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Speech: Health Care (Governance) Amendment Bill

The Hon. T.A. FRANKS: I rise on behalf of the Greens to put our position on the Health Care (Governance) Amendment Bill 2019. The bill, of course, is the second tranche, as minister Wade so often referred to it in the previous debate, of a two-stage plan to reform the Health Care Act 2008. It revises the functions of the chief executive of the Department for Health and Wellbeing and it includes provisions for service agreements between the chief executive of the Department for Health and Wellbeing and the local health networks and the SA Ambulance Service.

The bill also dissolves the Health Performance Council once the commission on excellence and innovation in health is established. It makes provision for the annual reporting and transfer of assets for the metropolitan governing councils that will be dissolved on 1 July this year. It reflects the new governance and accountability framework for the public health system or clarifies that intent and removes—or will attempt to remove, because I think that might be a little hopeful—some of the disclosure requirements that were introduced and amended in the stage 1 bill regarding conflict of interest being noted in the minutes of boards.

The Greens have consulted as widely as we have been able to in the limited time frame and note that we also were part of this morning's stakeholder briefing that was organised by SACOSS and the Health Consumers Alliance, as well as other groups including the AMA, the Australian Association of Social Workers, SANDAS, the Mental Health Coalition, the Public Health Association, the Lived Experience Network leadership group and Health Promotion. I note that the minister ensured that he had a representative at that meeting as well. It was attended by representatives of all parties represented in this chamber.

On reflection, I think that meeting is probably where I will start and express some disappointment at the lack of in-depth consultation that has occurred to get us to this stage. In terms of time frames and the correspondence that we have received, I think people who were representing various stakeholder groups did feel a time pressure. I note the correspondence from the acting chief executive of the AMA (South Australia), Dr John Woodall, to minister Wade, dated 30 April this year, noting the intention to introduce the bill to parliament on 2 May this year, only a few days later.

In that correspondence I think it would be gilding the lily a little too much to say that there is widespread dissatisfaction from the stakeholders with the general intent of the bill, but rather the processes and some of the fine details of the bill are what has caused the angst. In that correspondence from the AMA (South Australia) they have noted that they are pleased that the minister has chosen to appoint Professor Paddy Phillips, who is currently the Chief Medical Officer and (jointly) the Chief Public Health Officer, as the first commissioner to head that proposed commission on excellence and innovation in health.

I would agree with the AMA that it does sound like a very fine thing, but we certainly do not have the detail at this point of the structure, the workings, of that particular commission on excellence and innovation in health. I indicate that the Greens have listened to various stakeholders who have expressed various concerns that perhaps we are putting the cart before the horse if we are to, in this bill, abolish the Health Performance Council without seeing how what it will be replaced with is set to operate and without understanding fully whether or not the two are both complementary, which would be a useful exercise.

In that correspondence, dated 30 April, I note that the acting chief executive of the AMA (South Australia) has also noted:

We would also be concerned if the Commissioner were to report solely to the CEO of SA Health, and not have direct access to the Minister. Similarly, we would query the value of a Commission that was able to report only on the public system and not include an overview of the private system and its interactions with (and resulting impacts on) the public system.

With regard then to the dissolution of the Health Performance Council, it states:

The AMA(SA) is concerned that in abolishing the Health Performance Council the Bill will eliminate the independent and objective oversight of the system the Council has provided since 2008. The AMA(SA) has in the past supported the Council as an independent body that investigates, gathers data and provides recommendations for change. We believe it is vital for our health system that we have in this state an independent body that can investigate and assess the performance of the state's health systems—and that can do so without fear of retribution.

The Council has additionally proven its value in examining the pieces of the health system—public and private, state and national, primary and tertiary—and the issues within it. It has also performed the role of examining the impact of programs that start and stop; to measure their success; and to pinpoint reasons, such as limited access to data or the absence of measurable targets, that such measurement may not be possible. We note, for example, that in its most recent report to you [meaning the minister] tabled in parliament on 4 April 2019, the Council offered advice, including that in many cases the data it sought to monitor and evaluate services was not available—including data that reported health cut outcomes, including patient-reported outcomes that arise from services in public and private sectors, to inform clinical improvement and policymaking. This is an onerous omission in an era when data is increasingly seen as essential to developing and guiding strategy, decision-making and performance monitoring.

I note that in the briefing notes with which we have been provided it has been claimed that the Health Performance Council's remit and output is largely already duplicated elsewhere, but I am certainly not yet convinced of that and we would want to see more about the commission that is proposed before abandoning the current mechanisms without an informed debate. I note also that the AMA goes on in that correspondence, stating:

The AMA wishes to ensure that the independent, objective oversight of the system the Council has provided will continue as a mandated element of the new Commission. We agree with its advice to you that the new governance framework should clearly (describe) how the new governing boards must work to ensure their governance reflects all dimensions of quality and safety and access and equity within their local health networks and collectively across the health system for all consumers and communities.

On that, the AMA also goes on to express some concern with, I guess, not being consulted in a timely fashion. It is unfortunate when we get to a point where bills such as this come before this place with stakeholders still very keen to have their voices heard by all members of this council because they feel that they have not been listened to and that their cautions and concerns have not been addressed. In some cases they may well be incorrect in that assumption, but in some cases it appears that we are putting the cart before the horse. Until there is more detail on this commission on excellence and innovation the Greens will not be supporting the abolition of the Health Performance Council.

I note also some of the government proposals to reduce some accountability and transparency about conflict of interest where decisions are made by ensuring that there is not just the declaration of those conflicts of interest on a register but that it is recorded in the minutes where the decisions of those conflicts of interest are most relevant. We will certainly vote to support the continuation of those protections and safeguards to ensure that conflicts of interest are transparent.

I have also received correspondence, which is a copy of a letter to the Minister for Health and Wellbeing, from the aforementioned Health Performance Council's chair, Mr Steve Tully. It notes that on 6 May this year, after the bill was tabled, the council, meaning the Health Performance Council:

The council understands and supports the government's commitment to devolve accountability and responsibility for local health service delivery to the community level. This is an ambitious program of work to restructure the South Australian public health system including provisions for service agreements with local health networks and tightly focusing the role of the chief executive of the Department for Health and Wellbeing.

The council sees many opportunities, and is working to contribute to your government's efforts to provide quality care for all South Australians. In its current form, the bill focuses too narrowly on public health services and a process perspective rather than a population wide and whole of health systems perspective. This will be to the detriment of understanding all-of-SA population health outcomes. A picture of health system performance that only draws on public hospital activity is incomplete, and may be misleading. In our role under our Act, the council advises you on significant trends in the health status of South Australians and considers future priorities for the health systems in South Australia. This whole of system approach can identify movements in health outcomes, including trends that relate to particular illnesses or population groups; as well as reviewing the performance of the various health systems established within the State. For example, in the latest 4-yearly report (December 2018) patient movement between the public and private health systems remains a huge data blind spot in South Australia, and oversight is important to ensure that the SA population is adequately and safely served.

The letter goes on to put the case, I think, that is supportive of the government's intent but perhaps issuing a level of concern that we do not act in haste and repent at leisure. Again, that underscores the Greens' intention that we will not support moves to abolish the Health Performance Council until we see what is to be put in its place in greater detail, and even then reserve our rights should those two roles in fact be complementary and positive for our health outcomes rather than detrimental.

The previous speaker from the opposition outlined some of the concerns that have been raised by many in the sector. It would be safe to say that the consumer voice is one where there are grave reservations and that by devolving the system, as we have done, the consumer voice may well be lost. I understand the minister believes that it will be picked up at those local levels but the Greens do not have faith that this will happen, and we will, in this debate, seek to ensure that there is a supported and structural consumer voice in our health system that is independent and resourced, as we would expect of a 21st century health system.

The time has long passed where consumers were treated as simply the recipients of a health service. We know that the consumer voice is vital to ensuring the best health services possible and that that voice has to be well resourced, respected, entrenched and embedded in our system.

Finally, there were grave concerns raised about the proposed abolition of the Mental Health Commission, and I echo those concerns. That is not actually embedded within this bill, but it should be part of the framework of our discussions and debates as we proceed through the committee stage of this piece of legislation.

All stakeholders at the meeting held this morning expressed their support for the continuation of the Mental Health Commission. Certainly, I would ask at this point if the minister could respond with some rationale as to why the Mental Health Commission is being disbanded and in what format that consultation process was taken. We were told at the meeting today that it was a consultant who wrote a report.

I have not seen significant dissatisfaction with the work of the commission raised in any public fora, and certainly not raised in this place. My personal experience of working with the commission has been that it has been very much a value-add to our system, and with the NDIS fast approaching—and what we know will not accommodate, particularly, mental health consumers with the new system coming in—I think it is time for more voices and those expert voices in mental health, rather than fewer.

With those few words, I indicate the Greens will be supporting the thrust of this bill. We understand that other members of the crossbench are not ready to proceed this week but will be ready in the near future. We look forward to the committee stage. We will not be supporting all of the clauses of the bill, but we certainly will not be opposing the general thrust of the devolution of the health services. That is something that was an argument of the last tranche, if you like, tranche 1. In tranche 2 I think we should focus on getting this right, and if we need tranche 3, then so be it.

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