutions are just being rejected by the local health network. These solutions would actually be able to be delivered with less expenditure than the local health network is currently putting out.

Firstly, the current arrangement at Streaky Bay is that the council has been subsidising the locums coming in for thousands and thousands of dollars every week. In these centres, the amount of money that the local health network is spending on those sorts of arrangements is over and above what it would actually take to afford to deliver some of these other costs. But the bloody-mindedness with which they have been going about these processes is stark.

The minister made his way, mollycoddled by the LHN to where they wanted him to be, down to Cummins—once again, without any sort of awareness about what the arrangements are with the wider medical system in Cummins. There was no phone call to the mayor, there was no, 'What can we do as a part of the community to help get the best outcome for the community?' No, once again they found after the fact, just like I did.

At Cummins we have a hospital which, to highlight the wider degradation in the regional health services, has had significant swathes closed due to a lack of investment, due to a lack of maintenance. The kitchen itself at the Cummins hospital has been condemned. For months the cooking of meals for people who are at this hospital and part of that health system has been done up the road at the Cummins Bowling Club. That includes meals for Meals on Wheels. This is a long way away from the hospital itself, and why? Because there has been a wider degradation in regional health services and infrastructure. That is why this point that has been taken out by this Labor government is so crucial in this motion. There has been a wider degradation.

If we go over the hill to the Tumby Bay community, the Tumby Bay Hospital has not just an active HAC but also a hospital auxiliary wanting to better their community. In regional communities, we all have a vested interest in having medical and health services that are up to community expectations, and we put in: we volunteer, we donate, we fundraise and we have people who are bequeathing significant amounts of money upon their death to be able to sustain what should be a core function of the state government.

At Tumby Bay, money has been available from the community to invest in bathroom upgrades for hospital rooms. You would think that having modern, all-ability access bathrooms should be a core function of what a hospital or a health system looks like, but in fact we have hospitals like Tumby Bay all around South Australia where these basics are not even done right because there has been a wider degradation in regional health services and infrastructure. This is what this motion is highlighting. It is not even highlighting the amount of money that needs to be spent; it is bringing the awareness of that wider degradation. To have this gutted out of this motion by the amendment put by this Labor government is stark.

I do not have time to speak about the need for the Patient Assistance Transport Scheme to have more funds put into it, to be upgraded to make sure that it better reflects the community's needs. We understand that not everything can be delivered by a regional health service. That is why a scheme such as this needs to be robust and comprehensive enough to support members of our regional communities to go to Adelaide and to not be significantly out of pocket when it comes to their medical costs.

We have not seen anything from this government on that either, and I am calling on the health minister to be eyes wide open with regional health because the gaps are getting wider, and the regional communities are crying out for more.

Mr McBRIDE (MacKillop) (12:45): First of all, I would like to acknowledge the member for Narungga's motion. Obviously, I can speak volumes to it, in particular at paragraph (d)(i) where it mentions the Keith and District Hospital. I am no stranger to this area: batting for local health, hospitals and networks, and services for our regions. I also acknowledge the member for Dunstan and her amendment because even though it is not the same as what is being advocated here by the member for Narungga, it is still a motion that supports regional health and the network that he has here, and it basically implores the state government to do all they can.

I will speak to both of them, because the Keith hospital would not be the Keith hospital if it did not have the state government's support—by the Liberal government or the Labor government. I am going to mention a name here that is front and foremost when the Keith hospital is talked about: a lady called Ms Kelly Borlase, who is now on the Limestone Coast Local Health Network board. She was the coordinator of the model that the Keith hospital as it exists is now using.

I was at the Keith hospital recently to visit a dear lady—obviously, it is an aged-care facility as well—who turned over 100 years old, and we celebrated her birthday. The hospital and the precinct with the aged care was just amazing. The director of nursing, Ms Jacquie Halliday, who I know quite well and have known for a long time, and her husband, Richard, who is a merino sheep breeder, runs this community hospital. They are locals.

When I first came into politics in 2018 it was a private hospital model that bled a lot of funds out of the community—I believe in the vicinity of $1.2 million of community funds keeping the Keith hospital alive and meeting the needs of the community—and in the end it fell over because of its private hospital status. It speaks volumes to the local health network now about where the Keith hospital has landed from the old health network back in the Limestone Coast under the previous chair and previous CEO to the new ones that are in their places now. It now has a nurse practitioner and is backed up by paramedics.

The thing that Keith really did struggle with was doctors. I think it has at least two or three doctors coming from places like Bordertown to back up the Keith hospital model, which was wanted, it was warranted, but we never knew where it was going to land and how it was going to work. It is my understanding that the relationship between the doctors now and the Keith hospital, and its model, is a really good model that is working well for the region and the township of Keith.

Just as everyone here has been speaking to this motion by the member for Narungga in advocating for regional health, never have we seen such dynamics in health and difficulty around the shortage of doctors, the shortage of services, and such pressure being put on the medical system statewide.

One thing that has to be highlighted—and there will be no hiding from this by government, whether Labor or Liberal; it will not matter—is that the health system has to take a long hard look at itself. I am not talking about the soldiers, be they the nurses, and I am not talking about the doctors, be they the GPs or even the specialists, but those who manage the health system. The tier above this has to have a long hard look at themselves and ask: are they worthy of their job, are they doing a job that is needed and are they in the way of good health services for this state? I can tell you it is going to be found and it is going to be seen if this is not the case.

It starts off from the fact that we know that we have a new Royal Adelaide Hospital, and we know that before this new Malinauskas government there was a new Women's and Children's Hospital being proposed. If we go back and see what the new RAH has cost, and its per square metre costings compared with a private hospital that was built in Adelaide, they will say, 'But the RAH is a lot bigger, better, grander and that was why it was so much more expensive.'

The point I make here is that the more money we waste, the more we say that we need this—and it is going to be the most expensive build and the best Women's and Children's Hospital—the more money we do not have for our regions. The Ardrossan hospital, the Keith hospital and all the other networks will have to suffer more problems because of the drain on the system by those who are up above, spending more than they should, more than the private sector would—and not just by a little way but by two and three times more than the private sector would. The Public Service and the health system have to take a long hard look at themselves because the people will revolt, and they will highlight it, and what is going on will be pointed out and there will not be anywhere to hide.

If you are in these jobs where it is—you could say it is my side—jobs for the boys or it is bureaucracy building on bureaucracy building on bureaucracy, and it just falls over and implodes, if that is inevitably where you are going to land and you do not mind that, then that is alright. We will stand back and watch. But when you turn and you go down to a collapse, and you look at where the Victorian government now lands itself, it cannot even complete its projects. It had to turn down a major sporting event because it has run out of money. This pot does actually run out and people are going to have to start saying, 'Well, we are going up to $44 billion worth of debt in this state and we cannot keep our people alive, and we cannot keep them in health services.' 'Oh, sorry, we just ran out of money.' That is not acceptable.

Obviously, I understand the struggles we are seeing there in Narungga. We understand the struggles. This community has now found itself without any foundations, it has found itself without any support. I imagine the budget for the local health network around the Ardrossan hospital probably does not fit and then, all of a sudden, 'It's too bad, we just have to close the doors.' People will just have to travel 40, 50 or 100 kilometres until they see the next health system, health network facility or whatever it is.

All I would then say is that that is the inference, and the inference is that we will just transport all our regional community into a citycentric hospital system that is probably and should be and could be Rolls Royce in being grand, and grand in its entirety. It does not mean that the tentacles out into the regions need to be rusted, worn out and tired, as we heard from the member for Flinders, where kitchens do not work, where bathrooms are not suitable for all patients with a disability or the elderly. Then you say, 'Well, how do we then live and how do we then cope?' 'But there is not enough money to go around.' And then, 'No, that's alright, we are spending it on this new Women's and Children's, we spent it on the RAH and we spend it around Adelaide. We will just fly the Flying Doctor up.'

I heard an interesting statistic recently because I am seriously looking in this area: apparently in the early 2000s, there used to be around 30 Royal Flying Doctor visits into Mount Gambier per year and now there are over 700. Those 700 now just happily fly down to Mount Gambier, pick up what they cannot do in Mount Gambier now in the way of services, fly them back to the Royal Adelaide or another hospital that is in the city, and it just adds to your problems in the city—and then the government suffers from ramping.

Well, you are not getting a good solution here I can tell you. You have 670 more visits from Mount Gambier because the services down there are not meeting the needs of the people. So we just then load it up here in Adelaide and then we wonder why the ambulances are stuck on their ramps. All I am going to say here is that I really do thank the state government, be it the previous Marshall government or the new Malinauskas government and the new Minister for Health.

In regard to the Keith model, in my own electorate we can probably see the Keith model roll out to other hospitals and its services. If those hospitals continue to lose more hospital services that we see there at the moment—e.g. Keith hospital does not have a hospital bed anymore, but it is better than having the doors closed. I can tell you, they have doctors there now and they can go 40 kilometres away to Bordertown, so that is a tick; the community will wear that.

We know that the model is more efficient and effective due to the fact that it has this nurse practitioner. The problem is that nurse practitioners are really hard to find. We know we have a beautiful nurse practitioner operating out of Pinnaroo. She is absolutely loaded with work. Not only is she seeing South Australian residents from Pinnaroo and Lameroo, she is seeing Victorian residents come across the border to go to Pinnaroo and work with her. Also, even the service sector around health and the specialists are coming from Victoria to back up the nurse practitioner at Pinnaroo. Maybe the Keith hospital will also eventually see some more specialists going to Keith because it is being backed up by the local GPs, backed up by a nurse practitioner and other nurses with an aged-care facility.

All I am going to say is I speak volumes for it. I thank the Limestone Coast Local Health Network for the Keith hospital model. I hope that model is able to be rolled out elsewhere rather than closing the doors on our health facilities. I wish the member for Narungga all the best with his advocacy for Ardrossan and long may we all have good health in the regions.

Mr BASHAM (Finniss) (12:55): I rise just for a few moments before allowing the member for Narungga to close the debate. I just want to make a few comments. Sadly, the Victor Harbor community lost the Victor Harbor community hospital back in April. That was very much a sad moment to lose a community-run hospital. It was co-located with the public hospital, the South Coast District Hospital. They shared the building, which meant they could share facilities, etc. It was, going back 25 years ago, the model that people saw as the future.

Intriguingly, it was actually a few years after its operation and its establishment that it was recommended by the manager of the public hospital that the private hospital take over the management of the public hospital so that they could manage it all as one from the private hospital side. That was an interesting suggestion then that did not ever come to fruition. Sadly, the hospital has been closed. The community of Victor Harbor has lost the ability to have a private option, which means that the public purse is now paying for every person who is being admitted to that hospital. Yes, the state government has taken on the beds that were in the private wing, but they are now being funded by the taxpayer and so it is certainly not a great outcome.

There are many people who have private health insurance who now will not use that private health insurance for their health care because if they are admitted into that hospital there is no difference in service that will be given to them, so they might as well go in as public patients under the care of the taxpayer. I just wanted to get that on the record. I very much support the original motion.

Mr ELLIS (Narungga) (12:57): I thank all members for contributing. I am somewhat surprised at the interest in the Ardrossan Community Hospital and the number of speakers that we had but I appreciate the support for regional health nonetheless and thank all of those individual speakers, particularly the member for Dunstan, who has put forward the government position. I wish to make it clear to the chamber that I accept the amendments from the government, acknowledging the fruitlessness of opposing them, but certainly prefer the original iteration that had slightly more detail.

The important thing out of all of it is that it has been brought to the parliament's attention at length and that we have all had the opportunity to highlight the dire situation in regional South Australia in regard to health. She did also remind me of one important fact and that was that I did not acknowledge the contributions that governments have made to the Ardrossan Community Hospital over a number of years. Both the previous Liberal government and the current Labor government had made contributions to try to ensure that that community hospital was able to keep running. Ultimately, the burden became too much, despite those contributions, but they should be acknowledged and thanked indeed.

I also should make an effort to exonerate the LHN. They have earnestly engaged with the community hospital about finding a solution. One has not been found yet, but John Voumard and co have earnestly sat down with the intention of reconciling a solution, and for that they should be congratulated. They are in a good place I think, the LHN. They have Dr Hendrika Meyer running the medical services. She has been a wonderful addition, along with Verity Paterson and a few other wonderful people there who are helping the situation, and they should be thanked.

The one exception that I do take to the member for Dunstan's contribution is that we are genuinely sick and tired of being told that investment in the Port Pirie hospital is a good thing for the Yorke Peninsula. It is one hour the other way from Adelaide and if we drove that way it would be three hours from town. No-one is going there to use their wonderful new facilities. It is basically irrelevant for the majority of the peninsula in regard to our health services. If we could stop being told that Port Pirie is a wonderful boon for the YP that would be a good thing. But, in essence, we need to ensure that there is a health service in Ardrossan into the future. I commend the amended motion.

Amendment carried; motion as amended carried.

Sitting suspended from 13:00 to 14:00.

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