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Legislative Council - Fifty-First Parliament, Second Session (51-2)
2008-06-17 Daily Xml
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STATUTES AMENDMENT AND REPEAL (INSTITUTE OF MEDICAL AND VETERINARY SCIENCE) BILL

Second Reading

Adjourned debate on second reading.

(Continued from 30 April 2008. Page 2541.)

The Hon. J.M.A. LENSINK (17:17): Our position has been stated very clearly in the other place by the shadow minister for health, the member for Bragg and deputy leader, Ms Vickie Chapman, who spoke for several hours on this particular bill on 29 April. Being a non-lawyer and, I say in jest, a non-serial offender in terms of lengthy speeches, I do not intend to speak for several hours on this bill, but I will restate a few very important points in relation to this particular proposal.

This bill will repeal the IMVS Act and transfer its functions to the Central Northern Adelaide Health Service, which has become one of the great monoliths within our health system, carrying a huge responsibility in terms of health services across the state. It is centralisation. It goes hand-in-hand with the actions of this government, as we have seen in its most recent budget, in relation to not only country health, where our country hospitals will be absolutely gutted, apart from the four major centres, but also the non-spine (I think that is the language that the government uses) metropolitan hospitals, which will also be dumbed down in the effort of centralisation.

There can be no more obvious proof in the pudding of how this government is managing our health system than the actions of well over 100 doctors to date who have simply had enough of the way they have been treated. This is a government that believes in buildings and not the people who work in them. It is all very well to make great announcements about infrastructure, but if you do not look after the people who work in your system you do not have a system at all.

In relation to this particular bill, the pathology services, which are currently provided by the IMVS, SouthPath and the women's and children's department, which have all evolved separately along their own lines into a single pathology service entitled SA Pathologies, are merely a smaller part of the picture but nevertheless a very important part of our health system.

I declare an interest in that my sister was an employee of the IMVS a few years ago as a research scientist. The people whom I know who work there these days are really quite fed up with the way they have been treated by this government. They are treated like mice in a running mill and have their particular skills and expertise dismissed as if they are all just numbers that can be pushed around in some grand plan by this centralist government.

The IMVS has a very good reputation. I am pleased that at least the government has seen fit to allow the title of the IMVS and Medvet Sciences to be carried forward so that those reputations may continue to attract research funding. We see this as a means by which the government will take over all of these pathology services so that it can get its hands on the funding that they raise. Rather than respecting the particular models that may have developed historically, they will be rolled into one homogenous system regardless of whether that is the best way to proceed going forward.

There are a number of issues in relation to staff. I understand that the IMVS lost its FBT status three or four years ago and was grandfathered until recently. We were told in a briefing—and I am grateful to the minister's staff for the information that they provided—that when staff becomes part of CNAHS they will be able to salary sacrifice again. There are also, I understand, some contract issues in terms of the transfer that still need to be approved. The new entity will need to become an approved pathology provider in order to receive commonwealth funding.

I think it also needs to be highlighted that, because of its reputation, the IMVS undertakes a significant number of tests from private GPs. It will be interesting to see whether that, in fact, continues.

I note that the government assumes that it will actually be undertaking more tests. I think that is optimistic. It also claims that there will be some cost savings of $2.177 million over two years. I think that is probably rather optimistic as well; possibly it is part of some illusion that is part of the vision of the shared services which has occurred in a lot of government departments but which really is not coming to fruition.

We are not sure where those savings of $2 million plus will come from. I also understand that there are 'fee for service' funding model issues that are still to be worked through. I note that the cost per test on average for the IMVS is $25, SouthPath $31 and the Women's and Children's $71, so one would have thought that, if one wanted to amalgamate them, the intelligent thing would be to keep the IMVS and make it the lead agency for pathology testing in South Australia.

Another disappointing thing about what happens when these entities are all rolled into one service is that the expertise of the board is lost, and I note that the CEO Professor Brendan Kearney has a great deal of experience in the health field. Once these entities are rolled into one under CNAHS, we will see the lack of transparency continue, with much less public information being made available.

When one looks at budget papers or annual reports these days, the funding, the number of patients and the number of tests and so forth, are all aggregated, so it is very hard to actually work out what is really happening in the service, which I suspect is part of the design of this proposal in that it reduces transparency. As we know, our health system is in crisis, and the government would rather that the real world should know as little as possible about what is really going on.

I would like to place on the record a question: does the government have any intention of selling any of the assets of any of those three services as this goes through? We have been given reassurances in the past, along the lines of, 'We're from the government; we're here to help; trust us.' As I said earlier, we were given those assurances in relation to Country Health and now look at what is happening there, where the services will be so minimal that, to be quite honest, speaking as a health professional myself, nobody will really want to go there to work, because the work is just not particularly challenging.

That equates to training places and so forth. It really is pulling apart the fabric of a health system that has taken decades to develop, and those communities within the health system that have developed and have been self-sustaining are being pulled apart. I fear that the same will happen with our pathology services in this state which have had such an excellent reputation to date. So, I seek an assurance from the government that no assets will be sold as a result of this within the next two years and, with those remarks, I indicate that we will be calling for a division on this bill in opposition.

The Hon. SANDRA KANCK (17:26): The IMVS has a very proud history in this state although, in the past 15 to 20 years, a lot of the tests that it made its money from have been creamed off by the private pathology firms which make a lot of money out of the large volume simple blood tests, and this has of course reduced the profitability of the IMVS. However, as an organisation, at this point with legislation like this, we need to pay tribute to the important role it has played in public health in this state.

Members will recall that about a decade ago we had the Garibaldi food poisoning outbreak, and the IMVS played a pivotal role in isolating the cause. This is part of the reason why the IMVS is so important, because the private pathology laboratories that are there to make money would not have gone down every burrow as the IMVS did in this case in trying to find the cause, because there is not a massive financial return in doing something like that.

I have had only two representations concerning this bill. One was a phone call in support, and in fact that person has rung twice and has asked us to support the bill, and one was an email very strongly lobbying against it. My concern about the bill echoes some of those concerns that have been spoken of by the opposition, in particular, the centralisation of services.

What I see happening in health at the moment has the potential to be reminiscent of the worst days of the Department of Human Services, and it certainly has the potential for a lot of empire-building in the long term, and that does concern me. I see that in a number of different portfolios where public servants see themselves as being king of a somewhat small castle, but their reputation is staked on it, and a lot can be built on that.

So, although I have had very little lobbying on it, my concern about the centralisation leads me to a position of supporting the second reading, but I indicate that I will listen with great interest and read what other members have to say in determining my final position at the third reading.

The Hon. A. BRESSINGTON (17:29): I have had the pleasure of receiving a number of briefings from minister Hill's office and, yesterday, I received a briefing from one of his staff members on this bill. It came as no surprise to me that, obviously, we only hear of the benefits. When I asked the question, 'What will the cost be to particular stakeholder groups?' the gentleman sat there almost dumfounded to think that I could even comprehend that there would be costs to any people with a bill from the government. However, I kept in mind the personal briefing I had from the minister (the Hon. John Hill) on the health care bill. I was reassured that there would be very little inconvenience to rural people, that most certainly hospitals were not going to close, and that it would be a more refined service for rural people.

Last week we heard that 43 out of 66 hospitals will be closing. We have had mass resignations from anaesthetists and doctors. It will not be long before nurses, too, are up in arms about the conditions that they work under, especially at the QEH. My daughter-in-law is a theatre nurse there and I hear some horror stories about what staff are now having to put up with regarding some of these reforms.

I have learnt that I cannot rely on these briefings to give me a broad spectrum view of what the long-term (or even short-term) ramifications will be. I remind members of this council of the Glenside proposal. We were told that it would be a you-beaut mental health facility, which would be state of the art and the best thing since sliced bread, and now we hear that our mental health patients will be sharing the grounds with movie stars on a movie set. I wonder how a Hollywood theme and mental health patients will mix and what the therapeutic value of having such a combined site will be. I am sceptical of the intention behind this.

Yesterday I met a staff representative from the IMVS. I was appreciative of his honesty in saying that they were supporting this bill only because they had the opportunity, after amalgamation, to salary sacrifice, which meant an extra $6,000 or $9,000 a year in their pockets. What I found interesting was that, for the past six years, the IMVS staff have been applying for taxation status to allow them to salary sacrifice but have been knocked back.

I read in Vickie Chapman's address on this issue, in the other place, that in 2006 the Treasurer made an announcement that the government would like to create an amalgamated pathology service called SA Pathology. I wonder whether it has been so difficult for IMVS staff to get the FBT status that they need to salary sacrifice because this has been in the wind for quite some time.

After speaking with the staff member yesterday and saying that, although I feel for the 1,200 employees of the institute, their ability to salary sacrifice was hardly a reason to pass a bill that could have long-terms impacts on the health and welfare of people in this state. That employee left my office yesterday saying that he would be rethinking his stand and that he is sure that most of the staff, if they could be assisted to get the status they need to salary sacrifice with the Taxation Office, would not support this bill; that they do want to keep their autonomy; and that they take pride in the services that they deliver and the research that they undertake. It is not their wish that they be amalgamated with the other two services.

At the briefing I asked what the other costs would be (apart from not being able to salary sacrifice) to the IMVS with this amalgamation, and I was told that the IMVS at present has a great deal of autonomy in being able to purchase new equipment that is required for research, whereas once the amalgamation takes place it will come under yet another layer of government and it will have to seek approval and funds for the purchase of equipment, which is probably going to compromise the quality of service that it has been able to deliver in the past. He was quite concerned about that. Again, it was stated that the only reason the staff are supporting this is the opportunity to salary sacrifice.

The gentleman yesterday also made the point that just because people are quiet and are not lobbying hard on this particular bill does not mean that there are not major concerns amongst the staff of the IMVS regarding this amalgamation.

I return to the lack of lobbying on this bill. It is very reminiscent of the lack of contact made regarding the health care bill, as well. My office went to a great deal of trouble to try to contact people working in the health care industry, prior to the adoption of that bill, and took their silence as a sign that all was well and that they had accepted the reforms. However, as I said, last week we saw mass resignations from the health care industry because of their dissatisfaction. I have learnt that lack of lobbying does not necessarily mean lack of interest or lack of concern.

I will read an email that I received from one of the employees of the IMVS. As I said, there has not been a great deal of comment but there are some valid points made in this email. It states:

Whilst the IMVS has been established for 70 years (this August) it is the history of the last 25 that has made it a unique contributor to public health in Australia.

In addition to its vital public health role, and unlike most public health institutions, it generates tens of millions of dollars in competitive earnings each year.

The money the IMVS earns by supplying diagnostic pathology to general practitioners and specialists is spent on training and research. This is money that the state does not have to extract from taxpayers, money Treasury does not have to find.

Public health—where to start; the HUS outbreak, the Yorke Peninsula water scare, legionella on Kangaroo Island, salmonella outbreaks, white powder incidents, the list goes on and on. Interestingly, and often, it's not the IMVS who takes the credit; the press most often talk to hospital spokespeople or to the department, but be in no doubt, it is the IMVS who does the work and provides the expertise. Furthermore, we do the work across the state through a network of regional laboratories; the staff lives and work in the local community. The IMVS supports and works in regional and rural South Australia, not everyone does.

The IMVS was the first public pathology provider, and only the second in Australia, to undertake ISO9000 series quality accreditation, a major undertaking and a major achievement. This is in addition to NATA accreditation requirements.

The Hanson Institute is the research division of the IMVS, it provides a career in medical research for hundreds of South Australians; these jobs simply did not exist before the IMVS directed its efforts and earnings into research. Young South Australians now have whole of career opportunities in medical research in this state and competitive earnings are paying for it. The results are visible.

I imagined that this was the sort of thing political parties dreamt of, a public institution showing initiative, generating valuable ideas, licensing the intellectual property, whilst minimising the burden on the state's financial resources. It seems not.

The earnings also support training; sessions for rural doctors, for students now that medical courses no longer provide comprehensive training in pathology. Training for scientists and technicians, look around the private pathology providers and ask where their staff were trained, overwhelmingly it was at the IMVS, from top to toe. Imagine if you had to find the money for all that solely from the public purse. Imagine how much poorer the service to South Australians would be if the IMVS just turned up for work each day and cranked the handle.

The reason the IMVS has been able to do these things, to actively contribute to the health of South Australia in so many different and innovative ways, is because the IMVS act enabled it to. The IMVS is independent but recognises that with independence comes responsibility; in my view it has amply met its charter.

That gives a feel of the staff and their passion for the work they do and for the institute for which they work. As I said, the gentleman who came to see me yesterday said that all but two of the 1,200 employees at that institute support this merger—as in a merger that will improve services and quality of service to this state.

We also must not forget that there are a great many assets that go with this amalgamation. That is of concern to me, as it was with the Glenside project, and it has not yet been proven that our suspicions on that were unwarranted. I will support the second reading of this bill, and look forward to the committee stage; however, at this point, and with the information I have at hand, I indicate that I am very unlikely to support the bill.

Debate adjourned on motion of Hon. J.M. Gazzola.

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