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Legislative Council - Fifty-Fourth Parliament, First Session (54-1)
2018-11-28 Daily Xml
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Motions

SHINE SA

The Hon. T.A. FRANKS (16:09): I move:

That this council—

1. Notes that SHINE SA provides vital services to people who are often in difficult circumstances seeking a safe place for sexual health support, testing and counselling;

2. Condemns the Marshall government’s 2018-19 budget cuts to SHINE SA, which will have a detrimental impact on the reproductive and sexual health of our community;

3. Recognises that over 350 doctors have signed a letter urging the government to reverse these cuts;

4. Expresses concern that these cuts could lead to an increase in rates of sexually transmitted infections, unplanned pregnancies and an increase in the use of hospital obstetricians and gynaecologists; and

5. Urges the Marshall Liberal government to restore funding to SHINE SA.

I move this motion today having alerted members last night to its urgency. The community has known of this urgency for some time, and many members of this council are aware that the impending cuts to SHINE SA are a matter that should be treated with urgency. Members may also be aware that SHINE SA has now issued a notice of its intent to close its doors in both the northern and southern suburbs as well as cease some of their HIV services in the CBD through SAMESH. This is as a direct result of the funding cuts in the most recent budget.

That letter, alerting the community and service partners, colleagues and collaborators to an early notice of SHINE's clinic closure intentions at Davoren Park and Noarlunga, was sent out on 16 November 2018, and it notes with regret that they provide early warning of the pending SHINE SA clinic closures at Davoren Park and Noarlunga. These closures are planned to occur in February 2019.

SHINE SA, of course, commenced in 1970 and many—certainly I, in my younger days—would be more familiar with the Family Planning Association of South Australia, which was the precursor name to SHINE SA. I remember it being on Phillips Street in Kensington and there, from 1970, it provided sexual and reproductive health services, primarily to women.

SHINE SA, of course, is now a key sexual and reproductive health agency, providing sexual health clinics, health promotion, education and workforce development. Its focus is on providing services to young people and other vulnerable populations at risk of unplanned pregnancy or sexually transmitted infections, including blood-borne viruses, and currently they have clinics in Woodville, Adelaide, Davoren Park and Noarlunga Centre.

They also provide clinics at the Adelaide Remand Centre, the Yatala Labour Prison and the Adelaide Women's Prison, and they deliver the SAMESH program, which is an HIV promotion program targeting people at risk of or living with HIV, in partner with Thorne Harbour Health. Previously, that was known as the Victorian AIDS Council.

The announcement in the state budget on 4 September came as a shock to SHINE. Indeed, the cuts of some 9.5 per cent of funding, with one service, Cheltenham Place, being completely defunded in terms of the sexual health sector, was quite a shock, not just to the sector but to the community. SHINE SA was one of the hardest hit of all the remaining services, losing 547 per year.

In addition to this latest decrease in funding, SHINE SA is also required by government to prioritise and expand their education and workforce development programs. Like many other organisations in the health sector, they have been faced with consistent cuts since 2012 to that SA Health component of their funding. This has come through loss of wages, indexation and/or the requirement to make significant cost savings.

At the request of SA Health over that time, SHINE SA has implemented and maximised commonwealth Medicare Benefits Schedule (MBS) billing, an income model for general practices, when in fact they are a specialised sexual health service. This, of course, has been implemented in an attempt to keep their services running. However, as expected by many of those who work within the sector, many of their most vulnerable and young clients do not fit the standard appointment that would ensure a full MBS cost recovery.

SHINE SA has pondered on this and deliberated. With a heavy heart, they have given full consideration to their options and have taken advice from experts, peers and staff. As a direct result of the $547,000 per year funding decrease, they find themselves now forced to close the doors of two SHINE SA clinics, plus the HIV counselling service component of the SAMESH service. Those clinics are, of course, on Peachey Road, Davoren Park, and Alexander Kelly Drive, Noarlunga Centre, with the HIV counselling service component of SAMESH being at Hyde Street in the city.

The Woodville and Hyde Street services will continue and they will continue to offer free bulk-billed sexual health checks for young people under 30 and other communities of interest, as published on their website. They fully appreciate that this significant loss of service will create difficulties for their partners, colleagues and collaborators, who have been using, referring to and working with SHINE to deliver seamless services to the people in the north and the south over many, many years.

In various forms, SHINE SA has provided services in both the north and the south since the mid-1970s, so it is with great sadness that they sent that letter out just over a week ago. In response, the health minister, Stephen Wade, has expressed surprise in the media that SHINE would opt to shut those two clinics, stating:

Similar services interstate are operating more efficiently and the government thinks there are more opportunities for SHINE to access Medicare revenue.

Further, the minister has stated:

They need to think again how they can more cost-effectively deliver services. It is a 9 per cent reduction in the grant, but they are talking about a 50 per cent reduction in their clinics.

These are quotes attributed to the minister. He has also gone on to say:

The government does not accept that SHINE SA needs to reduce services. Similar services interstate operate more cost-effectively.

He has gone on to say:

Taxpayers expect value for money and all health services need to strive to be more cost-effective.

If these things were true, that might be a viable argument, but taxpayers expect decisions made by the government to be made with full information and to address the realities and not the rhetoric. So let's start with some of the rhetoric.

The minister has claimed that, by closing two clinics, SHINE is cutting services by 50 per cent in response to a 9 per cent budget cut. This is simply not true. SHINE has lost 9 per cent of its funding, but it certainly has not closed 50 per cent of its services. SHINE SA is not just clinics. The two sites, at Davoren Park and at Noarlunga, are just a fraction of what SHINE does. Indeed, a quick glance at the SHINE SA operational model shows that the Woodville and Hyde Street sites are hub sites with far more comprehensive and complex services. They offer many services, not just the clinic. They offer workforce development and health promotion. Given the successive funding cuts since 2012, Noarlunga was only operating two days a week, as it was.

While Davoren Park and Noarlunga are busy clinics, they actually function as satellites. They certainly do not constitute 50 per cent of the work that SHINE SA does. Within that operational model, I will point out to members for their information that the clinical services at Davoren Park include sexual health clinics, counselling, clinical training and a clean needle program. At Noarlunga, they include clinical services, such as sexual health clinics, counselling and clinical training.

However, if you look at the entire operations of SHINE, there are also prison health clinics. As I mentioned, they are at the Adelaide Women's Prison, Yatala Labour Prison and the Adelaide Remand Centre. At Hyde Street, there are clinical services, which include general practice, HIV and bloodborne viruses and opioid dependence prescribing, HIV point-of-care testing, Health Care Homes trial, sexual health physician, sexual health clinics, a psychologist, a clean needle program and outbreak response.

With the SAMESH program, currently at Hyde Street, in partnership with the former Victorian AIDS council (now Thorne Harbour Health), they have a HIV and STI health promotion for gay men and MSM, HIV and STI prevention, community groups and a SASHA email current awareness service. They also have housed in that premises Foundations of the LGBTIQ Inclusion Workforce Education. They have the Gender Wellbeing Service, which also includes a Port Adelaide outreach that is based there. They have the Bobby Goldsmith Foundation (indeed, given that World AIDS Day is coming up, it is very timely to make note of that). They have research projects, including primary research, higher degree student projects, external projects and clinical research trials.

When you look at Woodville, there are even further services. There you have clinical services, sexual health clinics, counsellors, clinical training, clinical utilities and warehouse, a state sexual health line, an appointment phone line and the Clean Needle Program. They have the DASSA (Drug and Alcohol Services South Australia) clinic there as well. At Woodville they also have prevention education campaigns, including health promotion, media, online, content provision and consultancy. They also have groups, workshops and peer education. They further have professional communications; indeed, the SHINE website is a valuable resource.

They foster professional networks, doctors, nurses and teachers and provide evidence updates and outbreak response. They have a library and resource centre in Woodville that schools, clinicians, workers, education institutions and the public are able to access. Their online resources are housed there as well. They have medical education, and they provide the FPAA certificate and STI and BBV (blood-borne virus) education. They provide contraception and pregnancy choices and they have cervical and HPV screening. They have nurse and midwifery education, which includes a certificate in sexual health, and education in STI and BBV, contraception, pregnancy choices and surgical and APV screening.

They also have community worker courses for youth workers, disability and mental health workers, CALD workers, Aboriginal health workers and child protection workers. They have a Focus Schools Program curriculum that includes many public and private schools at all levels, as well as universities. From those premises, they also operate the Keeping Safe: Child Protection Curriculum teacher training. That service is from preschool to year 12 and includes a train-the-trainer component. They also have other education and training, including mental health first aid, tailored training, consultancy and some inclusive LGBTI services, just to name a few. Certainly, the two clinics that are facing closure, which were already running with limited capacity, are far from 50 per cent of SHINE's clinic work.

I note that the minister claims that similar services interstate are operating more cost effectively. Upon receiving advice of the funding cut, SHINE SA management moved quickly, benchmarking and taking advice from experts, peers and staff in their deliberations on how they could manage the most recent funding cuts. In October 2018, SHINE SA engaged an independent consultancy firm to conduct an external review of all corporate and administrative services.

SHINE had already acted on this advice, reducing corporate, administrative and management costs. SHINE SA further reviewed, sought external advice on and benchmarked their clinical services and found that SHINE's two hub sites (being Woodville and Hyde Street) were the most cost effective and would allow the organisation to continue to offer the most complex and integrated clinical services, as well as deliver education and workforce development as is requested by SA Health.

In the absence of any funding to cover them, and in the light of those previously mentioned requirements specified by SA Health, the two satellite clinics at Davoren Park and Noarlunga were identified as the least viable. The scope and complexity of services and programs that are provided from their sites are illustrated by the operational model that I just went through.

However, their benchmarking has also found that other organisations in similar situations in similar states have fewer clinic locations. Victoria, for example, only has two: one in the Melbourne CBD and one in Box Hill. Looking at the annual reports of comparative organisations for Victoria, they recorded 13,166 clinical consultations last financial year. In comparison SHINE SA had 43,709: so 13,166 in Victoria compared with 43,709. Clearly, that is not comparing apples with apples.

Comparisons are, of course, complex, as the health system is woven together from many different funding sources, which makes any benchmarking quite difficult. They cannot speak for another service, but those numbers are certainly cause for the minister to take pause. They also found that without reducing the number of sites their overheads, including the required clinical support staff, would, in fact, remain too high.

I note that the minister has faced many questions in this place with regard to the syphilis outbreak, the horrific example of a baby being born with congenital syphilis in the Port Augusta Hospital, and the fact that that outbreak has now spread to Adelaide. I also note that back on 18 September the minister, in response to a question from the Hon. Russell Wortley, noted that in terms of what communication they had had from SHINE SA since the budget, he would take it on notice and check with his department. I believe we are still waiting for those answers, but perhaps I am to be corrected on that. The minister also noted, to the Hon. Russell Wortley, that it was:

important again to appreciate that services evolve over time. SHINE SA provides a comprehensive sexual health service for vulnerable members of the South Australian community at high risk of STIs.

I certainly agree with the minister on that. However, he went on to say:

It is our view that SHINE SA will continue to provide clinical services through billing under the Medicare Benefits Schedule. SHINE SA has increasingly used Medicare billing in recent years to the point where their reliance on funding from SA Health for their core program has declined from around 80 per cent in 2013-14 to around 60 per cent in 2016-17. The funding change reflects…that SHINE SA is increasingly utilising Medicare funding, and it is our view that there is further capacity to do so.

I contend that it is the independent advice that SHINE SA has received, and SHINE SA's view, that there is little blood left to be squeezed from this stone.

Indeed SHINE SA has, of course, been MBS billing since 2013, and the SA Health recent contract-related communication to SHINE asked that they 'transition to increasing utilisation of external funding sources, eg billing under MBS,' when in fact they have been billing under MBS for some five years. Through benchmarking and the utilisation of expert MBS billing consultants they have found that, in fact, SHINE's current billing is already largely maximised, given the priority populations and the complexity of services they are required to deliver. Indeed, any remaining refinements would come nowhere close to that $547,000 per year.

Further, in November the minister repeated an answer in response to the Hon. Ian Hunter. He noted that SA Health had expressed a view that a significant portion of the services provided by SHINE SA, 'could be, shall we say, 'Medicarised'; in other words, the funding could be accessed through Medicare item numbers.' Therefore it was still, at that point some months later in November, the government's view that services could be 'sustained without state government funding'.

Clearly this is not the case. We are facing clinic closures, we are facing cuts to SHINE SA, and they not acceptable to the community. The minister should be getting a second opinion, and if he wants a second opinion on this he has not just one second opinion to consider, he has 350 or so from those medical professionals who have signed an open letter protesting the closure of the two suburban sexual health clinics. Those medical professionals have warned that this would lead to a spike in unplanned pregnancies and STIs. That doctors' protest letter, which has in the past week been sent to the health minister, has been signed by GPs, paediatricians, psychiatrists, obstetricians and gynaecologists, as well as emergency doctors and various other clinicians.

Dr Erin O'Connor, the doctors' spokesperson with regard to that group letter of over 350 medical professionals, said the clinics being closed were, of course, in the areas of most need and warned that people in those regions would not travel to the city for help and advice on sexual issues. She also noted in the media that she has sought a meeting with the minister, and I hope that he will elaborate on the progress of that meeting. I note in the letter from concerned doctors that they say:

Denying people, particularly the poorly educated and under or unemployed, access to timely sexual healthcare has ramifications which reach father than the individual. It increases the community's vulnerability to sexually transmitted diseases, some of which are life-threatening. It may also result in the births of children to women who are in circumstances in which they are less well able to meet their child's needs and can hinder their ability to attain higher levels of education, and thus contribute more to our economy. In many cases, it may perpetuate the welfare cycle.

The biggest social determinant of health is education, and timely access to contraception and sexual health services enables our vulnerable and youngest community members to finish their education.

Sexual health is not an optional component of individual health; and those clinics are located where they are because they serve some of our most disadvantaged communities.

The doctors go on to say:

The state health service will no doubt see a measurable rise in STIs and unplanned pregnancies in two communities which are already socially and economically disadvantaged.

They note that many of the clients that SHINE serves are often victims of abuse and they are often seeking a safe place to turn to to get support, testing and counselling, and that needs to be local. They need to feel safe, and safety is near home. It states:

SHINE SA is [of course] a trusted and confidential service which is respected by young people. Young people are often shameful or scared to access STI testing from their regular GP.

Certainly if it is their family GP. It continues:

South Australia is already experiencing outbreaks of Syphilis. Unfortunately this is disproportionately affecting Aboriginal and Torres Strait Islander people. If the government wants to get serious with closing the gap, it needs to pay attention to the current health issues and provide primary care services such as SHINE SA.

Patient deprivation is not the only outcome of this decision, referral points for a service like Streetlink and Centacare are now limited. These services have had to use SHINE SA on a regular basis for second doctor reviews for young patients under 16yo who seek contraception if the young person is Gillick competent.

SHINE SA is recognised statewide as a safe place for young LGTBI people, and this is reflected in their Rainbow Tick accreditation. There is a large community of young people for whom their local clinic is their only safe space to seek medical attention and counselling, and for which it would be extremely difficult for them to travel to the city.

Local obstetrician and gynaecologists both public and private often suggest people go to SHINE SA for discussion around unplanned pregnancies and for IUD insertions. This includes post natal contraception, public hospitals do not have the capacity to do such things such as postnatal IUD insertions, many of which are done at the two SHINE sites set for closure. Many of these new mothers cannot travel.

The Medicare rebate for IUD insertion in general practice barely covers the cost of consumables, let alone the nursing support required, as well as the running costs of the clinic—there are basically no GPs that routinely bulk bill IUD insertions.

Davoren Park SHINE has a Clean Needle Programme (CNP). It is one of the busiest sites in the state. Cutting this while trying to decrease the burden of BBV (blood borne viruses) in the state…is completely counterproductive.

The doctors finish with their extreme concern at the cutting of the services and urge the minister to reconsider. Those concerns were also reflected in an AMA South Australia media release of 22 November. They have called on the government to reconsider this cut.

These are not people who take such calls lightly. This is not playing politics. This is urging the government to revisit a decision that has been made in error on incorrect and out-of-date information. SHINE is as disappointed as we all are about the closure of these services, but they are simply faced with little choice. They have copped cut after cut after cut. This was the straw that broke the camel's back and will see those doors close in Davoren Park and Noarlunga.

We cannot let particularly the young people of the north and the south down. I urge the minister to take on board the submissions from those 350 medical professionals and the counterclaims from SHINE with regard to the information that has been put out to the public. These 9 per cent cuts are not being equated to 50 per cent of the services; they are being equated to the services that they can least afford to continue.

I have moved this motion with some urgency today because this is an important matter. Sexual health and the timeliness of this, with those closures set to take place in February, mean that the staff have already begun the process of transition of ending their jobs. It means the other referral services have already begun the process of finding other options. Indeed, it is a small amount in the scale of the budget, but it will have a profound impact. That profound impact—on sexual health, unplanned pregnancies, sexually transmitted infections and blood-borne viruses—constitutes significant health burdens into the future, and they are devastating situations to put vulnerable communities and young people of our state into.

I note that there are other members listed to speak today, and there has been great community support for keeping and restoring the funding to SHINE. It is a well-loved institution. It is not without controversy. Indeed, that is the very reason it is needed. Young people cannot necessarily go to their family GP to seek these services; they need access at this level in the safe environment that SHINE has provided and has the reputation of providing, what is more. That corporate knowledge and those corporate connections within the medical profession are invaluable, and when we cut them they will be very hard to restore. When we have an increase in STIs and when we have unplanned pregnancies that were needless—when we have those situations for those young people in particular—it will be on our heads that we did not reconsider the folly of this particular cut.

I think the minister comes to this role with a very hard job before him and an enormous portfolio, and one of the most important portfolios in this state. This today is a small matter, and it is not a matter that I brought lightly as a motion of urgency to this place, but it is certainly not a motion I wished to suspend question time for and move in a way of no confidence in the minister. I think the minister has been badly advised, and I think the Marshall government have made a mistake in seeing their cut in isolation from previous cuts and the current situation that SHINE was already in.

I know that the minister and the Marshall government members of this place oppose proceeding with this debate today. I urge them to listen to this debate today and to reconsider this decision. We have put this here with urgency because we know it is important and a small change can make a very big difference. If the minister needs overnight to consider his response to what is put before him today, certainly I would be open to that, if we were to resume this motion tomorrow in government business time. However, I do not believe we should be putting it off another week, because next week is the final week of this parliament, and this parliament will have no recourse to act further before the doors at Davoren Park and Noarlunga are closed, possibly forever.

This is too important to let slide. If the government's only argument is about conventions and processes of this parliament, well, this parliament is here to represent people, and conventions are rules that we abide by when there are gentlemen's agreements, but when a matter is important we have often agreed to progress debate, and this is an important matter today. With that, I urge members to support the motion. I would certainly be happy to amend the motion and not to condemn the Marshall government should they reverse these cuts. It is these cuts that are at fault here today, and it is these cuts that I hope the Marshall government will respond to, not the conditions around them. With those few words, I commend the motion.

The Hon. I.K. HUNTER (16:40): I rise to indicate that the Labor opposition will support this motion today. Since 1970, SHINE SA and its predecessors have delivered sexual and reproductive health services wherever they are most needed. The Hon. Tammy Franks reflected on the organisation once being called Family Planning but I can remember back even beyond that when it was called Mothers' and Babies'.

The job that this organisation has done through those various iterations and names has been immense for our community. We can, as a state and as a community, be proud of the work that SHINE has done since it opened its doors. South Australians have had a place to go for those critical services which quite often people feel are inaccessible in other places, such as their doctor's surgery or hospitals. SHINE has been a safe place for those people to go and it continues to be.

Sexual and reproductive health needs, as the Hon. Tammy Franks reflected on, can be difficult for many people to grapple with and to deal with. Stigma, embarrassment and a level of uncertainty can play on the minds of people who need to find support and treatment and prevaricate about that. SHINE subverts that and allows people to go to a safe place and have their situation assessed and dealt with. That is why the services that SHINE provides are so vital and so unique. They are affordable, they are accessible to all and they offer help that is free of judgement.

We know that health outcomes are better, they are improved when sexual and reproductive health options are more accessible to more people in our community. This is particularly true for groups within the health services that do not find their particular needs are addressed by the mainstream services; for example, women in certain situations, LGBTI community members, those experiencing homelessness, or indeed mental illness, and also new arrivals to our state.

South Australians, as a community, are diverse; we are not all the same and, as the make-up of our community is diverse, so are our health needs. The simple fact of the matter is that many LGBTI young people do not want to talk to their family GP about their sexual health needs, for fairly obvious reasons I would suggest. Young women can be worried about their reproductive health needs and often they do not feel that they want to talk to the same doctor that their parents see.

SHINE SA is one of the few places that people with these types of needs and concerns can feel that they can go to and get the help they need. These communities know that SHINE understands the health challenges they face and will not judge them. That is why these cuts that the Minister for Health and the Treasurer are inflicting upon SHINE SA are so cruel and ultimately, I say, counterproductive, because in the end they will cost the health system and they will cost the taxpayer even more.

The minister said, as the Hon. Tammy Franks outlined, 'Well, you know, these services can be Medicare rise', but you cannot Medicare rise these services in SHINE if the offices are not there. If they close these clinics in the north and south, the minister knows that many of these people in vulnerable communities will not travel into the city to access these services. They will not because they will have to explain to their family or other members they are close to why they are doing so. That is why these services are so valuable in those centres in the north and south of Adelaide, because they are so easily accessible for people who need them.

SHINE advises that non-government organisations in South Australia are having their funding cut by an average of about 2 per cent—that is bad—but why then, if that is what is happening to most of the services, are SHINE and the sexual health sector in particular being hit with cuts greater than 2 per cent? It is 5 per cent and up to 9.5 per cent, I am advised. Those figures do not even go close to touching what is happening to Centacare's Cheltenham Place HIV refuge, which I have spoken about in this place previously. That service is suffering a 100 per cent cut to its funding and is closing.

These figures, dare I say it, beg the question: is there an ideological agenda here about closing certain services because there is a view that they should not be provided at all by government health services? The Liberal government is cutting sexual health services at a rate far higher than average—that is beyond question. Why? That was the question voiced on Monday when advocates, experts and community groups convened for a round table about these cuts, hosted by the shadow minister for health and wellbeing, the member for Kaurna. We were joined by doctors, practitioners, LGBTI community groups, youth organisations, advocates for people with lived experiences of trauma and others. They were of one mind on this issue: that the Liberal government's cuts are wrong, but they need to be reversed.

We were also joined by the members for Wright and Reynell. The member for Wright is in the north of Adelaide, where one of these clinics is near, and the member for Reynell of course is in the south of Adelaide, near to another of these clinics. They represent constituencies at opposite ends of the CBD. Their communities, however, now face this common threat from this government: the loss of vital community health services in their area.

In the northern suburbs the SHINE SA clinic at Davoren Park will close its doors, as the Hon. Tammy Franks advised us, because of this loss of government funding. In the southern suburbs the community is losing the SHINE clinic at Noarlunga. Right in the middle, the CBD is also being hit. The minister tells us that people can travel. They cannot travel if services are not being provided in the CBD. The HIV counselling component of SAMESH, available from Raj House on Hyde Street, will also be closing its doors because of a lack of government funding.

Across Adelaide, people who need access to sexual health services will be losing this access. Why? Those groups I spoke about earlier—the LGBTI community, young people and many others—may well choose not to access sexual health services at all. A judgement-free space of SHINE will be lost in the northern and southern suburbs—they will not want to go to their local GP, which may be their family GP—as will be their access to free bulk-billed sexual health checks for those under 30 and other communities of interest; they will just not be there.

As I indicated—and I am sure the minister has had advice on—many people in these vulnerable communities will not travel into the city to access similar services. Across the regions communities have lost access to important health services in this budget. At the round table we heard from advocates from the Cheltenham Place HIV refuge, who spoke about the importance of the service for regional people travelling to Adelaide for support in dealing with HIV and all the difficulties that that brings.

In the face of a brutal budget and its cruel slashing of sexual health programs, however, I am hoping that the government will reconsider its position. I left the round table on Monday with a sense of optimism, given the depth of feeling provided to us by the community advocates, because those people are not going anywhere. They are going to keep up the fight about these cuts, they are going to stand up for their communities and their needs. That fight has already begun.

As this motion notes, more than 350 doctors signing an open letter urging the government to reverse its funding cut and help keep SHINE SA clinics open is a first salvo. Those doctors come from a range of areas within the health sector. There is Dr Megan Brooks, the director of the emergency department at the Royal Adelaide Hospital; Dr Simon Kane, head of obstetrics and gynaecology at the Lyell McEwen Hospital; Dr Christine Lai, a senior clinical lecturer at the University of Adelaide; Dr Erin Oliver-Landry, from the Streetlink Youth Health Service in Adelaide and the McIntyre Medical Centre in Para Hills West; Dr Gabrielle Hart, a child and adolescent psychiatrist based in North Adelaide; and hundreds of other medical professionals, all united in condemning these cuts and calling on the government to reverse its position.

The letter touches on a topic on which I recently sought answers from the minister: the ongoing outbreaks of syphilis in South Australia. With the past several years seeing a report of congenital syphilis, ongoing outbreaks in regional South Australia, and now the spread of the outbreak to Adelaide, clearly we need more sexual health support in this state, not less.

The letter rightly points out that young people are often shameful or scared to access STI testing from their regular GP, and that the syphilis outbreaks are disproportionately affecting Aboriginal and Torres Strait Islander people. Medical experts understand the importance of SHINE SA services—that is why they wrote the letter. Advocates and community groups understand the importance of SHINE SA services—that is why they came to the meeting with the shadow minister on Monday.

Now it is time for the Minister for Health and Wellbeing, the Hon. Stephen Wade, to understand their importance too. So far, disappointingly, he has proven himself completely tone deaf on the matter. These deep cuts to sexual health services were announced on World Sexual Health Day. Just let that sink in: these deep cuts by this government to sexual health services in South Australia were announced on World Sexual Health Day, and now we debate this motion in the middle of AIDS Awareness Week, which is this week obviously, and just days away from 1 December, which is World Aids Day.

These occasions are designed for us to remember the huge and tragic losses suffered under the AIDS epidemic. They are a call to action to continue the fight to end HIV, and to support good sexual health around the world. This issue is a very personal one for me. I remember as a young community campaigner, when the AIDS epidemic was hitting, and we tried to unite the LGBTIQ community with one voice to go to government and say, 'We need help. We need the help of the government and the health services to consider this as a major health issue and increase the funding for it.'

It was not easy, it was a long road, but we did it. We talked to government at state and federal level. We communicated with the clinicians, and we came to the view that the best way of proceeding forward was to work together and have government funding dedicated to community organisations who could speak to these communities, provide the services they need, and stop people from getting infections and dying. I saw a graphic today on Facebook, which made me reflect. It was a graphic of the original San Francisco Gay Men's Chorus, and it showed seven members of that original choir still alive. The other 60 are all dead, all dead from AIDS. And that is because the government in America at the time was not engaging with the community and providing the services the community needed to understand about HIV, to learn about HIV and to avoid the infections.

We worked our way through that in this country and the government came on board. All governments, Liberal and Labor successively, state and federal, understood the importance of funding community organisations to give the information to these community groups that they needed. It is a sad day for me to be here in this place and debate an issue for which this state government is now withdrawing funding, and withdrawing that funding at a time of a syphilis outbreak for goodness sake. We should be putting more investment in prevention programs, not withdrawing it.

I am incredibly frustrated and I am incredibly sad that we are having this debate today. The Liberal government should take the advice of the clinicians who are telling them this was a bad, bad decision. We have to demand a higher standard of government. I say to the Minister for Health and Wellbeing: please reconsider. What we are asking you to do is to further reflect on this decision, and to think again about the dangers that these budget cuts put in place, and the dangers they will pose for members of the community who will no longer get their testing, and who will no longer get the health advice they need to stay healthy and not be infectious and a danger to other people.

We are asking the Minister for Health to wrestle with the Treasurer and make him see sense that these small, paltry amounts of money in the overall health budget are vitally important in keeping people out of acute medical needs, and keeping them out of hospitals, which will cost us more. This small amount of funding is vitally important. Minister, there is no shame in listening to expert advice, and there is no shame in deciding that your original position was wrong, that you have seen the light and that you are going to reverse these budget cuts. I beg you to do so.

The Hon. I. PNEVMATIKOS (16:53): I rise today to speak about the invaluable work undertaken by SHINE SA and the need for immediate restoration of funding. I endorse the comments made by both the Hon. Tammy Franks and the Hon. Ian Hunter. I thank the Hon. Tammy Franks for raising this motion and pressing this matter with due urgency as it should be. Early in my working life, I was employed as a bicultural, bilingual caseworker at the Adelaide Women's Community Health Centre. I was part of a team of doctors, nurses and social workers who undertook a multidisciplinary approach to women's health, and we worked closely with SHINE SA, complementing each other's work and programs.

Clearly, SHINE SA performs an invaluable service to women in our community, because I have seen the difference they have made to so many in the community over the years. SHINE SA specialises in providing vital sexual health services, including clinical services, counselling, sexual health education, early intervention and health promotion. Their focus is on providing services for young people and vulnerable populations, and they often provide the services that are not easily accessible elsewhere.

Unfortunately, the Liberal government does not share my respect for SHINE SA and has cruelly cut funding, resulting in the potential closure of two health clinics, in Davoren Park and Noarlunga, as well as cuts to HIV counselling services in the Adelaide CBD. The impact falls deeper, as the loss of services will create complications for health partners who have worked with SHINE SA, as well as collaborators who have been using, referring to and working with SHINE SA to deliver accessible services to people in the north and south for over 40 years.

GPs, psychiatrists, physicians, paediatricians, emergency physicians, obstetricians and gynaecologists are all banding together against the cuts, with over 350 having signed a letter urging the government to reverse its decision. Their message has been unanimous. With the reduction of this health service, the state health service will no doubt see a measurable rise in STIs and unplanned pregnancies, which undoubtedly will place a further burden on the health system, which is already buckling under the pressure.

It is not just those in the medical profession who are concerned by this cut. In just two weeks, my colleagues and I have received support from over 500 electors who share our disappointment in these cruel cuts. Community advocacy has also garnered support from over 4,500 people who have encouraged the government to reconsider their funding cut and encourage incentives to ensure this does not recur, and have shared their disappointment in the targeting of the sites that have been selected for closure.

I would like to share with the Minister for Health and Wellbeing and his colleagues feedback on the closures that has been provided by Sam:

I grew up in the Barossa and SHINE Davoren was an essential service. Youth in the regions struggle with accessing medical services without parental interference already—having to go far as Woodville or the City will devastate the youth population.

The government cannot refuse to listen to the feedback from specialists in our state, to the increasing support from the community and to Sam, representing the voice and concerns within the community, and must resort funding to SHINE SA.

The Hon. K.J. MAHER (Leader of the Opposition) (16:57): I rise to support this motion and congratulate speakers who have made a contribution, in particular the mover of the motion and the Hon. Ian Hunter, who spoke with passion, expertise and compassion in relation to this issue. Sexual Health Information Networking and Education, or SHINE SA, has done, and continues to do, invaluable work helping to protect the community from a range of sexually transmitted infections. Now the work that they do is in jeopardy.

We are better than this as a state and as a society. I am informed that SHINE SA provides the only rapid testing clinic for HIV. They have a non-judgemental service that takes around 20 minutes to test and provide counselling. What happens to the service if the scalpel is run over the budget of SHINE SA? What do these cuts mean for front-line services?

We have heard speakers talk about the Davoren Park clinic closure, the clinic at Noarlunga Centre being closed and the HIV counselling service component of SAMESH in Adelaide being closed. This is not just a way to save what is a very small amount of money. This is about real humans and real lives. Basic economics tells us that things that reduce harm or prevent harm, and education, will have proven impacts on our front-line health services.

Unfortunately, these are the same services the government has already cut and it makes no sense. For example, if one person contracts hepatitis C, it costs up to $14,000 for a liver transplant, plus that person's life has been altered irreparably. Contracting hep C can also lead to chronic cases. Then there is the ongoing cost of medication, the disruption to life and family life, and a possible shortened lifespan.

On top of the cuts that the state Liberal government has made in health and these ones specifically, the federal government has, in recent years, made drastic cuts to our health system, so it is understandable that people are so concerned when services like this are abolished. What we are doing, in effect, is taking services from some of the most vulnerable in the community. We are taking from one budget line and then adding a larger figure to another budget line, which is putting more pressure on our hospitals. This makes absolutely no sense.

At the same time as the government is starting to cut nearly half a billion dollars from our hospital system, we are seeing these cuts at the preventative end. At the same time the government is seeking new innovative pathways for our health system, they are taking away things that will save money at the front end. It makes absolutely no sense.

We saw cuts with things like Service SA and now we are seeing them in our health system, but these cuts have a much bigger impact. These cuts could literally mean the difference between life and death and, particularly, quality of life. These are cruel cuts that we do not support. You do not have to take my word for it. You do not have to take the word of members who have spoken on this. You can take the word of 350 doctors who have signed a letter urging the government to reverse these important cuts in reproductive and sexual health services. The government must reconsider these cuts. They must understand the vital work that SHINE SA provides as a leader in this sector and they must help protect the community.

The Hon. C. BONAROS (17:01): I, too, rise to indicate wholeheartedly the support of SA-Best in relation to this motion. I would like to start by noting that Saturday is World AIDS Day, which is held every year to raise awareness across the world about HIV and AIDS. On Saturday, some of us might buy a ribbon or attend an event to commemorate the solemn occasion to show our support towards people battling HIV, as well as to honour those who have died of AIDS-related conditions or other conditions related to HIV.

It is against this backdrop that we come to debate the motion and the cruel cuts by the Marshall government to SHINE SA, forcing the service to close vital services. At the risk of repeating some of the statistics that have already been placed on the record, I would like to point to recent research from the Kirby Institute that shows that there were 963 new HIV diagnoses in Australia in 2017, the lowest number of diagnoses since 2010, with a 7 per cent decline over the last five years and a 5 per cent decline between 2016 and 2017.

HIV rates among heterosexual people have risen by 10 per cent over the five years to 2017. Sixty-one per cent of newly-diagnosed cases were males. In Australia, prevention strategies are mainly focused on homosexual men, who recorded a 15 per cent diagnosis drop in 2017 alone. New data has raised concerns about HIV among Aboriginal and Torres Strait Islander people, whose diagnosis rate is double the rest of the population. These are scary statistics. In addition, the Seventh National HIV Strategy 2014-2017 has lapsed, despite HIV/AIDS remaining a major health concern in Australia.

When the government points to efficiencies as a rationale for the cuts in funding to SHINE SA, I, on behalf of SA-Best, point to the lives of vulnerable South Australians who need care and support and who are living with HIV and AIDS. As we know, SHINE SA currently operates four clinics, which have been well canvassed today, across Adelaide, providing sexual health services and offering key advice about contraception and support to people with unplanned pregnancies and sexually transmitted infections. Many of the young members of our community do not have the ability or the luxury to go to the family GP and discuss these issues openly, particularly when other family members, most commonly parents, are involved.

I would like to provide some further statistics, firstly on chlamydia. Chlamydia notification rates increased substantially between 1999 and 2011, from 74 to 363 infections per 100,000 people. Since 2011, the rate increased slowly until 2016, when it reached a peak of 385 infections per 100,000 people. The rate for 2017 was slightly lower than for 2016, at 379 infections per 100,000 people.

Gonorrhoea notification rates have increased since 1996, most noticeably between 2008 and 2017, when the rate more than tripled from 36 to 118 notifications per 100,000 people. The rate of syphilis notifications has more than doubled between 2004 and 2017, from 10 to 26 notifications per 100,000 people. Before 30 September 2018, there were 2,300 cases of syphilis diagnosed: 1,184 cases in Queensland, 877 in the Northern Territory, 196 in Western Australia and 44 in South Australia; 15 are babies, with up to seven babies believed to have died from congenital syphilis.

In 2016, Aboriginal people were three times more likely to be diagnosed with chlamydia, seven times more likely to be diagnosed with gonorrhoea and five times more likely to be diagnosed with infectious syphilis when compared to non-Aboriginal people. It is clear that Australia is experiencing a syphilis epidemic, and the cuts to SHINE SA will only serve to enable rates of sexually transmitted infections to increase, particularly in some of Adelaide's most disadvantaged communities in the long term, and that is the direct result of the cuts that this government is proposing.

The Hon. Tammy Franks, the Hon. Ian Hunter, the Hon. Kyam Maher and the Hon. Irene Pnevmatikos have outlined in detail the tremendously important work and services provided by SHINE SA. They have, I think, also set the record straight in relation to a number of important issues that SHINE SA has outlined very succinctly for us in response to the decision to close clinics, but particularly also in response to some of the comments that have been made by the government.

As we have heard, those concerns have been echoed by the AMA SA and other stakeholder groups, but also by those 350 doctors that we have just heard the Hon. Kyam Maher refer to. At the risk of repeating what the AMA has said, I would like to refer to a media release in which Professor William Tam says:

'We are calling on the State Government and Health Minister Stephen Wade to continue to fund these essential community services at SHINE SA.'…

'The new State Government has shown leadership in health for children and young people by funding meningococcal vaccinations to protect them from this devastating disease—

this is a matter that is very dear to me, and I am extremely grateful that the government has taken a very important step—

But STIs and unplanned pregnancies can also have huge repercussions on young people's lives and health.'

'SHINE SA provides tremendously important services to people who are often in extremely difficult circumstances. SHINE clients are also often victims of abuse, seeking a safe place for help and support, testing and counselling…

'We believe the Government has not realised the impact this cut would have, and we are urging it to review its decision. If not, we fear the results: an increase in rates of sexually transmitted infections; a rise in unplanned pregnancies; a loss of counselling services for LGBTI youth, which may be seriously detrimental to their mental health; and a lack of access to PrEP and PEP (HIV prevention)—running contrary to the federal government's goal of virtual elimination of HIV transmission by 2020.

In closing, the release, attributed to Associate Professor William Tam, says:

The clinic closures would also lead to an increase in the use of hospital outpatient clinics for long-acting contraception (eg IUD insertion), as well as for reasons such as pelvic inflammatory disease due to untreated infection, pelvic pain, etc. Senior obstetricians and gynaecologists have told us how frequently they refer patients to SHINE for information and treatment because of its easy access and prompt specialised services, which are bulk billed. For those most at need this can make all the difference.

SHINE reduces the burden on the public gynaecology outpatient departments, by providing sought after GPs who are motivated and skilled in this particular aspect of women's health, under one banner. Removing these clinics will remove services from socially disadvantaged groups in the north and south who will now be isolated by distance from these services. This would be detrimental to the community and state as a whole, as well as those directly affected.

I do not need more convincing than that, Mr President. For what it is worth I think those we ought to be listening to are not the bean counters but those in the know, the doctors in the know, and particularly the AMA (SA), that we so often refer to for advice and which advice we often quote in this place as being so important to decisions we make.

I would like to close by saying this: to put it simply, as others have done, we cannot afford to see these cuts come to fruition. On behalf of SA-Best I too would like to urge the government to follow the Prime Minister's lead in acknowledging when they have it wrong. Just two weeks ago we saw the Prime Minister fully acknowledge that he had it wrong in relation to Foodbank funding, and that decision was promptly reversed and the funding reinstated—and it was reinstated because the government simply cannot afford to lose such a valuable service.

Our position is that we cannot afford to do the same here, in relation to SHINE SA. We urge the minister and the government to reconsider their position. In so doing I personally echo the sentiments expressed in this place by other honourable members.

The Hon. J.A. DARLEY (17:12): I rise very briefly to say that I will be supporting the Hon. Tammy Franks' motion. I have always believed that prevention is better than cure, and funding early intervention programs should be prioritised as, ultimately, they cost the taxpayer less. Cutting these services could lead to an increase in sexually transmitted infections.

There are some infections that are asymptomatic, and people may not be aware they carry an infection until damage has been done to their reproductive system. The government should seriously consider whether it is worthwhile saving a dollar up front if they will have to spend hundreds of dollars down the track.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (17:12): I move:

That the debate be adjourned.

Ayes 8

Noes 13

Majority 5

AYES
Dawkins, J.S.L. Hood, D.G.E. Lee, J.S.
Lensink, J.M.A. Lucas, R.I. Ridgway, D.W.
Stephens, T.J. Wade, S.G. (teller)
NOES
Bonaros, C. Bourke, E.S. Darley, J.A.
Franks, T.A. (teller) Hanson, J.E. Hunter, I.K.
Maher, K.J. Ngo, T.T. Pangallo, F.
Parnell, M.C. Pnevmatikos, I. Scriven, C.M.
Wortley, R.P.

The Hon. S.G. WADE (Minister for Health and Wellbeing) (17:17): By way of preface to my speech, I express my disappointment as a member of this council at such a low bar that the council is setting so early in its term. It has been a longstanding expressed view of the crossbenchers that they do not want to be rushed with matters, that they would like to consider motions and bills in an orderly manner.

For this motion to have been moved yesterday, for us to be given notice last night that it was to be brought forward to debate and for the express request of the government that it be considered next week is very disappointing. I remind honourable members on the crossbench that that is the standard they have set. I certainly agree with the statements made that sexual health is important. Sexual health is too important to be rushed through without due consideration.

I want to acknowledge at the beginning the contribution that SHINE SA has made to the sexual health of South Australia since 1970 and in particular pay my respects to the recently deceased Ms Kaisu Vartto, the former chief executive of SHINE SA and a tireless advocate for family planning in this state over many years. I would also like to acknowledge the letter from medical practitioners, raising concerns about the funding changes. This government welcomes input from health professionals and health consumers and we respect their view.

I encourage all doctors to take up the opportunity to work with SHINE SA. They provide relevant, welcoming and supportive clinical services to communities wherever they may be. This includes a range of services. The community should be reassured that a significant portion of SA Health's $4.5 million annual grant funding contract with SHINE SA is to provide education and training in clinical sexual health services to GPs. This is so GPs across South Australia are supported to provide sexual health services to their communities, whether that be prescribing contraception, inserting lUDs or testing for STIs.

I acknowledge the work that has been done by SHINE SA in terms of workforce development earnings. They have increased by 300 per cent since 2015-16. SA Health's funding is being increasingly focused on workforce development, and it is our view that one of the ways that SHINE SA can ensure that services will be maintained is by amplifying its impact by developing the capacity of the health workforce.

Another area where SA Health and the government are of the view that SHINE SA can continue to develop its revenue and therefore maintain its services is in relation to Medicare Benefits Schedule billings. SA Health expects SHINE SA to increase their budget through maximising MBS billings for primary care services and to build the capacity of GPs and nurses to deliver sexual health services through its function as the provider of sexual health workforce development across the state.

In the context of MBS billings, SHINE SA introduced MBS billing in 2014. I think I have a slightly different date from that of the Hon. Tammy Franks, but it is around that period. MBS clinic earnings have increased every year since then; in fact, they have increased 167 per cent since 2015-16. SA Health and the government welcomes the way that SHINE SA has engaged in that revenue stream. It is our view that the Medicare revenue can be further increased, and we urge SHINE SA to do so.

From next year, pending procurement approval, SHINE SA will receive annual funding of $4.45 million for core services. SHINE SA will continue to provide a targeted HIV prevention program. In addition, the government invests almost $800,000 per year for the targeted HIV and STI-prevention SAMESH program. Overall, SA Health’s total funding to SHINE SA has increased by $750,000 since 2012-13.

In relation to the recent budget, I met with executive staff from SHINE SA on 26 October in what I thought was a productive meeting. I advised SHINE SA that the government is committed to its budget. I also advised SHINE SA that I do not agree with their decision to close the clinics in the northern and southern suburbs of metropolitan Adelaide and urged them to review their priorities in order to meet the needs of community members in those areas. I stress that the department and the government did not request or suggest that SHINE SA close those particular clinics.

We agreed to work closely with SHINE SA on a range of related matters, including meeting the health needs of international students. In addition to maximising alternative funding sources such as MBS billing, transition priorities will include supporting clients to access primary care services and enhancing the sexual health workforce development for primary care providers across South Australia. SA Health advises that the rates of sexually transmitted infections and unplanned pregnancies and an increase in the use of hospital obstetricians and gynaecologists are multifactorial and cannot be attributed to SHINE SA or to funding changes alone.

In relation to the decision to close particular clinics, I would call on SHINE SA to reconsider its decision. If SHINE SA believes that there is significant need for services in the northern and southern suburbs, which is certainly my view, it makes no sense that they would close those two clinics and keep two centrally located clinics open. The northern suburbs and the southern suburbs are areas of particular need. I reiterate the fact that similar services interstate are operating more efficiently, and we believe that SHINE SA can derive more revenue from Medicare to fund its services and more revenue from fee-for-service and education programs.

All health services need to continually strive to be more cost effective and SHINE SA is no exception. In that context I indicate to the council that there was another organisation that had a similar funding change to that of SHINE SA in this budget, and instead of withdrawing from the northern suburbs they took the opportunity to base their services in libraries. I would urge SHINE SA to be creative in terms of maintaining services. It is certainly the view of the government that with a range of strategies they can maintain services and in particular services in the north and the south.

I will take the opportunity to respond to some of the comments made by members in their contributions earlier. In relation to the Hon. Tammy Franks' comments about my comments in relation to 50 per cent of clinics, the Hon. Tammy Franks kept referencing 50 per cent of services. I never claimed that SHINE SA was reducing 50 per cent of services. In relation to her comments about the number of episodes of care by the Victorian organisation compared with the South Australian organisation, that is exactly why these sorts of debates are best held in an orderly fashion so that the government can look at the assertions being made and respond in a timely fashion.

The Hon. Ian Hunter posed the question as to whether there was an ideological agenda in these funding changes. I just ask the honourable member: when the former Labor government reduced health promotion funding by two-thirds since 2012, was that ideological? When the former Labor government cut funding to SHINE SA by 6.9 per cent in 2012, was that ideological? When the former Labor government cut funding to SHINE SA by 5 per cent in 2017-18, was that ideological?

In closing, I urge SHINE SA to reconsider the decisions it has made in the context of the budget. Whether it is the Central Local Adelaide Health Network or other providers such as MOSAIC, the fact of the matter is that all health services need to continue to strive to be sustainable so that South Australians continue to get the services that they need.

The Hon. T.A. FRANKS (17:27): I rise to thank those members today who have made a contribution to what I think is a very important and urgent issue: the Hon. Ian Hunter, the Hon. Irene Pnevmatikos, the Hon. Kyam Maher, the Hon. Connie Bonaros, the Hon. John Darley and the minister, the Hon. Mr Wade.

I reflect particularly on minister Wade's remarks. Certainly the minister has been out there in the media stating that 'SHINE SA has lost 9 per cent of its funding but closed 50 per cent of its clinics.' None of those quotes ever went on to say that that of course is not 50 per cent of its services, and the very point that I was making the minister has just highlighted himself by pointing out that the clinics are simply one fraction of the services that SHINE provides.

I note that SHINE SA has experienced successive funding cuts since 2012 to the SA Health core grant equivalent to a 30 per cent decrease in funding over eight years. That now represents a loss of funding in real terms of $1.5 million per year from the year 2020 onwards. Over this time SHINE SA has implemented MBS billing which is now approximately $650,000 per year. However, MBS billing does not fully fund SHINE SA's clinical services given the level of disadvantage and complexity of clients who are referred to them by GPs and other government health services, and of course that the revenue was already offsetting previous years' cuts.

These are cuts that the minister should have been ready, willing and able to debate today because they are not cuts that the opposition created or the crossbench created: these are the cuts of the Marshall government, which the Marshall government has been out spruiking since September.

We have heard in the other place this week of a minister having a tin ear and being unwilling to properly consult. The minister's response to SHINE SA to 'get creative' concerns me. I think the minister needs to get consultative, to lose that tin ear and to meet with Dr Erin O'Connor of those doctors who have signed that open letter, giving minister Wade not just a second opinion but a 350th opinion, because Dr Erin O'Connor is easily accessible on Twitter—she has just started following me—and she has noted that she has yet to hear from the minister with regard to those 350 doctors who have expressed their concerns. If you do not believe this council, perhaps if you met these doctors you might actually believe them.

These cuts are a folly; they are a small amount. There is the ability for the Marshall government to reverse these cuts, with barely blinking an eye, but they will have a profound impact on people's lives if they are not reversed. With those words, I thank members for their indulgence and for recognising this issue with the importance it deserves. I again urge the minister to reconsider these cuts.

Motion carried.

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