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Legislative Council - Fifty-Third Parliament, Second Session (53-2)
2016-05-17 Daily Xml
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Health Care (Miscellaneous) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 12 April 2016.)

The Hon. S.G. WADE (16:12): I rise to speak on behalf of the Liberal opposition on the Health Care (Miscellaneous) Amendment Bill. The bill seeks to regulate stand-alone private day procedure centres through various licensing arrangements and setting standards for construction facilities and equipment. The state already issues licence of the private hospitals under part 10 of the Health Care Act 2008, but at present South Australia and the Northern Territory are the only two Australian jurisdictions which do not regulate stand-alone private day procedure centres.

Currently private day procedure centres are not unregulated: operators must obtain a provider number from the commonwealth Department of Health. They need to be accredited against the national safety and quality health services standards, and they need to be declared to be a hospital pursuant to the Private Health Insurance Act, but this legislation would bring them within the remit of a state regulatory regime.

There are approximately 30 DPCs in South Australia, and there has been substantial growth in the sector. Many procedures, which previously required overnight admissions, can now be performed on a same-day basis. As an indication of that growth, in the decade up to 2011-12 the number of private day surgery beds in South Australia has increased by more than two-thirds.

The government has brought forward this bill because it considers that licensing stand-alone private DPCs would provide a range of benefits including: first, the ability to impose specific licensing conditions; secondly, to ensure that potential safety risks are addressed; and, thirdly, to put in place a similar set of regulatory compliance requirements on private DPCs as those that apply to private hospitals.

The opposition has consulted a range of stakeholders, and in particular I acknowledge the engagement of the Australian Day Hospital Association, the Australian Nursing and Midwifery Federation and the Australian Private Hospitals Association. The stakeholders broadly support this bill and the state government's regulation of DPCs. The opposition too supports the bill.

The ADHA and the APHA did express concern about the retrospective application of previous versions of this bill. Ultimately their concerns were that, if the proposed licence conditions were applied on existing DPCs, then the financial viability of such facilities could be put in jeopardy without any demonstrable benefit.

The government in large part alleviated these concerns with the amendment of section 89A(3) in the other place. Accordingly, under the bill licence conditions will not apply retrospectively to existing DPCs. The new licensing conditions will apply to existing DPCs if they alter or extend their premises or change the health services they provide. The opposition welcomes that amendment.

The ADHA also expressed concern about the absence of a definition for 'a suitable person whom the minister may appoint as an inspector under this act'. The ADHA suggested that an amendment be included which would require such persons to have relevant experience in the operation and management of private DPCs. The government rejected this suggestion on the grounds that existing inspectors were appointed on the basis of their skills, knowledge and experience. The opposition is not proposing an amendment in that respect. With those remarks, I look forward to the committee stage of the bill.

The Hon. I.K. HUNTER (Minister for Sustainability, Environment and Conservation, Minister for Water and the River Murray, Minister for Climate Change) (16:16): I believe there are no other speakers, so I will close the debate. The Health Care (Miscellaneous) Amendment Bill 2015 amends the Health Care Act 2008 to enable the licensing of stand-alone private day procedure centres in South Australia, a sector that has grown substantially over the past 20 years.

Many complex, invasive and high-risk surgeries and procedures that have previously required an overnight hospital stay are being done now on a day-only basis, and the regulation of private day procedure centres provides a range of measures to ensure potential safety and quality risks are addressed. The bill also amends the act to remove the prescribed limit on hospital bed numbers, allowing the private hospital sector to expand and complement the public health system in meeting the demands of an increasingly ageing population.

The other change is around updating the standards of construction, facilities and equipment. Enabling private hospitals to provide services at approved off-site locations and providing for the inclusion of fees for licence variations on a cost-recovery basis all improve the administrative functioning of the act. In summary, these changes modernise private health facility licensing arrangements and bring South Australia into alignment with other state and territory jurisdictions.

The Hon. Tammy Franks in her contribution I think asked two questions, for which I will put on the record answers now. The first was: what arrangements have been made for this legislation with respect to the potential renal dialysis centre in community on the APY lands and Ernabella and whether or not work has progressed between SA Health and the money that is on the table federally to ensure that we see in community renal dialysis in Ernabella?

This legislation provides for specific health services or classes of health services to be prescribed in the Health Care Regulations 2008 under the act. Consequent to the Health Care Act 2008 being amended, it is planned to include renal dialysis as a health service prescribed by the regulations for the purpose of requiring private facilities offering these services to be licensed.

All stand-alone private day procedure centres that meet the criteria of a prescribed health service will be advised of the requirement to be licensed. SA Health will work with any new facilities meeting the criteria to be licensed to initiate an application process. The 31 DPCs that have already been declared by the Australian government for private health insurance purposes on the basis of a previous recommendation from SA Health will be deemed to be licensed in South Australia, I am advised.

It should be noted that not all existing DPCs currently operating in South Australia are in fact registered with the Australian government Department of Health. There are a number of other DPCs currently operating that charge full fees and have not sought to be declared and issued with a provider number for private health insurance purposes. A number of these undeclared facilities are within the cosmetic surgery field, I am advised.

An undeclared DPC operating outside of the Private Health Insurance Act 2007 (commonwealth legislation) is effectively able to avoid the requirement under the commonwealth legislation to be accredited against the National Safety and Quality Health Service Standards. This is why the ability to implement a jurisdictional licence and regime in this state, including the ability to impose licence conditions, is so important in ensuring that potential safety and quality risks are addressed.

Her second question was: will this see that very worthwhile project going ahead in time to be captured by this legislation when it passes the parliament? The answer I have been provided with says that questions about particular projects that may or may not fall under the new regime are not relevant to agreeing to this bill. With those few remarks, I would like to thank honourable members for their contributions and their indications of support for the bill, and look forward to a speedy passage.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 to 9 passed.

Clause 10.

The Hon. I.K. HUNTER: Mr Acting Chairman, with your permission I might speak to government amendments Nos 1 to 3 standing in my name. I move:

Amendment No 1 [SusEnvCons–1]—

Page 4, after line 26 [clause 10, inserted section 89]—Before the definition of declared day hospital insert:

conscious sedation means the sedation of a person by the intravenous administration of one or more drugs such that communication with the person may be maintained during the sedation;

Amendment Nos 1, 2 and 3 relate to a minor change in terminology from simple conscious sedation to conscious sedation. This is a result, I am advised, of discussions held with the Australian Dental Association (SA).

The ACTING CHAIR (Hon. J.S.L. Dawkins): The minister has spoken to all three, but my advice is that you cannot move all three together. We are just clarifying as to whether we can do any multiples. I take it that you have moved amendment No. 1?

The Hon. I.K. HUNTER: Indeed.

The Hon. S.G. WADE: The opposition will be supporting amendment Nos 1, 2 and 3 in the name of the minister.

Amendment carried.

The Hon. I.K. HUNTER: I move:

Amendment No 2 [SusEnvCons–1]—

Page 4, line 39 [clause 10, inserted section 89, definition of prescribed health service, paragraph (b)]—Delete 'simple'

I move the amendment for the reasons I have already outlined.

Amendment carried.

The Hon. S.G. WADE: I move:

Amendment No 1 [Wade–1]—

Page 4, after line 39 [clause 10, inserted section 89, inserted definition of prescribed health service]—After paragraph (b) insert:

(ba) a health service that involves the administration of local anaesthetic; or

This amendment proposes to expand the definition of a prescribed health service for the purposes of requiring a private day procedure to be licensed to also include a health service that involves the administration of a local anaesthetic. Both the ADHA and the ANMF suggested a simple amendment to the definition of a prescribed health service under section 49A to include the term local anaesthetic.

SA Health agreed in principle that procedures of sufficient complexity, even where only a local anaesthetic is involved, should be included, but suggested that that should be by prescribed regulation. The opposition considers that the issue is such a significant one and agreed with the ADHA and ANMF that an amendment should be preferred. To facilitate the consideration of the house, we welcome the subsequent amendment from the government. The Hon. Gail Gago, on behalf of the government, indicated some of the concerns the government had with the workability of my amendment alone and we note we will be supporting the government's subsequent amendment No. 4.

The Hon. I.K. HUNTER: The government accepts the amendment and will support the inclusion of local anaesthetic within the definition of prescribed health service in recognition of the fact that some specific procedures, although only involving the use of local anaesthetic, are of sufficient complexity, invasiveness and/or patient risk to warrant that they be subject to licensing. However, the amendment proposed by the shadow minister as currently drafted would be unworkable in practice, I am advised.

If the government were to licence all day facilities that provide a health service involving the administration of local anaesthetic, a large number of general dental surgeries and office-based general practitioners' rooms performing simple, minimally invasive and low-risk procedures would become subject to regulation. This would clearly broaden the scope of the type of facilities to be licensed significantly and would be beyond current SA Health resources to effectively regulate. Consequently, the government has proposed government amendment No. 4. The Hon. Mr Wade has indicated that the opposition will be supporting it, and we are grateful for that. This builds on the Hon. Mr Wade's amendment and more effectively, we think, targets the scope of the licensing regime.

Amendment carried.

The Hon. I.K. HUNTER: I move:

Amendment No 3 [SusEnvCons–1]—

Page 5, lines 3 to 6 [clause 10, inserted section 89, definition of simple conscious sedation]—

Delete the definition of simple conscious sedation

I move the amendment standing in my name for the reasons I have outlined earlier.

Amendment carried.

The Hon. I.K. HUNTER: I move:

Amendment No 4 [SusEnvCons–1]—

Page 5, after line 6 [clause 10, inserted section 89]—After line 6 insert:

(2) Paragraph (ba) of the definition of prescribed health service does not apply in relation to the following health services involving the administration of local anaesthetic:

(a) a health service provided by a medical practitioner in the course of practice as a general practitioner;

(b) a health service provided by a dentist in the course of general dentistry practice;

(c) a health service, or health service of a kind, prescribed by the regulations.

Amendment No. 4, as I indicated earlier, builds on the amendment proposed and now carried by the shadow minister for health, Hon. Mr Wade, to expand the definition of prescribed health service for the purposes of requiring a private day procedure to be licensed to include '(ba) a health service that involves the administration of local anaesthetic.' The government amendment proposes that:

...the definition of prescribed health service does not apply in relation to the following health services involving the administration of local anaesthetic:

(a) a health service provided by a medical practitioner in the course of practice as a general practitioner;

(b) a health service provided by a dentist in the course of general dentistry practice;

(c) a health service, or health service of a kind, prescribed by the regulations.

It was not the intent to target simple or minimally invasive procedures using only local anaesthetic for inclusion within the licensing regime, such as dermatological procedures undertaken in office space, general practitioners' rooms, or restorations undertaken in general dental surgeries.

It is recognised, however, that some specific procedures, although only involving the use of local anaesthetic, are of sufficient complexity, invasiveness and/or patient risk to warrant they be subject to licensing. Cosmetic surgery procedures such as liposuction and breast augmentation are increasingly being done under high volumes of local anaesthetic only. As has been seen from recent high-profile adverse events in New South Wales, I am advised, as well as a case in South Australia a few years ago that was the subject of a coronial investigation, these procedures involve inherent risk.

Amendment carried.

The Hon. I.K. HUNTER: I move:

Amendment No 5 [SusEnvCons–1]—

Page 5, after line 10 [clause 10, inserted section 89A]—After inserted section 89A(1) insert:

(1a) In establishing standards under subsection (1) the Minister should consider any relevant codes, standards and guidelines.

Following the passing of the bill in the House of Assembly, the Australian Day Hospital Association remained concerned that the minister was not required to consider any relevant codes, standards and guidelines in establishing, by notice in the Gazette, standards of construction, facilities and equipment applying to the premises of a private day procedure centre.

At a meeting held in February 2016 with ADHA and attended by the deputy chief executive of SA Health, it was agreed that the government propose an amendment to this effect. In order to set the standards by notice in the Gazette, the government would, in the normal course of business, consider relevant existing codes, standards and guidelines such as Australasian Health Facility Guidelines and Building Code of Australia minimum standards widely accepted by the industry.

As has been noted in the house, the standards to be gazetted will not be applied retrospectively to private day procedure centres that have already been declared by the Australian government, except in relation to assessing applications for any alteration or extension of licensed premises, or where there is a proposed change in the nature or scope of the health services to be provided.

The Hon. S.G. WADE: The opposition supports the amendment.

Amendment carried.

The Hon. S.G. WADE: I move:

Amendment No 2 [Wade–1]—

Page 6, lines 17 to 33 [clause 10, inserted section 89D]—Delete section 89D and substitute:

89D—Conditions of licence

(1) Each private day procedure centre licence will be taken to be subject to the conditions prescribed by the regulations.

(2) The Minister may impose such other conditions on a private day procedure centre licence as the Minister thinks fit.

(3) The Minister may, on application or the Minister's own motion, vary or revoke a condition of a private day procedure licence imposed under subsection (2), or impose a further condition on such a licence, by notice in writing given to the holder of the licence.

(4) If the Minister imposes a further condition under subsection (3) on the Minister's own motion, the condition will not, except with the agreement of the licensee, take effect until the expiration of the period of 30 days after service of the notice imposing the condition.

The ADHA indicated concern that the licensing standards and conditions are going to be established by Gazette and will not be subject to parliamentary scrutiny. The minister has very wide powers under section 89A, and although the minister may adopt standards, guides and codes, he or she is not required to do so under the proposed bill. A suggested amendment by the ADHA was that the minister be required to liaise in good faith with relevant industry bodies such as the ADHA, the APHA, etc., before gazetting any standards. With all due respect, the opposition's view is that the best way to ensure the government negotiates in good faith is to put matters not subject to gazettal but subject to regulations. The amendment standing in my name is to that end.

The Hon. I.K. HUNTER: The government accepts the amendment. The conditions to be prescribed by the regulations will be of a similar general nature to the conditions listed in section 82 of the act relating to private hospitals, for example, conditions requiring that the licensee seek approval to alter or extend the licensed premises, or to change the kind of health services provided. It is also intended that there will be a condition of licence requiring facilities to be accredited against the National Safety and Quality Health Service Standards, and for those reasons the government is happy to accept the Hon. Mr Wade's amendment.

Amendment carried; clause as amended passed.

Remaining clauses (11 and 12) and title passed.

Bill reported with amendment.

Third Reading

The Hon. I.K. HUNTER (Minister for Sustainability, Environment and Conservation, Minister for Water and the River Murray, Minister for Climate Change) (16:33): I move:

That this bill be now read a third time.

Bill read a third time and passed.

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