Health Care (Governance) Amendment Bill

18 Mar 2021

Second Reading

The Hon. D.C. VAN HOLST PELLEKAAN: Thank you, member for Kaurna, whom I expect will be the lead speaker for the opposition, for allowing me to slot in just before he has his turn speaking on this very important bill.

Health is important, so health services is one of the absolute most important things. When you think about the highest priorities that government must provide for its people, you go immediately to health, to education, to roads and important infrastructure, to safety, to police emergency services, and that is certainly not the end of it. But I say without any hesitation that delivering health services is without any doubt right towards the very top of that list, perhaps at the top. So our government takes this responsibility extremely seriously. I can add to that that, as a country outback member of parliament, this is a very high priority in my electorate as well.

Country people have a much stronger connection to their local hospitals than city people do. I do not mean that with any disrespect to city people, and I am not actually talking about people's connection to their hospital's services as patients—I am talking about their connection to their hospitals and other health services as community members, and that is for a range of different reasons, including the fact that country people regularly contribute to fundraising that goes towards local health services to supplement what comes through taxpayer support, because having health services in a country or outback district is one of the key things that allows the town that has that service delivery or that health institution in it to attract other services, which is very important.

If you have a hospital, you are more likely to have a doctor; if you have a doctor and a hospital, you are more likely to have a pharmacy. If you have a hospital, a doctor and a pharmacy, you are more likely to have a physiotherapist, etc.—it goes on and on. So people are very supportive of the core institutions and the delivery of the health services in their areas because they know that the benefit to the community extends well beyond the primary purpose of the institution or the health service in terms of contributing to the district.

A short trip back in time: not very long ago, and I am thinking perhaps 11 or 12 years ago, in country areas we had what were called hospital boards. The use of the word 'board' in that context is not the same as the use of the word 'board' that we are discussing at the moment with regard to health governance boards. Hospital boards were made up of local people, some of whom were health practitioners, but broadly speaking it was a group of local community representatives and contributors.

It would be pretty normal to have a mayor, a councillor or, ideally, some younger or middle-aged people on there, men and women, people involved in sport. It was not meant to be a group that told the hospital how to operate, far from it. None of us would think that a community group is the right organisation to tell medical professionals exactly how to go about their work. But what it was very much about was making sure that local community's needs and expectations were being fed into the medical service, an understanding of those needs and expectations.

It might be that in one community having a birthing service would be incredibly important; in another community, it might not be so important. Nobody was going to tell a gynaecologist or the GP who had those qualifications how to go about delivering babies; it was more about, using this example, of whether this was absolutely vital to retain, or was there something we should attract, or is it that there is another hospital not too far away, so would it be okay if we lost this service in one hospital and wrapped it up in another hospital. It is just an example, but it could be extended to just about any type of health service.

Another reason why country people had a very strong attachment to their local health services was that, broadly speaking, their local community leaders were on the hospital board. A hospital board might represent more than one hospital, of course; it could represent a small cluster of hospitals. In my part of the world, Booleroo, Orroroo, Peterborough and Jamestown are good examples of that. That cluster of four hospitals in fairly close proximity has been represented collectively for quite a long time.

These services—and I stress that not always but usually it is a range of medical services, not just a hospital, that are typically delivered out of the same town that the hospital is in—are very important to country people and outback people. If I think about outback in my electorate, Leigh Creek comes straight of mind.

In the electorate of Stuart, the hospitals—again, I realise this bill is about health more broadly, but these are the centres of health—are in Port Augusta, Kapunda, Eudunda, Burra, Leigh Creek, Booleroo, Orroroo, Peterborough and Jamestown. Then, of course, there are a range of hospitals that are the primary place for delivering service to Stuart constituents, but these hospitals are outside Stuart.

That might be because the constituents live near the boundary—inside but near the boundary of the electorate—so their closest or most appropriate hospital is actually outside the boundary. This is not an extensive list, but Quorn, Hawker, Port Pirie, Whyalla, Angaston, Crystal Brook and others in the country area are also all extremely important health service-providing centres for the constituents I represent here in this parliament.

Then, of course, there are metropolitan hospitals as well. I am not suggesting that my constituents have the same connection to the metropolitan hospitals, but we all know that people from the country do access health services in metropolitan Adelaide as well. Having outlined that and having outlined my interest on behalf of the people I represent in parliament on this issue, let me move on from what I was describing before as the hospital boards.

The former government changed from hospital boards to health advisory councils (HACs). There were pros and cons with that. At the time, my constituents certainly told me that there were far more negatives than positives with regard to that transition. It was a transition that unfortunately diminished—not removed but diminished—the connection between communities and their local hospitals and health services. It was not because they did not care anymore but because they did not have the same opportunity to participate.

Secondly, and I think this is actually more important, they felt that the level of capacity to contribute community perspectives, needs, wants and desires to the local health service was reduced by the move from hospital boards to health advisory councils. Not all cases but in many cases this included the management of funds and a range of other things.

There were communities who had done an enormous amount of fundraising—I am talking very significant amounts of money—who had actually set that money up in trusts where it was protected for that purpose and that community, very sensibly, and that stayed like that. There were other communities who had done similarly with regard to their fundraising but not similarly with regard to protecting or essentially quarantining that money for that purpose and that community. There was an enormous amount of money that essentially went into the health system and/or the health minister at the time. So that was a step. Very deliberately, I want to be clear that it was not all bad, but there was certainly a strong belief in my constituents that it was more a backward step than a forward step.

We fast-forward to the lead-up to the 2018 election, and the then shadow minister for health, the Hon. Stephen Wade, now Minister for Health, said very clearly we were going to actually give a good chunk of the influence and the steering of decision-making back to local communities—not telling doctors and nurses and other health professionals how they do their work but giving a good chunk of authority back to local people so that their needs, wants and wishes would be front and centre again in the delivery of these health services, and what I mean by that is which services are more or less important, how the budgets are operating, where the stresses are in the hospital that could be relieved, where the opportunities in the hospital and the health services more broadly are which could be made better use of, etc.

That is where we come to with this bill. This is the second phase of the delivery of this very important health governance change. The first stage was completed on 1 July 2019 with the commencement of the Health Care (Governance) Amendment Act 2018, which established the governing boards of the local health networks. The second stage began with the introduction of the Health Care (Governance) (No. 2) Amendment Bill 2019. That bill, unfortunately, lapsed for parliamentary reasons, but we are back here discussing the same core topics.

I am strongly in favour of the direction the health minister has taken on this topic. In my part of the world we have very good people running the new local health governance boards. We have very good people on those boards as well—good chairs, good contributors—and I know that the minister has gone to great lengths to try to ensure that the people on these governance boards are as representative of the communities that they speak for as possible and also that they have a good lay understanding of medical services, I think is the best way to put it.

They are not necessarily professional health providers, but they are people with connection—not all of them but plenty of them. That is important, too, because you do have to have an understanding of the system you are seeking to influence as a board speaking on behalf of the local community. So we have good people running these boards. The health minister wanted to make sure that there were women; that there were men; that there were people with a deeper understanding of medical health services, a deeper understanding of the needs; and that there was Aboriginal participation wherever possible—ideally absolutely everywhere, but it is a fact that we have found it difficult on some of these boards to have Aboriginal members.

It is not for want of trying, and it is not for want of capacity of many Aboriginal people either. It is just that we have not always been able to line up the right people in the right places to make it happen, but certainly I know in my part of the world it has happened, which is a good thing. I think, for example, of the very highly regarded Aboriginal woman Glenise Coulthard AM. She is a very highly regarded local person in many ways who has actually worked in health in the state government for a very long time as well.

Minister Wade has tried to make sure that these boards would be as well comprised as possible so that they can represent these communities in the best way possible. He has also made sure that there is appropriate funding for these boards to operate. He has also made sure that there is a very positive connection from the board through the local health area CEO; in many cases, but not in every case, it is the person who was leading Health or Country Health SA in that region previously.

If I think about two boards—Flinders and Upper North—Craig Packard was not the CEO previously but is now. If I think about Yorke and Northern, Roger Kirchner was the CEO before and is now. So Minister Wade has made sure that we have the right people in the right places. He has done that, in fact, in consultation with the chairs of those boards. Overwhelmingly, we have extremely good health services in country and outback South Australia and metropolitan Adelaide, but it is not always perfect. There would not be a member of this house who would not any week receive a representation from a constituent who says that health service delivery for him or her or a family member or a friend was not what it should have been. I am not trying to dodge that; it does happen.

But I am happy to be on the record to say that overwhelmingly our health service in South Australia is very good. Is there room for improvement? Yes, of course there is room for improvement. Is it just right everywhere? No, it is not just right everywhere. But is it really good everywhere, particularly if you compare it to other states and, more importantly, other nations, other places around the world? We are very fortunate with regard to the health service that we receive in South Australia.

I remember quite a few times in opposition talking on this topic and saying that, while the government of the day and the opposition of the day often disagree on health service delivery, the reality is that we are talking about the difference between 'very good' and 'better than that' or 'better than that' and 'even better again'. We have every right on both sides of this chamber to try to push the bar up higher and higher every day of the week on behalf of our constituents, but we should recognise that the bar we quite rightly are trying to push up is actually already very high when compared to other jurisdictions around the nation and around the world.

Going back to health governance boards, I have recognised already in my electorate a key difference. We still have health advisory councils and they are still doing very good work. We have a collection of health advisory councils, which jointly come together under a regional health board. They work collaboratively together. I know that the regional health boards in my area are very respectful of the HACs, and in many cases people who were previously members of HACs have gone onto the health governance boards. In many cases, the people who were previously on HACs have stayed on HACs and decided, 'No, my interest isn't in the bigger region. My interest or perhaps my capacity to contribute is in the smaller part of the region, my home town or my home district.' It has worked both ways and it has worked very well.

As a country and outback MP, I will always do everything I possibly can to support people with regard to the delivery of health services. I know that my colleagues in the country and in the metropolitan area feel exactly the same way. I know that our Premier and our health minister feel exactly the same way. Whether it is the volunteer ambulance service or the most senior person in the largest hospital in the state, we want to make sure that the right people are doing the right job and delivering the right services for the communities.

Service delivery to the patient is one thing. It is a far more immediate issue. While that care might go on, in some cases for years and years, it is a far more immediate issue and a far more concentrated issue between health service professionals and patients. What this health governance system is about is making sure that there is very strong community representation on what are the right types of services to deliver in these country, outback and, yes, of course, metropolitan areas as well, although that is not the focus from my electorate's perspective.

We are determined to get this right. We are determined to get it as good as we possibly can. We recognise that the day we get it as good as we possibly can, the next day things have changed, adjusted and moved on a bit, so we need to keep evolving. As health technologies improve, as patients' needs change and as demographics change, this is something we will need to keep working on, but we will not back away from the fact that we want local people to have a strong input into local healthcare delivery.