Health Care (Governance) Amendment Bill

Mr DULUK (Waite) (16:38): I also rise to make a contribution to the Health Care (Governance) Amendment Bill. With the introduction of the bill in this house, I suppose the government is taking another step to do our bit to improve the state health system that we inherited after 16 years of Labor. It is going to take a long time because the mess and the morale within public hospitals are so horrific because of the decisions of the former Labor government. In my own community, wonderful staff who used to work at the Repat are suffering from low morale, as the former government shunted staff all across SALHN.

We once again listened to the dulcet tones of the member for Kaurna in his contribution, which seemed to completely wash over his time and involvement with the health portfolio. The member for Kaurna was an adviser to the former health minister, the Hon. John Hill, and to the former federal health minister, the Hon. Nicola Roxon. He was, in his time in this house as well, intimately involved with the health policy of the former government. You would not know it from his contribution today. There was only criticism of our desire to improve a pretty broken health system.


In his contribution, the member for Kaurna said that health boards do not work. I do not know if they do or do not work, but what I do know is that what has been in place for the last 16 years certainly does not work and that it is incumbent on any government to do their bit to try to improve the lot of South Australians. I would love, for one moment, for those opposite to come on board with some of our plans—across any portfolio area, but today we are talking about heath—to support us, to give us a go, to get on board with this idea and to actually make a positive contribution to this health board.

Look at people who you think may be eminent people to serve on these boards and recommend that they serve. I think that is really important. A key part of this legislation is going to be to give a voice to regional and rural communities. I am sure the member for Giles knows some eminent people who can sit on the boards in his community. I say to the member for Giles, who is also a very decent man, to get on board and make a positive contribution to the debate here and what we are looking to do on this side of the house.


As I have said, the health system has been through a pretty difficult period. We had 'Trashing Health', which was introduced a couple of years ago and it literally trashed the SA health system. We are doing our bit to fix Transforming Health, as it was. We have had broken promises and incompetence from the former government and, once again, we are here to fix Labor's mess. Of course, one of the key objectives for us and one of our key election promises was around health boards.


One of the biggest issues that people come to see me about in my constituency is the current healthcare situation and their hospitals. It is incumbent on us to put in as much effort as we can to increase access to safe and timely care for all South Australians. People are expecting more from this government and we will certainly be delivering for them.


I applaud the introduction of this bill into this house, which of course is part of our reforms. The bill in front of us looks at changes that will result in 10 local health networks, each with their own governing board. I know that many of my constituents will be especially pleased with the introduction of a Southern Adelaide Local Health Network governing board. Local communities will once again come first and patient safety will be improved through this system.


Currently, SA Health is managed centrally. This means that it can be hard to manage the many different communities throughout South Australia. Once again, we on this side of the house know that local communities know best. As someone who lives in my electorate of Waite, through Mitcham and the Mitcham Hills, I do not know what is best for the people of Port Augusta in the member for Stuart's electorate, but they certainly know what is good for them and for those who live in that community. By people in his community directly having a say in the running of their healthcare system—experienced practitioners and people who are skilled in governance—we are giving them the opportunity to have a say in the decisions of the government that affect their daily life.


Health is a large and complex system and cannot operate optimally under centralised control. Many communities, whether regional or city, have strongly supported the re-establishment of local health boards. Healthcare needs and challenges vary between areas within metropolitan Adelaide and across regional South Australia. These changes will deliver better outcomes for patients and that is, ultimately, the first priority. The health needs of communities will be understood, with local boards overseeing the decision-making. Of course, we are seeing the reversal of minister Hill's decision back in 2008 to abolish our local healthcare boards.


In my wonderful part of the world of Adelaide, you really cannot go about your business without bumping into someone you know, a bit like it is in Port Lincoln. Indeed, in southern Adelaide we have an ageing population and a lot of retirees, and this was really brought home to me on a recent tour of the Flinders Medical Centre that I undertook with the member for Elder and the member for Davenport. During the tour they talked about the need in southern Adelaide for additional older persons healthcare services and the real strain that has been put on SALHN and southern Adelaide residents with the closure of the Repat and with facilities such as Flinders Medical Centre and Noarlunga Hospital not being able to cope with the service demand or need.


One good example is the ED at Flinders Medical Centre, which was designed, I think, to take about 60,000 to 70,000 patients through the door every year. It was explained to us on our recent visit that right now Flinders Medical Centre is seeing about 90,000 patients through that ED. The largest metropolitan hospital in Adelaide is meeting a demand that it is not and was not built to cope with. That has just been exacerbated with the closure of the Repat.


One can only assume that a decision taken by government to close the Repat would never, ever have been able to occur in a system where you had community health boards and localised health boards, because there would be people—for example people on the SALHN health board, people from the community, people with skill sets that complemented healthcare decision-making; and of course there are opportunities for community representation—who would not allow such a bad decision of government—

—because they knew the importance of community-based health care. The Repat was such a wonderful community asset. As the member for Kaurna himself is a southern suburbs MP, I have no doubt that he would have known of the importance of the Repat to SALHN health care. It is a real shame that he served in a government that did not stand up for the people of the southern suburbs.

At the March 2018 election, the Marshall Liberal Party made a commitment to establish a new governance and accountability framework for the public health system. A promise was made to delegate decision-making in the public health system through the establishment of metropolitan and regional governing boards. Once again, in this debate through the house we are delivering on these promises. The governing boards will put responsibility and accountability at a local level. Governing boards will be held accountable and must deliver real progress.


I will come back to the Repat, which is so important in this debate. From where we sit, we cannot talk about health without talking about that decision and the consequences closing it had, especially throughout the whole metropolitan health system. The former government did not listen to the community, but we are. It is great to be working with the minister in a productive way and, in particular with the members for Elder and Davenport, in listening to the community about what is needed. I know that the minister is out there at the moment with a ranging consultation, one with clinicians and service providers; at a community level, my neighbouring state colleagues and I are doing exactly the same thing.


We are listening, and I suppose that is an important part of this debate at the moment. We are not just taking selected advice or selective advice, as the former government did for their political agenda: we are being quite genuine about this. For as long as I am a member here, I will fight for my community. I know that the government will be listening to the community all the way, which is so important. I repeat that the closure of the Repat was such a detrimental decision, and I do not believe that it would have happened if we had had the board governance in place.


It is important that we keep reminding the people of South Australia about Transforming Health and why we are making the decisions that we are. We are asking the public of South Australia to be patient as we fix the issues because they are going to take time; none of them is easy. For example, one recent fix was the Chest Clinic back into the NRAH. When the NRAH was being designed, it was missed out from the old RAH. These decisions take time and finding space. I know that the member for Florey is proposing and has on the Notice Paper an inquiry into Transforming Health.


We know what a lot of the issues and problems are with Transforming Health. We urge the general public to bear with us as we go on this long and difficult journey to get our state and our health system back on track. The Transforming Health agenda was driven by health bureaucracy and did not put people first. The final report of the Select Committee on Transforming Health, which was tabled in November 2017 and chaired by the Hon. Stephen Wade in the other place, expressed concerns about Transforming Health. In June 2017, the previous government announced that the Transforming Health program was completed, having achieved significant reforms. However, the November report states:


Transforming Health is not completed in the sense that of the 52 Clinical Standards it was designed to achieve, only 10 have been achieved thus far and there is no clarity as to whether the remaining standards will be achieved in the foreseeable future.


The report goes on to state:


There is also no evidence that Transforming Health is completed in terms of dealing with the 500 avoidable deaths that the Government asserted was the key reason for Transforming Health.


That is avoidable deaths within the public hospital system. Transforming Health did not deliver any cost-saving measures despite needing to reduce the expenditure of health care. The former government obviously closed the Repat, and this decision was made under the disastrous Transforming Health.


The report also raised the concerns of clinicians about increased demand on outpatient departments with the closure of the Repatriation General Hospital and the relocation of rehabilitation services from Hampstead to The QEH. The report states:


Evidence suggests that inadequate planning—described as a 'scramble'—of outpatient facilities at the NRAH has further compounded the problem.


This policy has left a gaping hole in southern health care and, indeed, in statewide services. As far as I am concerned, patient care was not the top priority of Transforming Health, and this contributed to patients' experiences of appalling failures of quality of care. For examples of that one has to look no further than the disastrous Oakden scandal, the chemotherapy dosing saga and, of course, the prostate cancer bungle as well.


It is our desire to re-engage with the South Australian public, to re-engage with clinicians—the many good clinicians who were pushed aside by the bullying of the former Labor government and the upper echelons of SA Health bureaucracy—and of course to re-engage locally and across the state with South Australians to restore confidence in public health, which is a vital and important community asset. That is why the South Australian Liberal Party will put a greater focus on the quality and the value of care.


I commend the hard work of minister Wade in the other house, especially in opposition. I had the pleasure of working closely with him on several projects, and he diligently and assiduously went about mounting the case for why Transforming Health was such a shambles. He did not stop at saying why it was a shambles; he came with reasons and solutions for what needed to be done to unscramble the eggs and to fix some of the issues, and putting health board governance into production is a way of doing that. That is so important.


One thing that I hope we will see with health boards coming into play is a more efficient health sector, which is so important, so that we can see a bit of competition between the different health regions and look at a new way that health does procurement, the way services are provided and the manner they are provided as well. I think it is really important that we take a holistic approach to healthcare provision, the way we provide it, and look at what best practice is from interstate and overseas jurisdictions as well because we can do a lot better.


With a centralised bureaucracy, you get very up-and-down decision-making. You do not get that competition that a more decentralised system brings. I think in the case of health care and the provision of healthcare services and the mixture that we provide to the general public, there is a great opportunity for there to be a greater and more robust provision of healthcare services. What we want, and this is a good way of beginning that, is to see an improvement on waiting list time, to see more staff on wards and to see a change in attitude. I suppose this is why the minister has the word 'wellbeing' in the title of his portfolio because a focus on wellness is important.


What we can do at a primary healthcare level is avoid having people go into acute care in the first place in hospitals, putting strain on the system. I think there will be a big focus on community health boards and how they promote wellness within the community at an absolute grassroots local level. I think this is a very good bit of legislation and proposed policy change. I commend this bill to the house.