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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2024-03-06 Daily Xml
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Motions

Patient Assistance Transport Scheme

Mr BELL (Mount Gambier) (11:06): I move:

That this house—

(a) recognises the importance of the Patient Assistance Transport Scheme (PATS) to regional patients that are required to travel over 100km for essential medical services;

(b) notes that the accommodation allowance for the PATS scheme has not increased since 2014; and

(c) calls on the state government to increase the accommodation allowance and all subsidies to be tied to CPI.

In 2013, I began my campaign to be the member for Mount Gambier. During this time, I was approached by a local resident called Fred de Bruin. Fred had undergone life-threatening heart surgery and had just had part of his Patient Assistance Transport Scheme (PATS) claim refused and was seeking my assistance, as the candidate, to have his story heard.

Fred was seeking an accommodation payment for his wife, Heather, who I got to know very well over that period of time and since. Heather travelled with Fred to Adelaide as his escort while he underwent his procedure. He had discovered conflicting information in the PATS booklet and on the website regarding entitlements of patient escorts and was determined to fight for what he believed was right. If you ever met Fred—who has, sadly, passed away now—he certainly made sure of that.

Prompted by Fred's story, I set up a community meeting to hear firsthand residents' experiences with the PATS scheme. What became clear was that while PATS was an essential service for country residents, it was in drastic need of an overhaul and increased funding. I started a petition calling for serious reform to PATS which garnered over 2,000 signatures and was presented to parliament in early 2014. I was fortunate enough to become the member for Mount Gambier in March of the same year, and so began my now 10-year campaign to improve PATS for our regional residents.

I do not think anyone here would deny the crucial role that PATS currently plays. Last year, over 13,000 South Australians received financial assistance from the scheme. While improvements have been made in recent years, including a much-needed doubling of the fuel subsidy, what is clear from the stories that we regularly receive in our office is it is not enough.

The last significant independent review into PATS was conducted in 2013 by Dr David Filby. Some of the main themes to come from the numerous letters and submissions at the time were the need for increased fuel and accommodation subsidy, the administration of PATS claims, the lack of provision for escorts and carers, and the need for expanded coverage of services. I would argue that those themes are still very relevant today.

As I mentioned earlier, the fuel subsidy was increased last year and I do thank the health minister for that. But let us not forget it had been over 20 years since the previous change. In 2001 when the subsidy stood at 16¢ per kilometre, petrol averaged 87¢ per litre; 2023's average petrol price was $1.91 per litre. While the subsidy may have increased 100 per cent, the cost of petrol has increased 120 per cent, so we could argue South Australians are getting less today than they did in 2001. That is why I state there must be an inclusion in the PAT Scheme that allows for annual CPI indexation.

This becomes even more apparent when we look at accommodation costs. It has been 10 years since the accommodation subsidy was last increased, from $33 per night to $44 per night, the lowest rate anywhere in Australia. A quick search of Adelaide's accommodation will show you that $44 does not get you very far, maybe a tent somewhere. In comparison, New South Wales residents receive $75 per night for the first seven nights, which then increases to $120 per night from night 8 onwards. New South Wales also provides a $40 per night subsidy for those staying in private accommodation, allowing them to contribute something towards their cost to stay with friends or relatives. There is no such provision in South Australia.

We also need to highlight that South Australia is the only state that requires residents—unless they hold a healthcare card or are pensioners—to pay for the first night's accommodation themselves. My electorate is approximately a five-hour drive from Adelaide. I am constantly hearing that residents are undertaking daytrips to Adelaide, which can often turn into 14-hour journeys, simply because they cannot afford the accommodation. At a time when our road toll is higher than it ever has been and we are constantly pushing the road safety message, we should be doing everything we can to encourage safe driving. It needs to be remembered that a lot of the people accessing the Patient Assistance Transport Scheme are in their 80s and beyond, and I do not think 14 hours on the road is a safe practice.

Wendy from Port MacDonnell contacted our office with her recent experience. She had submitted her claim form for two trips to Adelaide with a night's accommodation for her husband, who was escorting her while Wendy was treated in hospital. Her specialist had said that an escort was required to support Wendy while she travelled, yet her claim was rejected and the accommodation not paid. Without her husband's assistance, an extra night's accommodation for each stay would have been required, and as her second visit involved Wendy being under anaesthesia, she was unable to drive for a further 24 hours and would not have been able to leave hospital without a responsible person to take care of her.

Yet when Wendy appealed the decision, she was told, 'As the specialist has written support this is not a valid medical reason.' This strict interpretation of the rules surrounding escorts and support carers is not in touch with the needs of patients. How can we expect patients who are travelling long journeys for a hospital stay, often when they are extremely unwell or frail and elderly, to undertake these journeys on their own?

Paul and Gwenda from Mount Gambier recently submitted their accommodation claim for a stay. They have been using PATS for 10 years, as Gwenda suffers from MS. They used the booking platform Wotif, which they have done previously without issue, and provided the confirmation to PATS. Their claim was denied. When they appealed the decision, they were told it was not a tax invoice so PATS was unable to accept the receipt from Wotif.

After further investigation by my office, we discovered that Wotif is not registered for GST in Australia and is therefore unable to provide an appropriate tax invoice for PATS. How is the public supposed to know this information? The users of PATS, again—I have said before—are often elderly and can struggle to navigate online booking systems. The stress of having claims rejected due to perceived technicalities places further unnecessary anxiety on patients.

The bureaucracy and red tape around navigating the PATS system is at best frustrating and at its worst, I would say, dangerous. We are finding ourselves in a situation where people are not undergoing medical treatment as they cannot afford to do so or they are unable to navigate often complicated processes of submitting a PATS claim.

Just last week, Limestone Coast residents Pauline and John dropped into our electorate office. They wanted to detail their experience with PATS and how it had impacted them during Pauline's cancer journey.

Pauline was diagnosed with cancer in December of 2022 and subsequently spent 13 weeks, between January and April of 2023, in Adelaide undergoing chemotherapy and radiation therapy. Pauline filed her block treatment PATS claim after her treatment but had her claim rejected. We are currently trying to assist her with following up why this was the case.

Pauline and John were offered accommodation through the Cancer Council at Greenhill Lodge; however, Pauline was conscious of taking accommodation that others might need so elected to decline the offer as they were in the fortunate position of having family they could stay with. However, this decision also came at an extra cost. John was not always able to be in Adelaide, which resulted in Pauline having to take a taxi to her appointment, adding additional financial burden as there is no provision in PATS for taxi services.

Due to the nature of Pauline's treatment she has since suffered ongoing issues with severe hearing loss, loss of eyesight, a perforated bowel, burns, dental issues and more. This has meant regular trips to Adelaide to visit specialists that are not available to her in Mount Gambier. However, many of these appointments, such as her audiology and dental appointments, come under allied health and are not covered by PATS. These issues are a direct result of her cancer treatment, yet it is up to Pauline and John to carry the full financial burden of addressing these issues.

The next step in Pauline's journey is 40 days of hyperbaric oxygen therapy at the Royal Adelaide Hospital: 40 days away from her home and family and relying on the kindness of relatives while she is undergoing treatment. There needs to be further investigation into the expansion of PATS to allied health services, particularly if it is linked to a primary diagnosis such as cancer and treatment is not available locally.

Until her diagnosis Pauline worked as a nurse at our local hospital. It is now unlikely she will ever work again, and she has been unable to drive for the past 12 months. Her independence has been taken away and the physical, emotional, and financial effects of Pauline's cancer and subsequent treatment have taken a heavy toll on Pauline, John and their extended family. While they are grateful for the support they have received, they want their story told to raise awareness of how this affects everyday country people so that others do not face the same barriers. This is an example of how one diagnosis can take a hardworking family from financial independence to living week to week.

Patients using this scheme are doing so because they cannot access the services locally. They do not have the ability to return to the comfort of their own home at the end of a day of treatment in Adelaide. They are often in a motel room worrying about the financial implications of accommodation, travel and time off work when they really need to be focusing and should be focusing on recovery.

Our rural patients require increased support. I believe the government must introduce a practical subsidy to aid country residents in accessing the necessary medical treatment that is not available locally, without facing excessive financial strain. This subsidy should be regularly adjusted in line with CPI to keep pace with rising costs. Immediate action is needed, beginning with an increase of the accommodation allowance. It is unacceptable that the subsidy has remained unchanged for a decade and we must do better for the future health and wellbeing of our regional residents.

Mr ODENWALDER (Elizabeth) (11:20): I move to amend the motion as follows:

Delete paragraph (c) and insert new paragraph (c):

(c) commends the Malinauskas Labor government for doubling the fuel subsidy and committing to annual indexation; and

Insert a new paragraph (d):

(d) calls on the state government to continue to review further improvements to the PATS over time.

I move this amendment with the full knowledge and acknowledgement that the member for Mount Gambier has been pursuing this for a long time and is a tireless advocate for his community, but for the reasons I outline here, we are putting the amendment to the floor and we will see how the member for Mount Gambier feels about it.

The Patient Assistance Transport Scheme provides financial subsidies to patients who are required to travel more than 100 kilometres each way to access necessary and approved medical specialist appointments that are not available locally. The scheme is designed not to provide full reimbursement, but rather to provide a vital financial offset via a subsidy when patients have no option but to travel for specialist services.

Changes to the scheme are considered on a regular basis. For example, in 2023, significant improvements were made with the fuel subsidy increased from 16¢ to 32¢ per kilometre, a prosthetic and orthotic subsidy introduced and all Kangaroo Island residents becoming eligible for a ferry subsidy when travelling to the mainland. The accommodation subsidy provides $40 ($44 with GST) per person per night, with an additional $40 per night for an approved escort. Non-concession cardholders are required to fund the first night of accommodation.

The Liberal Party have suddenly taken an interest in the scheme, despite a four-year term when they made no substantial reforms. Their rationale, cost of living, is particularly galling given global events drove up fuel prices in 2020 and they made no attempt then to improve the subsidy for regional South Australians. In contrast, the Malinauskas Labor government doubled the fuel subsidy in our first year, which is the first fuel subsidy increase in more than 20 years, with the subsidy last increased from 10¢ per kilometre in 2001.

There is a common theme here for the Liberal Party, who have still not released any of their own health policies, including any regarding the Patient Assistance Transport Scheme. While further reforms to PATS will continue to be considered over time, the Malinauskas Labor government is continuing to focus its investments in growing specialist services in regional areas, which will reduce the need for regional patients to travel and be accommodated away from home.

This includes infrastructure upgrades and workforce initiatives across regional South Australia, particularly for our larger regional hubs such as Mount Gambier, Port Pirie, Naracoorte, Port Augusta and Whyalla, and our growing peri-urban cities of Gawler, Mount Barker and Victor Harbor. For those reasons, while commending the member for Mount Gambier for his motion, I seek support for the amendment.

Ms PRATT (Frome) (11:23): I rise to certainly support the original motion and pass reflections on the amendment that has been put. I thank the member for Mount Gambier for his advocacy on this issue and recognise that since his election, and before, he has been a consistent voice on this, as have all the country MPs who represent the Liberal Party in this chamber in this current term and previous terms.

I note that comments have been made in support of the PAT Scheme by members opposite, the member for Stuart and the member for Giles. I think country MPs generally understand what city MPs do not, and that is that our inboxes and our electorate offices are flooded with representations from patients who are already sick. That is the battle they are facing, and here comes an administrative burden that they battle sometimes on a daily basis.

Regarding the government's amendment, comment has just been made that this scheme is not designed to provide full reimbursement, but it is a false economy for the government to suggest that they are investing in country roads and regional health services and that this is just a part payment, when the anecdotes that will come through today dispute that. There is a multimillion dollar backlog on our road maintenance.

There is a gentleman living in Balaklava who needs to make decisions about the safest and most comfortable route to the city. He can go west from Balaklava onto Port Wakefield Road and accrue or meet the threshold of 100 kilometres travelled, but the more direct route on the Nine Mile up Traeger Road, as the member for Stuart is familiar with, comes under the 100-kilometre threshold. He has a terrible journey and is suffering from comorbidities and there is no reimbursement or part-payment for his trouble. So, it is to be disputed that the government is investing where it needs to. It is certainly not investing in all elements of regional health.

Today is an opportunity to support a motion that brings attention to the Patient Assistance Transport Scheme, but also requires a thorough prosecution of the flaws in this system. We are seeing and hearing reports of unprecedented delays. There is an administrative burden, not just on individuals but on charities, not-for-profits and organisations that are part of the supply chain in providing accommodation to those who need it. I note just a sample of organisations like the Cancer Council, Cottages for Country Care, and Ronald McDonald House.

We are certainly getting reports from these organisations that, while they are providing an essential service, often not funded by government investment, they are carrying the moral duty of providing accommodation and wraparound services, but they are also penalised by the bureaucracy and red tape of this system. These organisations and charities that are providing accommodation services are seeing thousands of people come through their doors on a yearly basis, and carrying up to hundreds of thousands, if not millions of dollars, of reimbursement payments coming through.

The challenge back to the government, the minister and the Rural Support Service within the Barossa, Hills and Fleurieu LHN is to get on top of their paperwork. Every country Liberal MP has reflected on the number of complaints and distressed phone calls from people who are experiencing delayed payments. Late last year, the RSS said on radio, in recognition of these four to six-week delays, that they thought they would be getting on top of it within a couple of weeks. I am here to report to the house that that is not the case and it is a disgrace.

Just as an example, I have a resident, Allen, in Eudunda, who is still waiting on payments from late last year, and the human toll in prosecuting the success or the failures of this scheme will be told at length today, I am sure. The paperwork is cumbersome. This policy is littered with conditions that mean that it is engineered to reject and decline the applicants more often than they would be successful. I think the best example of that now is the very overdue attention on the overnight accommodation subsidy: $40 is unacceptable in 2024. It does not come close to the commercial rate, and it needs to be addressed urgently by the minister and his department.

The government challenges the opposition to put a policy position forward. Well, listen to the speeches today, and I think you will hear the consistent cry for an increase in the overnight accommodation rate, an entire reform of this policy and its criteria for eligibility. What we should be seeing by comparison to other states is a cumulative approach to kilometres travelled.

Bob Moulton, of Melrose in the Flinders Ranges, has had to go to the media—in the member for Stuart's own electorate—explaining that for the renal dialysis he requires three times a week to keep him alive for the rest of his life, he has to travel from Melrose into Port Augusta. That is the most direct and local service he can access. But that is going to accumulate to 140 kilometres a week. Is he entitled to apply to the PAT Scheme for reimbursement? No, he is not. That does not happen in the city. These examples do not happen in the city.

We certainly would argue, as country MPs, country Liberal MPs, that the scheme does not go far enough. When you compare it to other jurisdictions, our overnight accommodation rate is the lowest in the land. While we look at the 32¢ per kilometre rebate or subsidy, again it is a false economy. This policy really stipulates that we will be paying more to fewer people because the threshold that you have to meet is you have travelled 100 kilometres one way and, truly, that pushes people further out.

People further out than 100 kilometres are entitled only to this rebate, which means the further away you live, the more likely you are to stay overnight in the city. The member for Mount Gambier makes this point. Whether it is from the South-East or the West Coast, the travel time on the road—and it is not a debate about roads today or the quality of the roads, but it should be because it is part of the story—the further you have to travel, the longer you are on the road, the more unwell you are, the more likely you are to be requiring overnight accommodation, and that is if your appointment goes ahead. The stories that we have heard, the number of times that that appointment has been cancelled, that that surgery was delayed, and now you are unwell, stuck in the city without plans, left in limbo to find accommodation, and perhaps you did not travel the 100 kilometres, so you do not qualify for that subsidy anyway.

I think other opportunities to improve this scheme come back to the frontline of GPs who, while diagnosing and providing that primary care to their patients, have an extra duty that we are laying on them, and that is to promote, to be the comms agent and arm for the South Australian health department, so we are relying on our GPs to diagnose, consult, squish all of those assessments into their 15-minute consult, and promote a PAT Scheme to a resident who might never have heard of it before. I think the government needs to do a lot more to promote the existence of it.

The impact to regional health is high, and the figure could be as high as 30 per cent of patients who are in our city hospitals are from regional South Australia. If we are not going to see the government invest in regional services like it needs to, then the Minister for Health and Wellbeing should expect that our country patients are making their way to the city. They are part of a system that is struggling to admit and discharge patients. We certainly want to see more investment in our bigger country hospitals, so that where treatment is possible it can be provided.

A gentleman living in my electorate required one injection for cancer treatment a week for 18 months, but because he could not get that locally he had to travel to the northern suburbs, but it was under the 100 kilometres, so it is clear today, as I commend the motion, that this is an opportunity for reform. I commend the motion to the house.

Mr HUGHES (Giles) (11:34): I welcome the motion as a country member but I also welcome the amendment, because clearly we are stating that there needs to be further review and further improvement of the PATS system. Any local member in the country is going to receive a whole range of stories about PATS and how it needs to be improved.

There has been incremental change over time. During the Weatherill government, there was a 30 per cent increase in funding for PATS, with some improvement when it came to escorts and a number of other changes. Of course, this government has doubled the travel subsidy, which has made a significant difference to a lot of people. But accommodation is one of those things that still stands out as needing some adjustment, and that will be considered in the goodness of time—hopefully, not too much time.

Improvement is necessary, and the complaints about the flexibility and responsiveness in relation to PATS are accurate. They were accurate during the term of the previous government, a government that chose not to increase the travel subsidy, I would point out, when they had the opportunity to do so.

When it comes to responsiveness and flexibility, there needs to be improvement. There needs to be, sometimes, the application of common sense. Sometimes, people who are making decisions in Adelaide need to have a look at the map of South Australia and the main transport routes in the state so they do not say to someone in Whyalla, 'Your nearest professional is not in Adelaide but in Wallaroo,' but the person has to depend upon catching a Stateliner or a Greyhound bus, or whatever it is now, to get to that place. Often, Adelaide is a lot simpler.

There is always this tension in wanting to locate services especially in the bigger regional hospitals—preferably resident specialists and others—but that has been very challenging over the last decade or so. We have seen a reduction of a range of specialists who are willing to live in regional communities, which I think is very unfortunate, but we still have visiting specialists to our major hospitals. There is an issue there with visiting specialists, and it is something that is incredibly important; that is, continuity of care.

You might have someone who has been seeing a specialist in Adelaide for many years who knows their case back to front, and that person is denied PATS because there is at least a relevant visiting specialist in a nearby community or in the community in which they live, but that visiting specialist has not had the background with that particular patient. So, sometimes there is that tension.

Another issue surrounding that is that you often get in regional communities—once again, usually the bigger regional communities where you have visiting specialists—a revolving door of specialists. I will come back to the importance of continuity of care, and I do not pretend that it is necessarily an easy one to address. We do want services in the country so people do not have to travel but, in making decisions about providing subsidised assistance for patients travelling to Adelaide, we have to take into account, and we should take into account, continuity of care because it is an important element.

The stories that people come to see us about are many and varied, and I think all country MPs have their dealings with PATS to try to get changes to decisions that have been made. In one tragic case in some respects—because it was a wrong diagnosis in a country hospital—someone was diagnosed with a hernia and operated on, even though the person said, 'Listen, I've had this small hernia for many years; this is not the issue.' The specialist insisted it was the hernia, and that small hernia was operated on. He came back to the hospital, still in distress, some months later and it was terminal pancreatic cancer.

This person also had a cardiac condition, and the level of communication between the visiting cardiac specialist from Adelaide and the oncologist in Whyalla was not great and a number of things happened. This person took himself off to see an oncologist and a cardiologist in Adelaide, both of whom would communicate effectively about the condition, and PATS knocked him back.

There were four visits to Adelaide and he was knocked back four times before he came to see me. This is under the previous government, but there is a continuity of these issues. I will give credit to Stephen Wade: when I wrote to him about this issue a change was made to policy so that for people with terminal conditions it became far easier to access PATS.

Clearly, a range of things have to be done, and sometimes when you look at the health budget you have to look at the wider context. This is where I get a bit dark with those opposite, especially with their federal colleagues. The ripping up of the federal-state health agreement by the Abbott government stripped billions of dollars out of the public health system, and that had an ongoing cascading impact. This was a system under stress even before COVID.

They did that to the public hospital system, which obviously affects regional communities as well—either the services in regional communities or the system relating to higher-end surgery and other specialist needs in Adelaide. Not content just to cut back on the public hospital system and the federal government's contribution, they froze the Medicare rebate, which had multiple impacts. It led to the partial collapse of bulk billing, so that meant that some of the most vulnerable people delayed seeing a doctor and often ended up in accident and emergency in public hospitals in a worse condition than they would otherwise have been.

The freeze on the Medicare rebate had another impact, namely, the number of graduates choosing to become GPs reduced very significantly. That was not the only factor when it came to graduates deciding to be GPs—a whole range of issues were at work. But the federal policies that were pursued over a long period of time by the Coalition had an incredibly damaging impact upon our health system.

When we look at the reforms needed at the state level, it has to be taken into account with the wider changes and what we do. I am incredibly confident that this minister understands these issues and that there will be a serious look at all the issues raised, both here today and on an ongoing basis by individual members. At some point we will arrive at a point where we make some of the necessary improvements.

Those of us in the country know that there are mortality and morbidity gaps compared with the metropolitan area. I always argue that you need to pull apart those figures—you cannot just look at aggregate country figures and aggregate metropolitan figures. Some is the result of socio-economic determinants, and these issues impact on that, but clearly some of it is about access to services, distance and remoteness.

Mr PEDERICK (Hammond) (11:44): I rise to support the original motion by the member for Mount Gambier, in regard to the Patient Assistance Transport Scheme:

That this house—

(a) recognises the importance of the Patient Assisted Transport Scheme (PATS) to regional patients that are required to travel over 100km for essential medical services;

(b) notes that the accommodation allowance for the PATS scheme has not increased since 2014; and

(c) calls on the state government to increase the accommodation allowance and all subsidies to be tied to CPI.

There are many people—about 30 per cent of the population—who live outside Adelaide, and many of those live outside the 100-kilometre limit to access the PATS scheme.

With the redistribution of boundaries there are not many in my electorate who can access the scheme; parts of Mannum are really the only places that are eligible. It is 100.2 kilometres from Adelaide to Mannum, and I have had correspondence from people who have said, 'Well, we miss out by half a kilometre, or a kilometre, five kilometres.' It all depends on exactly where you live, either in the town or on the edge of the town or in the surrounding areas. It is a bit of tough love for those who do not qualify, but I guess you have to have a boundary somewhere.

It is interesting to note that up to 30 per cent of the people in Adelaide hospitals (and this reflects on the 30 per cent of the people who live in the state) are country people, so there are many people who have to travel to Adelaide for various services, whether it is specialist services or cancer treatment, a whole range of specialist services that cannot be accessed in the country. Sadly, it has got to the stage where it is very hard to attract even general practitioners to some country areas, even though a lot of the time you get people—and it does not matter whether it is in health or whatever sector—who, when they travel to the bush, suddenly realise how good it is and end up staying there and setting up their life there.

If you look at the extremities of the state, as the member for Mount Gambier already put it, Mount Gambier is five hours south of Adelaide. If you want to go further out, right out to the Western Australia border, Border Village in the member for Flinders' electorate is 1,254.9 kilometres. Innamincka, up in the north-east corner, is 1,024.3 kilometres. In some of those areas people might have access to enable them to fly in, but it is certainly a long drive—and some of them would absolutely drive to get the health services required. Just in regard to flying, it is great to see that all-weather airstrip up there at Innamincka, on bitumen.

In regard to what PATS supports, it obviously supports transport and accommodation when people fit the eligibility criteria to access those necessary medical specialist services that are not available locally. That is notwithstanding that there are visiting specialists who come out; there are certainly visiting specialists who come out to Murray Bridge, but it should be noted that Murray Bridge is only about 75 kilometres from the city, so it does not qualify anyway.

The scheme is funded by government and administered by the Rural Support Service through the six regional local health networks. We had an election commitment, before the last election, to ensure that the fuel allowance rebate would increase by double to 32¢ per kilometre.

The Labor opposition scorned us at the time. It took Labor another seven months to announce in a city paper that they would double the scheme. That is welcome—it is a bit too late, but it is welcome. That was for appointments from 1 January 2023. No other improvements have been made since. Instead, we on this side of the house, especially those of us in the regional areas, continue to receive plenty of feedback that the processing of reimbursements is delayed by many weeks at times.

The accommodation rate for the Patient Assistance Transport Scheme is the lowest of the state and it is leaving many people out of pocket. A lot of these people have to stay—and I know this firsthand from talking to some country patients—for some cancer services. They have to come in the night before because they need to be there first thing in the morning, so there is obviously an accommodation cost to take up.

This is where the issue is. With not enough money being invested into country health, it certainly makes sure that more country patients have to come to Adelaide to see specialist doctors. I salute other members on this side of the house who have championed the cause for country patients.

The eligibility criteria includes that you must live more than 100 kilometres away from the nearest treating specialist, that you are a permanent South Australian resident, that you are receiving treatment claimable under Medicare, and that you have claimed any benefits from a private health fund first, if applicable. Under the scheme, there is a requirement for a medical specialist pathway to be accessible for a subsidy and this means that the person must have an appointment with a recognised medical specialist under the PATS subsidy scheme.

Health professional appointments such as allied health, general dentists, nursing professionals and GPs are not covered in this scheme, but approved services include the Pregnancy Advisory Centre, BreastScreen SA, chemotherapy services, prosthetic and orthotic clinics, radiology services (provided they are referred by a GP or an approved medical specialist), renal dialysis, clients that have been admitted to country hospitals, and inpatient rehabilitation services. That is the list of eligible treatments. There are some other subsidies around the accommodation allowance and there is some assistance with private medical travel.

In 2022, the Cancer Council of South Australia, together with other local South Australian charities, asked the incoming state government to increase the Patient Assistance Transport Scheme for accommodation from $40 a night to $100 for singles, and from $80 a night to $115 for couples. Certainly, when it comes to seeking further reform in this scheme, there is no more credible voice than the Cancer Council of South Australia.

I want to note the incredible work that the Cancer Council do in this state and their recent upgrade of accommodation to make it more comfortable for those patients who already are outside the comfort zone of their own home. A lot of these people are older patients who are unhappy enough that they have to be in Adelaide, and certainly organisations such as the Cancer Council make it the best they can for people to access those vital life-saving services. I commend the original motion.

Mr ELLIS (Narungga) (11:54): I rise to support the original motion as it was put by the member for Mount Gambier, but, in so doing, I would like to make it clear to the house that that does not mean that I necessarily disagree with the content of the amendment. Certainly, the doubling of the fuel subsidy is a good thing, committing to annual indexation is a good thing, and continuing to review further improvements to the PATS is also a good thing. But I do object that the amendment attempts to remove 'calls on the state government to increase the accommodation allowance' and committing to it being tied to the CPI. I think that is a pivotal part of the motion as it was originally put, and I will be supporting that original motion due to the fact that that disappears in the amended one.

I imagine that, over the course of the debate this morning, we will have quite a few similar stories that are told by different regional members, which goes to highlight how widespread this problem is, if I can call it that, and how many constituent complaints we all get as regional members. I know that, in my almost six years as a member, it has been a consistent theme in our inbox: people who are having difficulties with PATS, either in accessing it or in understanding the wisdom as to why some applications are approved and others rejected. I know that this is a problem across the state.

I also know, and I think it should be noted, that it is a difficult problem for the administrators to have. The complexity in trying to create a solution that suits all is a difficult one. There will always be people who find themselves in the grey area, and trying to come up with a solution that will service all those people who find themselves in unique scenarios is a difficult thing for those administrators to do. Having said that, I do think that there is greater room for those people to understand that there could be flexibility applied on a case-by-case basis, so that some of those people who contact our office with obvious shortcomings in the way their claim has been assessed might find themselves funded and being able to access better health services, like their counterparts in the city do.

I also want to make clear from the outset that it does pain me a little bit that we have to have this debate about PATS consistently. I would much rather be having a debate about how we can get services into the country rather than making it easier for people to get from the country to the city. It is a double-edged sword. I quite often tell constituents, when they come into the office, 'I'm more than happy to support you and do my best to try to get this claim approved or overturned so that you can be refunded, but my primary goal, as the member for Narungga, will always be to try to ensure that our local health services are increased and improved so that fewer people have to go to Adelaide.'

It will have a dramatic effect on ramping, it will have a dramatic effect on congested hospitals in Adelaide and it will have a wonderful effect on our regional communities. It will encourage people to move there and stay there when they might become more old and frail, and it would really make for a livelier community. So, in supporting this motion, I do want to make clear to my constituents who may be listening that my primary goal, as the member for Narungga, will be to increase and improve our local health services so that fewer people need to access PATS and get to the city.

But until that happens—and hopefully it happens soon; we are working away assiduously on it—we do have a flood of people contacting our office with different PATS concerns. I will take this opportunity to communicate a couple of those to this house and to try to make sure that their concerns are on the record, so that in passing this motion, hopefully in its original form, it might trigger some action and improve these concerns.

The first one I want to share is directly applicable to the motion as it was originally put. A constituent of mine from Moonta Bay has had to have scans or appointments over two separate days in Adelaide, so they decided to make it easier for themselves and take their caravan down. They decided to stay at the Adelaide Showgrounds. That is a wonderful facility, a really comfortable facility, but it certainly is not the Ritz or anything flash like that. They set up their caravan there—

Mr Pederick interjecting:

Mr ELLIS: They might have caught the tram or might have walked down to the Goody and had a schnitty; who knows? They decided to stay there—presumably, without putting words into their mouth—because it would have been a relatively cost-effective option for them to stay there. However, as we have already established in the course of this debate, the PATS allowance is only $44 per night, and my understanding is that that is only for one night. So these wonderful people from Moonta Bay were out of pocket $69 per night. They were given an allowance of $44, so they were out of pocket some $100 or so, or slightly less.

It would have been better for them to have stayed in Moonta Bay and to have travelled up each day and claimed the travel allowance, as opposed to the accommodation allowance. Clearly, that is an undesirable outcome: having people drive back and forth twice on two consecutive days, racking up some 600 kilometres, rather than encouraging them to stay in town and get their treatment and then come home. It is a perverse outcome where the accommodation allowance is so poor that it encourages people to travel many multiple times along the same road.

Further to that, this constituent informed me that 18 years previously when her stepfather was accessing PATS, the subsidy was $40 per night, so in that 18 years, in her view, that has gone up $4 over that whole time. That is a reasonably insignificant rise, I would argue, and certainly one that I think should be dramatically increased and hopefully this motion brings about that change.

Another concern that we have quite frequently in our office is the timeliness in which these claims are assessed. I have to say in the case of this accommodation at the Adelaide Showground, the claim was made on 5 November last year and finally paid out on 2 February this year, so it is a three or four-month process, admittedly over Christmas, and we will give those people a bit of a break for family Christmas time. But it took a three-month break over Christmas to get that subsidy paid out, which I would argue is too long as well. We have had other complaints like that. Phil Hedger has had a processing time complaint and so on.

Further, and this has been raised by previous members, we frequently get complaints where people who are required to travel multiple times per week inside that distance of 100 kilometres but who rack up more than that over the course of the week are not being reimbursed. Peter Janssan, who lives in Kadina, has complex issues relating to an allergy to cancer treatment and is required to travel to Adelaide, but PATS will not pay as they think he should be travelling to Pirie every week, which is the wrong way. He would much prefer to drive 1½ hours to Adelaide as opposed to one hour to Port Pirie.

Then we have a gentleman in Snowtown who is required to travel to Port Pirie for seven days every fortnight for the rest of his life for injections he cannot receive anywhere else, who does not qualify for special consideration because the trip from Snowtown to Port Pirie is only 79 kilometres each way. So it is just 20 kilometres under that mandatory 100 kilometre limit and, of course, travelling seven days a fortnight every week for the rest of his life, he will certainly rack up that 100 kilometres pretty quickly. I would contend that this would be a prime example of something that could be considered outside of that rigid set of rules as a special circumstance that might call for a reimbursement regardless.

So I put those couple of examples on the record. I certainly support the original motion as it was put by the member for Mount Gambier. I look forward to seeing the passage of this motion through the house, hopefully in its original form, and it certainly is an area that we could well do to improve. I know that successive governments have tried their best but it seems to me that obvious improvements could be made. Another one is that if you have a visiting specialist at Wallaroo Hospital PATS will not pay you out to go to a more timely appointment in Adelaide because you have that visiting specialist who has an open appointment in a number of months' time.

It is all about the timeliness of service as well, making sure that if there are better options in Adelaide, more timely options in Adelaide, those people who need that service can attend. So more improvements could be made. Increasing the accommodation allowance would be a wonderful start and here's hoping this motion brings about that change.

Mr WHETSTONE (Chaffey) (12:02): I would like to make a contribution and support the member for Mount Gambier's motion because I think it is pertinent that we do bring to the attention of the current government just exactly why the PATS system is an important support mechanism through the health system. I do want to make the point: why has the Government Whip, the member for Elizabeth, who lives in North Adelaide, come in here to make an amendment?

Mr Odenwalder: Highgate.

Mr WHETSTONE: Highgate. I beg your pardon. Highgate. How can the government be taken seriously when we have an inner city MP coming in here to amend a regional issue which is so important to every person who lives in a regional setting? The PATS system has had a lot of complexities. Sadly, we continue to talk about the same issues, that is, the way it is assessed and the way that it is dealt with in a timely matter. The only thing that has not changed through the assessment of the PATS system is the public servants. It is the bureaucracy that continues to be the same, and obviously to push back on some of the claims and the current situation that we find ourselves in, living in a regional setting. As the member for Narungga so eloquently put it, we as regional MPs would like to see better health services in our electorate.

In regional South Australia, we continue to see the demise of services. The ability to attract health professionals into a regional setting is, I think, one of the critical shortfalls within the health system. The current government have a focus on the city, and they continue to do that at every turn.

We have to understand that we do have limited access in the regional setting. We acknowledge that, but the PATS system is there to support those who are having to travel significant distances. As we have already heard, the member for Giles has a faraway electorate, just as the member for Flinders does. We look at a lot of the regional settings where people have to travel multiple hundreds of kilometres to get to their health professionals.

In most instances, we see those people travelling under stress. Whether it is for a health appointment, whether it is for routine maintenance or whether it is for treatment, sadly, for cancer or for a debilitating illness, it does come with considerable stress. It comes with considerable time lost if you have to leave your workplace and be away from your family.

A lot of people living in the city do not understand the complexities of having to travel away from the comfort of your home, the support of your family and also the support of a small regional community, which in many instances is supporting those people who are, for instance, travelling for cancer treatment.

It does come at cost. It comes at significant expense, and when we talk about visiting a doctor it needs to be dealt with with some level of continuity. For many who are travelling those long distances, a companion is in many instances a vital tool of support. They are also a vital part of the support process when you are going for medical treatment.

In the great electorate of Chaffey, probably one of the most consistent inquiries that my office gets is about the health system, whether it is PATS, a lack of health services in our local area or a better understanding of how they can gain better support for health treatment. It is something that my office and I spend a considerable amount of time on: dealing with them, giving them information and giving them comfort, so that we can actually get the best possible support mechanism.

In most instances, it is PATS. The Patient Assistance Transport Scheme is a scheme that has been long questioned, as I have said, by the decision-makers within the halls of power, that is, the public servants. I think successive governments need to have a better understanding of exactly what their shortfalls are when we are looking for the support mechanism.

Obviously, I would say that the former Liberal government did make commitments to doubling the fuel rebate. This has been a topic of conversation for a very long time. When I came into this place in 2010, one of my first constituent inquiries was about a PATS claim. The PATS claim was put in, but it took many months to actually settle that claim because of the complexities of, 'No, you can't have it,' because of certain issues.

Travelling distance was never an issue in Chaffey, but the companion has always been, the amount of support, the accommodation and the fuel. Some people who come down to the city for health do not have vehicles. They have to catch buses and trains, public transport. By doing that, if they are looking for accommodation, they are always looking for the cheapest accommodation. You are not going to find that next to a hospital. You are not going to find that in the CBD. It is going to be a little further out of the way, and that comes with complexities of travel to get to that appointment.

As many regional MPs have said, if you are coming down for an appointment one day, there are complexities around the travel time. Sometimes—most times—doctors are behind time. If you are looking to get back within a day, it is very difficult to logistically make that happen and so sometimes it might take two days. It is not just about the travel; it is about the time away from your workplace. That comes at a cost, because a number of people who travel are doing it regularly. Sadly for them and their families, ongoing treatment continues to chew up sick pay or holiday pay. If you have an agreement with your employer, it only stretches so far.

I would like to think that the member for Mount Gambier's motion does get a high level of support. Obviously, we understand that the government have the numbers and they will move their amendment. I am hoping that we will divide on it, because every regional MP will use that as a conversation piece, that they are representing their people but the government have denied them the opportunity and the access to a better support mechanism when they are seeking intervention to address the costs and the emotional stress of attending.

The accommodation allowance for PATS is well overdue. As I understand it, in South Australia the PATS accommodation rate return is the lowest in the nation. Why does that have to be? Why are regional South Australians penalised by the expense, as I have said, and to the detriment of the emotional support that they need? Why has there not been an increase since 2014? Regional communities continually are marginalised. Living in the regions is tough enough with the tyranny of distance. I would say that a lack of government support within the health services is now marginalising South Australia more and more.

I do want to compliment and thank the Cancer Council here in South Australia and Ronald McDonald House, which I paid a visit to only last week to understand the great service that they provide for regional families that are travelling down to Adelaide while their children are having treatment at the Women's and Children's Hospital. I was really taken aback by the level of support that they give and the home away from home environment they provide to regional South Australians when they are travelling long distances for long periods of time. I am not talking about one or two days; I am talking about weeks, months and even longer, when they travel down to Adelaide for those poor children who are having extended stays down here in Adelaide for their treatment. I commend the member for Mount Gambier's motion to the house.

Mr TELFER (Flinders) (12:13): I rise today to speak on this important motion. It pertains to what is probably one of the most important aspects for my community of Eyre Peninsula and the West Coast, and that is regional health delivery and, specifically, the important role played by the Patient Assistance Transport Scheme, known very well by regional South Australians as PATS.

Obviously, the ideal for health delivery is for it to be as close to home as possible, but we who live in regional South Australia know that at times it is necessary to travel to get to that health care, especially specialist care. This is why it is so important for us to have a properly functioning and funded Patient Assistance Transport Scheme to reflect the additional challenges and the additional costs which regional people are facing when seeking medical care.

Health patients from my electorate in particular rely on an effective PATS system, as the specialist health delivery within my community is very limited. Thus, those patients have to travel significant distances, usually to Adelaide which is 500-plus kilometres away—and that plus is a big plus because some of my electorate is hundreds of kilometres further than that—to receive important medical care.

I want to highlight the inconsistency in the policy around the nearest specialist stipulation and how it actually plays out in the real world. With hundreds of kilometres between regional areas, sometimes this policy actually results in perverse outcomes for regional South Australians. I have had community members from Ceduna told that instead of catching a flight to Adelaide to see a specialist, instead they would only be funded to drive hundreds of kilometres to go to either Whyalla or Port Lincoln to receive care. Sometimes it just does not make sense.

I firmly believe that there needs to be a greater clinical understanding of medical challenges when making decisions around PATS applications, not simply making them on a bureaucratic or a financial basis. People tasked with making decisions around applications need to better understand the clinical and personal risk of such travel, and this needs to be a policy direction change.

Towards the end of last year, the health minister responded to a question during question time saying:

…if there are issues in terms of the processing time—

for PATS—

then we will look into that with some urgency and take what appropriate action needs to happen.

I am here to say once again that my office has received a significant escalation in community concerns on the extended response times to their PATS applications, with reports of patients waiting several weeks or up to several months for any response from their PATS applications. These are individuals and families who are left out of pocket several hundred dollars, or up to thousands of dollars each, waiting for their PATS applications to be approved.

After assistance from my office to work through a follow-up process for many patients, they received correspondence from PATS officers admitting that, indeed, the wait time for processing amounts from several weeks to several months. I also have many constituents who are waiting for multiple PATS claims to be returned, with further upcoming medical visits necessary soon. As I said, we are talking about several hundred dollars for each one of those claims and if you multiply that for patients who have several claims outstanding, you can see why this has become a significant issue for individuals and families.

This is real life, these are real people and these are real costs that they are facing. With the cost of living being a significant issue for our community at the moment, some are seriously considering whether they can afford the significant up-front cost of travel which is necessary for that treatment. They have to fork out the dollars and then wait for that process to get some of those dollars back. This is not me being alarmist; this is me reflecting stories which I am regularly hearing from members of my community. There is obviously a considerable backlog of claims at the moment within the PATS system, and the reasons why still have not been explained to us by the minister.

I want to share in this place the story of the Chandler family as an example of one of the many constituents facing challenges, and it is one close to my heart. Levi Chandler passed away in his home at Cummins on 20 January, just short of his 19th birthday, lovingly surrounded by his friends and family, especially his parents, Marty and Tanya, and his sisters, Luka and Stella. Over his extended cancer treatments, Levi and his family had to travel significantly back and forth from Cummins to Adelaide, which is near on 700 kilometres one-way. They had to face many different interactions with the PATS system, having incurred significant travel costs. When they contacted my office, they had thousands of dollars of outstanding claims for which they were waiting for payment.

You can imagine being in the shoes of a family such as the Chandlers, having to deal with government bureaucracy down to the finest detail with phone calls and emails trying to justify costs to someone at the other end of the line who seems to be only taking a bureaucratic perspective on these claims—at a time when this family, and many families around our state, are going through significant challenges with a member of their family. Unfortunately, and tragically, Levi lost his battle earlier this year.

As I said, these are real people. They are forced to go over and above what should be expected, working through a bureaucracy that does not seem to be managed appropriately. What I do know is this is a significant issue for my community. I am imploring the minister to allocate more resources. It needs to be done.

This processing should not be taking this long. We should not have hundreds of thousands of dollars outstanding. These PATS arrangements are in place for the most isolated people of regional South Australia, and the government should be doing what it can to expedite this delayed process. There are hundreds of thousands of dollars of outstanding costs. It is putting individuals' and families' personal finances at risk, as well as the accommodation service providers which we have heard about which rely on this for their ongoing operations—organisations such as the Cancer Council and Ronald McDonald House Charities.

The accommodation allowance at the moment sits at only $40 per night—$40 per night. That is only $40 to cover families staying in Adelaide. You cannot even get into a backpacker's for $40, so you can see it is only just touching the edges of what the cost is going to be. On top of this, the $40 is only paid on the second night and subsequent night stays as well, not on the first night. To travel from my electorate it is pretty difficult to get a daytrip in to see a medical specialist, even if you are flying, so staying a night is more often than not absolutely required.

It is clear to see this dollar figure simply is not enough and it is costing our regional communities. We need to have a PATS system that recognises that crucial medical services do not get delivered into our regional communities, so we need to have the support for those in regional communities who need to travel. It should be as effective as possible to suit the needs, it should be at a level which better reflects the cost to our people, and it should be administered in a more expedient and responsive way. Our regional community members deserve better.

Mr BELL (Mount Gambier) (12:21): I really want to thank all members who have made a contribution to this very important private member's motion. I think the member for Flinders summed it up beautifully: whilst this motion talks about accommodation and increasing that part of the PAT Scheme, as well as tying it to CPI so that the dollar amount increases, there is actually a lot more that needs to be reviewed with the Patient Assistance Transport Scheme.

We have heard today that some of those are around the time it takes to be reimbursed. Maybe there does need to be a time frame put on it and then some type of consequence for that—whether it is a percentage interest payment on top or what, I do not know, but there should be a very strong message that these claims need to be paid within 14 days or some reasonable amount of time. In terms of the forms and the bureaucracy that surrounds that, surely it can be streamlined in today's modern age where it is basically a click or a photograph and a send, so that that part of it puts the least amount of stress on people.

These people are not using this scheme to make money, they are using this scheme because they have to access specialist services that people in the city take for granted. When you are accessing those services you are going to be definitely out-of-pocket yourself, but quite often you will not be returning to the comfort of your own home that night—or for some people facing cancer treatments, for many nights—whereas again for our city cousins, whilst they still go through the same journey of treatment, the conditions are extremely different.

This is about fairness and equity. It is about recognising again that these specialist treatments are quite often at a very serious level—a life-altering level—and we need to do everything we can to make sure that that journey is as smooth as possible for regional residents and communities. I think this can go just a short way, but I am also very cognisant of the fact that a lot more work needs to be done. So with those words I commend the original motion to the house and thank all those who made a contribution.

The house divided on the amendment:

Ayes 20

Noes 15

Majority 5

AYES

Andrews, S.E. Bettison, Z.L. Bignell, L.W.K.
Boyer, B.I. Brown, M.E. Champion, N.D.
Close, S.E. Cook, N.F. Fulbrook, J.P.
Hildyard, K.A. Hughes, E.J. Hutchesson, C.L.
Michaels, A. Mullighan, S.C. Odenwalder, L.K. (teller)
Pearce, R.K. Picton, C.J. Savvas, O.M.
Thompson, E.L. Wortley, D.J.

NOES

Basham, D.K.B. Batty, J.A. Bell, T.S. (teller)
Brock, G.G. Cowdrey, M.J. Ellis, F.J.
Gardner, J.A.W. Hurn, A.M. Patterson, S.J.R.
Pederick, A.S. Pratt, P.K. Tarzia, V.A.
Teague, J.B. Telfer, S.J. Whetstone, T.J.

PAIRS

Stinson, J.M. Speirs, D.J. Szakacs, J.K.
Pisoni, D.G.

Amendment thus carried; motion as amended carried.

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