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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2023-09-28 Daily Xml
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Parliamentary Committees

Select Committee on Access to Urinary Tract Infection Treatment

Ms STINSON (Badcoe) (11:02): I move:

That the final report of the committee be noted.

I rise as the Chair of the Select Committee on Access to UTI Treatment and to speak to its 29 well-researched and rigorous recommendations. I would like to start by thanking my fellow committee members.

It is fair to say that we each arrived at this issue with different ideas and different perspectives, and I think the committee was a great example of where we worked productively to interrogate the evidence, to look at some of the criticisms seriously and to assess some of the evidence, which was conflicting, and arrive at a position where we are unanimously recommending that women aged 18 to 65 should be able to access UTI antibiotics from a specially trained pharmacist under some tight safeguards.

I would also like to thank our research officer, Dr Amy Mead, who came to this issue with some professional experience of her own, which has really benefited the committee, and also Patrick Dupont, who ably assisted us in receiving the whopping 151 submissions over the nine-month inquiry and who organised so well for us to take evidence.

Since tabling the final report yesterday afternoon, I have been inundated with texts, emails and social media messages. There must have been hundreds so far from women like me who have suffered the debilitating effects of a urinary tract infection, better known as a UTI. Some have been very emotional, and the sentiments have reminded me why I first brought this matter before the parliament and why we are all here—that is, to make a difference for the people of our state. One wrote to me and said:

Amazing work, thank you so much. Last time I had a UTI, I had to find a random GP who was free to welcome me straightaway as my GP was unable to see me for days.

Another said:

Thank you so much for this. This means I can get onto this straightaway instead of having to wait days to see a GP. We know when it's coming days before it hits us, so thank you.

Half of South Australian women will get a UTI, so those sentiments are not uncommon at all. For those who are unfamiliar, this infection is usually sudden and unexpected. It leads to a burning urination, a feeling of having to go to the bathroom, even if you do not need to go, and also considerable discomfort. For sufferers, the symptoms are unmistakable. Once a woman has had it once, they are pretty adept at identifying it again.

The committee heard that when a UTI strikes it has some serious social and economic consequences for women. We heard that for many it means they cannot work and they cannot earn money. We heard from Nicki, who is self-employed as a landscape gardener. She simply cannot do physical labour and has to call clients suddenly and cancel the jobs when it strikes. She loses money from that, and that has an impact for her as she waits several days usually, she said, to get into a GP and to get a prescription, despite all along knowing exactly what she needed. Many others echoed that experience in their evidence to our committee. Even those in desk jobs found it hard to work and had to take time off, awaiting access to effective treatment.

I think that this is a measure that women deserve. They deserve to have their pain taken seriously, and they deserve that members of this parliament think seriously about what can constructively be done to address that, rather than saying, 'Well, this is the way it has always been done.' For others, it prevented them from caring for loved ones like children or older relatives, either costing them money to put children into child care or they would simply be in excruciating pain while trying to continue those caring responsibilities. Of course, there were many women who just could not do the things that they loved—swimming, socialising or even reading—because of this very intense and distracting intimate pain and discomfort.

We also heard from many patients who ended up in the queue at our emergency departments, either because they had no way of getting a script for the medication or because they had not gone to get that medication in a timely way and were suffering the complications and needed to be admitted to hospital. The member for Elder shared her personal story of ending up in the emergency department when she was younger. Because she was concerned about the cost, she put off getting treatment and she ended up in hospital. That story is certainly not alone.

The committee received evidence from SA Health that in 2021-22 more than 8,800 people reported to our emergency departments with a UTI or a kidney infection. Of those, more than 2,700 were admitted to hospital—that is 31 per cent—so it can be deduced that some portion of the remainder were provided medication (antibiotics) and sent home. Some of those people may not have been eligible for this proposed scheme, but many of them would. I am of the view that whatever we can do to relieve pressure on our emergency wards and take preventative measures to avoid hospitalisation we should certainly be doing, and that means faster and better care for those who do require the expertise of our doctors.

So what is proposed? We have recommended that women aged 18 to 65 be able to access this scheme. For very good reason, we have not extended that to children, people over 65 or, indeed, men. That is because the evidence before our committee was that those groups are more likely to suffer a complication and would benefit from having a GP do a more detailed examination than a pharmacist is probably able to do.

These recommendations lay out the basics of the proposed scheme and also a framework for implementation. Some of the things we touch on are the additional training for pharmacists, enabling them to provide this new service; their use of a checklist to identify any red flags that should see them refer the patient to a GP; and three lines of antibiotics should be made available. I will go into some detail about that. We also looked quite carefully at privacy measures, such as whether consulting rooms, quiet areas or privacy shields should be mandated, and I will expand on that as well.

We also settled on the fact that a consultation fee should be able to be charged, around $20. We did give some consideration to whether that cost should be waived or the service should be made free and in fact paid for by the government, but the patients were very helpful in saying that they felt that that was a considerable saving from the amount they are paying to go to a GP and that in fact as health consumers they would feel comfortable paying that amount.

I might turn to some criticisms, which we did go through in some detail over the nine months of the inquiry. There was a great deal of criticism from doctors' groups around pharmacist training and claims that pharmacists are not qualified to assess a patient for an uncomplicated UTI. We took that on board and tested it by looking at the training that is provided to pharmacists. We heard from UniSA, which provides the only pharmacy qualification in the state. They submitted that UTI, as well as things like antimicrobial resistance and how to be respectful of privacy, forms part of their core university degree training. Our pharmacists are actually trained for UTI dispensing, even though they are not allowed to prescribe in SA at the moment.

We also heard from regulators and accrediting bodies for pharmacists and the medical sector, who stated that diagnosing an uncomplicated UTI is well within the scope of pharmacists right now and that no further training is even needed. The committee obviously took that into account, but also took on board that not all pharmacists in our state would be trained by UniSA and that some pharmacists may have been trained at uni many decades ago, before this training module was offered.

We have recommended that additional online training is required for participation in this scheme. That training covers a range of matters, including antimicrobial resistance, but we are also recommending cultural competency training and data security training to make sure that our pharmacists are well on top of their responsibilities.

It was concerning, I have to say, from my point of view that some advocacy groups expressed on one hand that they worked collaboratively with pharmacists yet on the other hand seemed to have little or erroneous knowledge of the training and scope of expertise of our pharmacists. I personally felt that some of the criticism of the lack of ability or aptitude of our pharmacists was unwarranted, and I do not think it was borne out in the evidence that we heard from many parties and experts throughout the inquiry.

Criticisms were also made of the Queensland trial, which we looked at in some detail. Chiefly, those criticisms were from doctors' groups. I think it is worth putting on record that there has been some misinformation about the Queensland trial. The committee carefully assessed the outcomes of the Queensland trial, and in fact went up there to see it in action, which was very instructive for us.

The main area, though, that was criticised, which we did think warranted investigation by the committee, was the follow-up mechanism and the rate of replies after a patient had been seen, replying to the pharmacist indicating whether the treatment had been successful or not. There was criticism that that follow-up rate, or response rate, was quite low. We have made a recommendation that the minister looks into an automatic text message service, so that an automatic text might be sent to users of the service three to seven days after their treatment, just to check in with them.

This would be, firstly, to check if their symptoms are continuing but also to remind them, as they will be told in their in-person consultation, that if their symptoms have not resolved then they should go and see a GP. That is critical advice, and obviously advice that pharmacists dispense daily to customers, that if the treatment that they are provided at the pharmacy is not effective they should seek further examination and treatment from a GP. I hope that recommendation will be taken on board and technologically can be achieved.

Antimicrobial resistance (AMR), I thought, was something that was a criticism but something well worth looking into. UTI sufferers like me are acutely aware of AMR and the risk it poses very directly to us. When you suffer a condition that can only be treated by antibiotics and you may have that condition for your whole life, you are conscious that you want it to work for your whole life, and you need it to, so AMR was a key focus. While I put a different weight on different concerns presented by doctors' groups, this is one on which they are certainly on the money.

We spoke at length with the peak AMR authority in this state, SAAGAR, about the safety of this program in terms of AMR risk, and there are a few points in evidence to draw out. One was that this program does not result in a greater overall volume of antibiotics being prescribed; it is simply a different avenue to get them. A patient will absolutely need antibiotics if they have a serious UTI. All this is doing is saying, 'Well, instead of getting that particular dose from your GP after several days' wait, you'll be getting that same dose from a pharmacist.' So it is not contributing to an overall increase in the amount of antibiotics in the community. In fact, we heard that it may reduce the need for large volumes of antibiotics to be given to patients later on if they suffer complications like kidney infections.

There was consideration by us of whether to offer one or three lines of antibiotic treatment. SAAGAR recommended one line of treatment but said that was a very borderline and contentious or debated proposition that they put to us. We tested that against other expert witnesses and also against what is happening in other states, and even overseas, and have ended up recommending that three lines of antibiotics should be made available. Trimethoprim will cater for about 80 to 90 per cent of patients—maybe even more—but the other options are available there in case someone cannot take trimethoprim.

The evidence was also that safeguards, which have been outlined in our recommendations, are sufficient to address AMR. But it is important, I think, that we do note that antimicrobial resistance is a huge issue, that there is a huge amount of work to be done and that it should be taken incredibly seriously. To the extent of this program further exacerbating those issues, there was no solid evidence that this program would seriously exacerbate the threat that AMR poses, though it is real.

Another issue that was raised was privacy, and this is also a valid concern and one that we spent some time on. While I now find myself talking quite willingly about UTIs, previously I was actually pretty embarrassed and shy to be talking about this, and I can understand that many people going to either their doctor or a pharmacy will not be wanting their conversations to be overheard by anyone. Patient privacy, especially in the pharmacy, is very important.

Ideally, I think the committee thought that it would be great if every pharmacy did have a private consulting room, but that is not achievable in some areas. Particularly, we had a mind to regional areas and outer suburban areas where there may be only one pharmacy, and if that pharmacy did not have a private consulting room it would not be eligible to offer this service. We thought that that was an issue of equity, so we have not put any prerequisite for a separate consulting room but we have said that separate consulting rooms, quiet areas for consultations and also privacy shields should be considered and should be implemented by pharmacies as a priority.

I hope I will have an opportunity to round off later, but I am very much looking forward to hearing the other committee members' contributions.

Ms PRATT (Frome) (11:17): As a committee member, I also rise to speak to this final report on the Select Committee on Access to Urinary Tract Infection Treatment. I take the very first opportunity to thank—as did the member for Badcoe—Amy Mead and Patrick Dupont who, in supporting us as the secretariat service and research service, did an outstanding job to consolidate what has been quite technical scientific and clinical information.

The duty of our committee, of course, was that we were established to examine how pharmacists could safely and promptly dispense medication for painful urinary tract infections without the need for a visit to the doctor. At the outset, I take the opportunity to thank my committee members who sit across the chamber and our Chairperson, the member for Badcoe. I concur with her on the experience of working through this committee.

I think we have achieved a collegial committee culture, we have all been actively engaged in this process and, speaking on behalf of the opposition, we were fully engaged with the topic and it has been an important national health policy conversation to bring to a parliamentary committee to consider. That being said, it is notwithstanding that, while I think we shared the same objective, we were not always in agreement and we have needed the committee process to explore all avenues that were presented to us.

I want to thank the stakeholders, the industry groups and the UTI sufferers who came in person, in a virtual capacity or in writing to give their evidence. They often spoke with some vulnerability, including the professionals, either making comments that might have gone against their own profession or, as the member has already outlined, sharing some very personal and private health information. Perhaps today we are normalising that.

Speaking again about that collegial approach, I think our objective was, of course, to explore opportunities to make recommendations that would improve and promote public health options for UTI sufferers—in this instance, very specifically, for women aged 18 to 65. To reflect on some of the priorities of this committee, for me I felt that our first consideration needed to be patient safety. That was paramount: patient safety, patient outcomes, patient privacy.

The task that the committee had before us allowed us also to reflect on more options for women's health and to explore opportunities and health services for women. I certainly took time to reflect on the pressures that our GPs are currently facing in terms of workload, both in the metro and rural areas. This committee gave us an opportunity to reflect on what an expanded scope of practice might look like for community pharmacists.

As an individual committee member, it was my duty to hear the evidence, to interrogate the science and to weigh that against the portfolios that I share, the rural community that I represent, and the difference in opinion between stakeholders including pharmacists, UTI sufferers, researchers and general practitioners.

The member has touched on points we will all share today, I think, that we came to understand: the concerns that were being raised by medical practitioners as well as researchers—in fact, every stakeholder, I think, was alive to issues like global supply of antibiotics, the pressures that pharmacists find themselves in in just dispensing the standard medications that they need to fill through prescriptions, and also antimicrobial resistance. There was no getting around the fact that there are barriers to this treatment being provided by pharmacists.

Committee members know that I used my seat at the table to interrogate our process, to quibble on wording and to question, perhaps, the pace of some of the recommendations. I want to pick up the member's, I hope, proud acknowledgement that this committee has really begun and completed its work in about seven months. This house is often criticised for not moving nimbly and getting results in a meaningful amount of time. I think that we did our duty to the task ahead of us.

However, I do have reservations about the pace we are now setting for the implementation team, the minister and the rollout of the recommendations that we are supporting. I will speak to that shortly. It is certainly good to get these outcomes from a committee in reasonable time, but I think that some of the language that we have debated now sets a bigger task for the minister and the implementation team.

Submissions to the committee from GPs and pharmacists have been quick to point out that they share a symbiotic relationship. I want to address that fact, that GPs and community pharmacists alike in their submissions were quick to say that they rely on each other, that there is mutual respect and that one really does not exist without the other. There is a natural and important level of independence between a doctor who is prescribing medication and the independence of the pharmacist who is dispensing that medication.

The member for Badcoe has beaten me to the punch by starting to reference the importance of our country rural community pharmacists. They are a profession that I hold dear. I had an opportunity to make sure their voice was at the table when we tried to understand the recommendations that we are setting and the practical implications for them in perhaps rolling out these recommendations. They go above and beyond in country SA. They provide wellbeing support to their customers. They know everyone by name. They do not all have private consulting rooms, but I am sure they appreciate that their profession has had such a platform.

The committee process certainly allowed us to have robust conversations and where we might not have always agreed, we did find consensus, and that is how we have come to be able to put forward a final report like this. I think that we tried to make the final report and set of recommendations as rigorous as possible, with safeguards and pharmacy practice protocols written into these recommendations.

If I quickly reflect on a national jurisdictional review—what is happening in the rest of the country—we know that this committee was established or triggered by a trial that was initiated in Queensland and that has had much ventilation and is really still current today, with industry groups still reflecting on the outcomes and the experiences of those users.

Since then, other states have followed Queensland's model with some variation. Really, there is a split, as I see it, between states like New South Wales and Victoria, which are well on the way to beginning to implement a trial. WA, Tasmania and now South Australia are really going to bypass the trial or pilot program option and go for full implementation. The member for Badcoe has explained why the committee feels that the recommendations from our state to the minister say that he should consider getting on with the rollout.

It will not surprise committee members that I have expressed interest in the New South Wales trial, which commenced in July and will run for 12 months. It is an opportunity to learn from another state separate from Queensland, which has become contentious in its interpretation, and to really use them as guinea pigs to see if there are any more learnings that could have been adopted.

While I make those comments, I reiterate that there has been no dissenting or minority report and that as a committee we have worked well and put forward our recommendations. As the shadow minister for preventative health, I have worn a different hat, which is to reflect on what is likely to become, should the minister agree, a statewide change to health policy. There has been unanimous committee support for these recommendations and now it is a matter for the minister to consider. I commend the report.

S.E. ANDREWS (Gibson) (11:28): I rise to speak as a member of the committee for access to UTI treatment. I would like to begin my remarks by thanking the member for Badcoe for initiating this investigation. It is incredibly worthwhile work and you have begun making a difference to women's lives and I thank you for that. It is incredibly important and will be highly valued from here on in.

Health care, unfortunately, is highly gendered and women often find it very difficult for people to listen to their concerns, to take their health issues seriously and for, in fact, research to be done properly with regard to health issues that impact purely women, so this has been a real opportunity for us as a committee to make a difference in that regard. I am very pleased to be a part of recommending a report for accessible and safe health care for women who are suffering from a UTI.

I would also like to take this opportunity to thank all the people who took time to provide evidence, both the sufferers and the professionals, who had an interest in this matter. I also acknowledge that it is not for everyone an easy thing to talk about publicly, and the fact that they did has really meant that we have been able to thoroughly investigate this issue, and I do thank them for that.

I, too, would like to state how thorough I believe the committee has been in our deliberations. That has also been supported by the work of the parliamentary staff who have worked on the committee: our secretary and research officer. We could not have done this work in such a thorough and timely fashion without their support, and I thank Patrick Dupont and Dr Amy Mead for their work.

I would also like to thank the member for Waite, the member for Unley and the member for Frome. It has really been a worthwhile investigation. I, too, would like to state on the record that our work together has been collegial and we have always taken the time to listen to each other, consider different views and want to find a way through. I really appreciate having had the opportunity to be on this committee.

I do not have anything to add with regard to our recommendations, other than I am so pleased with what we have put together in this report and I commend it to the house.

The Hon. D.G. PISONI (Unley) (11:31): I rise to speak as the token male on this committee. I do appreciate the manner in which the Chair took my contributions seriously when I participated in the process. I also thank those who did share, in many instances, their intimate stories about the difficulty they had in getting treatment for a mild UTI.

For a man, it was quite an interesting experience to learn how ironic health can be. We all hear that men do not pay enough attention to their health and, from this committee, we learnt that women have barriers in the way of their attending to their health. It is easy for men and they do not do it; it is difficult for women and they insist on doing it. I think there is something for men to learn from that experience.

There are a couple of recommendations I would like to speak specifically to. One of the things we heard from a pharmacist in Queensland was that she was a UTI sufferer and she was not even aware that Queensland was going through a trial and that she could go to a pharmacist and be issued the antibiotics to deal with it and go through a process of identifying whether she qualified. She was told by someone outside of pharmacy that this process was available.

So one of the recommendations is that the scheme should be publicly advertised. There are suggestions of that through news media, mainstream paid advertising, social media, out-based advertising, and also that pharmacists be encouraged—and, of course, I am sure they will do this—to have in-store promotions. If somebody is looking at cranberry juice, for example, there might be a sign saying, 'By the way, we can help you if you are suffering from a UTI. Ask us how.' I think that would be important because we want women to be aware that this is an opportunity for them.

There were some criticisms from those who were against pharmacists taking on this additional role, in that privacy was more difficult to offer in a pharmacy, as opposed to a doctor's surgery, when women wanted to discuss these issues. Of course, everything has changed since COVID. Pharmacy changes happened way before COVID, when pharmacists were given the ability to give flu injections.

I do recall there were sections of the health sector that opposed pharmacists being able to give flu injections. Now, of course, it is a big part of pharmacists' services, and most people go to pharmacists as opposed to their GP to get flu injections and also COVID vaccinations. We know that COVID vaccine injections are a very big part of the service that pharmacists provide.

Every day when so many Australians were working from home, and people who needed to visit their GPs were told to wait in the car park rather than in the waiting rooms before they came in for their appointment, pharmacists were in their pharmacies servicing patients' needs during this time. You simply cannot work from home as a pharmacist. In order to deal with those flu vaccinations and COVID vaccinations, lots of investment has been made in private consulting rooms for that process. That will continue.

I think the other issue was there was some debate about a consultation fee. I know in the New South Wales trial the government is picking up a $20 consultation fee; the state government is paying pharmacists for doing that. A very important point raised when we visited a pharmacy in Queensland was that there is this perception out there that you can go to your pharmacy and have things done for nothing. There was no resistance from UTI patients about paying $20. As a matter of fact, they were very pleased that they could get access immediately and that it was only $20, not the $50 to $70 gap fee they would pay if they visited their doctor, if they could get in.

We also heard representatives from the Royal Australian College of GPs claim that special time slots are available for women with UTIs who ring up, but not a single witness who was a UTI sufferer was able to validate that they got an early appointment because they said they had a UTI. This was quite surprising for the committee to hear.

By having a $20 fee—the case has been $20 in the trials—we felt we did not want to have any barriers to the government implementing this. We did not want the health minister or the Treasurer saying, 'Where are we going to find this extra money for this to happen?' Well, this is a solution. It does not mean that during the two-year period in the lead-up to a review we cannot look at whether there needs to be a package for socially disadvantaged people who might struggle to find that $20, because we understand that that could be an issue for some people. We certainly did not hear any evidence of that.

Another issue that was raised as a reason why pharmacists should not be doing this is that they do not hold the patients' health records, but that was smashed by the fact that there is a product called My Health Record. People's vaccination records are there, and records of the drugs they have been prescribed are there. It is an opt-in or opt-out process. About 97 per cent of Australians are in the My Health Record program, so that information is available.

If a pharmacist issues an antibiotic to deal with a UTI, it is recorded in their My Health Record and it is there for their doctor to see. It is not just a matter of handing over an antibiotic when a pharmacist deals with a patient. They always finish with the advice, 'If symptoms persist, see your doctor.' What I learnt during this campaign is that you always hear about a doctor-pharmacy rivalry and we certainly saw that in some of the evidence we heard that was presented to the committee.

I want to finish by saying that during this committee process we also saw at a federal level the introduction of the 60-day prescription, where basically the Labor government in Canberra, the Albanese government, said that they were going to reduce the cost of pharmaceutical products—or, if you like, prescriptions—to the community. They were doing that by basically telling pharmacists that they had to prescribe two prescriptions of drugs for the cost of prescribing just one.

The average pharmacy earns about $180,000 a year. The entire business model is based on the pharmacy agreements that are made every five years. We know that already in South Australia these cutbacks will not deliver savings to pharmacy patients because pharmacists will now have to charge for things that they have been doing for free like blood pressure tests, like Webster packs.

Ms Pratt: Delivery.

The Hon. D.G. PISONI: And delivery, of course. All these things are done for free. A Yorke Peninsula pharmacy was suggesting it could add $300 a year to those who might be benefiting from the Pharmaceutical Benefits Scheme cap of $400 a year, where they get medicines free after that. No longer will that be the case.

Ms HUTCHESSON (Waite) (11:41): I, too, rise to support our report for the Select Committee on Access to Urinary Tract Infection Treatment. I want to start by thanking the member for Badcoe and the Minister for Health and Wellbeing for bringing together the opportunity to have this committee in the first place. I know there was a lot of work there by the member to make it happen, but it has definitely been incredibly worthwhile. I would like to thank the members of the committee as well for the tussle of conversation we had sometimes to get through to the recommendations, but I think we have come out with a report that we can all be incredibly happy with.

Access to UTI treatment—myself, I do not tend to suffer from UTIs but I do know plenty who do. I have from time to time, and the pain is incredible, especially when you know what is wrong with you, you cannot access the medication that you need quickly; it is incredibly frustrating. It does not matter how much cranberry juice or Ural you consume, you know you are not going to be able to stop it.

It has been an incredible opportunity to be part of this committee. It is the first select committee that I have been on as a new member of parliament. To hear all the evidence that was provided, from not only sufferers of UTIs but also stakeholders such as the universities, the pharmacists and the GPs, was really interesting and sometimes conflicting, which then allowed us to sit back and fully understand what they were all saying to be able to come up with the recommendations.

As an endometriosis sufferer—I am loud and proud to say that—I think women struggle to access health care, just like the member for Frome mentioned, and it is unfair in a number of ways because we often are more in tune with our bodies perhaps, as the member for Unley suggested indirectly, and we do sometimes know what is wrong with us. Even today I rang up to access a GP and I have had to book an appointment in 2½ weeks, so that leads you to the understanding of what we go through.

When we spoke to the GPs about that, they mentioned that if a woman rings up with UTI symptoms then they will be triaged and prioritised, but then in speaking to other sufferers we sometimes heard that that is not always the case. It can also be that those sufferers are too embarrassed to tell the receptionist what is going on or did not even realise if they did mention it then they might have had an opportunity to see the doctor quickly. So the fact that we have come up with the recommendations so that women hopefully will be able to access the medication through their pharmacist is going to save a lot of women a lot of pain on weekends and in the evenings.

It is good that one of the recommendations talks about affordability, and I thank the member for Unley for his conversation when we talked about what is affordable. For me, it was important that the cost was advised up-front; as somebody who has spent many years without a great deal of disposable income, it is important to know that there is a cost up-front. Whilst it is $20, for some $20 can be that last meal for the week, so it was important we were clear about that.

What I can see through this process, and the project that will be rolled out, is that the impact on our emergency departments will come through very clearly. Women who have currently not been able to get in to see their GP often get to a point where their pain is unbearable and tend to present at our emergency departments; hopefully, this will lower the number of those presentations, which will be a good thing.

Our work was long, and I enjoyed our trip to Brisbane to see the process happening in person and see the pharmacists working together to support women when they came into their store. Some had private areas and some just had some sort of shielded-off areas; I think we will have to do our best with that. It is sometimes an embarrassing topic to talk about, but as we are becoming more and more equitable in our community women are getting better at talking about themselves and their health issues out loud—even here in parliament—for everyone to hear.

I would like to thank the witnesses who came forward. As I said, they did sometimes have to talk about embarrassing things—including the members for Elder and Badcoe letting us all know—but it is important that we heard firsthand from them because, while we can read as much as we like and take as much as we want from the pharmacists and the GPs, it is the sufferers who are going to benefit from this. It was good to be able to hear from them.

I would like to thank our parliamentary secretary and the team that worked on this, Amy Mead and Patrick Dupont. They have done an incredible amount of work, and the report is very, very thorough. Even when we were away they did a very good job of keeping us organised, and I thank them for all the work they did.

I am very pleased to have been part of such an important outcome for women going forward. As the member for Badcoe said, I think there will be so many women everywhere happy that they are going to be able to access care as soon as they need it and get onto these things quickly, because the quicker you can get onto it the quicker you can get on with your life. Again, I thank all our members for being part of the committee, and commend the report to the house.

Ms STINSON (Badcoe) (11:47): I will start by very warmly and genuinely thanking all the members of the committee for their contributions here today in the house. They have picked up on some very important areas that the committee analysed, and sometimes grappled with, and found our way to recommendations.

I reflect on the member for Frome's contribution in relation to patient safety. That was really the key thing at the end of the day: is this safe, and is this something we should be introducing to South Australian women? We arrived at the position that, yes, this can be done safely with a range of safeguards in place, as we have outlined in the recommendations.

The member for Frome also brought to the committee a real focus on the regions, and I admire her tenacity in always bringing us back to that and to the importance of making sure people in regional and remote areas are well serviced. The fact is that they are not at the moment, and a lot more needs to be done there. I thank her for her contribution.

The member for Gibson made an excellent point in relation to women's pain, that we do not take it as seriously as we could; certainly historically women's pain has not been taken seriously. There are some great advancements being made in that area, and this committee is one more step towards recognising that pain and, more critically, trying to address it with real action.

Having a bloke on the committee, the member for Unley, was greatly appreciated. At first I thought, 'Why does he even want to be on this committee?' You brought a perspective that was really well needed and, as always, you were not afraid to ask the hard questions. I am very grateful. You have made the recommendations we have reached stronger by your presence, so thank you. I really appreciate the contribution you just made in relation to the promotion of the service.

I suppose everyone would like to think that we could put forward recommendations and they cost nothing. I think a good investment of government funds would be in promoting this service properly to pharmacists to make sure that they enrol and get the training and come on board with the service, to doctors so that they know what their pharmacy counterparts are doing—undoubtedly, they will get referrals from this service, and it is important that they know what it is the pharmacists are doing before those patients ending up with red flags are being sent to GPs—and also, of course, to women aged 18 to 65.

We did hear in Queensland that, although it has been in operation for years up there, women are just busy: they are working, they are caring and they are not necessarily turning their mind to this until they find themselves at a point of crisis. It would be a valid use—and the Minister for Health is right here—to use government funds to properly promote that service and make sure that people know about it so that we can realise some of the benefits to our health system, and particularly our emergency departments.

I would like to reflect as well on the member for Waite's contribution. I know that she is very hot on the issue of women's health. On the issues that she advocates for and this one, I hope that people will come to terms with the fact that these should not be embarrassing and shameful things for us to talk about. They are important matters of public policy, and I am so grateful that this committee has treated these issues with the seriousness they deserve and demonstrated to the community that these are things that we think are worthy of discussion.

I would like to take the opportunity to urge the minister to take on board this very thorough work that our committee has invested its time and effort into. We were lucky to hear from some people with incredible expertise. I would like to particularly thank SAAGAR, and also the Chief Pharmacist, who spent some time with us.

We have a recommendation that an implementation team should be established, and that should be headed by the Chief Pharmacist. We would certainly, as a committee, like to see that recommendation taken up as the starting point for seeing this scheme rolled out and delivering the benefits to women that we think it will. So thank you very much for the expertise and professional experience that so many people contributed.

Lastly, I would like to sincerely and deeply thank all the sufferers of UTI who came forward and shared their views with us. Their real-life, real-world experiences were critical in us assessing some of the assertions that were being made with what is the real on-the-ground experience that these women are going through. They had a real, purposeful and important influence on these recommendations. I thank them so sincerely for sharing their quite intimate experiences with us.

Motion carried.

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