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Legislative Council - Fifty-First Parliament, Second Session (51-2)
2007-10-25 Daily Xml
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HEALTH CARE BILL

Second Reading

Second reading.

The Hon. G.E. GAGO (Minister for Environment and Conservation, Minister for Mental Health and Substance Abuse, Minister Assisting the Minister for Health) (15:26): I move:

That this bill be now read a second time.

I seek leave to have the second reading explanation inserted in Hansard without my reading it.

Leave granted.

South Australia has a very good public health system staffed by very committed health professionals and administrative staff. It is also well supported by volunteers and communities. It consistently provides safe and effective health services for South Australia’s population. However, it is governed by legislation developed over 30 years ago which is now in need of major reform if it is to respond positively to the contemporary and future healthcare demands.

In South Australia’s Health Care Plan recently announced by the Government, there is recognition of the fact that consistent with national and international experiences, South Australia faces a number of increasing challenges to and demands on its health services. These include an ageing population, the increasing incidence of chronic diseases, changes in medical technology, ageing infrastructure, challenges in recruiting and retaining health professionals and higher expectations about the range, safety and quality of services.

These challenges to the health system will make it increasingly difficult for the public health system to meet the demands in a cost effective and equitable way unless reforms to the health system are instituted.

These are also some of the pressures and trends identified in the Generational Health Review (GHR) report which provided the impetus to begin the reform process needed for our public health system.

The GHR report guided the initial directions for structural reform of the public health system in South Australia. It clearly identified fragmentation and duplication of planning, funding and governance arrangements as major inhibitors to the development of a coordinated health system and a systemic approach to improvements in health outcomes for South Australians.

It recognised a need to shift the health system to a greater population focus, a primary health care approach and an accident and illness prevention focus.

Released in 2003, the Government’s response to the GHR, First Steps Forward, established the initial reform process including the establishment of three metropolitan health boards:

Central Northern Adelaide Health Service (CNAHS)

Southern Adelaide Health Service (SAHS)

Children Youth and Women’s Health Service (CYWHS).

These Boards became responsible for the governance and delivery of health services in their regions and some statewide services, such as dental and drug and alcohol services.

Following on from these initial reforms, in July 2006, the seven country health regions were consolidated into one regional country body, Country Health SA. However, responsibility for the delivery of health services in their local communities remained with the then 44 local country hospital boards.

These governance changes were instrumental in setting the direction of the reforms. The Health Care Bill 2007 before the House represents a critical opportunity to make more fundamental reforms to the governance arrangements for the public health system. Without these reforms South Australia risks having a public health system that is incapable of meeting the challenges identified in the GHR report and by other national and international bodies to provide a more sustainable public health system with better and more equitable health outcomes for its population.

This Bill provides a sound legislative framework to address the challenges ahead. It repeals the South Australian Health Commission Act 1976, the Hospital Act 1934 and the Ambulance Services Act 1992 and relevant functions have been incorporated into this Bill.

Greater coordination and less fragmentation of services and reduction of unnecessary duplication in the planning and delivery of service have been clearly identified by the GHR report as vital to providing better services and health outcomes. The key governance changes under the Health Care Bill will enable the Chief Executive of the Department of Health to have the overall responsibility for and greater control over services provided by the public health system. This will enable the public health system to have a much greater capacity to act as a coordinated, strategic and integrated system.

The Bill ensures that the Chief Executive (CE) of the Department of Health will be responsible to the Minister for Health for the management, administration and delivery of public sector health services in the State. The CE will have the powers to direct public health services and staff, and will be subject to direction from the Minister. However, consistent with what exists in the South Australian Health Commission Act, neither the Minister nor the CE will be able to give a direction concerning the clinical treatment of a particular person.

Two other well identified areas requiring reform are to orientate health services towards a greater population focus and primary health care approach in the planning and delivery of services and to ensure that communities are engaged in planning health services.

These are reflected in the Bill’s objectives and principles. They state that health services need to be part of an integrated system supporting health promotion, disease, accident and illness prevention and the safe and effective management and treatment of disease, illness and injury.

They also state that service providers should engage with the community and volunteers in the planning and provision of health services and to encourage responsibility at individual and community levels for the promotion and development of healthy communities and individuals.

Importantly the Bill’s principles recognise the health needs of Aboriginal people and the need for the health system to support values that respect their contemporary and historical cultures. This, I believe, is a very important principle and has been well supported by Aboriginal organisations. It orientates the health system far more strongly towards providing services that can work well with Aboriginal communities.

Another principle requires the planning and provision of health services to take into account the needs of people living and working in country and regional areas of the state. Again, this will support the delivery of services for people living and working in our country regions.

To simplify the current governance arrangements and consistent with providing greater accountability, the metropolitan boards will be dissolved. However the metropolitan regions as incorporated hospitals will remain but be managed by a chief executive officer accountable to the Chief Executive of the Department.

The capacity for providing independent advice is addressed in the Bill by the establishment of the Health Performance Council. The Council will ensure that the Minister can have access to high level advice independent from the Department and provides greater public accountability for health outcomes. Having a single body will also support a more consistent and strategic approach in providing advice.

The Health Performance Council will evaluate and report on the overall performance of the public health system in relation to agreed outcomes. It will produce an annual report to be tabled in the Parliament as well as a substantial four yearly report. This latter report will identify significant trends, health outcomes and future priorities of the health system. It will review the health system as a whole, including the public, private and non government systems involved in the provision of health services. The four yearly report will also be tabled in the Parliament and the Government will provide a response to the Parliament within 6 months of it being tabled.

The Health Performance Council will be made up of persons appointed by the Governor and these members will be persons who collectively have the knowledge, skills and experience necessary to enable the Health Performance Council to carry out its functions effectively. They will not be on the Council to necessarily represent the interests of particular groups but to be able when required, to provide sound advice about the needs of particular groups or on specific issues. To this effect the Government will ensure that we consult a wide range of bodies in order to determine the best possible membership, and the regulations will prescribe the key bodies that at a minimum must be consulted before making recommendations to the Governor.

As soon as the Bill is passed we will be seeking the views of a range of bodies regarding the membership of the Council.

To further support the capacity of the Department and the Minister to have access to independent advice, and in particular that of local communities, the Bill provides for the establishment of Health Advisory Councils (HACs) as either incorporated or unincorporated bodies. Where a HAC holds assets it will be an incorporated HAC governed by a constitution. Where it is an unincorporated body, it will be governed by a set of rules. The primary purpose of these Councils is to provide advice on health and service issues, planning and resource allocation, and advocate on behalf of the local community, population group, service or issue the Councils are established in relation to.

In the country, following extensive consultation with hospital Boards, we propose to establish the Country Health SA Board as an incorporated HAC, responsible for providing the Minister and the Department of Health with advice on health and service issues and planning and resource allocation for the whole of country South Australia.

The Government also intends to establish incorporated HACs to replace country hospital and health service Boards. These HACs will be incorporated unless they choose not to be. This will generally be the case when they do not manage assets. The establishment of HACs to replace country Boards will ensure the strong link between country communities and local health services is maintained. These HACs will undertake a range of advisory and advocacy functions, including the ability to raise funds if they choose and playing a significant role in processes for the selection of senior management of the local hospital or health centre.

The membership of the Country Health SA HAC and these local country HACs will, as a transition arrangement, be drawn from the existing Boards. HAC membership will be determined by the individual HACs constitution, and will generally consist of appointed and elected positions. Again, to support community involvement, the majority of members will be local community members elected at an annual general meeting. The Minister will have the capacity to appoint up to 3 members.

To suit the purposes of specific Councils to meet local needs or for example, the needs of bodies such the Country Ambulance Volunteers Health Advisory Council to be established under the proposed Act. The Minister will, subject to consultation, have power to vary the membership functions and powers of a HAC.

The CHSA Board will be established as an incorporated HAC acting as an ‘umbrella’ body for all country HACs. This Board will have similar functions to a local HAC but also have additional functions and powers that will enable it to hold and manage assets. The CHSA Board will continue with its advisory role in planning the location and types of services and the allocation of resources provided by Country Health SA. Members of current CHSA Board will be transitioned into the new body until such time as new membership is required.

In relation to HACs, the Bill gives powers to the Minister to amalgamate HACs, transfer the assets of a HAC or dissolve a HAC. This is consistent with the need to ensure services are allocated on the basis of need and to maximise the efficiency with which they can be provided.

In addition, the Bill has provisions describing the process that must be followed should there be a need to transfer any assets or abolish a HAC. The Bill ensures that the Minister must consult with the relevant HAC and that the Minister is satisfied that there has been a reasonable level of consultation with the community before any actions are taken. Where agreement is not reached, mediation is required. The Bill also provides for the regulations to prescribe the criteria which must be met before actions such as transferring assets or dissolving a HAC can occur. These criteria would include for example, the lack of demand or need for a service, the ability to ensure availability of qualified staff, and reasonable access to alternative services.

These provisions in the Bill and the regulations ensure that the principles of consultation with community and relevant bodies are maintained. They also support a balance between the powers to transfer or amalgamate assets that are necessary to ensure the health system can operate safely, effectively and efficiently and the right of local communities to have a strong voice about the use of their assets.

Unincorporated HACS will not hold assets but will have important advisory functions. They may be established for parts of the metropolitan area or for particular population or service groups. For example, the Country Ambulance Advisory Committee will become a Country Ambulance HAC that advises on issues for the volunteer ambulance service providers. The Country Ambulance Advisory Committee is well established and the principles of electing members will be reflected in their rules.

Under the proposed Act the Government will establish a HAC for veterans and as part of this will consult with organisations such as the RSL and other relevant bodies to determine the membership, functions and other matters that should be part of the Rules. Should the Repatriation General Hospital become part of Southern Adelaide Health Service, the Minister can establish, in consultation with its Board, a HAC for that hospital site.

The Bill provides for the establishment of incorporated hospitals. The existing three metropolitan regions, Central Northern Adelaide Health Service, Southern Adelaide Health Service and the Children Youth and Women's Health Service will be maintained as incorporated hospitals. Country Health SA will be established as the incorporated hospital for the country region. These incorporated hospitals will be administered by Chief Executive Officers. As suggested earlier, the Repatriation General Hospital will remain as a separately incorporated hospital with its own board unless it chooses to become part of Southern Adelaide Health Service.

Staff of the incorporated hospitals will maintain their Fringe Benefits Tax entitlements under the Fringe Benefits Tax Assessment Act 1986. The Department has been formally advised of this by the Australian Taxation Office which has ruled that the three metropolitan incorporated hospitals and the Repatriation General Hospital are hospitals for the purposes of Fringe Benefits Tax exemptions. The Australian Taxation Office is examining information from Country Health SA to determine its status as an incorporated hospital for Fringe Benefits Tax purposes. The Department expects that the Australian Taxation Office will make a similar ruling as for the other incorporated hospitals.

The Bill provides that health service staff will be employed under the proposed Health Care Act 2007.

Consistent with the Statutes Amendment (Public Sector Employment) Act 2006, the Chief Executive of the Department of Health will be the employing authority for all staff across the portfolio and will assign staff to the incorporated hospitals and the South Australian Ambulance Service as appropriate.

Transitional arrangements in the Bill provide for employees under the South Australian Health Commission Act 1976 and ambulance officers under the Ambulance Services Act 1992 to be assigned to work where they are currently employed without alteration to their conditions of employment and with recognition of current entitlements and awards.

Clerical and administrative staff under the Ambulance Services Act 1992 will also translate to employment under the proposed Health Care Act without loss of conditions.

Under the Health Care Bill the Ambulance Services Act 1992 will be repealed and the functions of SAAS will be managed under a new arrangement within the Department. The Bill ensures that SAAS will remain as an identifiable incorporated entity. Consistent with the incorporated hospitals, it will be managed by a chief executive officer. Services and staffing levels will remain unchanged under the proposed new governance arrangements.

It is important to note that SAAS does not operate as a commercial provider and, consistent with National Competition Policy principles, it is to the benefit of the community that it remains as the sole provider of emergency ambulance services in South Australia.

The Bill in its principles, makes it clear that it is in the public interest to have a single provider of emergency ambulance services to ensure that the maximum efficiency in terms of prioritising of calls, allocations based on need and nearest access to the service can be achieved in an emergency situation. Having a single provider will minimise the risk to the public that might arise from delays resulting from needing to coordinate a number of emergency ambulance services providers when a local, regional or statewide medical emergency arises. It will ensure the most efficient delivery of emergency ambulance services, consistent and appropriate standards of training and service delivery where lives are at risk, and a single system where a coordinated and unified response is required.

The licensing and exemption provisions of the Ambulance Services Act 1992 will be part of the Health Care Bill.

While SAAS will not be required to have a licence, the Bill requires non-emergency ambulance providers to have a restricted ambulance licence. Private operators will continue to be able to transport patients in non emergency situations where a clinical decision has been made that a patient requires a level of assistance for transfer between locations.

Transitional provisions will ensure that businesses currently holding a licence to provide non emergency ambulance services can continue to do so under the conditions of their licence for a period of 12 months. After that time they will need to apply for a restricted ambulance service licence under the new Act.

While the provision of emergency ambulance services will be restricted so that these can only be provided by SAAS, the Bill allows other emergency ambulance services to be exempted from the licensing requirements and enables them to provide emergency ambulance services as they do currently. It is our intention to exempt certain services including the State Rescue Helicopter Service, patient retrieval services arranged by hospitals and medical practitioners and the Royal Flying Doctor Service.

In the interests of public health and safety the Bill will enable SAAS to authorise a person holding a restricted ambulance service licence to provide an emergency ambulance service in the case of a State emergency.

These licence holders will also be able to provide emergency ambulance services if the condition of a patient being transported by the operator suddenly deteriorates and they have taken reasonable action to contact SAAS seeking authorisation to provide such a service. To ensure that private operators act within the intent of this section of the legislation, SAAS can require them to provide a written report on the circumstances of the particular case that required them to operate as an emergency ambulance service. The fitting and use of appropriate lights and sirens will be subject to further consultations when drafting the regulations for this Bill along with consequential amendments to other regulations.

The Bill will also have provisions to allow the remaining country ambulance service operators to be exempted from certain provisions so they can continue to provide emergency ambulance services and there will be no change to the ambulance services currently provided.

The Bill has a specific provision to enable SAAS staff or volunteers to use force to enter premises. On occasion they have needed to use force to enter premises where it was believed that a person was in need of medical assistance and the police were unavailable to access the premises for SAAS in a timely manner. In such circumstances, SAAS acts in what it believes to be the best interest of the person, although no such express powers exist in the Ambulance Services Act 1992. This has created some uncertainty for SAAS staff and volunteers.

The Bill addresses this issue and gives powers to SAAS staff, including volunteer staff, to use force to enter premises where they reasonably believe that a person is in need of medical assistance. SAAS will develop a set of protocols or procedures that staff must follow for the purposes of this section. Included in these will be the need to contact the police in the first instance. These protocols will largely reflect current practices, but remove the uncertainty for SAAS where staff have had to forcibly enter premises in the past.

The quality and safety of health services is a prime concern of the public and health professionals. It is also an important consideration of the Bill. The Bill has much clearer provisions than those in the South Australian Health Commission Act 1976 to ensure quality and safety activities can be carried out in a way that ensures information that can enhance or protect public health and safety is publicly available, but at the same time, protect the confidentiality of persons providing information or having access to information that supports such an activity.

The quality improvement or research activities are protected in the same way as that currently provided for under section 64D of the South Australian Health Commission Act 1976. However the provisions in this Bill have taken into account recent Crown Law advice and court judgements to ensure persons or groups of persons conducting research into the causes of mortality or morbidity, or involved in the assessment and improvement of the quality of specified health services are properly protected from being legally required to make certain information public.

The provisions in the Bill support clinicians, managers and others to communicate openly and honestly in assessing the processes and outcomes of the provision of health services where there has been a significant adverse event and to make recommendations for system improvements. This is most likely to happen where those involved are secure in the knowledge that what they divulge cannot be made public or used in any proceedings. The Bill, in promoting full and frank discussion in a ‘protected’ environment for the purposes of facilitating quality improvement in health services, maintains the right to have access to or disclose information in the public interest. This is consistent with what is the current intent of section 64D of the South Australian Health Commission Act 1976. To further support participation in an analysis of an adverse event undertaken under Part 8 of the Bill, a provision is drafted enabling a person who believes they have been victimised as a result of this participation to take action that can be dealt with as a tort or under the Equal Opportunity Act 1984.

The Bill provides for a specific investigative procedure, a Root Cause Analysis, to be undertaken where there has been an adverse incident. Root Cause Analysis is a specific type of quality improvement activity which uses an investigative method to determine the underlying contributing factors leading to an adverse event. The purpose is to identify the system issues that result in adverse events occurring and to arrive at a series of recommendations to reduce the likelihood of the adverse event from occurring again. RCA has a systems focus. It does not review individual responsibility nor does it investigate performance, intentionally unsafe acts, criminal acts or acts relating to clinician impairment. These are left to the appropriate bodies such as registration boards or courts.

In drafting these provisions, account has been taken of interstate and overseas legislation and a ‘best practice’ document issued by the Australian Council for Safety and Quality in Health Care.

Importantly with these governance changes, the Bill has provisions for testamentary dispositions or trusts made or created before or after the commencement of the Act. These provisions ensure that they can be applied according to the testator’s wishes or, in circumstances where this may no longer be possible, establishes a process to ensure that they are properly dealt with to minimise the risk of a testamentary disposition or trust failing.

The provisions do not derogate from the Trustee Act 1936 and ensure that the Attorney-General is consulted as part of the process where the Minister is to make a designation regarding the disposition of a trust to another entity where the entity to which the trust had originally applied, may no longer exist.

The Bill has provisions to allow trusts previously held by an existing local country hospital board to continue to be held for the same purpose by an incorporated HAC. This is intended to ensure that any gifts or bequests to those bodies will not fail.

These provisions are based on extensive consultations between the Attorney General’s Department and the Department of Health.

The Government is also mindful of the need to be able to regulate the management, operation or winding up of any gift fund, or other funds or accounts. The Government is committed to the prudential management of such funds and accounts and aware of the potential taxation implications if appropriate regulatory provisions are not in place. Accordingly, a specific regulation making power is included to address these issues. However, it will also be necessary and appropriate that any relevant regulations operate subject to any requirements imposed by a trust, under another Act or by the general law with respect to the management or disposal of property, including so as to ensure consistency with the terms or conditions of any trust or gift.

Private hospitals will continue to be regulated under the Health Care Bill in the same way as they are under the South Australian Health Commission Act 1976. However this section will need to be reviewed and the Act will potentially need to be amended at some later stage to address any changes.

This is not directly relevant to the reforms of the public health system and therefore I do not intend to confuse matters that may arise from a review of these provisions with the governance reforms for the public health system.

The Bill provides for greater sharing of information with carers, health professionals and others involved in providing care, and balances this with the right of the patient to privacy. This is in response to the concerns of carers and families and clarifies the circumstances where information can be disclosed for on-going treatment and care of patients.

This Bill makes possible very important changes to the governance and orientation of our public health system. It also improves existing provisions or provides new provisions such as those for the better protection of public health and safety; for persons having made or who may consider making a testamentary disposition to a health service and for greater protection of staff and patients by giving powers to authorised officers to remove or restrain persons who are behaving offensively.

Transitional provisions will ensure that necessary by-laws, including those of health centres designated by the Governor, can continue until such time as they are re-issued or replaced under alternate arrangements.

The Bill as tabled is the outcome of a thorough consultation process and has incorporated many of the suggestions and recommendations arising out of this process. The responses from the regions and metropolitan area have been supportive of the reforms embodied in the Bill. For example, Southern Adelaide Health Service stated that 'it believed that the draft legislation appropriately translates the Government’s announced directions for health system governance. It is recognised that the intention of the Bill is to create a unified, single public health system with improved statewide coordination and integration of public health services. The establishment of both the proposed Health Performance Council and the Health Advisory Councils are welcome initiatives and are important to further enhance the community and consumer interface that has been an important focus of health reform to date.'

The RSL also acknowledged the 'need for improvements to the public health system' and offers 'our support to these changes, designed to provide a unified and coordinated health system for the future'.

The country region, where there will be a significant impact, has been particularly supportive and it is appropriate to read some of their comments.

The Country Health SA Board—'would like to express appreciation of the open manner in which the whole process has been conducted and in particular to the Minister for Health for his responsiveness to the comments offered from time to time by Country Health SA and to the views expressed by country people in general. The Minister has remained faithful to a vision of stronger and more sustainable health services for country residents delivered closer to home and to maintaining the strong connections between local communities and the health services which have developed over many years. The Country Health SA Board thanks the Minister for the consistency of his approach and for his support for country health services in the context of this major change to governance arrangements. The Board supports the general thrust of the draft Bill and wishes to express its support for the following aspects of the Bill.' The comments from the Board went on to list support for a range of provisions in the Bill, including: the object of having an integrated system that provides optimal health outcomes for South Australians; the principles of the Bill; inclusion of representatives with knowledge of Aboriginal issues in the model constitution and rules for HACs; and the establishment of the Health Performance Council.

Aboriginal Health Council SA—stated it supports the overall objective of the Bill, to ensure a health system that is accessible, safe, and reliable for all residents of SA.

Mid North Health—while Mid North Health commented it would prefer to remain as a Board, it also stated 'we have welcomed the opportunity to be involved in the consultation about the draft, enabling us to have input to produce an outcome that is as 'user friendly' as possible'.

Ceduna District Health Service—'Board are in support of the intent of the proposed legislation, in particular the board feel that the proposed role of the HACs is much more in line with what community members believe the role of existing boards should be. That is, advocacy and provision of advice, rather than administration of clinical and corporate governance.'

Aboriginal Health Council—commented that it generally supports the processes that are in place at present and proposed for moving forward.

Yorke Peninsula Health—'the Board gives in principle support to the introduction of the Bill to underpin the transition to a systematic approach to future health care delivery'.

In closing I would say that all South Australians are entitled to enjoy a good long healthy life. To better support people to have this opportunity, the public health system needs to change to address the challenges before it and provide safe and effective health care and support to individuals and communities as well as supporting the full range of health professionals. The complexities of the contemporary health system require more direct responsibility and accountability for the services it provides.

As stated in South Australia’s Health Care Plan, 'Improving the health and well-being of the South Australian community will require us all to take responsibility to develop a combined approach from individuals, community groups, government and non government sectors…'

The Bill will enable the development of a better more coordinated and integrated health service and support a stronger focus on the quality and safety of the services.

I commend the Bill to Members.

Explanation of Clauses

Part 1—Preliminary

1—Short title

This clause is formal.

2—Commencement

The measure will be brought into operation by proclamation.

3—Interpretation

This clause sets out the terms that are defined for the purposes of the measure.

The following key definitions are specifically noted:

ambulance means a vehicle that is equipped to provide medical treatment or to monitor a person's health and that is staffed by persons who are trained to provide medical attention during transportation;

ambulance service means the service of transporting by the use of an ambulance a person to a hospital or other place to receive medical treatment or from a hospital or other place at which the person has received medical treatment;

emergency ambulance service means an ambulance service that—

(a) responds to requests for medical assistance (whether made by 000 emergency telephone calls or other means) for persons who may have injuries or illnesses requiring immediate medical attention in order to maintain life or to alleviate suffering; and

(b) is set up to provide medical attention to save or maintain a person's life or alleviate suffering while transporting the person to a hospital;

health service means—

(a) a service associated with:

(i) the promotion of health and well being; or

(ii) the prevention of disease, illness or injury; or

(iii) intervention to address or manage disease, illness or injury; or

(iv) the management or treatment of disease, illness or injury; or

(v) rehabilitation or on going care for persons who have suffered a disease, illness or injury; or

(b) a paramedical or ambulance service; or

(c) a residential aged care service; or

(d) a service brought within the ambit of this definition by the regulations,

but does not include a service excluded from the ambit of this definition by the regulations;

medical treatment includes all medical or surgical advice, attendances, services, procedures and operations.

4—Objects of Act

The objects of the measure are—

(a) to enable the provision of an integrated health system that provides optimal health outcomes for South Australians; and

(b) to facilitate the provision of safe, high-quality health services that are focussed on the prevention and proper management of disease, illness and injury; and

(c) to facilitate a scheme for health services to meet recognised standards.

5—Principles

A number of principles are to be applied in connection with the operation and administration of the legislation.

Part 2—Minister and Chief Executive

6—Minister

The Minister is to have a variety of functions in connection with the operation of the measure (to be performed to such extent as the Minister considers appropriate).

7—Chief Executive

The Chief Executive of the Department is to have a variety of functions in connection with the operation of the measure. The Chief Executive will be responsible to the Minister for the overall management, administration and provision of health services within the Minister's portfolio, to assume direct responsibility for the administration of incorporated hospitals and to ensure that the Department undertakes a leadership role in the administration of health services. The Chief Executive will also be required to ensure that the Department establishes and maintains consultation processes with members of the community, volunteers, carers and health service providers.

8—Delegations

The Minister and the Chief Executive will have the ability to delegate functions and powers.

Part 3—Health Performance Council

9—Establishment of Health Performance Council

The Health Performance Council (HPC) is to be established. The members of HPC will be constituted by persons who together, in the opinion of the Minister, have a variety of talents and a range of experience, skills and qualifications to enable HPC to carry out its functions effectively.

10—Provisions relating to members, procedures and committees and subcommittees

Schedule 1 sets out associated provisions with respect to HPC.

11—Functions of HPC

The functions of HPC will include to provide advice to the Minister about—

(a) the operation of the health system; and

(b) health outcomes for South Australians and, as appropriate, for particular population groups; and

(c) the effectiveness of methods used within the health system to engage communities and individuals in improving their health outcomes.

12—Annual report

HPC will be required to prepare an annual report, which will be laid before both Houses of Parliament.

13—4-yearly report

HPC will prepare a 4-yearly report that assesses the health of South Australians and changes in health outcomes over the reporting period. In particular, the report will be required (amongst other things) to—

(a) identify significant trends in the health status of South Australians and consider future priorities for the health system having regard to trends in health outcomes, including trends that relate to particular illnesses or population groups; and

(b) review the performance of the various health systems established within the State in achieving the objects of this Act.

The report will be laid before both Houses of Parliament. The Minister will be required to prepare a formal response to the report within 6 months after the receipt of the report.

14—Use of facilities

HPC may, with the approval of the responsible Minister or, if relevant, a responsible public sector instrumentality, make use of the staff, services or facilities of an administrative unit or another public sector instrumentality.

Part 4—Health Advisory Councils

Division 1—Establishment of Councils

15—Establishment of Councils

The Minister will be able to establish Health Advisory Councils (HACs) to undertake an advocacy role on behalf of the community, to provide advice, and to undertake other functions, in relation to health service entities, the Minister or the Chief Executive. The Minister may establish a HAC as an incorporated body or an unincorporated body.

16—Status

This clause makes provision with respect to the corporate nature of an incorporated HAC, and the powers and functions of HACs.

17—Constitution and rules

An incorporated HAC will have a constitution and an unincorporated HAC will have a set of rules.

Division 2—Functions and powers

18—Functions

This clause provides an indication of the functions that a HAC may adopt (as set out in the constitution or rules of the HAC). Subject to the Act, a HAC will be required to take into account the strategic objectives that have been set or adopted within the Government's health portfolios. An incorporated HAC will be expected, with respect to the entity in relation to which it is established—

(a) to support and foster the activities and objects of the entity; and

(b) subject to this Act, to hold its assets for the benefit, purposes and use of the entity on terms or conditions determined or approved by the Minister.

19—Specific provisions in relation to powers

A HAC will require the approval of the Minister before exercising a number of specified powers.

Division 3—Related matters

20—Specific provisions in relation to property

This clause sets out a scheme for the transfer of assets, rights or liabilities of a HAC by a notice published by the Minister in the Gazette.

21—Accounts and audit

A HAC will be required to keep proper accounts and financial statements.

22—Annual report

This clause provides for the preparation of an annual report in connection with the operations of a HAC.

23—Use of facilities

A HAC may, with the approval of the responsible Minister or, if relevant, a responsible public sector instrumentality, make use of the staff, services or facilities of an administrative unit or another public sector instrumentality.

24—Delegations

A HAC will have the ability to delegate functions and powers, subject to any limitation or exclusion determined by the Minister.

25—Access to information

This clause sets out a specific power vested in a HAC to request the provision of information.

26—Common seal

This clause facilitates proof of the use of the common seal of an incorporated HAC.

27—Schedule 2 has effect

Schedule 2 sets out associated provisions with respect to HACs.

28—Administration

The Minister will be able to remove the members of a HAC from office on a ground specified by the regulations. The Minister will be able to appoint an administrator pending the appointment of new members. An administrator may act for a period of up to 12 months.

Part 5—Hospitals

Division 1—Incorporation

29—Incorporation

The Governor will be able to establish an incorporated hospital to provide services and facilities under the Act.

30—Hospital to serve the community

An incorporated hospital must be administered and managed on the basis that its services will address the health needs of the community (which may occur by focussing on 1 or more areas or sections of the community).

31—General powers of incorporated hospital

An incorporated hospital will have various statutory powers.

32—Common seal

This clause facilitates proof of the use of the common seal of an incorporated hospital.

Division 2—Management arrangements

33—Management arrangements

The Chief Executive will be responsible for the administration of an incorporated hospital. The Chief Executive will be able to appoint a person as the CEO of an incorporated hospital. Such an appointment will not prevent the Chief Executive from acting personally in a matter. This scheme operates subject to Schedule 3 with respect to the Repatriation General Hospital.

Division 3—Employed staff

34—Employed staff

This clause provides for an employing authority to employ persons to work in an incorporated hospital.

35—Superannuation and accrued rights, etc

This clause sets out various matters associated with the employment of persons at incorporated hospitals.

Division 4—Accounts, audits and reports

36—Accounts and audit

An incorporated hospital must keep proper accounts and prepare financial statements.

37—Annual report

An incorporated hospital will prepare an annual report.

Division 5—Sites, facilities and property

38—Ability to operate at various sites

This clause makes it clear that an incorporated hospital may be established or undertake its activities at various sites.

39—Ability to provide a range of services and facilities

This clause sets out some specific powers of an incorporated hospital, including to operate—

(a) sites that provide a variety of health services;

(b) health and community care services for all or specific sections of the community, including residential services for the aged and other vulnerable groups, or for persons who must interact with the public health system;

(c) other forms of service or facilities (including services and facilities that benefit (directly or indirectly) staff, patients or visitors, and services and residential facilities for the aged and other forms of accommodation).

40—Acquisition of property

The Minister will be able to acquire land under the Land Acquisition Act 1969 for the purposes of an incorporated hospital.

Division 6—Delegations

41—Delegations

An incorporated hospital will have the ability to delegate functions and powers.

Division 7—By-laws and removal of persons

42—By-laws

An incorporated hospital will continue to have power to make by-laws for specified purposes. A by-law must be approved by the Minister and confirmed by the Governor.

43—Removal of persons

This clause sets out a scheme to enable an authorised officer to take action in relation to a person who—

(a) is considered by an authorised officer to be acting in a manner that constitutes disorderly or offensive behaviour; or

(b) is considered by an authorised officer on reasonable grounds to be a threat to another person at the site; or

(c) is suspected by an authorised officer on reasonable grounds of being unlawfully in possession of an article or substance; or

(d) is otherwise suspected by an authorised officer on reasonable grounds to have committed, or to be likely to commit, an offence against any Act or law.

Division 8—Fees

44—Fees

The Minister will be able to set fees to be charged by an incorporated hospital in respect of services provided by the hospital.

Division 9—Rights of hospitals against insurers

45—Interpretation

46—Report of accidents to which this Division applies

47—Notice by designated entity to insurer

48—First claim of designated entity

These clauses replicate Part 3 Division 8 of the current Act.

Part 6—Ambulance services

Division 1—South Australian Ambulance Service (SAAS)

49—Continuation of SAAS

The SA Ambulance Service is to continue as a body incorporated under this Act. The staff of SAAS will include volunteers who are appointed to assist with the operations or activities of SAAS.

50—Management arrangements

The Chief Executive will be responsible for the administration of SAAS. The Chief Executive will be able to appoint a person as the CEO of SAAS. Such an appointment will not prevent the Chief Executive from acting personally in a matter.

51—Functions and powers of SAAS

The primary function of SAAS will be to provide ambulance services within the State (and beyond).

52—Employed staff

This clause provides for an employing authority to employ persons to assist SAAS in its operations or activities.

53—Accrued rights for employees

This clause sets out various matters associated with the employment of persons at SAAS.

54—Delegation

SAAS will have ability to delegate functions and powers.

55—Accounts and audit

SAAS must keep proper accounts and prepare financial statements.

56—Annual report

SAAS will prepare an annual report.

Division 2—Provision of ambulance services

57—Emergency ambulance services

Emergency ambulance services will be provided by SAAS, as prescribed by the regulations, or under a specific exemption granted by the Minister for the purposes of this Part. In addition, a person holding a restricted ambulance service will be able to provide an emergency ambulance service if—

(a) the person is acting within the scope of an authorisation given by SAAS (either in relation to specified cases, or in relation to a particular case, and subject to such conditions as may be prescribed by the regulations or determined by SAAS); or

(b) the person has reason to believe that failure to provide such a service will put at risk the health or safety of a particular person, or of a section of the public more generally, and the person providing the service has taken such action as is reasonable in the circumstances to contact SAAS to seek an authorisation under this section; or

(c) the person is acting at the direction or request of SAAS.

58—Licence to provide non-emergency ambulance services

A person will not be able to provide a non emergency ambulance service unless—

(a) the services are carried out—

(i) by SAAS; or

(ii) by a person acting under the direction or request of SAAS; or

(b) the person holds a licence under this section (a restricted ambulance service licence); or

(c) the services are provided by a person or a person of a class, or in circumstances, prescribed by regulation; or

(d) the services are provided under an exemption granted by the Minister under this Part.

Division 3—Miscellaneous

59—Fees for ambulance services

The Minister will be able to set fees to be charged for ambulance services.

60—Holding out etc

A person must not hold himself or herself out as carrying on the business of providing ambulance services except as provided or authorised under this Part. A person must not hold himself or herself out as being engaged in the provision of ambulance services unless he or she is a properly authorised member of the staff of an ambulance service.

61—Power to use force to enter premises

A member of the staff of SAAS will be able to break into premises if the person believes that it is necessary to do so to determine whether a person is in need of medical assistance, or to provide medical assistance. A person so acting must comply with any protocol or practice established by SAAS.

62—Exemptions

This clause facilitates the scheme for granting Ministerial exemptions under this Part.

Part 7—Quality improvement and research

63—Preliminary

This clause sets out various definitions associated with a new scheme to provide for the assessment or evaluation of health services under a Ministerial declaration.

64—Declaration of authorised activities and authorised persons

The Minister will be able, by notice in the Gazette, to declare an activity to be an authorised quality improvement activity or an authorised research activity, or to declare a person or group of persons to be an authorised entity for the purposes of carrying out a declared quality improvement activity or research activity. The Minister will be required to make the health and safety of the public the primary consideration when acting under this provision.

65—Provision of information

Information (including confidential information) may be disclosed for the purposes of an authorised activity without the breach of any law or principle of professional ethics.

66—Protection of information

This clause provides for the protection from disclosure of information gained as a result of an authorised activity, or gained on behalf of an authorised person in connection with an authorised activity.

67—Protection from liability

No act or omission in good faith for the purposes of an approved activity, or that is reasonably believed to be for the purposes of an approved activity, gives rise to a liability.

Part 8—Analysis of adverse incidents

68—Preliminary

This clause sets out various definitions associated with a new scheme to provide for the investigation of adverse incidents in the provision of health services.

69—Appointment of teams

It will be possible to appoint a team under this Part to investigate an adverse incident.

70—Restrictions on teams

An investigation will not extend to inquiring into the competence of a particular person.

71—Provision of information

Information (including confidential information) may be disclosed to a team under this Part without the breach of any law or principle of professional ethics.

72—Reports

A team will prepare 2 reports at the end of an investigation. 1 report will contain—

(a) a description of the adverse incident, based on facts that, in the opinion of the team, are known independently of its investigation; and

(b) the team's recommendations.

The second report will contain (as the team thinks fit)—

(a) a description of the adverse incident;

(b) a flow diagram;

(c) a cause and effect diagram;

(d) a causation statement;

(e) the recommendations of the team;

(f) the working documents associated with the team's investigation and processes (incorporated as attachments);

(g) any other material considered relevant by the team.

The second report will not be released to the general public.

73—Protection of information

This clause provides for the protection of information gained through the activities of a team under this Part.

74—Immunity provision

No act or omission in good faith for the purposes of an investigation, or that is reasonably believed to be for the purposes of an investigation, under this Part gives rise to a liability.

75—Victimisation

This clauses sets out a scheme to protect a person who provides information in connection with an investigation under this Part.

Part 9—Testamentary gifts and trusts

76—Interpretation

A prescribed entity under Part 9 will be a hospital or health centre incorporated under the repealed Act, an entity incorporated under another Act that provides health services (other than a private hospital), or an entity incorporated under this Act. However, the regulations may exclude an entity from the operation of the Part.

77—Application of Part

The Part will be in addition to, and not in derogation of, the Trustee Act 1936.

78—Testamentary gifts and trusts

The scheme will facilitate the effect or operation of testamentary dispositions or trusts made for the benefit of a prescribed entity that has been dissolved and that has had its functions transferred to an incorporated hospital under the Act. A comparable provision will apply if the disposition or trust is for the benefit of patients or residents of a prescribed entity.

Part 10—Private hospitals

79—Prohibition of operating private hospitals unless licensed

80—Application for licence

81—Grant of licence

82—Conditions of licence

83—Offence for licence holder to contravene Act or licence condition

84—Duration of licences

85—Transfer of licence

86—Surrender, suspension and cancellation of licences

87—Appeal against decision or order of Minister

88—Inspectors

These clauses replicate Part 4A of the current Act.

Part 11—Miscellaneous

89—Application of PSM Act

The Governor will be able, by proclamation, to apply (with specified modifications) provisions of the Public Sector Management Act 1995 to persons employed at incorporated hospitals (see section 59 of the current Act).

90—Recognised organisations

This clauses contains a scheme that allows recognised organisations to make submissions about matters arising out of, or in relation to, the performance or exercise of functions or powers of an employing authority or incorporated hospital under the Act (see section 61 of the current Act).

91—Duty of Registrar-General

This clause will facilitate the registration of the vesting of any land in a relevant entity under the Act (see section 62 of the current Act).

92—Conflict of interest

This clause requires a health employee to declare a conflict of interest (see section 63A of the current Act).

93—Confidentiality and disclosure of information

This clause relates to personal information obtained by a 'person engaged in the operation of the Act'. A person engaged in the operation of the Act will be taken to be—

(a) an officer or employee of the Department engaged in the administration of the Act; or

(b) a person employed by an employing authority under the Act; or

(c) a member of the staff of SAAS; or

(d) a person otherwise engaged to work at an incorporated hospital or in connection with the activities of SAAS.

Such a person so engaged (or formerly engaged) will not be able to disclose personal information except to the extent that the person may be authorised or required to do so under this clause. The disclosure will be on the grounds set out in the clause, as authorised by the Chief Executive, an employer, an incorporated hospital or SAAS, or as authorised under the regulations.

94—Offences by bodies corporate

If a body corporate is guilty of an offence against the Act, every person who is a member of the governing body of the body corporate is guilty of an offence and liable to the same penalty as is prescribed for the principal offence unless the person proves the general defence under the Act.

95—General defence

It is a defence to a charge of an offence against the Act (the general defence) if the defendant proves that the alleged offence was not committed intentionally and did not result from any failure on the part of the defendant to take reasonable care to avoid the commission of the offence.

96—Evidentiary provision

This clause sets out various evidentiary presumptions.

97—Administrative acts

This clause provides for the immunity from liability of the Minister and SAAS with respect to certain administrative acts under the Act.

98—Forms of Ministerial approvals

This clauses facilitates the operation of those provisions of the Act that provide that the Minister may give an approval.

99—Gift funds established by Minister

This clauses makes express provision for the establishment of 1 or more gift funds by the Minister.

100—Regulations

The Governor will make regulations for the purposes of the Act.

Schedule 1—Health Performance Council

This schedule relates to the members and proceedings of the Health Performance Council.

Schedule 2—Health Advisory Councils

This schedule relates to the members and proceedings of Health Advisory Councils.

Schedule 3—Special provisions relating to the Repatriation General Hospital Incorporated

This schedule provides for the administration of the Repatriation General Hospital by a board of directors.

Schedule 4—Related amendments, repeals and transitional provisions

This schedule makes a series of related amendments to other Acts, provides for the repeal of 3 Acts, and sets out transitional provisions associated with the enactment of this new measure.

Debate adjourned on motion of the Hon. J.M.A. Lensink.

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