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Legislative Council - Fifty-Fourth Parliament, Second Session (54-2)
2020-12-01 Daily Xml
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Bills

Health Care (Governance) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 15 October 2020.)

The Hon. S.G. WADE (Minister for Health and Wellbeing) (15:37): I will briefly thank honourable members for their contributions. I do not propose to delay the committee stage of the consideration of the bill. I think it is best to address each of the issues raised by honourable members when the relevant clause is considered by the council.

Bill read a second time.

Committee Stage

In committee.

Clause 1.

The Hon. K.J. MAHER: I have quite a number of questions that I propose to ask at clause 1 that I think traverse different aspects of this bill and how the scheme in total works, so I might get started with the questions. Minister, what has been the cost per annum for board members' fees?

The Hon. S.G. WADE: I do not have that figure with me.

The Hon. K.J. MAHER: Is the minister proposing that that question will never be answered or is he proposing that he will take that on notice?

The Hon. S.G. WADE: I am happy to take it on notice. If I could make clear that the fees for the boards are gazetted, but I am still happy to take it on notice.

The Hon. K.J. MAHER: As the minister has taken it on notice, can he also take on notice, as well as the annual total cost for board member fees, what has been the total cost for fees since the beginning of this reform process?

The Hon. S.G. WADE: The boards were established formally from 1 July 2019, so they have only had one full financial year so far.

The Hon. K.J. MAHER: Can the minister also take on notice what the total cost has been for all public sector staff who are working as governance or secretariat staff for local health network boards?

The Hon. S.G. WADE: Yes.

The Hon. K.J. MAHER: Can you take on notice what the total cost is for all non-staff costs in relation to the boards across health networks, including travel, meeting fees, catering, functions and expenses?

The Hon. S.G. WADE: Yes.

The Hon. K.J. MAHER: Can the minister, I assume on notice as well, advise what the cost is for departmental staff who have worked on the governance reform as a total cost? I might just ask these rather than have the minister stand up after each question.

The Hon. S.G. WADE: With all due respect, I will make best efforts on that one, but that one is a relatively vague question. Considering the member's concern is perhaps a misuse of government resources, I do not want the answer to the question to become exactly that.

The Hon. K.J. MAHER: This might be an easier question as well for the minister to take on notice: have any contracts been issued with consultants or other contractors in relation to the governance reform process, and can the minister outline what those contracts are and what the cost has been?

The Hon. S.G. WADE: I am happy to do so.

The Hon. K.J. MAHER: In relation to distribution between local health networks, I think the minister has claimed a figure in recent times of an introduction of 600 additional clinicians since taking office. Can the minister confirm that and can he confirm whether they are additional FTEs, which LHNs they are for and what are the clinicians' roles, i.e., a breakdown of doctors, nurses and whatever else is included as 'clinicians' in that figure that has been bandied about of 600?

The Hon. S.G. WADE: I am happy to take that on notice. I would make the point that my understanding is that is not a reference to FTE, that is a reference to head count.

The Hon. K.J. MAHER: In relation to that 600 head count, can the minister also take on notice the year-on-year difference since the end of the 2017 financial year for those figures?

The Hon. S.G. WADE: With all due respect, this is not to do with governance. The honourable member is wanting to wander into estimates. I would suggest that he might either ask that in question time or, shall we say, in the Auditor-General's considerations or whatever.

The Hon. K.J. MAHER: In relation to distribution across the local health networks, which the boards set the structure for, can the minister outline which local health networks in particular have received the increase that the minister claims of $20 million funding for mental health?

The Hon. S.G. WADE: This does remind me of the House of Assembly estimates committee discussion last week. I think there are two points to be made. There is both earmarked mental health initiative funding, such as the Urgent Mental Health Care Centre that is being established, and there is also activity-based funding, and of course activity-based funding relates to mental health as well. I am more than happy to provide further information to the honourable member.

The Hon. K.J. MAHER: In relation to service level agreements with local health networks, is the minister able to inform the committee how many of the 2020-21 service level agreements have been signed with governing boards?

The Hon. S.G. WADE: I am advised thus far, six.

The Hon. K.J. MAHER: If six have been signed, can the minister then outline which of the local health networks have not signed those service level agreements?

The Hon. S.G. WADE: My understanding is that the Central Adelaide Local Health Network, the Flinders and Upper North Local Health Network, the Northern Adelaide Local Health Network and the Women's and Children's Health Network have not signed their service agreements at this stage.

The Hon. K.J. MAHER: Does the minister have any information as to why those four LHNs have refused to sign their service level agreement to date?

The Hon. S.G. WADE: I do not have that information with me.

The Hon. K.J. MAHER: Just to be clear, have none of those boards or the board chairs expressed concerns directly to the minister?

The Hon. S.G. WADE: Service level agreement negotiations are primarily between the department and the local health network. Most of the concerns that have been raised with me by board chairs in relation to the service level agreements have been in relation to the service level agreement processes. They are very keen that the process is collaborative and that not only management but also the board are engaged in the process.

The Hon. K.J. MAHER: Can the minister outline concerns that any board chairs have expressed about the process in terms of service level agreements?

The Hon. S.G. WADE: One of them, for example, is the template. The view is that the template being used was far too bulky and cumbersome, and significant improvements have been made in the current year.

The Hon. K.J. MAHER: Has the minister any information as to when it is expected the Central Adelaide Local Health Network service level agreement will be signed?

The Hon. S.G. WADE: I do not recall any suggestion having been made to me on that.

The Hon. K.J. MAHER: Can the minister let the committee know what the consequence is if a service level agreement is not signed?

The Hon. S.G. WADE: I am advised that, even if a service level agreement has not been signed, under the governance and management arrangements, particularly section 33 of the act, the boards still have a statutory responsibility to manage the operations of the incorporated hospitals efficiently, effectively and economically. They have a responsibility to manage their budgets so that performance targets are met and hospital resources are applied equitably. In that context, service level agreements are a document which help crystallise what that means for that particular network.

The Hon. K.J. MAHER: I thank the minister for his informative answer. Are service level agreements renegotiated every financial year for each LHN?

The Hon. S.G. WADE: Yes, they are. They are actually an obligation under the National Health Reform Agreement.

The Hon. K.J. MAHER: For the 2019-20 year, are there any service level agreements that are not completely signed and signed off?

The Hon. S.G. WADE: There were a number that were left unsigned. My understanding is that the LHNs and the department agreed that it would be better to work on the next year's rather than go back and work on last year's.

The Hon. K.J. MAHER: For that 2019-20 year, can the minister outline which agreements were left unsigned for that year?

The Hon. S.G. WADE: I am advised that it was the three metropolitan and one statewide, that being the Women's and Children's Health Network.

The Hon. K.J. MAHER: So the agreements of three metropolitan and the statewide, as I understand the minister's answer, were not signed for the 2019-20 year. I think it was Central Adelaide, Northern Adelaide, Flinders and Upper North and Women's and Children's that are not yet signed for this year. Is it right that three of the four that were not signed—

The Hon. S.G. WADE: Can you just hold for a second? I think I might have misled you on an earlier answer. If I could go back to an earlier answer, we answered it by contrasting it with the list of ones that had been signed, but I have given you a mistranscription there. The local health networks that have not signed 2020-21 service agreements, I am advised, are the Central Adelaide, Flinders and Upper North, Yorke and Northern, and Women's and Children's.

The Hon. K.J. MAHER: I think the difference was that it was the Northern Adelaide rather than the Yorke and Northern—that was the mistranslation there. Can I check whether is it right that the Central Adelaide and the Women's and Children's are those that had not signed in 2019-20 and still have not signed in 2020-21? Do I have that right?

The Hon. S.G. WADE: I think that is correct.

The Hon. K.J. MAHER: Is there a power for the minister or the chief executive to issue a direction that a service level agreement come into force and be taken as signed?

The Hon. S.G. WADE: Under the current act, no.

The Hon. K.J. MAHER: This goes back to something the minister spoke about a few questions ago, that is, the consequences of an agreement not being signed. What are the ramifications, in terms of national funding and national reform agreements, if these agreements are not signed?

The Hon. S.G. WADE: My understanding is that it does not have an impact on commonwealth payments. It does not have an impact.

The Hon. K.J. MAHER: Is there a possibility, for example, with the Central Adelaide Local Health Network and the Women's and Children's Health Network that agreements will not be signed for two years in a row? Is there any consequence if that happens?

The Hon. S.G. WADE: I am advised there are no direct consequences.

The Hon. K.J. MAHER: I think this will be the last question on the agreements. Is the minister concerned that for two very large and important local health networks agreements have not been reached for two years in a row at this stage?

The Hon. S.G. WADE: I am not going to start commenting on this financial year. This financial year is work underway. What I am pleased with is that the information available to me suggests there have been significant improvements in the way the government's relationship with the department and the boards is evolving, and service level agreement improvement is an important part of that. I am optimistic that the service level agreement and the relationship generally will continue to improve.

The Hon. K.J. MAHER: Just to clarify, the minister holds no concerns in relation to the failure to sign service level agreements with the Central Adelaide Local Health Network or the Women's and Children's Health Network.

The Hon. S.G. WADE: Of course I would like all service agreements to be signed. What I was talking about is the process more generally. I think there have been significant improvements, and I am sure improvements will continue.

The Hon. K.J. MAHER: This is definitely the final question on this now. What steps have the minister or his department taken to encourage the signing of agreements, particularly with the two with which agreements were not signed last year?

The Hon. S.G. WADE: The whole point is that the agreements are a discussion between the local health networks and the department in its commissioning role. The department inherently is in that conversation and is seeking to bring a mutually agreed final version.

The Hon. K.J. MAHER: Is the minister able to inform the committee which of the boards currently have vacancies and how many vacancies there are for each board at this point in time?

The Hon. S.G. WADE: The boards under the legislation are required to have between six and eight members, and there is only one board below that statutory minimum, which is Yorke and Northern, and steps are underway to have that vacancy filled.

The Hon. K.J. MAHER: For the Yorke and Northern Local Health Network board, for how long has that vacancy that has taken it below the statutory minimum of six been the case, and what are the consequences for decisions a board makes when it is below the statutory minimum?

The Hon. S.G. WADE: I am advised that, pursuant to section 6 of schedule 3 of the Health Care Act, which schedule relates to governing boards for incorporated hospitals, an act or proceeding of a governing board is not invalid by reason only of a vacancy in its membership or a defect in the appointment of a member. In September, a process was initiated to seek additional governing board members, and it is the government's intention not only to fill that vacancy but also to establish a pool of suitable candidates for future appointments.

The Hon. K.J. MAHER: The minister has informed the committee that currently it is the Yorke and Northern Local Health Network that has fallen below the minimum legislated requirement of six members. Has there been at any point in time in the past since the current governing board arrangements were put in place by this government a time when other boards have not met the minimum of six members?

The Hon. S.G. WADE: That is a question such that we would need to take it on notice and consult our records.

The Hon. K.J. MAHER: Is the minister aware of any advice that any board members or chairs currently serving on a local health network may not meet the eligibility criteria as they currently stand without the amendments being proposed?

The Hon. S.G. WADE: No.

The Hon. K.J. MAHER: Are there any specific individuals the government has in mind to appoint to local health network boards or as chairs who would be excluded under the current eligibility requirement that would meet the government's proposed expansion of eligibility?

The Hon. S.G. WADE: Not that I am aware of.

The Hon. K.J. MAHER: To be very clear on this one, is the minister saying that he is not aware of or that he is not aware of any discussions that have occurred between individuals who do not meet the current criteria but may meet the expanded criteria for proposed appointment to boards or as chairs?

The Hon. S.G. WADE: I am not aware of any candidate who is waiting in the wings to be appointable with the passage of this legislation. I am sure in the past there have been discussions about eligibility, because the sorts of cases that have prompted this amendment have been as a result of officers being aware of people presumably making inquiries and not being considered eligible.

The Hon. K.J. MAHER: I thank the minister for his response. Does the minister have any advice as to how many individuals have either made inquiries or been approached that have not met the current eligibility criteria but may meet the expanded ones?

The Hon. S.G. WADE: I do not have that information.

The Hon. K.J. MAHER: Is the minister able to take that on notice?

The Hon. S.G. WADE: To be honest, it is a broad question, and if those discussions took place they may well have been casual conversations. They may not have been recorded.

The Hon. K.J. MAHER: I appreciate that and understand that not all conversations will be recorded and documented and required to be kept as records under the State Records Act, but as far as is possible—and I do take that caveat into account—is the minister able to see if there are such records?

The Hon. S.G. WADE: In the spirit of the committee could I suggest I will not take on notice the number, but I will ask officers if they could identify any relevant information.

The Hon. K.J. MAHER: I thank the minister for his cooperation. Is the minister able to outline for the benefit of the committee, and as we come to consider the clauses of this bill, what the current requirements are for the publishing of board minutes?

The Hon. S.G. WADE: I believe we are wandering into clause matters. It is one thing to talk about general resourcing issues that, if you like, undergird the act and the bill. Having put the committee on notice that I think we should be moving on, I am advised—again, it is schedule 3, section 8(7):

A governing board must have accurate minutes kept of its meetings and must, within 7 days of a meeting, publish the approved minutes of the meeting on a website accessible by the public at no charge.

The Hon. K.J. MAHER: I thank the minister for his information. Have all boards complied with that seven-day requirement for the publishing of their board minutes?

The Hon. S.G. WADE: I do not have figures on that.

The Hon. K.J. MAHER: Just to check for the sake of clarity, the minister—or in the advice the minister has access to—is not aware of any instances where that seven-day requirement has not been met?

The Hon. S.G. WADE: That was a very different question the second time round. Let me say that we do not have statistics to indicate what percentage of minutes are posted in accordance with that clause.

The Hon. K.J. MAHER: I thank the minister for his answer to the 'very different question'. It was a good answer, but not quite the answer to the question that was asked. Is the minister aware of any instance or does the minister have any advice to suggest there are any instances where that requirement for minutes to be published within seven days is not being met? It might be easier to ask the second part of that question with it: and what consequences flow if that has happened?

The Hon. S.G. WADE: I am advised that we are not aware of any instances of noncompliance, but I would underscore again there is no compliance data in relation to that provision. The second question was the consequences?

The Hon. K.J. MAHER: Yes.

The Hon. S.G. WADE: It would be a technical breach of the legislation and, of course, in the whole context that may be significant, but there are no direct consequences.

The CHAIR: Before I call the Leader, we are still on clause 1. I am keen to continue so I will call the Leader and then I will go to the Hon. Ms Bonaros.

The Hon. K.J. MAHER: It may help, Mr Chair, but I outlined at the start that there will be quite a few questions at clause 1 that traverse how the scheme of local health networks operate, and there will be fewer as we come to the clauses.

The CHAIR: Sure.

The Hon. K.J. MAHER: This will be the final question on board minutes. Is the minister able to take on notice whether it is possible that there is data that regularly reports on the compliance with things like adherence to the seven-day board minute publishing? There may well be some reason why that is not possible, but is the minister able to take on notice whether it is possible to do that?

The Hon. S.G. WADE: Just to clarify, I am certainly willing to take on notice clarification to confirm whether or not there are statistics held on compliance with schedule 3, section 8(7).

The Hon. K.J. MAHER: Is there any information the minister has available to him to indicate whether the ICAC task force has made any recommendations for any amendments to this act and to the local health network scheme regarding the improvement of governance to prevent corruption or maladministration?

The Hon. S.G. WADE: I am advised there were no formal submissions in the context of the bill consultation but, of course, a number of our senior leadership are involved in that work and it may well have been that they drew on their learnings in that process to inform the development of this.

The Hon. K.J. MAHER: I have a series of questions on the Mental Health Commission that I am happy to ask, but I do appreciate that I have been asking questions on clause 1 for some time, so I am happy to go through those questions or happy to—

The Hon. S.G. WADE: I am prepared to do them at clause—

The Hon. K.J. MAHER: Or if other members want to ask some of those sorts of questions now, but I am happy to ask.

The Hon. C. BONAROS: I want to ask a follow-up question in relation to the Central Adelaide Local Health Network and the Women's and Children's Health Network, and the 2019-20, 2020-21 years. Just to confirm, there was no service agreement in place for 2019-20, and not one for 2020-21 as yet?

The Hon. S.G. WADE: As yet.

The Hon. C. BONAROS: As yet—we are working on that. I am not sure if I missed this, but did the minister provide us with the reasons why that is the case in both those instances?

The Hon. S.G. WADE: I am certainly happy to seek that information but I have no specific information as to the reason why.

The Hon. K.J. MAHER: How many staff worked directly for the then full-time Mental Health Commissioner before there were changes to the role and the creation of three part-time commissioners? How many staff were there when the role of Mental Health Commissioner was full time?

The Hon. S.G. WADE: We do not have that information. I am happy to take it on notice.

The Hon. K.J. MAHER: Can the minister also take on notice how many staff currently operate under the current model of three part-time commissioners; that is, staff who work there, not seconded from other parts of the department but directly under the commission? Can the minister let us know whether that is head count or FTEs—it will be obvious from the comparison of the two—and also how that has changed since the changes were made.

The Hon. S.G. WADE: I do not have that information available. Could I just indicate that this is a question that relates to an amendment where the opposition seeks to insert the Mental Health Commission into this act. It is the government's view that this bill is not about the Mental Health Commission.

The Hon. T.A. FRANKS: I will just add that it is also the view of the Greens that the Mental Health Commission is not in the purview of this act.

The Hon. C. BONAROS: I want to go back to my previous question in relation to those service agreements. At the moment, those agreements are implemented by way of administrative arrangements; is that not the case?

The Hon. S.G. WADE: No; I think I would characterise it this way—sorry, do you mean before this act is passed? Sorry; yes, indeed. I think they are actually called service agreements but they are also sometimes called service level agreements—they are the same thing—and they have been in place since the boards were established. In fact, I think they predate the boards.

Up to this point they have had only moral suasion, so when this government committed to establishing a performance and accountability framework through a second bill, one of the key things was to legislate for the service level agreements. To address the issue flagged by the honourable leader earlier, it is certainly the expectation of the government that we will continue to have improvements to the process and continue to have more local health networks sign the agreement—and, hopefully, sign them earlier.

The Hon. C. BONAROS: Thank you for that clarification. I will just focus on those two again, the CALHN and the Women's and Children's Health Network. If we do not have a service agreement under those—we will call them 'administrative arrangements'—and there is nothing in the bill that would force one of those arrangements to come into place under the current bill if it were not agreed to—I think that was the answer from the minister in relation to one of the questions—

The Hon. S.G. WADE: I do not think that question has been asked. Let me answer that one.

The Hon. C. BONAROS: I would like you to answer that one. I suppose the other thing is, does the minister expect that the framework he is providing through this will help focus the attention of those who are supposed to be entering into these agreements?

Are we dealing with a situation where we have scenarios where those agreements are not being entered into and there is a bit of frustration there because they are not being entered into? Does this bill go any way to addressing that by focusing the mind of those individuals who are supposed to be entering into these agreements by providing guidelines, if you like, in terms of what is anticipated will be covered in those agreements?

The Hon. S.G. WADE: I hope you do not think I am labouring the point, but the enshrinement of the statutory agreements is part of our commitment to have performance and accountability within our framework. The provisions before us are not trying to reflect on the willingness of the department or the networks to make best efforts to finalise agreements. There is what I would call a last resort provision in the bill, and this is new section 28C(5), which provides:

If the parties entering into or proposing to vary a service agreement cannot agree on a term or variation of the agreement, the minister may make a decision about the term or proposed variation and must advise the parties of the decision in writing.

However, let us be clear, I see that as a last resort. I think one of the key things about the service agreement is to make sure we have robust and respectful dialogue between the department and the local health networks.

The Hon. C. BONAROS: If we do not know the reasons why those two have not been signed off, if you like, for the two years, is it the minister's expectation that under these arrangements he, or anyone else in his position, will be kept abreast of developments? I am just trying to work out, in a practical sense, how that happens, because at some point you would need to be briefed to be told, 'There is no agreement here.' I assume that is not happening at the moment, if we do not know what the reasons are. Is that expected to happen under the current proposed arrangements?

The Hon. S.G. WADE: It is an interesting point the honourable member makes. I imagine that in considering any advice to use the proposed clause I would need to consider what the consequences are of not using the clause and allowing the agreement not to be signed. Going back to my answer to the honourable Leader of the Opposition, even without the agreements being signed for the last financial year, it is the government's view that board members had a statutory duty for good financial management, for good corporate governance of the board, so if I was being given advice under that particular clause, I would have to consider what the impacts of the alternative would be.

The Hon. C. BONAROS: Just to be clear, at the moment under the administrative arrangements, you do not receive that sort of advice in terms of where the stumbling blocks are in these agreements.

The Hon. S.G. WADE: From time to time I am given updates and they would often be from board members or chairs as much as the department. I am certainly not seeking to insert myself in those discussions but this bill suggests that the minister could have a role as a last resort.

The Hon. K.J. MAHER: Is the minister able to outline the role of the Health Performance Council in monitoring the performance of local health networks?

The Hon. S.G. WADE: I specifically think this relates to a clause. There is a clause in the bill which proposes to abolish the Health Performance Council. I suggest that is the place where we should be talking about the Health Performance Council.

The Hon. K.J. Maher interjecting:

The CHAIR: I am keen to progress. I am happy to pursue those broader issues under clause 1. The Leader of the Opposition has the call.

The Hon. K.J. MAHER: The minister is indicating that he is refusing to answer further questions at clause 1. I am not really sure why he is refusing to answer further questions. I will ask again and he might answer here, so we consider it in the context of the whole bill.

The CHAIR: The minister will resume his seat and the leader can ask that question. I do not believe he refused to answer a question.

Members interjecting:

The CHAIR: No, I am talking. But what he did say was he thought it was more appropriate to deal with those questions at that particular clause and I tend to agree with him. We have had a fair canvassing of issues at clause 1. I will continue to allow that to an appropriate level but I think the leader needs to continue. I call the leader.

The Hon. K.J. MAHER: No, if that is the rule.

The CHAIR: Do you have any other issues at clause 1?

The Hon. K.J. MAHER: Yes, but I will try to figure out the best way.

The Hon. R.P. WORTLEY: In regard to this, the minister by giving an answer now would save time because if we have to wait until we get to that clause and we need information, it may take a while to get that and it may hold up the bill. I think if the minister could actually give the answer now, it would help to progress through the clauses.

The CHAIR: Before calling the minister, the minister has been pretty generous in addressing a range of issues across the bill and I will allow him to answer if he wishes.

The Hon. S.G. WADE: Yes, I certainly do not aspire to offend the opposition, so I am happy to give an answer now. I just think it is orderly to deal with matters at the relevant clause. Under section 11 of the Health Care Act, the functions of the Health Performance Council are to provide advice to the minister about the operation of the health system and outcomes for South Australians and, as appropriate, particular population groups, and the effectiveness of methods used within the health system to engage communities and individuals in improving their health outcomes.

The council was established in 2008 when the previous Labor government abolished local health boards and centralised authority and accountability for the state's public health system in the chief executive of the department.

The Hon. K.J. MAHER: Given the minister has made suggestions about how we should proceed with this bill, which clause does the minister feel that Health Performance Council questions are best suited to? Is it clause 4, is it an amendment to clause 4, or is it a clause further on? How many clauses relate to the Health Performance Council and should we save the questions for one of those particular clauses, given his advice?

The Hon. S.G. WADE: For the benefit of the council, it is the government's view that clause 4 is the first reference to the Health Performance Council.

The Hon. K.J. MAHER: So is that the most appropriate?

The Hon. S.G. WADE: Yes, I am happy to do that there.

Clause passed.

Clauses 2 and 3 passed.

Clause 4.

The Hon. T.A. FRANKS: I seek to delete this clause, so I formally move that the clause be opposed.

The CHAIR: You do not need to move it; you are opposing the clause.

The Hon. T.A. FRANKS: I am outlining what my intention is and then I will outline what the clause does and why I am doing so. This clause would have the effect of amending the long title to delete the words 'the Health Performance Council and'. Obviously, while amending the title, this will then lead to consequential amendments further in the bill, which I have also sought to amend. In all those cases, we are seeking to oppose those particular clauses that flow on from the deletion of the Health Performance Council.

It is not just the Greens that oppose deleting the Health Performance Council not just from the title of the bill but from the functions of our state health system. A vast range of stakeholders, but in particular headed up by SACOSS, have continued to quite rightly voice their concerns about the removal of the Health Performance Council for various reasons. While I did outline the reasons in my second reading, I will reiterate that the removal of the Health Performance Council results in a lack of independent monitoring, data analysis and reporting, as well as those community or consumer engagement mechanisms.

Currently, the data routinely collected and stored by the Health Performance Council is indeed a valuable resource and can be used quite effectively to inform both clinicians and consumers, to enable the scrutiny and accountability of system performance. The Greens strongly believe that we need to retain the Health Performance Council, if not in the future in the same form, we certainly will not be supporting removing it until we have something better on offer in its place.

At this stage, we fully support that independent oversight. For example, this body has looked at systemic racism in our health system. We believe that sort of work will not necessarily be done by the local health networks off their own bat and it is the role of an organisation such as the Health Performance Council to do so. With that, I will be vehemently opposing this clause on behalf of the Greens.

The Hon. C. BONAROS: I rise to indicate that this is obviously one of the areas of concern that we discussed during my second reading contribution. I think the Hon. Tammy Franks has effectively hit the nail on the head in terms of the concerns around this. It has been drummed into us that the HPC provides a very important, impartial service that we simply cannot afford to lose. We have reports into mental health, we have reports into racism, and the fear from stakeholders and from us, effectively, is that if that body were to be dissolved we would not necessarily have that same information being provided to us.

Again, stakeholders have been very firm in terms of the importance of this body in terms of the impartial information that it provides to us, and I think that needs to be considered in the context and in the light of some of the alarming stories that we have all heard about SA Health. If you think of it through that lens and through that context, the reason for this body becomes even more important.

Whilst I understand what the minister is saying about this work being done elsewhere, there is no guarantee that the work that this body is doing will actually be done. I do not accept that it is a matter of replicating work that is going to be done elsewhere. This body operates with a level of independence and impartiality that we absolutely must maintain. For those reasons, and after a lot of consideration and discussions with the minister and otherwise, it is our position, very firmly, that we will not be supporting the abolition of this body and therefore those provisions of the bill that relate to it.

The Hon. S.G. WADE: I thank the honourable members for their contributions. As the Hon. Connie Bonaros indicated, I have had extensive discussions with both the Hon. Tammy Franks and the Hon. Connie Bonaros. It is the government's view that the Health Performance Council was established when the boards were dissolved. It makes logical sense that, if they were established by the former government to fill a gap with the abolition of the boards, we had to ask the question: were they still relevant? Was the council still relevant, when boards were going to be reintroduced?

It is also our view that there was a strong alignment between work being done by groups like Wellbeing SA's prevention and public population health outcomes research and analytics unit and those of the commission. In relation to the two points the honourable members make, I would suggest that systemic racism may well have been dealt with under the Commission on Excellence and Innovation in Health. In relation to the point the Hon. Connie Bonaros makes about mental health, there may well be issues that could be looked at by the Mental Health Commission.

I do appreciate that the honourable members are still resolute in their view that the Health Performance Council should be retained, and that is what this council will determine. I put on notice that it is the government's view that there needs to be discussions between those bodies to make sure that we minimise duplication, that they each make sure that we are using taxpayers' dollars wisely to get relevant insights, so that our health services can be of increasing quality and increasing effectiveness.

The Hon. K.J. MAHER: The minister mentioned in his contribution just now that the work, for example, that was done into the prevalence of institutional racism in various local health networks might be picked up by the Commission on Excellence and Innovation in Health. Is the minister able to inform the committee whether the Commission on Excellence and Innovation in Health is required to report to parliament?

The Hon. S.G. WADE: The Commission on Excellence and Innovation in Health and Wellbeing SA are both administrative units. I am advised that both of them, therefore, would need to provide annual reports, which would be tabled in parliament.

The Hon. K.J. MAHER: So I understand correctly, is the minister saying that the Commission on Excellence and Innovation and the Health Performance Council both have the same reporting obligations and report in the same way, which I take it to be through the minister and not directly to parliament? Is that the contention?

The Hon. S.G. WADE: Yes, the Health Performance Council, like administrative units, has a requirement under section 12 of the act to do an annual report. They also have a further obligation under section 13 to provide a four-yearly report.

The Hon. K.J. MAHER: I thank the minister for the answer. It is a good answer; it is just not the answer to the question that I asked, it is half of it. What is the difference in the reporting requirements between the Health Performance Council currently and the Commission on Excellence and Innovation in Health? Do they report in the same way? Do either of them report through the minister rather than directly to parliament? Is the minister obliged to table reports for both of them as they are written to him, or does he have any discretion with either reporting mechanism in what comes to parliament?

The Hon. S.G. WADE: On my reading, the provisions are similar in relation to the annual report. Section 12 of the Health Care Act provides:

HPC must, within 3 months after the end of each financial year, deliver to the Minister a report on the operations of HPC during that financial year.

That is similar to section 12 of the Public Sector Act, which provides:

(1) Each public sector agency must, once in each year, present a report on the agency's operations to the agency's Minister.

(2) Subject to this section, the report must be related to a financial year and must be presented within 3 months after the end of the financial year to which it relates.

The Health Care Act in section 12(2) provides, in relation to the annual report of the Health Performance Council:

(2) The Minister must, within 12 sitting days after the receipt of a report under this section, cause a copy of the report to be laid before both Houses of Parliament.

That is similar to the Public Sector Act, section 12(8), which provides:

(8) A Minister must, within 12 sitting days after receipt of a report under this section, cause copies of the report to be laid before each House of Parliament.

The Hon. K.J. MAHER: I ask the minister about the ability of either the Commission on Excellence and Innovation in Health or the Health Performance Council to be subject to a direction by the minister or the chief executive.

The Hon. S.G. WADE: I am advised that there is no specific power of direction in relation to an attached office to a department, but attached offices to a department are responsible to the Premier and the office's minister.

The Hon. K.J. MAHER: Again, I thank the minister for a very well thought-out answer to another question, but I am specifically asking in relation to the Health Performance Council and the Commission on Excellence and Innovation in Health. Is the minister saying that both are attached offices and therefore that both have the exact same power of direction?

The Hon. S.G. WADE: I am sorry, leader, I had omitted to answer that one. There is no power of direction in relation to the Health Performance Council.

The Hon. K.J. MAHER: To be clear, there is some form of direction available for the Commission on Excellence and Innovation in Health, but there is no power of direction at all in terms of the Health Performance Council; is that correct?

The Hon. S.G. WADE: I am happy to categorise the Health Performance Council as an independent council in a way that the administrative units are not.

The Hon. K.J. MAHER: I guess the minister can understand the concern that the opposition, and I think probably the crossbench as well, has in relation to this, when the report of the Health Performance Council was raised and it found that all but one of the local health networks had, I think, a very high level, or whatever the highest level was, of institutional racism across those health networks.

I think the concern that many would hold is that a commission or an attached unit that is subject to the power of direction may be less likely to be as forthright and as critical of the health system as the Health Performance Council, which the minister himself has characterised as independent in that respect. Does the minister think that the Commission on Excellence and Innovation in Health would exert the same independence as the Health Performance Council?

The Hon. S.G. WADE: I have already answered that in the immediate past question. I indicated that the council is more independent.

The Hon. K.J. MAHER: That just about wraps up the bulk of the questions we have on this, particularly given that the answer to the last question was rolled in with the question before. The opposition cannot support the abolition of the Health Performance Council, which, in the minister's own words, exercises a more independent functioning in the monitoring of the health system.

Clause negatived.

Clause 5.

The Hon. T.A. FRANKS: I indicate that this clause will be opposed by the Greens. It is consequential on the Health Performance Council debate.

The Hon. S.G. WADE: The government agrees that this is consequential.

Clause negatived.

Clause 6 passed.

Clause 7.

The Hon. K.J. MAHER: I move:

Amendment No 1 [Maher–1]—

Page 3, after line 29 [clause 7(1)]—After paragraph (e) insert:

(ea) to establish and maintain a body that independently represents the interests of consumers and patients;

Many of these issues were thoroughly agitated when we had the first iteration of the local health networks and the associated governance legislation. I reiterate that this is an amendment that was suggested by the coalition of stakeholders, led by SACOSS, which suggested a range of amendments to the governance legislation.

This amendment requires the government to establish and maintain a body that independently represents the interests of consumers and patients. It is borne out of the government's $1.5 million cut to the Health Consumer Alliance in its first budget, a move that has ultimately led to the alliance disbandment just recently.

The government's decision to cut the alliance funding makes South Australia the only state not to have an independent consumer body advocating for the rights and interests of patients. This amendment seeks to help the government by righting the wrongs of their decision and requiring the maintenance of an independent body representing patients and health consumers.

The Hon. S.G. WADE: It is the government's view that establishing a separate body is not supported and would result in unnecessary duplication, given the existing statutory mechanisms to ensure consumer engagement within the Health Care Act. A fundamental principle of devolution of the public health system is to bring clinicians and consumers closer to the decision-making in their local health services, to create a truly integrated approach to community engagement to support patients, carers, families, consumers and clinicians at the local level to inform service delivery.

In that context, I would stress that the accreditation processes for hospitals do require consumer engagement, so in that regard the hospitals are accountable, even beyond state government, for making sure that they engage with consumers within their services. We do not think it is appropriate under a devolved governance model for the department.

The honourable member, in relation to the Health Performance Council, was highlighting how important it is for the department to be subject to independent oversight. We certainly do not think it is appropriate for the department to lead consumer engagement processes relating to local health service delivery, as the department is no longer directly accountable for these services or for determining how they will be delivered.

Through their existing statutory functions, which commenced on 1 July 2019, the local health network governing boards are responsible for establishing a strong relationship with health consumers, local communities and frontline health professionals, particularly through the development of a clinical engagement strategy and a consumer and community engagement strategy.

The Hon. T.A. FRANKS: The Greens will be supporting the Labor opposition's amendment, but we note that we are not able to ensure funding to this body, and without that funding it does seem somewhat of a moot point. Unfortunately, we are not in a position to ensure the funding, but we do recognise and acknowledge the difficult situation of a devolved health system with ensuring a consumer voice that is somehow driven by a department when it should indeed be independent.

The Hon. S.G. WADE: I do not really know if the opposition knows the, if you like, inconsistency of their position. A minute ago they were saying how important it was that the Health Performance Council be independent and not subject to my direction, and now they want a function of the chief executive of the department to establish and maintain a body that independently represents the interests of consumers and patients. It is basically giving the chief executive officer of the department direct control over the consumer voice. I just do not believe it is credible.

The CHAIR: Does the Hon. Ms Bonaros wish to contribute?

The Hon. C. BONAROS: Can I make a suggestion perhaps to the minister, given the discussions we have had and that I have just been caught a little off guard, that if we were to agree to this amendment right now on the understanding that I am happy to have a further discussion with him, then obviously it is something we can revisit between the houses if need be? I am concerned about those aspects of the amendment the minister has raised.

The Hon. S.G. WADE: Could I suggest to honourable members that we might report progress and adjourn on motion, and I could perhaps clarify some of the concerns Ms Bonaros has?

Progress reported; committee to sit again.

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