Community Health Services

My speech in support of my colleague Mark Parnell’s motion in regard to Community Health Services and the McCann of Worms review.

20 March 2013

Adjourned debate on motion of Hon. M. Parnell:

That this council—


(a)the review of non-hospital based services currently underway in the SA Department of Health, including the report prepared by internal consultant, Warren McCann, released on 3 December 2012;

(b)the recommendations of the report to significantly reduce community health and health promotion programs within SA Health and the wider community;

(c)the implications, if the recommendations are accepted, to services such as the Shopfront Youth Health Service in Salisbury that has been providing services since 1983;

(d)that these cuts will inevitably lead to reductions in services and programs targeting the most disadvantaged in our society, as it is these South Australians who make the most use of community-based primary healthcare services;

(e)that slashing community health and health promotion programs as a means to reduce government health spending is counterproductive because the whole point of these programs is to prevent ill-health and reduce demand in hospital services where the real growth on costs is occurring;

(f)the risk that these vital services and programs are being caught up in a cost-shifting battle between the state and federal governments; and

2.Calls on the government to reject the recommendations contained in the McCann report into non-hospital based services and ensure continued SA Health funding for vital preventative health and health promotion services and programs.

(Continued from 6 February 2013.)

The Hon. T.A. FRANKS (20:27): As the other member of the Greens in this chamber, it will come as no surprise to members that I will be supporting the motion put before us by the Hon. Mark Parnell.

I was one of those who attended the McCann of Worms event held at the University of South Australia. I believe that, just a few days into his new role, minister Snelling, to his credit, did turn up to face the music. Certainly, he indicated not only that he was willing to listen to the people who were there that night but also to take seriously the review of these proposals, as suggested by Mr McCann. Of course, the previous minister, John Hill, was the one who instituted the review of the so-called non-hospital services, and it is that I want to focus on first.

The McCann of Worms forum was incredibly well attended, from a diversity of stakeholder groups—the Nursing and Midwifery Federation, the South Australian Council of Social Services, the Youth Affairs Council of South Australia—and dozens of others, including Professor Baum, who emceed that event. Indeed, we saw the work firsthand of the Community Foodies who were inspirational in the work they are doing in preventative and health promotion work.

By assuming that non-hospital services should be reviewed in their totality, and in their diversity, it makes a false assumption that somehow hospital services and non-hospital services are not intertwined in terms of their effectiveness. In terms of looking at cutting costs and trimming budgets, the focus on preventing hospitalisation is, indeed, too narrow in its understanding of preventative health. Prevention is, of course, better than cure, it is much more pleasant than cure and it is often a lot cheaper than cure. When a report that looks into non-hospital services does not actually take into account the costs that these particular services are already making across the health budget, then that report itself is indeed flawed, the assumptions that it is based on, and it is indeed set up to fail its own test.

The review also undermines the state’s bid for two of its strategic priorities to be met, that of Safe Communities, Healthy Neighbourhoods and Every Chance For Every Child. The idea of targeting primary health care and health promotion flies in the face of the best wisdom that we have on health in the 21st century. The World Health Organisation has called for more, not less, investment in primary health care and indeed, the World Health Organisation director general has said:

Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher user satisfaction… It can prevent much of the disease burden and it also can prevent people with minor complaints from flooding hospital emergency wards.

Certainly my colleague, the Hon. Mark Parnell, in introducing this motion noted that the intent of this review is to find cost savings; yet, if implemented, the most likely outcome of these recommendations will indeed be an increase in costs. He pointed to renal dialysis in particular and, indeed, just one year of a South Australian not being on renal dialysis would save the health system upwards of $70,000. While HIV is not under the watch of this particular proposal, I understand that the budget for the AIDS Council is dwarfed by the cost of one case of HIV being diagnosed in a year, yet the preventative work being done clearly is saving us substantial amounts into the future and also creating better lives. As I say, prevention is not only better than cure; it is a lot more pleasant.

The Greens understand that the health budget is under pressure. We understand that the state budget is under pressure. We do seriously question, however, this particular review, and the way that it was undertaken. I will not labour the point too much, but the Hon. Rob Lucas touched on it when he noted that this review was undertaken in eight weeks and involved such a large number and diversity of agencies and services.

In my conversations with those who were subject to the review and indeed are slated for the cuts, they did not even know what the purpose of the review was to be. They informed me that, had they been told, they would have provided different information. They would have provided information that went to show that they were meeting their targets and how they were, in fact, an effective and positive and budget-saving initiative. Yet, they were not informed and adequately appraised of what the purpose of this review was and so they felt they had not been given the true opportunity to have provided that information and quite rightly were angry about that. I can understand their anger.

What we are also missing in this debate and why this motion is indeed quite urgent is that we are losing people in this workforce because of the difficulties and the stresses and the strains that we are putting them under with the razor gang’s axe hanging over their head. Who would not be looking for alternative employment if you knew that you were probably going to lose your job? You would be looking to get out while the going was good and that reduces morale and it leads to a talent and an expertise drain in the area. As I say, had the review actually looked at the ways that these programs were operating in terms of whether they were meeting their outcomes and whether the long-term benefits were well outweighed by the short-term costs, then I would have more faith in this review.

Of course, I would agree that not all programs should run forever and certainly there are programs that are effective for a time and then should rightly be ended, replaced or adapted, but that is not what we are talking about here. We are also talking about a suggestion that the federal government will pick up the pieces here, but we are doing it in such a way that we do not know that that is certain, and we are leaving this part of the health sector in the lurch on that and not giving that certainty. We cannot presume to know what the federal government will do here, we cannot presume to know that people will not leave these particular agencies and services and take with them the corporate memory they have and the networks they have built up. We will lose all that, and those costs have certainly not been calculated in this particular review.

I think that the way the review has been undertaken has led to ill will in the community, and will lead to ill health in our community as well. It has been a short-sighted approach, which stands in contrast to the rhetoric of this government.

I spoke earlier this evening about the importance of sport. In the same way that grassroots sport is incredibly important and creates health, it in fact saves the health budget far more than it costs it. Again, we have spent an enormous amount of money on projects such as the South Road Superway—which I call the Superwaste—and I would certainly like to see the ‘Superwaste’ not proceeded with, as well as the Adelaide Oval redevelopment.

It has been pointed out to me that Women’s Health Statewide, one of the agencies that has been heavily slashed as part of the budget savings measures over past times, looks out over the construction site that is the Adelaide Oval redevelopment. They can see where the money has gone that used to fund their coworkers and the programs that provided such essential services for the women of South Australia. With that, I commend the motion to the council.

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