Health Care Bill

12 Feb 2008 archivespeech

This speech is to express comprehensive and extensive reasons why the Liberal Party does not support the Health Care Bill.

The Hon. J.M.A. LENSINK (17:41): On 23 October 2007, in the House of Assembly, the member for Bragg (Vickie Chapman) outlined the very comprehensive and extensive reasons why the Liberal Party does not support this bill; indeed, the honourable member who preceded me in this debate has referred to some of that debate.

This bill is essentially about governance. It has a range of measures, including the establishment of health performance councils, health advisory councils and the like, and it basically transfers the influence within the health system to be concentrated around the minister and the CEO of the Health Department, and that is something to which the Liberal Party is fundamentally opposed. The preceding speaker outlined a number of individual cases where people have been disadvantaged by our health system, and this bill will make that situation worse.

My understanding of the Menadue recommendations is that he proposed that we have a population-based health system. When it comes to the country health regions, it is completely all over the place. In terms of this bill, it has been described to me as the government drawing a circle around Adelaide. Effectively, two of the 'super hospitals' will be established on Eyre Peninsula for a population of 28,000, yet the combined areas of Mid North, Barossa and Yorke Peninsula have a population of 110,000.

The government has claimed that no-one will have to drive more than two hours to get to a hospital, but a number of people in regional and rural South Australia will have more than a two-hour drive to get to any hospital. Effectively, this will downgrade the other country hospitals, and they will be left as basically GP proceduralist rooms to enable the government to completely centralise power within head office.

Country South Australia has been described as a minority, but it actually comprises half a million people of our 1.4 million, which is more than one-third of the population of South Australia. They are responsible for a large part of our agriculture and mining production and so forth, yet they are being treated very shabbily in this change to our health system.

Hospitals are very important in many communities. They bring additional people into the workforce and they are also very important places for training. Indeed, in my own profession I spent some time at the Murray Bridge Hospital as a student. They provide very important places for training and I believe that new graduates, in particular, will be scared of going to work in regional places because they will not be able to obtain the same amount of training and support as they have in the past, which is short-sighted when we have a workforce shortage in this state and we are lessening the opportunities for young people to undertake training within our health system.

I note that the AMA had some cautious criticism of this bill, in that in his CEOs report Duncan Wood stated that the bill establishes a new health performance council which is advisory in nature and is charged with the responsibility of independently reporting on health system performance. Whilst hope springs eternal, he says, about the potential effectiveness of newly created health advisory bodies, the AMA(SA) did request the bill be altered to allow for consultation with the medical profession and other groups in the selection of appointees, as well as ensuring that the body is appropriately resourced to fulfil its function.

I think there is some concern within the medical profession, in particular, that there are some anti-doctor people within the health department. As a physio student, I do recall receiving some lectures from certain people who did a unit who did try to downgrade the importance of doctors. I note too that the GPs have not signed the memorandum of understanding that exists with the Ambulance Service and mental health and so forth, and that they believe that their role in terms of mental health is being downgraded, which is just another factor within the government's attitude towards doctors.

Most recently, in The Border Watch, the local people have gone public and expressed their disappointment in relation to this bill. The Grant District Council is angry with the state government because it will no longer have any governance over the Mount Gambier Hospital board. I note that in this article, dated 7 February, it states:

The Local Government Authority yesterday put forward its case to member for Mount Gambier Rory McEwen in a telephone linkup, including South-East Local Government Association representatives.

Clearly, the member for Mount Gambier has fallen into lockstep with the Labor government in that he has not made any effort at the cabinet table to represent his local constituents and the board members of the Mount Gambier Hospital. Indeed, councillor Alan Hill has resigned from the hospital board in protest. So, I think that goes to the depth of concern that the locals have with this issue.

Probably one of the most significant areas in which the local communities who will be relegated from their current roles into merely being members of health advisory councils is that they do not have any financial control. I greatly appreciate the briefing that was provided to me by the department through the minister's office, but my suspicion is that they have just adopted a one-size-fits all approach. There may well be some communities who would be happy not to have control of issues such as hiring and firing and any other business decisions that need to be made within the hospital, but I am sure that that is not the case for all hospitals.

I think that is a reflection of the approach that this government has; that it likes to internalise control within itself rather than trusting local communities to manage those issues for themselves. It is beyond me and beyond my reasoning to understand how taking control away from local communities will result in better outcomes for those people. They will need to put their concerns in to the centralised organisation, and the organisation can then choose whether or not to take that advice on board. There may be specific local issues that come up, such as whether one particular region is experiencing a downturn. There may be increased road accidents as a result of that, increased violence or any sort of issues that may arise, but really that impact on the health of those local communities may well be ignored by the powers that be.

There are some areas in which I think this bill will improve systems, and that is in relation to adverse incidents and root cause analysis. I understand that there is some confidentiality required in terms of incidents because that encourages people who are involved with that incident to actually be much more frank about what may be a systems problem, or a particular incident or, indeed, a particular individual, and that is to be applauded.

I also note that new clause 75 relates, effectively, to additional whistleblower protection, which I think is also a very important issue within our health system, namely, that people cannot be victimised if they provide information that is to the benefit of the health system. Having worked in a hospital, I am very aware of the hierarchy that exists within such an institution and that people may be afraid to speak out for fear of retribution. I note that the issue of the licensing of private hospitals will be dealt with at some later date and that a range of information is consistent with provisions within the new mental health bill.

I do not wish to speak at length on this bill, because I think that many of the issues that are of concern to people have already been raised in the debate. I reiterate that the Liberal Party is very concerned about the impact this will have on public health. I have specific questions for the minister: what will be the difference between the clinical senate and the new health performance council and which parts of the health system will those bodies have responsibility for within our system?

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